Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Ocular surface assessment in patients with obstructive sleep apnea–hypopnea syndrome

Abstract

Purpose

The aim of this study was to assess the correlation between ocular surface changes and disease severity in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS).

Methods

Two hundred eighty patients with OSAHS were compared with respect to the presence of a floppy eyelid syndrome (FES), Ocular Surface Disease Index (OSDI) questionnaire, the corneal fluorescein staining stages, the Schirmer I test, and tear film break-up time (TBUT) values.

Results

Based on the apnea–hypopnea index, the presence of FES was detected at the following rates: 23.1 % in non-OSAHS group (A), 41.7 % in mild group (B), 66.7 % in moderate group (C), and 74.6 % in severe group (D); severe and moderate stage of FES was found in groups C and D and mild stage of FES in group B (p < 0.01). OSDI questionnaire values were as follows: group A, 12.57 ± 17.64; group B, 22.90 ± 16.78; group C, 45.94 ± 22.03; and group D, 56.68 ± 22.85(p < 0.01). Schirmer values were as follows: group A, 10.76 ± 3.58 mm; group B, 9.83 ± 2.53 mm; group C, 7.73 ± 2.42 mm; and group D, 6.97 ± 2.15 mm (p < 0.01). The TBUT values were as follows: group A, 10.53 ± 3.64 s; group B, 9.46 ± 2.40 s; group C, 7.29 ± 2.13 s; and group D, 6.82 ± 2.20 s (p < 0.01). Corneal staining scores are as follows: 0.26 ± 0.60 in group A, 0.40 ± 0.71 in group B, 0.98 ± 0.72 in group C, and 1.14 ± 0.90 in group D, and the differences were statistically significant among the groups(p < 0.01).

Discussion

OSAHS, particularly the moderate and severe forms, is associated with low Schirmer and TBUT values and high scores in OSDI questionnaire and corneal staining pattern stage. The presence of FES is observed as a practically constant finding in OSAHS. If complaints such as burning, stinging, and itching which can be commonly observed in middle-aged patients are accompanied by FES, the patient should be evaluated for sleep disorders. We speculate that appropriate treatment of OSAHS may result in better control of these symptoms.

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

References

  1. 1.

    Guilleminault C, Abad VC (2004) Obstructive sleep apnea syndromes. Med Clin North Am 88:611–630

  2. 2.

    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

  3. 3.

    Culbertson WW, Ostler HB (1981) The floppy eyelid syndrome. Am J Ophthalmol 92:568–575

  4. 4.

    Mojon DS, Goldblum D, Fleischhauer J, Chiou AG, Frueh BE, Hess CW, Gugger M, Bassetti C, Boehnke M, Mathis J (1999) Eyelid, conjunctival, and corneal findings in sleep apnea syndrome. Ophthalmology 106:1182–1185

  5. 5.

    Waller EA, Bendel RE, Kaplan J (2008) Sleep disorders and the eye. Mayo Clin Proc 83:1251–1261

  6. 6.

    McNab AA (2007) The eye and sleep apnea. Sleep Med Rev 11:269–276

  7. 7.

    Dhillon S, Shapiro CM, Flanagan J (2007) Sleep-disordered breathing and effects on ocular health. Can J Ophthalmol 42:238–243

  8. 8.

    Mastrota KM (2008) Impact of floppy eyelid syndrome in ocular surface and dry eye disease. Optom Vis Sci 85:814–816

  9. 9.

    Leibovitch I, Selva D (2006) Floppy eyelid syndrome: clinical features and the association with obstructive sleep apnea. Sleep Med 7:117–122

  10. 10.

    Culbertson WW, Tseng SC (1994) Corneal disorders in floppy eyelid syndrome. Cornea 13:33–42

  11. 11.

    Donnenfeld ED, Perry HD, Gibralter RP, Ingraham HJ, Udell IJ (1991) Keratoconus associated with floppy eyelid syndrome. Ophthalmology 98:1674–1678

  12. 12.

    Negris R (1992) Floppy eyelid syndrome associated with keratoconus. J Am Optom Assoc 63:316–319

  13. 13.

    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

  14. 14.

    Marcus DM, Costarides AP, Gokhale P, Papastergiou G, Miller JJ, Johnson MH, Chaudhary BA (2001) Sleep disorders: a risk factor for normal-tension glaucoma? J Glaucoma 10:177–183

  15. 15.

    Tsang CS, Chong SL, Ho CK, Li MF (2006) Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect. Eye (Lond) 20:38–42

  16. 16.

    Seif G, Trope G (2010) Impact of 10 years of glaucoma research funding: the Glaucoma Research Society of Canada. Can J Ophthalmol 45:132–134

  17. 17.

    Mojon DS, Hedges TR 3rd, Ehrenberg B, Karam EZ, Goldblum D, Abou-Chebl A, Gugger M, Mathis J (2002) Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy. Arch Ophthalmol 120:601–605

  18. 18.

