Sleep apnea is a disorder that effects millions of Americans. Symptoms include: an involuntary cessation of breathing, loud or frequent snoring, choking or gasping while you sleep, morning headaches and excessive daytime sleepiness. Science and countless studies have proven that sleep apnea can have serious and life-threatening consequences if left untreated. There’s a risk of heart conditions, high blood pressure, early onset of dementia, and even a chance of early death. But, did you know that sleep apnea can have negative effects on eye health? Thankfully, seeking treatment through an expert such as a sleep apnea dentist can prevent these problems.
Research has shown a correlation between sleep apnea and eye conditions. The link between sleep apnea and the development of serious eye disorders under investigation and it makes sense to heed these preliminary findings to be proactive about your eye health. The following eye conditions have been noted in patients with OSA.
Glaucoma is a group of eye conditions that damage the optic nerve, which needs to be healthy in order for you to maintain good vision. The damage to the nerve is often the result of abnormally high pressure in your eye. Currently, it affects nearly 60 million worldwide. If untreated, glaucoma reduces peripheral vision and eventually may cause blindness. Only half of the people who have glaucoma are aware of it, because the disease is painless and vision loss is typically gradual.
A new study now suggests that doctors should be screening sleep apnea sufferers for glaucoma. A retrospective study conducted by researchers at Taipei Medical University, used a population-based dataset to examine the prevalence and risk of the most common form of glaucoma among patients with the most common form of sleep apnea, which is Obstructive Sleep Apnea (OSA). The study determined that the risk of developing open-angle glaucoma within five years of an obstructive sleep apnea diagnosis was 1.67 times higher in those who had sleep apnea compared to the control subjects.
People with OSA may have a higher incidence of papilledema, swelling of the optic nerve in both eyes. Papilledema typically occurs due to increased pressure within the skull and can lead to progressively worsening vision and, in some cases, blindness.
Another eye health issue seen with sleep apnea patients is floppy eyelid syndrome. There is more than one theory on what causes the syndrome. Normally, a person would awake from the feeling of pressure from pillows or bedding against an open eye. However, in patients with sleep apnea, a decrease in cortical stimulation causes the eyelid to remain open when disturbed by mechanical stress during sleep. In time, the eyelid becomes more relaxed and is easily lifted up with slight sideways traction.
Nonarteritic anterior ischemic optic neuropathy (NAION) has also been seen in OSA patients. Researchers began linking sleep apnea with NAION due to the presentation of acute painless vision loss upon awakening in the morning. It is not possible to reverse vision loss from NAION. However, since it begins in just one eye, treatment for sleep apnea may help prevent an attack of NAION in the other eye, which occurs in 15 to 18 percent of cases.
Central Serous Choriorentinopathy
Studies suggest a causal relationship between central serous chorioretinopathy (CSCR) and OSA. CSCR is a relatively common cause of visual impairment in the Western world. It’s characterized by the accumulation of subretinal fluid in the macula. CSCR can resolve within six months of [ophthalmic] treatment.
There are also other retinal conditions that may cause significant dysfunction in the autoregulation of three major blood vessels—the posterior ciliary, central retinal, and ophthalmic arteries—OSA-related hypoxia may be responsible for retinal vein occlusions. When your retina doesn’t get enough oxygen, it leads to worsening existing underlying problems like diabetic retinopathy or hypertensive retinopathy. A recent Oxford study put OSA’s potential role in diabetic retinopathy in the spotlight. The study found a high prevalence of sleep apnea in patients with diabetic clinically significant macular edema (CSME).
Tracking the eye health of sleep apnea patients is extremely important. For patients with OSA, a routine eye examination to evaluate for early signs of glaucoma, particularly in the setting of visual loss or change, should be recommended. If you suffer from sleep apnea and are not currently getting regular eye health checkups, consider speaking with your doctor about the need for more frequent visits.
The eye health connection to OSA has another angle as well. A simple dilated retinal exam could be enough for your eye doctor to find something indicative of OSA, prompting further evaluation from a sleep specialist.
Not all treatments for OSA are equal. The CPAP device might cause some ocular side effects, such as irritation and tear evaporation. A more concerning issue is that there is some data showing that treatment of sleep apnea with CPAP may actually increase glaucoma patients’ nighttime Inter Ocular Pressure.
Dr. Mark Levy recommends a safer way to treat sleep apnea. He’s a sleep apnea dentist that has dedicated his life to helping those with the condition. His office uses oral appliances. Oral appliances are easy to use and require very little maintenance. Since they are easy to use, people are more likely to use their dental appliances regularly than CPAP. There are two types and both must be fitted by a dentist or orthodontist, and worn in the mouth at night include:
Mandibular advancement device (MAD). The most widely used mouth device for sleep apnea, MADs look much like a mouth guard used in sports. The devices snap over the upper and lower dental arches. They have metal hinges that make it possible for the lower jaw to be eased forward. Some, such as the Thornton Adjustable Positioner (TAP), allow you to control the degree of advancement.
Tongue retaining device. Used less commonly than MAD, this device is a splint that holds the tongue in place to keep the airway open.
For people with mild to moderate sleep apnea, particularly those who sleep on their backs or stomachs, dental devices may improve sleep and reduce the frequency and loudness of snoring. It’s imperative that anyone suffering from sleep apnea seeks treatment. Without treatment, the likelihood of developing permanent health issues increases drastically. However, with treatment, many of these conditions are reversible or preventable.