Skip to main content

Advertisement

SpringerLink
Log in

Choroidal thickness changes in obstructive sleep apnea syndrome: a systematic review and meta-analysis

  • Epidemiology • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Obstructive sleep apnea syndrome (OSAS) is a common chronic disorder associated with hypoxia and endothelial and vascular dysfunction. Many studies have analyzed choroidal thickness measurements in patients with different severities of OSAS versus normal subjects by optical coherence tomography (OCT), but the results have been inconsistent. Therefore, a meta-analysis was performed to evaluate the choroidal thickness changes in OSAS measured by OCT.

Methods

Pertinent studies were retrieved by a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library from inception to August 2015. For continuous outcomes, the weighted mean difference (WMD) and 95 % confidence interval (CI) were calculated by using a random effects model.

Results

Seven case-control studies were included in the final meta-analysis, containing a total of 784 eyes (558 in the OSAS group and 226 in normal controls). The results showed that subfoveal choroidal thickness (SFCT) was significantly reduced compared with normal controls, with pooled WMD −8.06 (95 % CI −15.72 to −0.41) for mild OSAS, −29.99 (95 % CI −52.40 to −7.58) for moderate OSAS, and −53.72 (95 % CI −88.95 to −18.48) for severe OSAS. Choroidal thickness at 1 mm temporal to the fovea and at 1 mm nasal to the fovea were also significantly lower than those in the normal controls (WMD = −28.94, 95 % CI −43.78 to −14.10 and WMD = −20.90, 95 % CI −36.62 to −5.18).

Conclusion

This meta-analysis suggests that choroidal thickness was reduced in OSAS. Considering the non-invasive nature of OCT, OCT could be a useful tool for grading the severity of OSAS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Quintyn JC (2013) Evaluation of the visual function in obstructive sleep apnea syndrome patients and normal-tension glaucoma by means of the multifocal visual evoked potentials. Graefes Arch Clin Exp Ophthalmol 251:1457

    Article  PubMed  Google Scholar 

  2. Sergi M, Salerno DE, Rizzi M, Blini M, Andreoli A, Messenio D, Pecis M, Bertoni G (2007) Prevalence of normal tension glaucoma in obstructive sleep apnea syndrome patients. J Glaucoma 16:42–46

    Article  PubMed  Google Scholar 

  3. Bilgin G, Koban Y, Arnold AC (2013) Nonarteritic anterior ischemic optic neuropathy and obstructive sleep apnea. J Neuroophthalmol 33:232–234

    Article  PubMed  Google Scholar 

  4. Palombi K, Renard E, Levy P, Chiquet C, Deschaux C, Romanet JP, Pepin JL (2006) Non-arteritic anterior ischaemic optic neuropathy is nearly systematically associated with obstructive sleep apnoea. Br J Ophthalmol 90:879–882

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Arda H, Birer S, Aksu M, Ismailogullari S, Karakucuk S, Mirza E, Gumus K, Oner A (2013) Obstructive sleep apnoea prevalence in non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 97:206–209

    Article  PubMed  Google Scholar 

  6. Muniesa M, Sanchez-de-la-Torre M, Huerva V, Lumbierres M, Barbe F (2014) Floppy eyelid syndrome as an indicator of the presence of glaucoma in patients with obstructive sleep apnea. J Glaucoma 23:e81–e85

    Article  PubMed  Google Scholar 

  7. Nickla DL, Wallman J (2010) The multifunctional choroid. Prog Retin Eye Res 29:144–168

    Article  PubMed  PubMed Central  Google Scholar 

  8. Usui S, Ikuno Y, Miki A, Matsushita K, Yasuno Y, Nishida K (2012) Evaluation of the choroidal thickness using high-penetration optical coherence tomography with long wavelength in highly myopic normal-tension glaucoma. Am J Ophthalmol 153:10–16

    Article  PubMed  Google Scholar 

  9. Schuster AK, Steinmetz P, Forster TM, Schlichtenbrede FC, Harder BC, Jonas JB (2014) Choroidal thickness in nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 158:1342–1347

