Prevalence of Glaucoma and Glaucoma Suspect Status in Patients Undergoing Sleep Studies

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Prevalence of Glaucoma and Glaucoma Suspect
Status in Patients Undergoing Sleep Studies

• Ivan G. Castillo, MD
• Muneera A. Mahmood, MD, FRCOphth
• Christopher T. Leffler, MD, MPH
• Elena Geraymovych, BS
• Hunter Holmes McGuire VA Medical Center
• Virginia Commonwealth School of Medicine
• Richmond, Virginia

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Background

• Several studies have evaluated a possible
  correlation between sleep apnea and glaucoma,
  however controversy still persists
• Marcus et al Prevalence of normal tension
  glaucoma higher in patients with sleep apnea. J
  Glaucoma 2001
• Geyer et al Prevalence same as general
  population (large study). AJO 2003
• Fisher et al Prevalence higher in African
  Americans with sleep apnea. AJO 2005
• Girkin et al. No impact of sleep apnea in
  development of glaucoma. BJO 2006

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Purpose of our study

• To evaluate the possible relationship of primary
  open angle glaucoma (POAG) and glaucoma suspect
  status in patients undergoing sleep studies for
  evaluation of sleep apnea syndrome at the Hunter
  Holmes McGuire VA Medical Center

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Design and Methods

• Retrospective case review
• All patients who had undergone polysomnogram
  studies at the Sleep Disorder Clinics between
  1/1/2004 and 3/29/2006, and had at least one Eye
  Clinic visit
• Approved by institutional IRB

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Clinical features of Sleep Apnea Syndrome (SAS)

• Excessive daytime sleepiness, chronic fatigue,
  and decreased cognitive abilities
• Repeated apneic episodes during sleep ranging
  from 10 seconds to 1 minute
• Each episode is associated with hypoxemia and is
  terminated by a transient arousal that resumes
  ventilation
• Most patients are unaware of nocturnal events,
  though they may occur hundreds of times every
  night
• Diagnosis of SAS is made by a polysomnogram study
  performed by simultaneous measurement of EEG,
  EMG, EOG, EKG, nasal and buccal airflow,
  respiratory movements and pulse oximetry

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Data Collection

• Demographics (age, sex, race, height, weight)
• Body mass index (BMI) wt (kg)/ht (meters²)
• Apnea-hypopnea index (AHI) Total number of
  episodes of apnea and hypopnea per hour of sleep.
  A value of 5 or greater is abnormal and may be
  associated with excessive daytime sleepiness.
• Oxygen saturation while awake and asleep (minimum
  and mean)
• Diagnosis of Primary open angle glaucoma or
  glaucoma suspect status
• Number and type of glaucoma medications
• Ophthalmologic exam and Visual Fields
• Co-morbidities such as hypertension (HTN),
  diabetes

Sleep 199922(5)667-89
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Main Outcome Measures

• Statistical analysis was carried out to evaluate
  the relationship between the apnea-hypopnea index
  (AHI), age, race, body mass index (BMI),
  diabetes, HTN, AHI, SAS, presence or absence of
  POAG and oxygenation during polysomnogram

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Results

• Charts reviewed 352
• Patients meeting inclusion criteria 331
• Patients with Glaucoma 49 (13)
• Glaucoma Suspect patients 0
• Patients with Sleep Apnea 252

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General Demographics
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Multiple Variable Logistic Regression of
Independent Predictors of the Diagnosis of
Glaucoma
OR after controlling for Age and Race
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Conclusions

• Regression analysis showed that there is no
  significant association between Sleep Apnea or
  oxygenation during sleep and the diagnosis of
  Primary Open Angle Glaucoma
• Age and black race are independently predictive
  of Primary Open Angle Glaucoma