Articles about Eye Health and Disease 2002
 

Sleep Apnea Linked to Ischemic Optic Neuropathy (NAION)

(From Arch Ophthalmol. 5/2002;120:601-605.)

Non-arteritic Anterior Ischemic Optic Neuropathy (NAION) is a complex name for what essentially is a stroke of the optic nerve of the eye, specifically cases not associated with the vascular disease known as Giant Cell Arteritis (thus "non-arteritic").  While there may be an association of cases of NAION with vascular diseases such hypertension and diabetes, and an association with advancing age, specific causes and treatments for the disorder have been illusive.

According to results of a study reported in the May issue of the Archives of Ophthalmology, three-fourths of patients with NAION have sleep apnea. The findings may explain why symptoms are often worst on awakening in this disease characterized by sudden, painless, mostly irreversible, and generally non-progressive visual loss. Investigators compared 17 patients with NAION with 17 age- and sex-matched controls with suspected restless legs syndrome. Based on overnight sleep testing (polysomnography), 12 (71%) of 17 patients with NAION had sleep apnea. As classified by the respiratory disturbance index, 24% of affected patients had "mild" sleep apnea, 24% had moderate sleep apnea, and sleep apnea was severe in four cases (24%). Only three (18%) of 17 controls had sleep apnea (P=.005).

The investigators reported, "Since there is no proven treatment of NAION, further studies are needed to clarify whether repetitive nocturnal upper airway obstructions might directly damage the optic nerve, whether continuous positive airway pressure treatment might help affected patients recover from NAION, and whether long-term treatment might help prevent involvement of the second eye. We found a high prevalence of SAS in patients with NAION, which supports previous case reports suggesting that such an association exists. This association may explain why approximately 75% of all patients with NAION discover visual loss on first awakening or when they first use vision critically after sleeping. Our findings indicate that SAS may play an important role in the pathogenesis of NAION."

 

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