    Article  PubMed  Google Scholar 

  10. Xin C, Wang J, Zhang W, Wang L, Peng X (2014) Retinal and choroidal thickness evaluation by SD-OCT in adults with obstructive sleep apnea-hypopnea syndrome (OSAS). Eye (Lond) 28:415–421

    Article  CAS  Google Scholar 

  11. Ekinci M, Huseyinoglu N, Cagatay HH, Keles S, Ceylan E, Gokce G (2014) Choroidal thickening in patients with sleep apnea syndrome. Neuro-Ophthalmology 38:8–13

    Article  Google Scholar 

  12. Kara S, Ozcimen M, Bekci TT, Sakarya Y, Gencer B, Tufan HA, Arikan S (2014) Evaluation of choroidal thickness in patients with obstructive sleep apnea/hypopnea syndrome. Arq Bras Oftalmol 77:280–284

    Article  PubMed  Google Scholar 

  13. Karalezli A, Eroglu FC, Kivanc T, Dogan R (2014) Evaluation of choroidal thickness using spectral-domain optical coherence tomography in patients with severe obstructive sleep apnea syndrome: a comparative study. Int J Ophthalmol 7:1030–1034

    PubMed  PubMed Central  Google Scholar 

  14. Karaca EE, Ekici F, Yalcin NG, Ciftci TU, Ozdek S (2014) Macular choroidal thickness measurements in patients with obstructive sleep apnea syndrome. Sleep Breath 19:335–341

    Article  PubMed  Google Scholar 

  15. Zengin MO, Oz T, Baysak A, Cinar E, Kucukerdonmez C (2014) Changes in choroidal thickness in patients with obstructive sleep apnea syndrome. Ophthalmic Surg Lasers Imaging Retina 45:298–304

    Article  PubMed  Google Scholar 

  16. Higgins JP, Green S (2011) Cochrane Handbook for systematic reviews of interventions. Version 5.1.0 [updated March, 2011], Available from:www.cochrane-handbook.org; 2011. edn: The Cochrane Collaboration

  17. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wang W, Zhang X (2014) Choroidal thickness and primary open-angle glaucoma: a cross-sectional study and meta-analysis. Invest Ophthalmol Vis Sci 55:6007–6014

    Article  PubMed  Google Scholar 

  19. Bayhan HA, Aslan BS (2014) Choroidal thickness alterations in obstructive sleep apnea-hypopnea syndrome (OSAS). Eye (Lond) 28:1387

    Article  CAS  Google Scholar 

  20. Bayhan HA, Bayhan SA, Intepe YS, Muhafiz E, Gurdal C (2015) Evaluation of the macular choroidal thickness using spectral optical coherence tomography in patients with obstructive sleep apnea syndrome. Clin Experiment Ophthalmol 43:139–144. doi:10.1111/ceo.12631

    Article  PubMed  Google Scholar 

  21. Shao L, Xu L, Chen CX, Yang LH, Du KF, Wang S, Zhou JQ, Wang YX, You QS, Jonas JB et al (2013) Reproducibility of subfoveal choroidal thickness measurements with enhanced depth imaging by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci 54:230–233

    Article  PubMed  Google Scholar 

  22. Matsuo Y, Sakamoto T, Yamashita T, Tomita M, Shirasawa M, Terasaki H (2013) Comparisons of choroidal thickness of normal eyes obtained by two different spectral-domain OCT instruments and one swept-source OCT instrument. Invest Ophthalmol Vis Sci 54:7630–7636

    Article  PubMed  Google Scholar 

  23. Chhablani J, Barteselli G, Wang H, El-Emam S, Kozak I, Doede AL, Bartsch DU, Cheng L, Freeman WR (2012) Repeatability and reproducibility of manual choroidal volume measurements using enhanced depth imaging optical coherence tomography. Invest Ophthalmol Vis Sci 53:2274–2280

