Posterior segment assessment in patients with obstructive sleep apnea syndrome

  • Bekir KüçükEmail author
  • Ender Sırakaya
  • Şenol Delibaş
Hypoxia • Original Article



The present study aimed to evaluate the lamina cribrosa thickness (LCT), lamina cribrosa depth (LCD), subfoveal and parafoveal choroidal thicknesses, peripapillary choroidal thickness (PCT), and retina nerve fiber layer (RNFL) thickness in patients with obstructive sleep apnea syndrome (OSAS) using spectral domain optical coherence tomography (SD-OCT).


This single-center, case-control study included 45 OSAS patients and 43 age-and sex-matched healthy controls. Only the right eyes of the patients and controls were included. Each participant underwent a comprehensive ophthalmic assessment including slit lamp examination (biomicroscopy), stereoscopic fundus examination, and intraocular pressure (IOP) measurement. The SD-OCT measurements were also performed in both patients and controls.


The mean ages of the patients (females, 55.6%) and controls (females, 51.2%) were 50.09 ± 9.7 years and 50.30 ± 4.2 years, respectively. The groups were similar in terms of age and gender. Evaluation of the study parameters revealed that there were no significant differences between the OSAS patients and controls regarding IOP, RNFL thickness, subfoveal and parafoveal choroidal thicknesses, and PCT. A significant difference was found between the OSAS patients and controls regarding LCT but not regarding LCD. The mean LCT values were 213.38 ± 30.7 μm and 300.49 ± 42.6 μm for the OSAS patients and controls, respectively (p ˂ 0.001).


The results of the present study indicated that the lamina cribrosa was significantly thinner in the OSAS patients than in the controls. In our opinion, this finding should be supported by large-scale studies and the reason underlying the thinning of the lamina cribrosa in OSAS patients should be investigated physiopathologically.


