The eye and sleep

BACKGROUND: Sleep-associated disorders of the eye are increasingly recognized. Disordered sleep has also been found in some blind patients. METHODS: Review of the current state of knowledge of sleep-related eye disorders and blindness-related sleep disorders. RESULTS: Incomplete eyelid closure during sleep (lagophthalmos) may be physiological but in some patients can cause significant symptoms. Nocturnal lagophthalmos may be a limiting factor in the surgical repair of some eyelid and orbital disorders. Normal eyelid closure has also been linked to the development of a number of ocular surface disorders. Sleep disorders are common, and obstructive sleep apnoea (OSA) the commonest. OSA is associated with a number of serious systemic diseases and also several eye disorders including floppy eyelid syndrome, optic neuropathy, glaucoma, anterior ischaemic optic neuropathy and papilloedema secondary to raised intracranial pressure. Treatment of OSA may help floppy eyelid syndrome, halt progression of associated glaucoma, and reduce intracranial pressure in patients with associated papilloedema. The diagnosis of OSA can only be made with formal sleep studies, but asking a small number of appropriate questions will help screen those patients who should be referred for sleep studies. Some blind patients have disordered sleep patterns due to disruption of the retinal input into the hypothalamic-pineal melatonin secreting apparatus. This can be alleviated by oral administration of melatonin. CONCLUSIONS: Ophthalmologists should be aware of sleep-associated eye disorders and refer appropriate patients for formal sleep studies. Sleep abnormalities in blind patients should be enquired about and patients offered assessment and treatment by a sleep physician.     

青光眼与睡眠

睡眠对于每个人来说都是非常重要的,对于青光眼患者更有极其特殊的意义。睡眠质量对青光眼有很大影响,而青光眼的躯体症状和患者的心理因素又对睡眠产生较大的影响。夜间睡眠时眼压会升高,而眼压是影响青光眼病情最重要的因素,夜间眼压波动对视功能有很大的损害。睡眠期间是青光眼治疗的关键时段,应引起青光眼患者和医生的足够重视。     

睑板腺功能障碍与睡眠质量的相关性研究

目的:研究睑板腺功能障碍(MGD)与睡眠质量之间的相关性。方法:回顾性病例对照研究。选取2021-01/2022-10我院收治的MGD患者150例,根据匹兹堡睡眠质量指数(PSQI)量表评分分为睡眠障碍组(75例,PSQI>10分)和对照组(75例,PSQI≤10分),均进行眼表疾病指数量表(OSDI)评分和睑板腺相关检查(睑缘形态、睑板腺分泌能力、睑板腺分泌物性质评分)、角膜荧光素染色(FL)评分、基础泪液分泌试验(SⅠt),检测泪膜破裂时间(BUT),评估睡眠指标(睡眠质量、睡眠潜伏期、主观睡眠质量、睡眠时间)。结果:两组患者OSDI评分、FL评分、SⅠt、BUT、睑缘形态评分、睑板腺分泌能力评分、睑板腺分泌物性质评分均有差异(P<0.05)。睡眠障碍组患者PSQI评分、睡眠潜伏期评分、主观睡眠质量评分、睡眠时间评分与OSDI评分、FL评分、睑板腺分泌能力评分和睑板腺分泌物性质评分均呈显著正相关性(P<0.05);PSQI评分、主观睡眠质量评分、睡眠时间评分与睑缘形态评分均呈显著正相关性(P<0.05);PSQI评分、睡眠潜伏期评分、主观睡眠质量评分与BUT...     

阻塞性睡眠呼吸暂停综合征与青光眼的关系

阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）是涉及全身多器官的呼吸系统的常见病。近年来大量的研究显示,ＯＳＡＳ与青光眼之间有着密切关系。本文从发病率、客观检查、发病机制等方面对ＯＳＡＳ与青光眼之间的关系及研究进展进行综述。     

Glaucoma and obstructive sleep apnoea syndrome

Glaucoma is increasingly recognized as a manifestation of both ocular and systemic risk factors. A number of disorders associated with reduced blood flow and ischaemia, collectively termed vascular risk factors, such as migraine, Raynaud's phenomenon, atrial fibrillation and reduced nocturnal blood pressure, lead to decreased ocular perfusion pressure. During sleep, alterations occur in cardiovascular physiology that are balanced by autoregulation to maintain homeostasis. However, in obstructive sleep apnoea (OSA), the normal physiological balance is upset. A potentially modifiable risk factor, OSA has been increasingly associated with glaucoma independent of intraocular pressure. OSA may alter blood flow to the optic nerve head and, in combination with other predisposing factors, lead to decreased ocular perfusion pressure. This in turn may directly affect the optic nerve or it may indirectly increase its susceptibility to other insults. The purpose of this review is to shed light on the association between OSA and glaucoma.     

