Relationship Between Sleep Position and Glaucoma Progression

Kevin Kaplowitz; Justin Dredge; Robert Honkanen


Curr Opin Ophthalmol. 2019;30(6):484-490. 

In This Article

Relationship Between Sleep Position and Immediate Intraocular Pressure Measurements

The positional increase in IOP after changing from the sitting to supine position has previously been reviewed, and is estimated to be near 4 mmHg in glaucomatous patients.[3,4] Data is limited for changes related to the lateral decubitus position (LDP), with the mean overall average increase in IOP from the supine to the LDP reported as 1.5–2 mmHg for each eye in its dependent position and 0.5–1 mmHg in the nondependent position for both healthy and glaucomatous eyes.[5,6,7,8,9,10,11–13]

The timing and duration of the positional increase has also been investigated. Some data suggests that although IOP increases rapidly after changing from the vertical to the horizontal position, the IOP may continue to rise by 2–3 mmHg over the subsequent 4 h.[14] Studies have used a range of instruments to measure IOP in various positions. One study compared multiple types of tonometers in the sitting and supine position in healthy patients and found that the positional increase was 4 mmHg with a penumatonometer, 3 mmHg with a Perkins device, and 2 mmHg with the Tonopen XL (Reichert, Depew, New York, USA).[15] There is no consensus regarding what IOP measurement device is most accurate in the context of positional changes. Many other characteristics of the positional increase are poorly understood.

Some data supports that healthy eyes experience a 1–2 mmHg increase in IOP from sitting to supine, and increases by an additional 1–2 mmHg in Primary Open Angle Glaucoma (POAG) patients, whereas normal tension glaucoma (NTG) patients may experience the highest increase.[16] Data surrounding the LDP is less clear, with at least one study finding a slightly higher IOP positional increase in POAG than in NTG.[17] In the context of LDP, although the IOP is often higher in the dependent than the nondependent eye, multiple studies found no significant difference between them.[11,13,18] In fact, in at least one study the nondependent eye actually had a higher mean IOP.[19] There is even less data on the physiologic prone sleeping position. One study of 20 healthy patients found that the positional increase in IOP from supine to the prone position was double the positional increase from supine to the LDP in the dependent eye.[7]

Despite the presumed importance of a particular sleep position and the duration of each position, there is a paucity of objective sleep position data in glaucoma. One study analyzed sleep laboratory videos as well as position monitors.[20] Overnight, 37% of the time was spent in the right LDP, 32% in the supine position, 23% in the left LDP, and only 8% of the time was spent prone. When those patients were asked to report their favored sleep position, it matched the objective data in 77% of participants. One study of POAG patients and healthy controls found no significant difference in reported sleep position preference, though the right LDP was the most common in both groups (48% of POAG, 46% of controls, P>0.05).[10] Another survey of 183 glaucoma suspects also found that the right LDP was the most frequent favored sleep position (45%), followed by the left LDP (33%), supine (11%), and prone (10%).[21] Limited objective data available suggests that the preference for sleeping in the LDP increases with age.[22]