Sleep Apnea and Your Eyes

Woman sleeping with CPAP machine

Sleep Apnea is a common sleep disorder affecting approximately 22 million Americans, according to the American Sleep Apnea Association (AASA). This condition can increase risk of many other health problems, but as many as 80% of those suffering from Sleep Apnea may not know that they have it. In this blog, we’ll discuss common signs and symptoms of Sleep Apnea, and how this sleep disorder can affect your eyes. 

Types of Sleep Apnea

There are 3 types of sleep apnea:

  • Obstructive Sleep Apnea (OSA) makes up a majority of cases. In this form, the soft tissues of the throat become relaxed, causing the airway to be blocked.
  • Central Sleep Apnea is a less common form that occurs when the brain does not send necessary signals to the breathing muscles.
  • Complex or Mixed Sleep Apnea occurs when an individual has both of the above forms.

Symptoms

Symptoms of Sleep Apnea include:

  • Loud snoring
  • Excessive sleepiness during the day
  • Episodes in which an individual stops breathing (as observed and reported by someone else)
  • Dry mouth upon waking
  • Gasping for air while sleeping
  • Waking abruptly while gasping for air
  • Headaches in the morning
  • Poor sleep
  • Irritability
  • Difficulty concentrating

Risk Factors

While Sleep Apnea can affect anyone, even children, there are some factors that may contribute to a higher risk. These include:

  • Being overweight-a leading cause of OSA
  • Physiological factors, such as having a thicker neck or a narrower airway
  • Family history of sleep apnea
  • Use of sedatives or alcohol
  • Age-sleep apnea is more common in older adults
  • Smoking
  • Nasal congestion
  • Underlying health problems, including heart disease, high blood pressure, diabetes, and some hormone disorders

How it Affects the Eyes

There are a number of eye diseases related to sleep apnea. These include:

  • Glaucoma-According to the Glaucoma Research Foundation, people with OSA are approximately ten times more likely to develop glaucoma. While the exact relationship between OSA and glaucoma is unknown, a number of studies have shown that those with OSA are at greater risk of this potentially blinding disease. 
  • Floppy-Eyelid Syndrome (FES)-FES is a condition in which the eyelids become elastic and easily pliable. People with FES may experience symptoms such as dry, gritty eyes when waking up, conjunctivitis, and discharge from the eyes. According to an interview in Optometry Times, fewer than five percent of those with OSA have FES, but approximately 100 percent of those with FES have OSA.
  • Nonarteritic anterior ischemic optic neuropathy (NAION)-NAION is a disorder of the optic nerve characterized by sudden, painless loss of sight. As many as 75% of cases of NAION occur overnight, with vision loss reported upon waking in the morning. Studies indicate that 70 to 80 percent of patients with NAION have been found to have OSA
  • Papilledema-Swelling of the optic nerve, known as papilledema, occurs as a result of increased intracranial pressure. The exact relationship between papilledema and OSA is not entirely known, however theories suggest that frequent breathing interruptions may be to blame for increases in intracranial pressure. Studies have shown improvement of OSA related papilledema with CPAP treatment.
  • Retinal Vein Occlusion (RVO)-Retinal Vein Occlusion occurs when a blood vessel in the retina becomes blocked. This prevents necessary oxygen and nutrients from getting to the retina and leads to vision loss. Studies suggest that OSA is a risk factor for RVO.
  • Keratoconus-Keratoconus is a condition in which the cornea thins and bulges into a cone-like shape. One study published in the journal Cornea showed that people with Keratoconus are 10-20% more likely to have sleep apnea than the general population.

Other Health Problems

Sleep Apnea is associated with many other health problems, including:

  • Fatigue/daytime sleepiness
  • High Blood Pressure
  • Heart Disease
  • Type 2 Diabetes
  • Liver Problems
  • Surgical Complications

Treatments

Treatments for sleep apnea include:

  • Continuous Positive Airway Pressure (CPAP)-CPAP is a machine that is fit over the mouth and/or nose to deliver air pressure during sleep. This pressure keeps the airway open, thus preventing sleep apnea.
  • Lifestyle Changes-Your doctor may recommend lifestyle changes such as losing weight, avoiding alcohol and sedatives before bed, and not sleeping on your back.
  • Surgery-If other treatments are not effective, your doctor may recommend surgery.

What You Can Do

Sleep apnea may occur without any symptoms. Your eye doctor may see ocular manifestations of sleep apnea before you know that you have it. An annual eye exam is a good way to prevent vision changes related to OSA. If you have symptoms of sleep apnea, or if your partner has noticed excessive snoring or stopped breathing while you sleep, talk to your doctor. They may run tests or refer you to a sleep specialist who can determine if your symptoms are sleep apnea. To schedule an eye exam at Mountain View Eye Center, call or text (907) 328-2920. 

Sources:

American Sleep Apnea Association, www.sleepapnea.org

Glaucoma Research Foundation, www.Glaucoma.org

Optometry Times, www.optometrytimes.com

Shahrokh Javaheri, M.D., F.A.A.S.M., Zeeshan Qureshi, M.D., and Karl Golnik, M.D., M.Ed., 2011, Resolution of Papilledema Associated with OSA Treatment, Journal of Clinical Sleep Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161773/

Kun-Ta Chou, Chin-Chou Huang, Der-Chong Tsai, Yuh-Min Chen, Diahn-Warng Perng, Guang-Ming Shiao, Yu-Chin Lee, Hsin-Bang Leu, 2012, Sleep apnea and risk of retinal vein occlusion: a nationwide population-based study of Taiwanese, American Journal of Ophthalmology, https://pubmed.ncbi.nlm.nih.gov/22464364/

Preeya K Gupta, Sandra S Stinnett, Alan N Carlson, 2012, Prevalence of sleep apnea in patients with keratoconus, Cornea, https://pubmed.ncbi.nlm.nih.gov/22333661/

Written by: Gina Stafford COA, LDO, ABOC

Posted in: Uncategorized

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