Skip to main content

Advertisement

SpringerLink
Log in

Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome

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

Abstract

Purpose

Retina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters.

Methods

Both eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients.

Results

According to the OSAS grading, patients were grouped as mild (n = 15), moderate (n = 27), and severe (n = 59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss.

Conclusions

We think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema.

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

Similar content being viewed by others

References

  1. Hee MR, Izatt JA, Swanson EA, Huang D, Schuman JS, Lin CP, Puliafito CA, Fujimoto JG (1995) Optical coherence tomography of the human retina. Arch Ophthalmol 113:325–332

    Article  CAS  PubMed  Google Scholar 

  2. Fjeldstad C, Bemben M, Pardo G (2011) Reduced retinal nerve fiber layer and macular thickness in patients with multiple sclerosis with no history of optic neuritis identified by the use of spectral domain high-definition optical coherence tomography. J Clin Neurosci 18:1469–1472

    Article  PubMed  Google Scholar 

  3. Galetta KM, Calabresi PA, Frohman EM, Balcer LJ (2011) Optical coherence tomography (OCT): imaging the visual pathway as a model for neurodegeneration. Neurotherapeutics 8:117–132

    Article  PubMed Central  PubMed  Google Scholar 

  4. Kirbas S, Turkyilmaz K, Anlar O, Tufekci A, Durmus M (2013) Retinal nerve fiber layer thickness in Alzheimer disease. J Neuroophthalmol 33:58–61

    Article  PubMed  Google Scholar 

  5. Kirbas S, Turkyilmaz K, Tufekci A, Durmus M (2013) Retinal nerve fiber layer thickness in Parkinson disease. J Neuroophthalmol 33:62–65

    Article  PubMed  Google Scholar 

  6. Vidal-Jordana Á, Sastre-Garriga J, Montalban X (2012) Optical coherence tomography in multiple sclerosis. Rev Neurol 54:556–563

    PubMed  Google Scholar 

  7. Mannarino M, Di Filippo F, Pirro M (2012) Obstructive sleep apnea syndrome. Eur J Intern Med 23:586–593

    Article  PubMed  Google Scholar 

  8. Ozben S, Guvenc TS, Huseyinoglu N, Sanivar HS, Hanikoglu F, Cort A, Ozben T (2013) Low serum copeptin levels in patients with obstructive sleep apnea. Sleep Breath. doi:10.1007/s11325-013-0822-7

    Google Scholar 

  9. Zamarron C, Paz VG, Riveiro A (2008) Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Int Med 19:390–398

    Article  Google Scholar 

  10. Macey PM, Kumar R, Woo MA, Valladares EM, Yan-Go FL, Harper RM (2008) Brain structural changes in obstructive sleep apnea. Sleep 31:967–977

    PubMed Central  PubMed  Google Scholar 

  11. Joo EY, Tae WS, Lee MJ, Kang JW, Park HS, Lee JY, Suh M, Hong SB (2010) Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. Sleep 33:235–241

    PubMed Central  PubMed  Google Scholar 

  12. Torelli F, Moscufo N, Garreffa G, Placidi F, Romigi A, Zannino S, Bozzali M, Fasano F, Giulietti G, Djonlagic I, Malhotra A, Marciani MG, Guttmann CR (2011) Cognitive profile and brain morphological changes in obstructive sleep apnea. Neuroimage 54:787–793

    Article  PubMed  Google Scholar 

  13. Yaouhi K, Bertran F, Clochon P, Mézenge F, Denise P, Foret J, Eustache F, Desgranges B (2009) A combined neuropsychological and brain imaging study of obstructive sleep apnea. J Sleep Res 18:36–48

    Article  PubMed  Google Scholar 

  14. Zhang JH, Fung SJ, Xi M, Sampogna S, Chase MH (2009) Recurrent apnea induces neuronal apoptosis in the guinea pig forebrain. Exp Neurol 216:290–294

    Article  PubMed  Google Scholar 

  15. Fung SJ, Xi M, Zhang J, Sampogna S, Chase MH (2012) Apnea produces excitotoxic hippocampal synapses and neuronal apoptosis. Exp Neurol 238:107–113