睡眠行为与近视发生发展关系研究进展

近视已成为全球范围的公共卫生问题.睡眠是在褪黑素调节下,人类生命过程中重要的周期性生理过程.睡眠与近视一样都会受到环境因素的影响,不同近视程度患者及正视人群在睡眠时间、睡眠质量及褪黑素水平上存在差异.本文回顾了近视发生发展与人群睡眠行为的现状研究及相关的基础实验学研究,从流行病学和生物学机制两方面,对近视发生发展与睡眠...     

IOP elevation in different phases of sleep

Large and significant increases in intraocular pressure (IOP) have previously been demonstrated after as little as 30 minutes of sleep.¹² The present experiment tests the hypothesis that the lack of eye movements during sleep is responsible for this increase in IOP. Nine subjects slept in the laboratory on two separate nights. IOP was measured (with subjects in the supine position) using a Keeler Pulsair noncontact tonometer. Eye movements were monitored using electro-oculography. Subjects were woken from sleep after 60–90 minutes, on one night when they were in rapid eye movement (REM) sleep, and on one night when they were not. IOP increased significantly on both nights, but the differences between these increases was not significant. Thus, mechanical factors associated with lack of eye movements do not appear to contribute to the increase in IOP after sleep.     

阻塞性睡眠呼吸暂停低通气综合征与糖尿病视网膜病变的关系

阻塞性睡眠呼吸暂停低通气综合征（ obstructive sleep apnea hypopnea syndrome,OSAHS）是一种以上气道塌陷反复发作为特征的,最终导致夜间间歇性低氧血症的一类疾病。近年来OSAHS与糖尿病视网膜病变的关系已有报道,我们就两者的临床联系、相关检查及其可能的作用机制进行综述。     

干眼与睡眠障碍关系的研究进展

近年来,由于社会经济发展、电子产品的普及和工作压力增加,造成人们睡眠障碍和干眼的患病率不断增加。这既影响了人们的身心健康,也给社会经济造成一定负担。有研究认为睡眠障碍与干眼有明显相关性,睡眠障碍是干眼的独立危险因素之一。因此,在干眼的诊疗中需要考虑睡眠因素的影响。目前关于睡眠障碍如何导致干眼及眼表损伤的机制是领域内的前沿课题。本文具体分析了睡眠障碍与干眼之间的相关性,总结了这种相关性的机制,并进一步分析了改善睡眠对干眼的影响,以期为眼科医生提供新的诊疗思路。     

阻塞性睡眠呼吸暂停综合征与视网膜分支静脉阻塞的关系

目的：探讨阻塞性睡眠呼吸暂停综合征(OSAS)与视网膜分支静脉阻塞(BRVO)的相关性。

方法：本研究共纳入70例BRVO患者及70例健康体检者作为对照(与BRVO患者的年龄、性别相匹配)。利用Berlin问卷对BRVO患者及对照组的OSAS患病风险进行评估,借助多导睡眠呼吸监测仪对BRVO患者及对照组的呼吸暂停低通气指数(AHI)、最小氧饱和度(MOS)等指标进行监测。根据AHI对OSAS进行诊断,对BRVO患者及对照组的OSAS发生率、平均AHI、平均MOS等指标进行比较。

结果：BRVO患者中伴发OSAS者为49例(70%),平均AHI为19.74±7.59、MOS为(82.45±9.17)%; 对照组OSAS患者为23例(33%),平均AHI为13.69±6.35、MOS为(88.44±8.72)%。BRVO患者及对照组OSAS的发病率、平均AHI及MOS均有差异(χ²=19.331,t=5.115、3.954,均P<0.01)。OSAS与BRVO呈正相关(r_s=0.319,P=0.033)。39例急性BRVO患者的平均AHI为16.905±6.31、MOS为(85.14±8.22)%; 31例慢性BRVO患者的平均AHI为17.84±5.47、MOS为(83.81±7.87)%,急性BRVO患者与慢性BRVO患者的平均AHI和MOS均无差异(t=0.653、0.685,P=0.516、0.496)。

