April 13, 2018

Approximately one in four men have sleep apnea, and it could lead to problems with eyesight.


If you’ve ever been told you’re a snorer, you might have obstructive sleep apnea. Both women and men can have obstructive sleep apnea, but according to Sleep Medicine Reviews Journal, it’s more prevalent in men. In addition to making you a noisy bedfellow, the disorder can cause daytime sleepiness and put you at risk for a host of other issues, but one you may not be aware of is glaucoma.

Kanika Bagai, M.D., MSCI, a neurologist and sleep specialist at the Vanderbilt Sleep Disorders Center, discusses the link between sleep apnea and glaucoma.


What is glaucoma?

Glaucoma is a disease characterized by progressive damage to the optic nerve of the eye, Bagai explained. This damage leads to decreased vision and can even lead to blindness. It is usually, but not always, accompanied by an increase in the pressure in the eyeball, known as intraocular pressure.


How does sleep apnea cause glaucoma?

Obstructive sleep apnea leads to decreased oxygen levels in the blood, known as hypoxia. “There is evidence that hypoxia in these patients results in a number of changes that may ultimately affect the blood flow to the optic nerve,” Bagai said.

In addition, obstructive sleep apnea leads to fluctuations in blood pressure that may alter the balance between blood pressure and pressure in the eyeball, leading to less blood flow to the eyeball. The reduced blood flow to the optic nerve increases the risk for optic nerve damage. Along with other known risk factors for glaucoma — such as family history, age, diabetes, myopia and thin corneas — obstructive sleep apnea can increase a person’s susceptibility to glaucoma.


What are the risk factors for obstructive sleep apnea?

Risk factors include obesity, large neck size, enlarged tonsils, a small airway due to nasal congestion or bony structure, a family history of sleep apnea, increasing age, or African-American or Hispanic descent.


What signs or symptoms are linked with obstructive sleep apnea?

Obstructive sleep apnea could be the culprit if you experience any of the following: loud snoring, gasping or choking while asleep, frequent nighttime urination, morning headaches, dry mouth, sore throat, lack of energy or excessive daytime sleepiness, hypertension, concentration problems, depression, irritability or mood swings. If you suspect you have obstructive sleep apnea, tell your doctor. Your physician can order a sleep study to determine a diagnosis and proper treatment, Bagai urges.


Why is it important for obstructive sleep apnea patients to get regular eye checkups?

Recent studies have shown that glaucoma patients with obstructive sleep apnea were found to have a higher intraocular pressure, more damage to the field of vision, and a greater thinning of the layer of nerve in the back of the eye (retina) compared with the people who do not have obstructive sleep apnea.

Although typical tests should be able to detect glaucoma related to obstructive sleep apnea, Bagai recommends that these patients tell their eye doctor about their sleep disorder. “OSA is associated with increased risk for a number of serious eye conditions other than glaucoma, such as bleeding in the retina, swelling of the optic disc due to increased pressure in the brain and inflammation of the optic nerve which can lead to painless loss of vision,” she explained.


What else is important about the link between glaucoma and obstructive sleep apnea?

“The same drops in oxygen and changes in blood pressure at night that occur due to OSA and increase a person’s risk for glaucoma also increase the risk of heart and blood vessel diseases, known as cardiovascular disease,” Bagai said.

If you do have obstructive sleep apnea, your physician may prescribe a CPAP machine (continuous positive airway pressure) for you to wear while you sleep, or discuss other treatment options. “Once OSA is properly treated with CPAP, the patient’s risk for several dangerous eye conditions such as glaucoma and cardiovascular diseases, like stroke and heart attack, decrease significantly,” Bagai said. “It is crucial that the patient uses CPAP as prescribed to obtain the full benefits of treatment.”

If you have lingering sleep issues, talk with your healthcare provider about finding a sleep disorder program. Vanderbilt’s Sleep Disorders Center can help.