    Article  PubMed  Google Scholar 

  16. 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

    Article  CAS  Google Scholar 

  17. Kargi SH, Altin R, Koksal M, Kart L, Cinar F, Ugurbas SH, Ayoglu F (2005) Retinal nerve fiber layer measurements are reduced in patients with obstructive sleep apnoea syndrome. Eye (Lond) 19:575–579

    Article  CAS  Google Scholar 

  18. 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 249:585–593

    Article  PubMed  Google Scholar 

  19. 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 

  20. Blaivas AJ, Uddin F (2013) Obstructive sleep apnea caused by substernal goiter presenting as nonarteritic ischemic optic neuropathy. Sleep Breath. doi:10.1007/s11325-012-0758-3

    PubMed  Google Scholar 

  21. Acar M, Firat H, Acar U, Ardic S (2013) Ocular surface assessment in patients with obstructive sleep apnea–hypopnea syndrome. Sleep Breath. doi:10.1007/s11325-012-0724-0

    Google Scholar 

  22. Leveque TK, Yu L, Musch DC, Chervin RD, Zacks DN (2007) Central serous chorioretinopathy and risk for obstructive sleep apnea. Sleep Breath 11:253–257

    Article  PubMed  Google Scholar 

  23. Abdal H, Pizzimenti JJ, Purvis CC (2006) The eye in sleep apnea syndrome. Sleep Med 7:107–115

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  25. Faridi O, Park SC, Liebmann JM, Ritch R (2012) Glaucoma and obstructive sleep apnoea syndrome. Clin Experiment Ophthalmol 40:408–419

    Article  PubMed  Google Scholar 

  26. Stein JD, Kim DS, Mundy KM, Talwar N, Nan B, Chervin RD, Musch DC (2011) The association between glaucomatous and other causes of optic neuropathy and sleep apnea. Am J Ophthalmol 152:989–998

    Article  PubMed Central  PubMed  Google Scholar 

  27. Kerr NM, Chew SS, Danesh-Meyer HV (2009) Non-arteritic anterior ischaemic optic neuropathy: a review and update. J Clin Neurosci 16:994–1000

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. AASM, Westchester

    Google Scholar 

  30. American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689

    Google Scholar 

  31. Nowak M, Kornhuber J, Meyrer R (2006) Daytime impairment and neurodegeneration in OSAS. Sleep 29:1521–1530

    PubMed  Google Scholar 

  32. Xu M, Yang Y, Zhang J (2012) Levels of neuroglobin in serum and neurocognitive impairments in Chinese patients with obstructive sleep apnea. Sleep Breath. doi:10.1007/s11325-012-0723-1

    Google Scholar 

  33. Gutiérrez-Díaz E, Pérez-Rico C, Díaz de Atauri MJ, Mencía-Gutiérrez E, Blanco R (2012) 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 Ophtalmol 250:1681–1688

    Article  Google Scholar 

  34. Moghimi S, Ahmadraji A, Sotoodeh H, Sadeghniat K, Maghsoudipour M, Fakhraie G, Latifi G, Nassiri N, Giaconi JA (2013) Retinal nerve fiber thickness is reduced in sleep apnea syndrome. Sleep Med 14:53–57

    Article  PubMed  Google Scholar 

  35. Bucci FA Jr, Krohel GB (1986) Optic nerve swelling secondary to the obstructive sleep apnea syndrome. Am J Ophthalmol 105:874–877

    Google Scholar 

  36. 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 106:1009–1012

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurology, Medical Faculty, Kafkas University, Kars, Turkey

    Nergiz Huseyinoglu, Serkan Ozben, Murat Yildirim Kale & Hilal Safak Sanivar

  2. Department of Ophthalmology, Medical Faculty, Kafkas University, Kars, Turkey

    Metin Ekinci

  3. Department of Biostatistics, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey

    Cagatay Buyukuysal

Authors
  1. Nergiz Huseyinoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Metin Ekinci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Serkan Ozben
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cagatay Buyukuysal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Murat Yildirim Kale
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hilal Safak Sanivar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nergiz Huseyinoglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huseyinoglu, N., Ekinci, M., Ozben, S. et al. Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome. Sleep Breath 18, 95–102 (2014). https://doi.org/10.1007/s11325-013-0854-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-013-0854-z

Keywords

Search

Navigation