Advertisement

Screening for obstructive sleep apnea amongst patients with retinal vein occlusion

Published:April 18, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.03.004

      Abstract

      Objective

      To evaluate the prevalence and varying severity of obstructive sleep apnea (OSA) amongst those newly diagnosed with retinal vein occlusion (RVO), and screen patients with the use of 2 in-office-administered questionnaires validated against polysomnography.

      Design

      Prospective cross-sectional study.

      Participants

      Consecutive adult patients (≥18 years of age) with a new diagnosis of RVO confirmed with intravenous fluorescein angiography were enrolled.

      Methods

      The study was conducted at a tertiary academic centre between March 22, 2017, and April 7, 2018. Patients completed the Berlin and STOP-BANG questionnaires screening for OSA at presentation. Diagnostic test properties of the 2 questionnaires compared with polysomnography at a certified sleep laboratory centre as the gold standard for detection of OSA were calculated.

      Results

      A total of 27 patients (37% females) with a mean (standard deviation) age of 69.6 (11.5) years completed the study. The diagnosis of OSA based on polysomnography was made in 96% (41% severe OSA) of patients with RVO. The Berlin questionnaire had a sensitivity of 43% (confidence interval [CI]: 22%–66%) and specificity of 67% (CI: 22%–96%). The STOP-BANG questionnaire had a sensitivity of 86% (CI: 64%–97%) and specificity of 50% (CI: 12%–88%).

      Conclusions

      Given the high prevalence of severe OSA amongst those with a new diagnosis of RVO, all patients should be strongly considered for polysomnography. The use of in-office questionnaires may aid in triaging urgency of referrals.

      Résumé

      Objectif

      Évaluer la prévalence et le degré de gravité de l'apnée obstructive du sommeil (AOS) chez des patients qui viennent de faire l'objet d'un diagnostic d'occlusion veineuse rétinienne (OVR) et assurer le dépistage de l'AOS à l'aide de 2 questionnaires validés par polysomnographie et administrés au bureau du médecin.

      Nature

      Étude transversale prospective.

      Participants

      Ont été admis des patients consécutifs d’âge adulte (≥ 18 ans) qui venaient de faire l'objet d'un diagnostic d'OVR confirmée par angiographie à la fluorescéine.

      Méthodes

      L’étude a été réalisée dans un centre universitaire de soins tertiaires du 22 mars 2017 au 7 avril 2018. Les patients ont répondu au questionnaire de Berlin et au questionnaire STOP-Bang en vue du dépistage de l'AOS lors de l'examen initial. On a examiné les propriétés diagnostiques des 2 questionnaires par rapport à celles de la polysomnographie réalisée dans un laboratoire du sommeil certifié à titre de référence absolue pour le diagnostic de l'AOS.

      Résultats

      Un total de 27 patients (37 % de femmes) dont l’âge moyen (± écart-type) était de 69,6 ans (± 11,5 ans) ont pris part à l’étude. Le diagnostic d'AOS obtenu au décours d'une polysomnographie a été posé chez 96 % des patients (dont 41 % affichaient une AOS grave) présentant une OVR. Le questionnaire de Berlin avait une sensibilité de 43 % (intervalle de confiance [IC]: 22 %–66 %) et une spécificité de 67 % (IC: 22 %–96 %). Pour sa part, le questionnaire STOP-Bang avait une sensibilité de 86 % (IC: 64 %–97 %) et une spécificité de 50 % (IC: 12 %–88 %).