    Peter L, Jacob M, Krolak-Salmon P, Petitjean T, Bastuji H, Grange JD, Vighetto A (2007) Prevalence of papilloedema in patients with sleep apnoea syndrome: a prospective study. J Sleep Res 16:313–318

  19. 19.

    Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276

  20. 20.

    Tong L, Saw SM, Lamoureux EL, Wang JJ, Rosman M, Tan DT, Wong TY (2009) A questionnaire-based assessment of symptoms associated with tear film dysfunction and lid margin disease in an Asian population. Ophthalmic Epidemiol 16:31–37

  21. 21.

    Dogru M, Stern ME, Smith JA, Foulks GN, Lemp MA, Tsubota K (2005) Changing trends in the definition and diagnosis of dry eyes. Am J Ophthalmol 140:507–508

  22. 22.

    Perry HD (2008) Dry eye disease: pathophysiology, classification, and diagnosis. Am J Manag Care 14:79–87

  23. 23.

    Bron AJ (2001) Diagnosis of dry eye. Surv Ophthalmol 45:221–226

  24. 24.

    Serin D, Karsloğlu S, Kyan A, Alagöz G (2007) A simple approach to the repeatability of the Schirmer test without anesthesia eyes open or closed? Cornea 26:903–906

  25. 25.

    Kim J (2000) The use of vital dyes in corneal disease. Curr Opin Ophthalmol 11:241–247

  26. 26.

    Bron AJ, Evans VE, Smith JA (2003) Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea 22:640–650

  27. 27.

    Netland PA, Sugrue SP, Albert DM, Shore JW (1994) Histopathologic features of the floppy eyelid syndrome. Involvement of tarsal elastin. Ophthalmology 101:174–181

  28. 28.

    Schlötzer-Schrehardt U, Stojkovic M, Hofmann-Rummelt C, Cursiefen C, Kruse FE, Holbach LM (2005) The pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation. Ophthalmology 112:694–704

  29. 29.

    Bilenchi R, Poggiali S, Pisani C, De Aloe G, Motolese PA, Motolese E, Rottoli P, Lombardi C, Rocchi R, Fimiani M (2004) Floppy eyelid syndrome associated with obstructive sleep apnoea. Br J Dermatol 151:706

  30. 30.

    Dutton JJ (1985) Surgical management of floppy eyelid syndrome. Am J Ophthalmol 99:557–560

  31. 31.

    McNab AA (1997) Floppy eyelid syndrome and obstructive sleep apnea. Ophthalmic Plast Reconstr Surg 13:98–114

  32. 32.

    Karger RA, White WA, Park WC, Rosales AG, McLaren JW, Olson EJ, Wogg JJ (2006) Prevalence of floppy eyelid syndrome in obstructive sleep apnea–hypopnea syndrome. Ophthalmology 113:1669–1674

  33. 33.

    Liu DT, Di Pascuale MA, Sawai J, Gao YY, Tseng SC (2005) Tear film dynamics in floppy eyelid syndrome. Invest Ophthalmol Vis Sci 46:1188–1194

  34. 34.

    Stern ME, Gao J, Schwalb TA, Ngo M, Tieu DD, Chan CC, Reis BL, Whitcup SM, Thompson D, Smith JA (2002) Conjunctival T-cell subpopulations in Sjögren’s and non-Sjögren’s patients with dry eye. Invest Ophthalmol Vis Sci 43:2609–2614

  35. 35.

    Rolando M, Zierhut M (2001) The ocular surface and tear film and their dysfunction in dry eye disease. Surv Ophthalmol 45:203–210

  36. 36.

    Gonnering RS, Sonneland PR (1987) Meibomian gland dysfunction in floppy eyelid syndrome. Ophthalmic Plast Reconstr Surg 3:99–103

  37. 37.

    van den Bosch WA, Lemij HG (1994) The lax eyelid syndrome. Br J Ophthalmol 78:666–670

  38. 38.

    Macri A, Pflugfelder S (2000) Correlation of the Schirmer 1 and fluorescein clearance tests with the severity of corneal epithelial and eyelid disease. Arch Ophthalmol 118:1632–1638

  39. 39.

    Parunović A (1983) Floppy eyelid syndrome. Br J Ophthalmol 67:264–266

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Mutlu Acar.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Acar, M., Firat, H., Acar, U. et al. Ocular surface assessment in patients with obstructive sleep apnea–hypopnea syndrome. Sleep Breath 17, 583–588 (2013). https://doi.org/10.1007/s11325-012-0724-0

Download citation

Keywords

  • Obstructive sleep apnea
  • Floppy eyelid syndrome
  • Ocular surface disease
  • Apnea–hypopnea index
  • Tear function tests
  • Oxford scheme