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What Every Optometrist Should Know About Sleep Apnea

Katherine Li-Wei Wang, OD, FAAO

San Diego VA Healthcare System
North County VA outpatient clinic
1830 West Drive, Suite 107
Vista, CA 92083

 

Contents

 

Summary

This course gives a basic review of sleep apnea, types of sleep apnea, symptoms and clinical signs, treatment and its relevance to normal tension glaucoma.

 

Introduction to Sleep Apnea

What is sleep apnea? Sleep apnea by definition, is cessation of breathing for at least 30 episodes, about 10 seconds in length each, during the night. According to the National Institutes of Health, it is one of the most commonly undiagnosed problems in the United States and many patients are often unaware that they have it. However if these patients go untreated, it increases their risk for heart attacks and cerebrovascular accidents.

 

Why do we care about sleep apnea as optometrists? As we are aware of, the optic nerve is neural tissue and more susceptible to damage from oxygen deprivation. Several different systemic factors can contribute to oxygen deprivation, one of which is sleep apnea. When patients have sleep apnea, oxygen saturation falls, causing decreased oxygen perfusion to the optic nerve head. Also, sleep apnea increases their risk for many systemic complications, such as: atrial fibrillation, bradycardia, and tachycardia. They may have AV block, a shorter life expectancy, increased risk for metabolic syndrome and increased risk for transient ischemic attacks and cerebrovascular attacks.[1] This problem occurs because apnea stresses the body by preventing important blood-pressure lowering that occurs during normal deep sleep and seems to alter blood chemistry in ways that can increase the potential for cardiovascular disease.

 

As a healthcare provider, we may be one of the only providers that can help these patients to get screened for sleep apnea when there are enough clinical signs and/or symptoms that would indicate a sleep test would be beneficial.

 

Several studies have shown a high correlation of sleep apnea with normal tension glaucoma. By getting these patients screened, diagnosed, and treated, we can help these patients in their overall health as well as possibly improve their glaucoma.

 

Statistics on Sleep Apnea

How common is sleep apnea? Thirty million Americans have sleep apnea and adult male has a 1 in 2 chance of having a sleep disorder[2] with about 50% of the population undiagnosed. Medicare is now even considering paying for home sleep testing to make the diagnosis easier. Though it is most common in adult males, it can even strike children if they have enlarged tonsils and adenoids. In addition, a study presented at the American Thoracic Society 2007 International Conference on 5-20-2007 found that people with sleep apnea were 2-3 times more likely to have a car crash than a non-apneic individual, and 5 times more likely to be involved in a serious car crash.[3] To be published this year in the journal, Sleep, University of California at San Diego found that 1,400 deaths from car crashes each year are caused by drivers with apnea.

 

As we know, normal tension glaucoma has a high association with systemic disorders, including sleep apnea. Dr. Marcus and associates found that up to 20% of all glaucoma patients have sleep apnea.[4] About 7% of all sleep apnea syndrome patients have glaucoma. Further, up to 70% of normal tension glaucoma patients have some type of sleep disorder.[4]