Lamina cribrosa thickness Lamina cribrosa depth Obstructive sleep apnea syndrome Spectral domain optical coherence tomography Retina 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR (2010) Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 11:441–446CrossRefPubMedGoogle Scholar
  2. 2.
    The report of an American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults (1999) Recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689CrossRefGoogle Scholar
  3. 3.
    Cochen De Cock V, Benard-Serre N, Driss V et al (2015) Supine sleep and obstructive sleep apnea syndrome in Parkinson’s disease. Sleep Med 16:1497–1501CrossRefPubMedGoogle Scholar
  4. 4.
    Buratti L, Viticchi G, Falsetti L, Cagnetti C, Luzzi S, Bartolini M, Provinciali L, Silvestrini M (2014) Vascular impairment in Alzheimer’s disease: the role of obstructive sleep apnea. J Alzheimers Dis 38:445–453CrossRefPubMedGoogle Scholar
  5. 5.
    Braley TJ, Segal BM, Chervin RD (2012) Sleep-disordered breathing in multiple sclerosis. Neurology 79:929–936CrossRefPubMedGoogle Scholar
  6. 6.
    Liu S, Lin Y, Liu X (2016) Meta-analysis of association of obstructive sleep apnea with glaucoma. J Glaucoma 25:1–7CrossRefPubMedGoogle Scholar
  7. 7.
    Zhao XJ, Yang CC, Zhang JC, Zheng H, Liu PP, Li Q (2016) Obstructive sleep apnea and retinal nerve fiber layer thickness: a meta-analysis. J Glaucoma 25:e413–e418CrossRefPubMedGoogle Scholar
  8. 8.
    Pérez-Rico C, Gutiérrez-Díaz E, Mencía-Gutiérrez E, Díaz-de-Atauri MJ, Blanco R (2014) Obstructive sleep apnea-hypopnea syndrome (OSAHS) and glaucomatous optic neuropathy. Graefes Arch Clin Exp Ophthalmol 252:1345–1357CrossRefPubMedGoogle Scholar
  9. 9.
    Karakucuk S, Goktas S, Aksu M, Erdogan N, Demirci S, Oner A, Arda H, Gumus K (2008) Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS). Graefes Arch Clin Exp Ophthalmol 246:129–134CrossRefPubMedGoogle Scholar
  10. 10.
    Yu J, Xiao K, Huang J et al (2017) Reduced retinal vessel density in obstructive sleep apnea syndrome patients: an optical coherence tomography angiography study. Invest Ophthalmol Vis Sci 58:3506–3512CrossRefPubMedGoogle Scholar
  11. 11.
    Bellezza AJ, Rintalan CJ, Thompson HW, Downs JC, Hart RT, Burgoyne CF (2003) Deformation of the lamina cribrosa and anterior scleral canal wall in early experimental glaucoma. Invest Ophthalmol Vis Sci 44:623–637CrossRefPubMedGoogle Scholar
  12. 12.
    Hernandez MR, Ye HG (1993) Changes in extracellular matrix in the optic nerve head. Ann Med 25:309–315CrossRefPubMedGoogle Scholar
  13. 13.
    American Academy of Sleep Medicine (2014) The International Classification of Sleep Disorders. Diagnostic and Coding Manual, 3rd edn. AASM, DarienGoogle Scholar
  14. 14.
    Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep. 7:110–114CrossRefPubMedGoogle Scholar
  15. 15.
    Margolis R, Spaide RF (2009) A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol 147:811–815CrossRefPubMedGoogle Scholar
  16. 16.
    Li L, Bian A, Zhou Q et al (2013) Peripapillary choroidal thickness in both eyes of glaucoma patients with unilateral visual field loss. Am J Ophthalmol 156:1277–1284CrossRefPubMedGoogle Scholar
  17. 17.
    Spaide RF, Koizumi H, Pozonni MC (2008) Enhanced depth imaging spectral domain optical coherence tomography. Am J Ophthalmol 146:496–500CrossRefPubMedGoogle Scholar
  18. 18.
    He M, Han X, Wu H, Huang W (2016) Choroidal thickness changes in obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath 20:369–378CrossRefPubMedGoogle Scholar
  19. 19.
    Yazgan S, Erboy F, Celik HU, Ornek T, Ugurbas SH, Kokturk F, Ayar O, Akdemir MO, Celik E (2017) Peripapillary choroidal thickness and retinal nerve fiber layer in untreated patients with obstructive sleep apnea-hypopnea syndrome: a case-control study. Curr Eye Res 42:1552–1560CrossRefPubMedGoogle Scholar
  20. 20.
    Xin C, Wang J, Zhang W et al (2014) Retinal and choroidal thickness evaluation by SD-OCT in adults with obstructive sleep apnea-hypopnea syndrome (OSAS). Eye (Lond) 28:415–421CrossRefGoogle Scholar
  21. 21.
    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 7:1030–1034PubMedGoogle Scholar
  22. 22.
    Lin PW, Friedman M, Lin HC, Chang HW, Pulver TM, Chin CH (2011) Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea/hypopnea syndrome. Graefes Arch Clin Exp Ophthalmol 249:585–593CrossRefPubMedGoogle Scholar
  23. 23.
    Bayhan HA, Aslan Bayhan S, İntepe YS, Muhafiz E, Gürdal C (2015) Evaluation of the macular choroidal thickness using spectral optical coherence tomography in patients with obstructive sleep apnoea syndrome. Clin Exp Ophthalmol 43:139–144CrossRefPubMedGoogle Scholar
  24. 24.
    Adam M, Okka M, Yosunkaya S et al (2013) The evaluation of retinal nerve fiber layer thickness in patients with obstructive sleep apnea syndrome. J Ophthalmol 2013:292158PubMedGoogle Scholar
  25. 25.
    Ferrandez B, Ferreras A, Calvo P et al (2016) Assessment of the retinal nerve fiber layer in individuals with obstructive sleep apnea. BMC Ophthalmol 16:40CrossRefPubMedGoogle Scholar
  26. 26.
    Park SC, Brumm J, Furlanetto RL, Netto C, Liu Y, Tello C, Liebmann JM, Ritch R (2015) Lamina cribrosa depth in different stages of glaucoma. Invest Ophthalmol Vis Sci 56:2059–2064CrossRefPubMedGoogle Scholar
  27. 27.
    Burgoyne CF, Downs JC, Bellezza AJ, Hart RT (2004) Three-dimensional reconstruction of normal and early glaucoma monkey optic nerve head connective tissues. Invest Ophthalmol Vis Sci 45:4388–4399CrossRefPubMedGoogle Scholar
  28. 28.
    Mojon DS, Hess CW, Goldblum D, Fleischhauer J, Koerner F, Bassetti C, Mathis J (1999) High prevalence of glaucoma in patients with sleep apnea syndrome. Ophthalmology 106:1009–1012CrossRefPubMedGoogle Scholar
  29. 29.
    Morgan WH, Yu DY, Cooper RL, Alder VA, Cringle SJ, Constable IJ (1995) The influence of cerebrospinal fluid pressure on the lamina cribrosa tissue pressure gradient. Invest Ophthalmol Vis Sci 36:1163–1172PubMedGoogle Scholar
  30. 30.
    Jonas JB, Berenshtein E, Holbach L (2003) Anatomic relationship between lamina cribrosa, intraocular space, and cerebrospinal fluid space. Invest Ophthalmol Vis Sci 44:5189–5195CrossRefPubMedGoogle Scholar
  31. 31.
    Jóhannesson G, Eklund A, Lindén C (2018) Intracranial and intraocular pressure at the lamina cribrosa: gradient effects. Curr Neurol Neurosci Rep 18:25CrossRefPubMedGoogle Scholar
  32. 32.
    Promelle V, Daouk J, Bouzerar R et al (2016) Ocular blood flow and cerebrospinal fluid pressure in glaucoma. Acta Radiol Open 5:2058460115624275PubMedGoogle Scholar
  33. 33.
    Fazio MA, Johnstone JK, Smith B, Wang L, Girkin CA (2016) Displacement of the lamina cribrosa in response to acute intraocular pressure elevation in normal individuals of African and European descent. Invest Ophthalmol Vis Sci 57:3331–3339CrossRefPubMedGoogle Scholar
  34. 34.
    Villarruel JM, Li XQ, Bach-Holm D, Hamann S (2017) Anterior lamina cribrosa surface position in idiopathic intracranial hypertension and glaucoma. Eur J Ophthalmol 27:55–61CrossRefPubMedGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyKayseri Research and Training HospitalKayseriTurkey
  2. 2.Department of NeurologyKayseri Research and Training HospitalKayseriTurkey

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