Perspective from Doug Rett, OD, FAAO
Disclosures: The authors report no relevant financial disclosures.
September 11, 2020
2 min read

RNFL thinning correlated to OSA severity

Perspective from Doug Rett, OD, FAAO
Disclosures: The authors report no relevant financial disclosures.
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The severity of obstructive sleep apnea may be associated with the thinning of the superotemporal retinal nerve fiber layer, according to findings published in the Journal of Glaucoma.

Samantha Sze-Yee Lee, PhD, of the University of Western Australia’s Centre for Ophthalmology and Visual Science and the Lions Eye Institute, and colleagues explored the differences in optic disc measurements that may resemble preclinical glaucomatous changes in relation to obstructive sleep apnea status and severity.

“Within the past decade, contemporary versions of OCT now have the capacity to measure the minimum rim width at the Bruch membrane opening [BMO]-minimum rim widths [MRW], which has been suggested as being more sensitive for detecting early glaucoma than the RNFL [retinal nerve fiber layer] thickness,” Lee and colleagues wrote. “Yet, the link between BMO-MRW and OSA [obstructive sleep apnea] has not been investigated.”

The researchers examined data from participants of an at-home sleep study (n = 865; 45% men) where apnea-hypopnea index [AHI] and sleep oxygen saturation levels were measured. The participants’ OSA status ranged from AHI with less than 5 events per hour to more than 30 events per hour.

At a 6-year follow up visit, the optic discs of participants were imaged using spectral domain OCT to measure the Bruch membrane opening minimum rim widths and RNFL thickness, investigators wrote.

They identified that on the basis of AHI, 48% of participants had OSA, with 11% of that population receiving a diagnosis of moderate OSA. Also, within the group with OSA, 3% had severe OSA.

Participants with severe OSA had thinner RNFL superotemporally compared with participants without OSA or with mild OSA, (P < .001 for both), Lee and colleagues wrote. Superotemporal RNFL was also inversely associated with AHI (P = .004) and a sleep time with oxygen saturation level less than 90% (P = .005), they said.

“Our findings do not provide strong evidence of a link between measures of OSA and the optic disc,” Lee and colleagues wrote. “However, the association between OSA severity and thinner superotemporal RNFL has been reported consistently in previous studies and thus warrants further evaluation.”