结论：OSAS可能是BRVO的重要危险因素,其对于BRVO病情的持续也可能起着关键作用。     

夜戴型角膜塑形镜对近视患者睡眠质量的影响

目的：观察配戴夜戴型角膜塑形镜对近视患者睡眠质量的影响。

方法：选取就诊于福建中医药大学附属人民医院眼科配戴夜戴型角膜塑形镜的近视患者30例58眼为试验组,随机选取同期配戴框架眼镜的近视患者30例60眼作为对照组。所有患者分别于戴镜前和戴镜后1、3mo应用匹茨堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)进行睡眠质量评估, 观察比较两组患者的睡眠质量。

结果：试验组患者戴镜前、戴镜后1、3mo等效球镜度数分别为-2.78±0.90、-0.30±0.31、-0.28±0.30D,戴镜后1、3mo分别与戴镜前比较,差异均有统计学意义(P<0.05)。戴镜前、戴镜后1、3mo试验组PSQI评分分别是2.13±1.36、2.47±1.98、1.74±1.39分。试验组与对照组比较,戴镜后3mo主观睡眠质量评分的差异具有统计学意义(P<0.05),而PSQI评分和入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能的评分差异均无统计学意义(P>0.05)。

结论：配戴夜戴型角膜塑形镜对近视患者总体睡眠质量无明显影响,在配戴初期患者主观睡眠质量下降。     

睑板腺形态及功能与阻塞性睡眠呼吸暂停综合征的关系

目的探讨阻塞性睡眠呼吸暂停综合征（OSAHS）患者睑板腺形态结构及其泪膜稳定性的改变。方法描述性研究。选取2013年11月至2014年6月期间于我院呼吸内科确诊为OSAHS的患者63例（126眼）作为OSAHS组,同期体检中心健康体检人群44例（88眼）作为对照组。对全部纳入对象询问个人基本信息及病史,并对眼表疾病指数（OSDI）进行评分后,再进行裂隙灯显微镜、非接触式红外线睑板腺成像仪、泪膜破裂时间（BUT）、睑板腺分泌物性状等眼部检查。结果睑板腺缺失发生率在对照组,轻度、中度、重度OSAHS患者中分别为12/88（14%）、7/18（39%）、14/30（47%）、53/78（68%）,组间差异有统计学意义（χ²=50.62,P＜0.01）;轻度、中度、重度OSAHS患者睑板腺缺失评分分别为2.29±1.25、2.29±0.91、2.64±1.18,差异无统计学意义。对照组,轻度、中度、重度OSAHS患者中睑板腺扭曲发生率分别为8/88（9%）、6/18（33%）、12/30（40%）,49/78（63%）,组间差异有统计学意义（χ²=51.96,P＜0.01）。OSAHS组睑板腺开口堵塞发生率（69%）、分泌物性状改变发生率（72%）较对照组高（分别为36%、39%）,差异均有统计学意义（χ²=22.42、27.26,P＜0.01）。结论与正常人群比较,OSAHS患者泪膜稳定性较低,睑板腺萎缩及腺体的形态异常发生率较高,并且睑板腺的形态改变与OSAHS严重程度有关。     

阻塞性睡眠呼吸暂停低通气综合征气道解剖功能异常的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种多病因导致的睡眠呼吸性疾病,其临床表现和并发症涉及医学诸多学科,近年来受到越来越多医师与患者的关注。本文关注OSAHS的发病机制,重点从解剖学角度分析其功能改变,并对其进行综述。     

The effect of cataract surgery on sleep quality: a systematic review and Meta-analysis

AIM: To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultraviolet-blocking clear intraocular lens (UVB-IOL) and blue-filtering intraocular lens (BF-IOL) implantation. METHODS: Electronic search was performed of PubMed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index (PSQI). A random/fixed-effects Meta-analysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS: Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3mo [mean difference (MD) =-0.62, 95%CI: -1.14 to -0.11, P=0.02, I2=66%] and 3-12mo (MD=-0.32, 95%CI: -0.62 to -0.02, P=0.04, I2=0), respectively. Considering different intraocular lens (IOL) implantations, relative post-operative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION: This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements.     

