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Feeling Tired? Talk to Your Ophthalmologist, You May Have Sleep Apnea!

Dr. Anthony Warren, 16/10/2018

It is now commonly known that sleep apnea, which creates episodes of dangerously low oxygen levels in your blood during sleep, may lead to serious, chronic health issues, such as increased chances of stroke and other cardio-vascular diseases, dementia and diabetes. Less known is the potential harm to your sight.  Recent research has linked several observable eye-related problems with sleep apnea.  Ophthalmologists are now being trained to look for these symptoms which may be early indications of sleep problems. They can then guide patients towards appropriate diagnoses before it is too late to provide corrective therapies. Here are some of the indications.

Floppy Eyelids.  Normally, you are awakened by sensing contact with bedding on an open eye. In patients with sleep apnea, the arousal reaction to shut your eye does not occur and the eye remains open after being disturbed.  Over time, the lid becomes more lax.

NAION, or Non-arteritic Anterior Ischemic Optic Neuropathy, is also a strong predictor of sleep apnea - 70 to 80% of patients with NAION suffer from OSA. The most common symptom is acute painless vision loss when waking up which affects 75 % of NAION patients.

Papilledema is a condition which causes the part of the optic nerve inside the eye to swell. Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination.

Glaucoma patients with OSA have a higher intra-ocular pressure, worse visual field indices, and a thinner retinal nerve fiber layer.

Retinal Damage. Studies suggest a relationship between a build-up of fluid under the retina and sleep apnea. This can cause blurred vision. When your retina doesn’t get enough oxygen it can exacerbate the problem. Alleviating apnea symptoms speeds up recovery in the eye.

Corneal Distortion. The cornea has a dome shape, like a ball. Sometimes, however, the structure of the cornea is just not strong enough to hold this round shape and the cornea bulges outward like a cone. This condition is called keratoconus and has been shown to be linked to sleep apnea.  An increase in cornea thickness creates blurred vision.

So next time you go for a vision check-up, make sure you ask your ophthalmologist about possible sleep problems – before it’s too late!

You can learn more in these references:

Punjami N M et al. PLoS Med. 2009;6(8):e1000132.

Stein J D et. al. Am J Ophthalmol. 2011;152(6):989-998.e3.

Moghimi S et. al. Sleep Med. 2012 Sep 1.

Jain A K et al. Graefes Arch Clin Exp Ophthalmol. 2010;248(7):1037-1039.

Ferrara N. Am J Physiol Cell Physiol. 2001;280(6):C1358-C1366.

Mason R H  et al. Retina. 2012;32(9):17911798.

Koseoglu H I et. al. Int Ophthalmol. 2016 Jun; 36(3):327-33.

Gupta P K  et. al Cornea 2012 31:595-599.

Woodward M A, et. al, Ophthalmology, 2015, 123:457-465.