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Evaluation of the visual function in obstructive sleep apnea syndrome patients and normal-tension glaucoma by means of the multifocal visual evoked potentials

  • Glaucoma
  • Published:
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Abstract

Background

This study was designed to objectively evaluate visual function and the causal relationship between sleep apnea and optic nerve dysfunction in patients with obstructive sleep apnea syndrome (OSAS) with or without diagnosis of normal-tension glaucoma (NTG) using multifocal visual evoked potentials (mfVEP).

Methods

This observational, cross-sectional study assessed 20 patients with recently diagnosed OSAS with or without NTG. Diagnosis of sleep apnea was based on overnight polysomnography (ApnoeScreen). All participants underwent a complete physical and ophthalmologic examination. MfVEP recordings obtained using VERIS software (Electro-Diagnostic Imaging, San Mateo, USA), SITA-standard 30-2 automated perimetry (Humphrey Visual Field Analyzer II) and optic coherence tomography (Topcon 3D OCT-1000) exams were performed to evaluate the changes.

Results

Abnormal mfVEP amplitudes defects (interocular and monocular probability analysis) were found in 40% of the eyes in the non-glaucoma group and in 90% of eyes of the NTG patients. As well, delayed mfVEP latencies (interocular and monocular probability analysis) were seen in 30 and 60% of the eyes of the non-glaucoma and NTG groups, respectively. The average RNFL (retinal nerve fiber layer) thickness was significantly reduced in the NTG eyes compared to the control database and the non-glaucoma eyes. On the Humphrey Visual Field total deviation analysis, all the NTG eyes showed significant clusters of abnormal points but none was detected in the non-glaucoma group eyes. However, the mfVEP amplitude and latency did not show any significant correlation with the standard perimetry and OCT variables, because the mfVEP technique was able to detect far more early visual defects in these patients. Systolic blood pressure, sleep efficiency, arousal index, mean and minimum arterial oxygen saturation (SaO2), time SaO2 < 90%, oxyhemoglobin desaturation index, number of central and mixed apneas and apnea-hipopneas index were shown to be significantly correlated with mfVEP amplitude and latency.

Conclusions

A significant incidence of subclinical optic nerve involvement, not detected with other structural and psychophysics diagnostic techniques was seen by means of the mfVEP. In this sense, the mfVEP may be a useful diagnostic tool in the clinic for early diagnosis and monitoring of optic nerve function abnormalities in patients with OSAS.

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Acknowledgements

This study was supported by FIS PI11/00533, Fundación Lain Entralgo and FISCAM PI-2008/09.

Conflict of interest

No financial conflicts of interest exist.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University Hospital Doce de Octubre, Madrid, Spain

    Esperanza Gutiérrez-Díaz & Enrique Mencía-Gutiérrez

  2. Department of Ophthalmology, University Hospital Príncipe de Asturias and Department of Surgery, School of Medicine, University of Alcalá, Carretera Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain

    Consuelo Pérez-Rico

  3. Department of Pneumology, University Hospital Doce de Octubre, Madrid, Spain

    María Josefa de Atauri

  4. Department of Ophthalmology, University Hospital General de Guadalajara and Department of Surgery, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain

    Román Blanco

Authors
  1. Esperanza Gutiérrez-Díaz
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  3. María Josefa de Atauri
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Correspondence to Consuelo Pérez-Rico.

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Gutiérrez-Díaz, E., Pérez-Rico, C., de Atauri, M.J. et al. 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 250, 1681–1688 (2012). https://doi.org/10.1007/s00417-012-1982-z

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  • DOI: https://doi.org/10.1007/s00417-012-1982-z

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