      Conclusions

      Compte tenu de la prévalence élevée d'AOS grave chez les patients qui viennent de recevoir un diagnostic d'OVR, on devrait recommander sérieusement une polysomnographie à tous les patients. Les questionnaires au bureau du médecin peuvent servir à cerner les cas urgents.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rogers S.
        • Mcintosh R.L.
        • Cheung N.
        • et al.
        The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia.
        Ophthalmology. 2009; 117 (313–9.e1)
        • Rogers S.L.
        • Mcintosh R.L.
        • Lim L.
        • et al.
        Natural history of branch retinal vein occlusion: an evidence-based systematic review.
        Ophthalmology. 2010; 117: 1094-1101
        • Hayreh S.S.
        Occlusion of the central retinal vessels.
        Br J Ophthalmol. 1965; 49: 626-645
        • Stem M.S.
        • Talwar N.
        • Comer G.M.
        • Stein J.D.
        A longitudinal analysis of risk factors associated with central retinal vein.
        Ophthalmology. 2013; 120: 362-370
        • Sodi A.
        • Giambene B.
        • Marcucci R.
        • et al.
        Atherosclerotic and thrombophilic risk factors in patients with ischemic central retinal vein occlusion.
        Retina. 2011; 31: 724-729
        • Wong T.Y.
        • Larsen E.K.M.
        • Klein R.
        • et al.
        Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the atherosclerosis risk in communities and cardiovascular health studies.
        Ophthalmology. 2005; 112: 540-547
        • Lahey J.M.
        • Tunc M.
        • Kearney J.
        • et al.
        Laboratory evaluation of hypercoagulable states in patients with central retinal vein occlusion who are less than 56 years of age.
        Ophthalmology. 2002; 109: 126-131
        • Kwon H.J.
        • Kang E.C.
        • Lee J.
        • Han J.
        • Song W.K.
        Obstructive sleep apnea in patients with branch retinal vein occlusion: a preliminary study.
        Korean J Ophthalmol. 2016; 30: 121-126
        • Chou K.T.
        • Huang C.C.
        • Tsai D.C.
        • et al.
        Sleep apnea and risk of retinal vein occlusion: a nationwide population-based study of Taiwanese.
        Am J Ophthalmol. 2012; 154: 200-205
        • Glacet-Bernard A.
        • les Jardins G.L.
        • Lasry S.
        • et al.
        Obstructive sleep apnea among patients with retinal vein occlusion.
        Arch Ophthalmol. 2010; 128: 1533-1538
        • Wang Y.H.
        • Zhang P.
        • Chen L.
        • et al.
        Correlation between obstructive sleep apnea and central retinal vein occlusion.
        Int J Ophthalmol. 2019; 12: 1634-1636
        • Tomita T.
        • Wada H.
        • Nagase T.
        • Ouchi Y.
        Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1.
        J Appl Physiol. 2003; 94: 179-184
        • Garvey J.
        • Taylos V.
        • McNicholas W.
        Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation.
        Eur Respir J. 2009; 33: 1195-1205
        • Marin M.
        • Agusti A.
        • Villar I.
        • et al.
        Association between treated and untreated obstructive sleep apnea and risk of hypertension.
        JAMA. 2019; 307: 1-3
        • Rim T.H.
        • Kim D.W.
        • Han J.S.
        Retinal vein occlusion and the risk of stroke development a 9-year nationwide population-based study.
        Ophthalmology. 2015; 122: 1187-1194
        • Abumuamar A.M.
        • Dorian P.
        • Newman D.
        • Shapiro C.M.
        The prevalence of obstructive sleep apnea in patients with atrial fibrillation.
        Clin Cardiol. 2018; 41: 601-607
        • Yaggi K.H.
        • Concato J.
        • Kernan W.N.
        • Lichtman J.H.
        • Brass L.M.
        • Mohsenin V.
        Obstructive sleep apnea as a risk factor for stroke and death.
        N Eng J Med. 2005; 353: 2034-2041
        • Brown D.L.
        • Shafie-khorassani F.
        • Kim S.
        • et al.
        Sleep-disordered breathing is associated with recurrent ischemic stroke.
        Stroke. 2019; 50: 571-576
        • Qaseem A.
        • Dallas P.
        • Owens D.K.
        • et al.
        Clinical guideline diagnosis of obstructive sleep apnea in adults : a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2014; 161: 210-220
        • Jordan A.S.
        • McSharry D.G.
        • Malhotra A.
        Adult obstructive sleep apnoea.
        Lancet. 2014; 383: 736-747
        • Kang K.
        • Park K.
        • Kim J.
        • et al.
        Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study.
        Sleep Breath. 2013; 17: 803-810
        • Chung F.
        • Subramanyam R.
        • Liao P.
        • Sasaki E.
        • Shapiro C.
        • Sun Y.
        High STOP-Bang score indicates a high probability of obstructive sleep apnoea.
        Br J Anaesth. 2012; 108: 768-775
        • El-Sayed I.H.
        Comparison of four sleep questionnaires for screening obstructive sleep apnea.
        Egypt J Chest Dis Tuberc. 2012; 61: 433-441
        • Myers K.A.
        • Mrkobrada M.
        • Simel D.L.
        Does this patient have obstructive sleep apnea? The Rational Clinical Examination Systematic Review.
        JAMA. 2013; 310: 731-741
        • Heinzer R.
        • Vat S.
