New Orleans—Sleep apnea is a lot more common than you might think, and it’s affecting your patients’ eyes and vision in drastic ways, says Brad Sutton, OD, FAAO. Dr. Sutton shared his advice on how to manage the ocular effects of sleep apnea during a session at the American Academy of Optometry annual meeting in New Orleans.
There are three types of sleep apnea:
• Central sleep apnea, which makes up 0.4 percent of apnea sufferers
• Obstructive sleep apnea (OSA), which makes up 84 percent of sleep apnea sufferers
• Mix of both, which makes up 15 percent of sleep apnea sufferers
Obstructive sleep apnea
OSA occurs when the soft tissue of the throat collapses and occludes the airway. It happens continually throughout the sleep cycle, and the airway occlusion leads to decreased blood oxygen. The pause in breathing—called an apnea—can last anywhere from seconds to minutes. The brain then signals the body to wake up and breathe, causing the body to gasp for air.
“You don’t frequently wake up during these episodes, but you take a gasping breath to try to increase the oxygen in your blood,” says Dr. Sutton. “So, it’s a cycle that never really stops.”
OSA is most common in overweight or obese men. It occurs in approximately 24 percent of men and nine percent of women. African Americans also have a 2.5 times higher risk.
Other risk factors include:
• Neck circumference over 19 inches (OSA occurs in 34 percent of NFL linemen)
Some common symptoms include:
• Snoring (“People with sleep apnea almost always snore,” says Dr. Sutton, but not everyone who snores has sleep apnea.)
• Daytime sleepiness
• Cognition problems
• Restless sleep
• Morning headaches
• Observed stop in breathing by family members
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An easy way to remember these risk factors and symptoms is the acronym “STOP BANG,” which stands for:
• Observed pause in breathing
• High blood pressure
• Neck circumference
“Patients aren’t really aware of what’s happening during the nighttime, but during the day, they’re sleepy, they’re tired, they don’t feel like they get restful sleep,” says Dr. Sutton.
Despite its relatively high rate of occurrence, OSA goes undiagnosed in 80 percent of the men and 90 percent of the women who suffer from the disease. High rates of undiagnosed patients may be due to the fact that the best test—a polysomnography sleep study—is both inconvenient for patients and can be very costly. Patients must stay overnight at a sleep study center and be hooked up to a number of machines to measure brain waves, eye movements, muscle activity, and oral and nasal airflow. The test can cost between $3,000 to $5,000, which may be out of reach for those with high deductibles.