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.