Comparison of vergence mechanisms between university students with good and poor sleep quality

AIM: To compare the vergence mechanisms between good and poor sleepers in university students. METHODS: A total of 64 university students were recruited in this study. The validated Malay version of Pittsburgh Sleep Quality Index questionnaire (PSQI-M) was used to measure the participants’ sleep quality over the past month. Participants were categorized as good sleepers (n=32) and poor sleepers (n=32) based on the PSQI-M scores. Heterophoria and fusional vergences were measured at distance and near. Mann-Whitney U test was used to compare heterophoria, negative fusional vergence (NFV), and positive fusional vergence (PFV) at distance and near between good and poor sleepers. Spearman correlation analysis was used to study the relationship between PSQI-M score and PFV at distance. RESULTS: Both distance and near heterophorias were not significantly different between good and poor sleepers (P>0.05). There was a difference in distance PFV (P<0.05) between good and poor sleepers, but not in distance NFV, near NFV, and near PFV (P>0.05). Distance PFV was negatively correlated with PSQI-M score (rs=-0.33, P<0.05). CONCLUSION: University students with poor sleep quality demonstrates a reduced ability to maintain fusion with increasing convergence demand at distance. Sleep quality assessment during binocular vision examination in university students is recommended.     

阻塞性睡眠呼吸暂停患儿术后生活质量及影响因素研究△

目的 利用儿童阻塞性睡眠呼吸暂停疾病特异性生活质量调查表(OSA-18量表)评估阻塞性睡眠呼吸暂停(OSA)患儿在手术干预前后的生活质量变化,分析患儿术后生活质量评分增高可能的影响因素。方法 2018年5月~2019年5月入院接受手术治疗的2~12岁OSA患儿152例。患儿监护人分别在术前,术后3个月、6个月、1年填写OSA-18量表。收集相关病史资料,利用多元线性回归对患儿术前、术后生活质量评分进行统计学分析,探讨与术后评分增高相关的影响因素。结果 152例患儿的平均年龄为(4.82±1.89)岁,59%为男性。与术前[(68.5±15.5)分]相比,术后OSA-18总分在3个月[(44.0±15.5)分]、6个月[(42.4±14.7)分]和1年[(38.7±13.4)分]均显著下降(P值均<0.001)。术前量表5个维度的得分与术后各个时间点相比也均显著下降(P值均<0.001)。比较患儿术后3个月与6个月的总分及各维度评分,除睡眠障碍(P=0.038)外,其余差异均无统计学意义。身体症状评分在术后各个时间点差异也均无统计学意义。根据多元线性回归分析,术前白天功能(P=0.021)是术后3个月生活质量评分增高的影响因素;免疫球蛋白E(P<0.001)和术前身体症状(P=0.027)是术后6个月的影响因素;而患儿性别(P=0.012)则是术后1年的影响因素。结论 手术干预可以给OSA患儿的生活质量带来长期持续性的提高。不同影响因素可能会引起患儿术后不同时期生活质量的下降。     

Obstructive sleep apnea in patients with central serous chorioretinopathy

BACKGROUND: Patients with central serous chorioretinopathy (CSC) show an increased sympathetic activity compared to controls. Additionally, there are several reports of increased corticosteroid and catecholamine levels in these patients. Obstructive sleep apnea syndrome (OSAS) has been shown to enhance sympathetic activity depending on severity. Respiratory disturbance increases urinary catecholamine secretion and is associated with the occurance of hypertension in a dose dependent manner. Therefore we hypothesize that OSAS may act as a risk factor for the development of CSC. METHODS: Patients with active CSC or with pigment epithelial disturbances after CSC were contacted to answer a questionnaire about general health, drugs and sleeping habits and to complete the Epworth Sleepiness Scale (ESS) score, a widely used subjective measure of daytime sleepiness. Patients with an ESS score of >10 were referred to our department of pulmonary medicine for evaluating of respiratory disturbance in sleep. RESULTS: We identified 56 consecutive patients with angiographic criteria for acute CSC or pigment epithelial defects after CSC, seven (12.5%) of whom were excluded because of a history of systemic or topic corticosteroid use. Thirty-six (73.5%) of the remaining 49 patients returned the questionnaire. Fourteen (38.8%) had an ESS score of >10. They were referred to the Department of Pulmonary Medicine. In eight (22.2%) of these patients, a diagnosis of obstructive sleep apnea syndrome was confirmed. CONCLUSIONS: We found that 22% of the patients with acute or chronic CSC in this case series also suffered from OSAS, whereas in the general population OSAS is considerably less frequently reported (2-4%). OSAS therefore may act as a risk factor for the development of CSC. However, prospective controlled data is needed to definitely evaluate the possible association between CSC and OSAS. Also the clinical course of CSC during treatment of OSAS would be of particular interest.