Estudio cuantitativo y cualitativo del sueño en el glaucoma mediante cuestionarios validados y pruebas morfofuncionales

Abstract

INTRODUCTION The influence of sleep-related circumstances in primary open-angle glaucoma (POAG) has been little studied. PURPOSE The main objective was to evaluate sleep quality, daytime sleepiness and the risk of suffering obstructive sleep apnea syndrome (OSAS) in patients with and without POAG. It also intended to evaluate their influence in the visual field (VF) and in the thickness of the retinal layers and optic disk parameters in both groups of patients. METHODS Prospective, observational and cross-sectional study that included patients without glaucoma and patients with POAG. Every patient completed the following tests: Pittsburgh Sleep Quality, Epworth daytime sleepiness, Berlin OSAS and an additional one on the dominant sleeping position and the number of pillows used. Using spectral domain optical coherence tomography (SD-OCT, Cirrus 4000) of the macula and optic disk, we evaluated the thickness of the retinal nerve fiber layer (RFNL), ganglion cell layer-inner plexiform layer complex (GCLIPL) and outer retina (OR) in the macula, and the peripapillary RFNL thickness, the disk area, the mean and vertical cup diameters, and the cup volume. With the VF 30-2 SITA Fast, the Visual Field Index (VFI), mean deviation (MD) and pattern standard deviation (PSD) were obtained. Only the eye with the worse MD was included for each patient. Perimetric and SD-OCT results were correlated with those of sleep quality, daytime sleepiness degree and risk of OSAS in the two groups of patients. RESULTS We included 157 eyes: 99 from patients with POAG and 58 from patients without glaucoma. Patients with POAG had worse sleep quality and had higher risk of OSAS than patients without glaucoma. No differences were observed in the degree of daytime sleepiness, nor in the dominant sleeping position between patients with POAG and patients without glaucoma. When the perimetric results were analyzed in relation to sleep quality and risk of OSAS, no differences were observed in any of the two study groups. However, in the group of patients without glaucoma, those with greater daytime sleepiness showed worse VFI, and in the group of patients with POAG, those with greater daytime sleepiness showed worse VFI and PSD. When the SD-OCT results were analyzed in relation to sleep quality and degree of daytime sleepiness, no differences were observed in the thickness of the macular layers, nor in the peripapillary RFNL thickness or in the optic disk parameters within the two groups of the study. When the SD-OCT results were analyzed according to the risk of OSAS, in the group of patients without glaucoma no differences were observed in the thickness of the macular layers, nor in the peripapillary RFNL thickness or in the optic disk parameters. However, in the group of patients with POAG, the thicknesses of the macular GCLIPL and peripapillary RNFL were smaller in patients with high risk of OSAS. CONCLUSION POAG is associated with decreased sleep quality and a higher risk of OSAS. Patients without glaucoma and with POAG and with a higher degree of daytime sleepiness show worse perimetric global indexes. Patients with POAG and high risk of OSAS have lower GCLIPL and peripapillary RFNL thickness than those with POAG and low risk of OSAS.