Sleep Apnea Linked to Anterior Ischemic Optic Neuropathy

Laurie Barclay, MD

June 03, 2002

June 4, 2002 -- Three-quarters of patients with nonarteritic anterior ischemic optic neuropathy (NAION) have sleep apnea, according to results of a study reported in the May issue of the Archives of Ophthalmology. The findings may explain why symptoms are often worst on awakening in this disease characterized by sudden, painless, mostly irreversible, and generally nonprogressive visual loss.

"Our findings indicate that sleep apnea syndrome may play an important role in the pathogenesis of NAION," write Daniel S. Mojon, MD, from the University of Bern in Switzerland, and colleagues. "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."

The investigators compared 17 patients with NAION and 17 age- and sex-matched controls with suspected restless legs syndrome. Based on overnight polysomnography, 12 (71%) of 17 patients with NAION had sleep apnea, classified by the respiratory disturbance index as mild in four patients (24%), moderate in four (24%), and severe in four (24%). Only three (18%) of 17 controls had sleep apnea ( P=.005).

Among patients aged 45 to 64 years, four (50%) of eight patients with NAION had sleep apnea, as did 11.9% of the random sample used in the prevalence study (P=.005). Among older patients, eight (89%) of nine patients with NAION had sleep apnea, as did 24% of the random sample ( P<.001).

"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," the authors write.

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

Reviewed by Gary D. Vogin, MD


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