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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lowering intra-ocular pressure is always a necessity to treat glaucoma. Others identified risks factors may be fought, with the hope to favourably act on the disease: arteriosclerosis worsening parameters, low diastolic arterial pressure, vasospastic or sleep apnea syndrome, inverse pupillary block in pigmentary dispersion. On the other hand, ignoring a noctural closure of the irido-corneal angle or a non-compliance to the medical treatment may lead to glaucoma worsening.
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PMID:[Improving management of glaucoma's risk factors]. 1951 34

Glaucoma is defined as a chronic progressive optic neuropathy, for which elevated intraocular pressure (IOP) is the only modifiable risk factor. Emerging research indicates that modifiable factors besides IOP may be associated with the presence of glaucoma. In this review, we discuss the role of modifiable determinants, specifically socioeconomic status, nutritional intake, body mass index and obesity, exercise, smoking, and sleep apnea, in the presence of glaucoma. Preliminary studies suggest that associations may exist between these non-inherent factors and glaucoma although research had significant limitations. The mechanisms of influence are unknown or understudied. Research needs to incorporate the broader behavioral and social factors that may affect glaucoma status.
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PMID:Risk factors for glaucoma needing more attention. 1981 85

Although the majority of patients with glaucoma have elevated intraocular pressure as the presumed etiology for their resultant neuropathy, it is well known that approximately 25% of patients with glaucoma have intraocular pressure within the normal range for their race. These patients may have conditions that facilitate non-pressure related stress to the retina and optic nerve that might directly contribute to their glaucomatous neuropathy and include chronic or intermittent ischemia (i.e atherosclerosis, heart disease, vasospasm, migraine, sleep apnea), altered scleral/optic nerve head morphology that predisposes to glaucomatous stress (i.e myopia); genetic mutations that predispose to glaucoma damage at normal IOP (OPA-1,optineurin, myocilin) and evidence of aberrant immunity that suggests that their glaucoma might be a form of an autoimmune neuropathy (i.e. presumed autoimmune glaucoma). This review provides a critical assessment of the potential role for autoimmunity as an initiating or exacerbating etiology in some patients with glaucoma.
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PMID:The case for autoimmunity in glaucoma. 2080 Nov 14

Glaucoma is now considered an abnormal physiology in the optic nerve head that interacts with the level of intraocular pressure (IOP), with the degree and rate of damage depending on the IOP and presumably the degree of abnormal physiology. Diagnosis of normal-tension glaucoma (NTG), defined as glaucoma without a clearly abnormal IOP, depends on recognizing symptoms and signs associated with optic nerve vulnerability, in addition to absence of other explanations for disc abnormality and visual field loss. Among the findings are a halo or crescent of absence of retinal pigment epithelium around the disc, bilateral pre-chiasmal visual field defects, splinter hemorrhages at the disc margin, vascular dysregulation (low blood pressure, cold hands and feet, migraine headache with aura, and the like), or a family history of glaucoma. Possibly relevant, is a history of hemodynamic crisis, arterial obstructive disease, or sleep apnea. Neurological evaluation with imaging is needed only for atypical cases or ones that progress unexpectedly. Management follows the same principle of other chronic glaucomas, to lower the IOP by a substantial amount, enough to prevent disabling visual loss. However, many NTG cases are non-progressive. Therefore, it may often be wise in mild cases to determine whether the case is progressive and the rate of progression before deciding on how aggressivene to be with therapy. Efforts at neuroprotection and improvement in blood flow have not yet been shown effective.
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PMID:Normal-tension glaucoma (Low-tension glaucoma). 2115 42

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.
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PMID:Glaucoma and obstructive sleep apnoea syndrome. 2233 17

Aim of this review was to resume risk factors for the assess and progression of primary open-angle glaucoma (POAG), particularly considering systemic risk factors that can be associated with glaucomatous damage. If intraocular pressure is the main risk factor, we must consider carefully familiarity, age, gender and possible associations with diabetes, hypertension, vascular autoregulation disorders, hypo- and hyperthyroidism, hypo- and hyperadrenalism, sleep apnea syndrome, corticosteroids therapies and other suspected factors cited in literature. Glaucoma's etiology remains unknown, its physiopathology is poorly understood and its diagnosis is often difficult. It is the leading cause of irreversible blindness worldwide and it is the real "silent thief of sight" because the loss of vision often occurs gradually over a long period of time, and symptoms only occur when the disease is quite advanced. Cost-effectiveness analyses for POAG screening are weighted by the degree of uncertainty that glaucoma screening can be effective and reliable achieved. Addressing patients to an ophthalmologic investigation on the basis of the identified risk factors is a fundamental preventing measure.
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PMID:An internal medicine perspective review of risk factors for assessing and progression of primary open angle glaucoma. 2400 9