        • Marques-Vidal P.
        • et al.
        Prevalence of sleep-disordered breathing in the general population: THE HypnoLaus study.
        Lancet Respir Med. 2015; 3: 310-318
        • Agard E.
        • El Chehab H.
        • Vie A.L.
        • Voirin N.
        • Coste O.
        • Dot C.
        Retinal vein occlusion and obstructive sleep apnea: a series of 114 patients.
        Acta Ophthalmol. 2018; 96: e919-e925
        • Mokhlesi B.
        • Punjabi N.M.
        “REM-related” obstructive sleep apnea: an epiphenomenon or a clinically important entity?.
        Sleep. 2012; 35: 5-7
        • Foster G.E.
        • Hanly P.J.
        • Ahmed S.B.
        • Beaudin A.E.
        • Pialoux V.
        • Poulin M.J.
        Intermittent hypoxia increases arterial blood pressure in humans through a renin-angiotensin system-dependent mechanism.
        Hypertension. 2010; 56: 369-377
        • Lindberg E.
        • Theorell-Haglöw J.
        • Svensson M.
        • Gislason T.
        • Berne C.
        • Janson C.
        Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample.
        Chest. 2012; 142: 935-942
        • Stamatakis K.
        • Sanders M.H.
        • Caffo B.
        • et al.
        Fasting glycemia in sleep disordered breathing: lowering the threshold on oxyhemoglobin desaturation.
        Sleep. 2008; 31: 1018-1024
        • Bilgin G.
        • Koban Y.
        • Arnold A.C.
        Nonarteritic anterior ischemic optic neuropathy and obstructive sleep apnea.
        J Neuroophthalmol. 2013; 33: 232-234
        • Mojon D.S.
        • Hedges T.R.
        • Ehrenberg B.
        • et al.
        Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy.
        Arch Ophthalmol. 2002; 120: 601-605
        • Karakucuk S.
        • Goktas S.
        • Aksu M.
        • et al.
        Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS).
        Graefes Arch Clin Exp Ophthalmol. 2008; 246: 129-134
        • Thurtell M.J.
        • Bruce B.B.
        • Rye D.B.
        • Newman N.J.
        • Biousse V.
        The Berlin questionnaire screens for obstructive sleep apnea in idiopathic intracranial hypertension.
        J Neuroophthalmol. 2011; 31: 316-319
        • Jonas D.E.
        • Amick H.R.
        • Feltner C.
        • et al.
        Screening for obstructive sleep apnea in adults evidence report and systematic review for the US preventive services task force.
        JAMA. 2017; 317: 415-433
        • Kim H.
        • Im S.
        • Park J.I.
        • Kim Y.
        • Sohn M.K.
        • Jee S.
        Improvement of cognitive function after continuous positive airway pressure treatment for subacute stroke patients with obstructive sleep apnea: a randomized controlled trial.
        Brain Sci. 2019; 9: 1-13
        • Ayas N.T.
        • FitzGerald J.M.
        • Fleetham J.A.
        • et al.
        Cost-effectiveness of continuous positive airway pressure therapy for moderate to severe obstructive sleep apnea/hypopnea.
        Arch Intern Med. 2006; 166: 977-984
        • Abumuamar A.M.
        • Newman D.
        • Dorian P.
        • Shapiro C.M.
        Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation.
        J Interv Card Electrophysiol. 2019; 54: 289-297
        • Baessler A.
        • Nadeem R.
        • Harvey M.
        • et al.
        Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers: a meta-analysis.
        J Inflamm. 2013; 10: 13
        • Govetto A.
        • Domínguez R.
        • Rojas L.
        • Pereiro M.
        • Lorente R.
        Bilateral and simultaneous central retinal vein occlusion in a patient with obstructive sleep apnea syndrome.
        Case Rep Ophthalmol. 2014; 5: 150-156
        • Osman A.M.
        • Carter S.G.
        • Carberry J.C.
        • Eckert D.J.
        Obstructive sleep apnea: current perspectives.
        Nat Sci Sleep. 2018; 10: 21-34
        • Randerath W.J.
        • Verbraecken J.
        • Andreas S.
        • et al.
        Non-CPAP therapies in obstructive sleep apnoea.
        Eur Respir J. 2011; 37: 1000-1028
        • McNellis R.J.
        • Thomas S.
        Screening for obstructive sleep apnea in adults.
        JAMA. 2017; 317: 407-414
        • Abrishami A.
        • Khajehdehi A.
        • Chung F.
        A systematic review of screening questionnaires for obstructive sleep apnea.
        Can J Anesth. 2010; 57: 423-438
        • Abumuamar A.M.
        • Dorian P.
        • Newman D.
        • Shapiro C.M.
        The STOP-BANG questionnaire shows an insufficient specificity for detecting obstructive sleep apnea in patients with atrial fibrillation.
        J Sleep Res. 2018; 27: 1-7
        • Abumuamar A.M.
        • Dorian P.
        • Newman D.
        • Shapiro C.M.
        A comparison of two nights of ambulatory sleep testing in arrhythmia patients.
        Sleep Disord. 2018; 2018: 1-6
        • Abumuamar A.M.
        • Dorian P.
        • Newman D.
        • Shapiro C.M.
        Assessment of sleep and mood symptoms in patients with undetected obstructive sleep apnea and atrial fibrillation.
        J Clin Exp Cardiolog. 2018; 9: 2-7
        • Chung F.
        • Yegneswaran B.
        • Liao P.
        • et al.
        STOP Questionnaire: a tool to screen patients for obstructive sleep apnea.
        Anesthesiology. 2008; 108: 812-821