阻塞性睡眠呼吸暂停低通气综合征与青光眼性眼底病变关系的初步研究

Relationship between obstructive sleep apnea-hypopnea syndrome and glaucomatous fundus lesions

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中青光眼性眼底病变,了解OSAHS对青光眼发病的影响。方法选取49例OSAHS患者作为OSAHS组,选取30例年龄、性别、屈光情况与OSAHS组相匹配的健康体检者作为正常对照组。对所有研究对象的双眼进行眼压测量、视野检查和光学相干层析成像,比较2组受试者的眼压、视野的平均缺损和模式标准差、视盘三维结构参数、视网膜神经纤维层(RNFL)厚度、脉络膜厚度,分析OSAHS组RNFL厚度与呼吸暂停低通气指数(AHI)、最低氧饱和度的相关性。结果 OSAHS组左、右眼的眼压、视野的平均缺损和模式标准差与对照组相比差异无统计学意义。OSAHS组左、右眼的垂直径杯盘比和视杯容积显著大于正常对照组(P<0.05),平均RNFL厚度、颞侧和下方RNFL厚度显著小于对照组(P<0.05),OSAHS组黄斑中心凹鼻侧/下方0.5、1.0、1.5 mm处的脉络膜厚度均显著小于对照组(P<0.05),OSAHS组视杯颞侧/上方/下方距视盘边缘0.5、1.0、1.5 mm处的脉络膜厚度均显著小于对照组(P<0.05)。OSAHS组左眼的平均RNFL厚度与AHI呈负相关(r=-0.266,P=0.024)。结论 OSAHS患者视盘凹陷扩大加深,眼底RNFL、脉络膜局限性变薄,RNFL变薄与OSAHS严重程度相关,认为OSAHS是引发青光眼的危险因素。

Objective To investigate the glaucomatous fundus lesions in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS) and to explore the effect of OSAHS on the incidence of glaucoma. Methods Forty-nine patients with OSAHS and 30 normal controls were enrolled. The control group was matched for age and sex. Intraocular pressure and visual field were measured in all participants. Optical coherence tomography was used to evaluate the peripapillary retinal nerve fiber layer(RNFL), peripapillary and macular choroid, and optic nerve head topography for early detection of glaucoma. The correlation between RNFL thickness and the apnea hypopnea index(AHI), and minimum SaO2 in the OSAHS group were analyzed. Results Intraocular pressure, mean defect and pattern standard deviation were similar between groups. The vertical cup/disk ratio of the left and right eyes in the OSAHS group was(0.48±0.14) and(0.46±0.15), respectively. The cup volume of the left and right eyes in the OSAHS group was(0.18±0.17) mm3 and(0.15±0.13) mm3, which were statistically higher than those in the normal controls(P<0.05). RNFL thickness in the average, inferior and temporal quadrants in both eyes in OSAHS group was significantly reduced compared with that in the control group(P<0.05). Choroidal thickness at 0.5, 1.0, 1.5 mm nasal and inferior to the fovea in OSAHS group was significantly thinner than that in the control group(P<0.05). There was a statistically negative correlation between the average RNFL thickness and the AHI in the left eye of OSAHS patients(r=-0.266,P=0.024). Conclusions OSAHS patients exhibited increased cup volume parameters, and partial decreased RNFL thickness and choroidal thickness. RNFL thickness was negatively correlated with AHI in the OSAHS group. These findings suggested that OSAHS patients were at increased risk for glaucoma.