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yamashita T, Yamashita T, Shirasawa M, Arimura N, Terasaki H, Sakamoto T (2012) Repeatability and reproducibility of subfoveal choroidal thickness in normal eyes of Japanese using different SD-OCT devices. Invest Ophthalmol Vis Sci 53:1102–1107

    Article  PubMed  Google Scholar 

  25. Laviers H, Zambarakji H (2014) Enhanced depth imaging-OCT of the choroid: a review of the current literature. Graefes Arch Clin Exp Ophthalmol 252:1871–1883

    Article  CAS  PubMed  Google Scholar 

  26. Sogawa K, Nagaoka T, Takahashi A, Tanano I, Tani T, Ishibazawa A, Yoshida A (2012) Relationship between choroidal thickness and choroidal circulation in healthy young subjects. Am J Ophthalmol 153:1129–1132

    Article  PubMed  Google Scholar 

  27. Okamoto M, Matsuura T, Ogata N (2015) Choroidal thickness and choroidal blood flow after intravitreal bevacizumab injection in eyes with central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 46:25–32

    Article  PubMed  Google Scholar 

  28. Kim DY, Silverman RH, Chan RV, Khanifar AA, Rondeau M, Lloyd H, Schlegel P, Coleman DJ (2013) Measurement of choroidal perfusion and thickness following systemic sildenafil (Viagra((R))). Acta Ophthalmol 91:183–188

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Orefice JL, Costa RA, Scott IU, Calucci D, Orefice F (2013) Spectral optical coherence tomography findings in patients with ocular toxoplasmosis and active satellite lesions (MINAS Report 1). Acta Ophthalmol 91:e41–e47

    Article  PubMed  Google Scholar 

  30. Vance SK, Imamura Y, Freund KB (2011) The effects of sildenafil citrate on choroidal thickness as determined by enhanced depth imaging optical coherence tomography. Retina 31:332–335

    Article  CAS  PubMed  Google Scholar 

  31. Agladioglu K, Pekel G, Citisli V, Yagci R (2015) Choroidal thickness and retinal vascular caliber correlations with internal carotid artery Doppler variables. J Clin Ultrasound 43(9):567–572

    Article  PubMed  Google Scholar 

  32. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    Article  PubMed  Google Scholar 

  33. Khayi H, Pepin JL, Geiser MH, Tonini M, Tamisier R, Renard E, Baguet JP, Levy P, Romanet JP, Chiquet C (2011) Choroidal blood flow regulation after posture change or isometric exercise in men with obstructive sleep apnea syndrome. Invest Ophthalmol Vis Sci 52:9489–9496

    Article  PubMed  Google Scholar 

  34. Tonini M, Khayi H, Pepin JL, Renard E, Baguet JP, Levy P, Romanet JP, Geiser MH, Chiquet C (2010) Choroidal blood-flow responses to hyperoxia and hypercapnia in men with obstructive sleep apnea. Sleep 33:811–818

    PubMed  PubMed Central  Google Scholar 

  35. Wang W, Zhou M, Huang W, Chen S, Ding X, Zhang X (2013) Does acute primary angle-closure cause an increased choroidal thickness? Invest Ophthalmol Vis Sci 54:3538–3545

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, 54S, Xianlie Road, Guangzhou, 510060, People’s Republic of China

    Miao He, Xiao Han, Huiming Wu & Wenyong Huang

Authors
  1. Miao He
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huiming Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenyong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wenyong Huang.

Ethics declarations

This is a meta-analysis; thus, requirements of ethics statement and consent statement are not needed.

Funding

The Chinese government provided financial support in the form of a grant from the National Natural Science Foundation of China (81570843).

The sponsor had no role in the design or conduct of this research.

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

This is a meta-analysis which does not involve human subjects; thus, the requirement of informed consent is not needed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

He, M., Han, X., Wu, H. et al. Choroidal thickness changes in obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath 20, 369–378 (2016). https://doi.org/10.1007/s11325-015-1306-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-015-1306-8

Keywords

Search

Navigation