Tear-film Stability in Patients with Obstructive Sleep Apnea Syndrome

Masaki Sato, MD Tetsuro Oshika, MD

Department of Ophthalmology

University of Tsukuba

Japan

The authors have no commercial or proprietary interest in any of the companies, products, or methods described in this presentation.

Epidemiology ： About 20 million patients in the world

Classification ： Obstructive ・ Central

Symptoms ： Snore ・ Daytime somnolence （ The risk of the traffic accident : seven times ）

Risk factors ： Obesity ・ Respiratory diseases ・ Alcohol

Systemic complications ： Hypertension ・ Diabetes etc…

Diagnosis : Polysonography Apnea/Hypopnea Index (AHI) ≧ 5 times / hr

Therapy : nasal CPAP (nasal Continuous Positive Airway Pressure)

Sleep Apnea Syndrome : SAS

Introduction

Ocular manifestations Glaucoma ： 2 ~ 27 %

The retinal nerve fiber layer thickness correlates nagatively the SAS severity (Eye 2005, J Glaucoma 2007)

Keratoconus

Filamentary keratitis

Reccurent corneal erosion

Tear abnormality

Floppy eye lid : 52% Corneal lesion

The SLE-BUT correlates nagatively the SAS severity ? (Ophthalmology 1999)

n= ？

Objective quantitative analysis !!

To evaluate the tear-film stability in

patients with obstructive sleep apnea

syndrome (OSAS) using the tear-film

stability analysis system (TSAS).

Purpose

Subjects & Methods

Design ： cross-sectional study.

Participants : Consecutive 116 left eyes of 116 cases

on nCPAP therapy.

Exclusion criteria : Contact lens wearing, post-

intraocular surgery, other ocular disease, diabetes,

and collagen disease.

Subjects : 86 eyes of 86 cases （ M:F = 74:12 ）

　　　 Age ： 55 ± 12 years ( range: 37-71 )

RT-7000® （ Tomey ） Corneal topographic maps each second for 10 seconds BUI (Breakup Index ; 0 〜 100) RBUT (Ring Breakup Time ; 0 〜 10)

TSAS (Tear Stability Analysis System)

Main Outcome Measures AHI （ at diagnosis / present ） BMI （ Body Mass Index ） Period of nCPAP therapy BUI RBUT

BUI RBUT

r P r P

Age

AHI （ at diagnosis ）

AHI （ at present ）

BMI

Period of nCPAP therapy

0.123

-0.273

0.004

-0.254

0.073

0.261

0.011

0.973

0.026

0.517

0.102

-0.265

-0.021

-0.067

0.052

0.349

0.014

0.854

0.570

0.647

(Pearson’s correlation coefficient)

Results

r = -0.273p = 0.0108

r = 0.004p = 0.973

AHI (at diagnosis)

BUI BUI

AHI (at present)

Correlation between AHI and BUI

(Pearson’s correlation coeffient)

r = -0.265p = 0.0135

r = -0.021p = 0.854

RBUT RBUT

(Pearson’s correlation coeffient)

Correlation between AHI and RBUT

AHI (at diagnosis) AHI (at present)

１） Exacerbation of OSAS

A long period before nCPAP therapy is started.

２） Influence of nCPAP (Optometry 2007)

　　 Ocular complications by nCPAP in 3 OSAS cases.

　　　

HCL wear for keratoconus → Keratoconjunctivitis

Injury for fellow eye → Keratoconjunctivitis

HCL wear for Pellucid cornea → Keratoconjunctivitis

Inappropriate fitting of CPAP mask → leaking air

Inappropriate fitting of CPAP mask → leaking air

DiscussionThe origin of the deteriorated tear-film stability…

Tear-film instability

Keratoconjunctivitis

Concept in Dry Eye

MGDMGD

ConjunctivochalasisConjunctivochalasis

クリアランス低　下

クリアランス低　下

Moisture ↓Moisture ↓

StressStress

CLwearCLwear

Eye dropsEye drops

MedicineMedicine

DMDMTrichiasisTrichiasisInjuryInjury

Limbal function ↓

Limbal function ↓

SurgerySurgery

LagophthalmosLagophthalmos

Sensation ↓Sensation ↓

Nictation ↓ Nictation ↓

InflammationInflammation

Tear secretion ↓

Tear secretion ↓

Lid abnormality

Lid abnormality

SASSAS

The tear-film stability in OSAS patients

correlates negatively with the AHI at diagnosis.

From the point of view of preventive medicine,

it is very important for the OSAS patients to

have the ophthalmic examinations.

This research was partially supported by the Grant-in-Aid for Young Scientists (B) No.20791244 from MEXT Japan.

Conclusions