Intraocular Pressure pattern changes following the use of Continuous Positive Airway Pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS) with and without primary open-angle glaucoma (POAG) Jessica V. Jasien1, René Goedkoop2, Cinthi Pillai1, Sonja Simon-Zoula2, Robert Ritch1 1
Einhorn Clinical Research Center, New York Ear Eye and Ear Infirmary of Mount Sinai, New York, NY, USA;
BACKGROUND • IOP is the sole proven modifiable risk factor for the development and progression of glaucomatous optic neuropathy. Fluctuations and peaks, which often occur outside office hours and during sleep, are related to progression1 • Patients with OSAS are at high risk for development and progression of glaucoma, particularly normal-tension glaucoma2 • OSAS is associated with reduced ocular blood flow and ocular perfusion pressure, leading to hypoxia and hypercapnia, which may contribute to glaucomatous optic neuropathy • OSAS has been related to loss of nycthemeral rhythm of IOP, that may be corrected by CPAP treatment3 • The benefits of CPAP treatment on ocular perfusion pressure and oxygenation may outweigh effects of IOP elevation, but a prospective study in glaucoma patients has not yet been performed
DEVICE SENSIMED Triggerfish®, a non-invasive system including a contact lens sensor (CLS) that wirelessly measures spontaneous dimensional changes of the eye at the limbus, was used to record the IOP-related pattern for up to 24 hours.
Sensimed AG, Lausanne, Switzerland;
METHODS • Single center, prospective, exploratory, open-label study • POAG and non-POAG patients with moderate to severe OSAS under CPAP treatment were included • Continuous 24-hr IOP-related patterns recording using the CLS in 2 sessions, 7 days apart, in the same eye • Session 1: 24-hr IOP-related patterns recording with CPAP • Session 2: 24-hr IOP-related patterns recording without CPAP • Wake to sleep (W/S) and sleep to wake (S/W) slopes for CLS output were computed by fitting linear regression to measurements from 1 hour before transition of W/S or S/W to 1 hour after transition • The maximum nocturnal IOP peak was calculated relative to the sleep time value
RESULTS • 4 POAG and 4 non-POAG patients; Mean age 64.3+7.8 years, 6 male and 2 female • With CPAP, the W/S slope for both groups were similar. Without CPAP, the W/S increased for POAG and decreased for non-POAG (Table 1, Figure 1) • The nocturnal mean IOP value was lower with CPAP compared to no CPAP for both POAG and non-POAG subjects (Table 2, Figure 2)
W/S slopes POAG Non-POAG 44.4+34.8 42.2+40.7
S/W slopes POAG Non-POAG -15.5+10.4 36.1+21.1
Table 1. Slopes in mV/h.
Image 1. SENSIMED Triggerfish® set up with recorder.
Table 2. Nocturnal Mean IOP value in mV/h.
Figure 2. Nocturnal Mean IOP Value in mV/h.
Acrophase increased by 7.4+31.4 mV during CPAP in POAG, whereas time of nocturnal acrophase occurred 2 hrs. earlier without CPAP. Non-POAG with CPAP decreased by 41.1+22 mV, the time of nocturnal acrophase did not change compared to no CPAP.
DISCUSSION The amplitude of the nocturnal IOP peak decreased in POAG eyes and increased in non-POAG eyes. The S/W slope was more moderate in POAG with CPACP than without. In nonPOAG with CPAP the difference was reversed.
CPAP may slow the rate of IOP increase when going from W/S and slow the rate of IOP decrease from S/W in POAG patients suffering from OSAS. CPAP decreases the nocturnal mean IOP value in POAG and non-POAG patients. Therefore, CPAP may be beneficial for OSAS patients with or without POAG. A larger trial is warranted to substantiate the beneficial effects of CPAP in POAG patients with OSAS.
Image 2. SENSIMED Triggerfish® contact lens sensor.
1. Asrani S, Zeimer R, Wilensky J et al. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. Journal of glaucoma 2000;9.2:134-142. 2. Mojon DS, Hess CW, Goldblum D, et al. High prevalence of glaucoma in patients with sleep apnea syndrome. Ophthalmology 1999;106:1009-12. 3. Pepin J-L, Chiquet C, Tamisier R, et al. Frequent loss of nyctohemeral rhythm of intraocular pressure restored by nCPAP treatment in patients with severe apnea. Arch Ophthalmol 2010;128:1257–63. 4. Kiekens S, Veva De Groot, Coeckelbergh T, et al. Continuous positive airway pressure therapy is associated with an increase in intraocular pressure in obstructive sleep apnea. Invest Ophthalmol Vis Sci 2008;49:934-40.
PURPOSE CPAP has been reported to increase IOP overnight in OSAS patients.4 The purpose of this study was to investigate the effect of CPAP on IOP patterns as recorded by a CLS in OSAS patients with and without POAG.
CONTACT INFO Figure 1. W/S and S/W Slope in mV/h.
Jessica Jasien, MEn [email protected]
Sensimed AG, Lausanne, Switzerland ResMed Corp, San Diego, CA. No conflict of interest.