Several lines of evidence suggest an association between (normal-tension) glaucoma and sleep apnoea syndrome (SAS). It is hypothesised that the glaucomatous damage may result from impaired perfusion of the optic nerve head secondary to repetitive prolonged apnoeas. Therefore, screening for SAS in suspectible glaucoma patients is recommended.
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PMID:[Sleep apnoea and glaucoma]. 2453 99

Purpose. To determine whether the diagnosis of sleep apnea syndrome (SAS) represents a risk-factor for glaucoma. Design. Retrospective records review. Methods. Records in an electronic database which exists at the Birmingham, Alabama Veterans' Affairs Medical Center (BVAMC) permit data retrieval and sorting based on diagnostic and procedural codes. Deidentified data of those having had an eye examination and a diagnostic code (ICD-9) for either sleep apnea or glaucoma were included. Statistical Analyses. SPSS version 19 was used to produce crosstabs and to conduct a bivariate logistic regression that examined the relationship between SAS and glaucoma. Results. A total of 70,960 unique records were included for analysis. Of the 2,725 patients with a diagnosis of sleep apnea, 228 (8.37%) also had a diagnosis of glaucoma. Diagnosis of glaucoma was present in 3,410 patients among 68,235 patients (5.00%) without sleep apnea. Bivariate logistic regression analysis yielded an odds ratio of 1.736 (P < 0.001) suggesting that individuals with SAS are more likely to have a coexisting diagnosis of glaucoma than individuals without SAS. Conclusions. Results of this investigation suggest that SAS may represent a significant risk factor for glaucoma and this should be considered when managing patients who report that diagnosis.
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PMID:Sleep apnea syndrome represents a risk for glaucoma in a veterans' affairs population. 2455 22

Most glaucomas are primary in nature. However, many adult and childhood glaucomas are secondary, and they require systemic evaluation to pick up associated systemic disease. Conditions such as nocturnal hypotension and sleep apnea may contribute to glaucomatous progression, whereas neurologic diseases may mimic normal tension glaucoma based on disc appearance. This review highlights those conditions in which a focused systemic work-up can improve glaucoma management and potentially discover life-threatening disease.
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PMID:Indications for a systemic work-up in glaucoma. 2543 39

Monitoring intraocular pressure (IOP) is a critically important part of glaucoma management; however, clinical tonometry predominantly involves sitting postures and is unable to detect variations in response to posture changes, muscular effort, deep respirations and during a wide range of activities, such as playing high wind-resistance instruments and wearing swimming goggles in addition to eye touching and rubbing. For example, the usefulness of 24-hour tonometric phasing may be increased, if nocturnal assessments included side and prone sleeping postures rather than being limited to supine posture tonometry. Continuous monitoring of IOP, which allows unrestricted involvement in a full range of sleep and non-sleep IOP elevating activities would provide an ideal method of quantifying the frequency, duration and degree of episodes of elevation in addition to physiological and pathological circadian rhythmic variations due to treatment. Apart from the degree of exposure to episodes of elevation of IOP, genetic influences and family history of glaucoma, other factors which are or could be associated with increased susceptibility to develop or progress glaucomatous pathology include age, frailty, race, type and degree of refractive error, systemic hypotension and hypertension, vasospasm, migraine, pigmentary dispersion syndrome, pseudoexfoliation syndrome, obstructive sleep apnoea syndrome, diabetes as well as medication interactions and side effects. Such information, when combined with all details relating to episodes of elevation of IOP, appears likely to be a strong basis for the detection, diagnosis and treatment of glaucoma. This review examines the limitations of methods of longitudinal monitoring of IOP with reference to their validity and the varying degrees of invasiveness involved. Also mentioned is the potential value of knowing the frequency, duration and level of variations of optic nerve subarachnoid space pressure, as the interaction of such changes with IOP and their potential influence on the lamina cribrosa, may help determine pathological significance.
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PMID:The importance of and potential for continuous monitoring of intraocular pressure. 2781 93


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