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Claudio Liguori, Maria Giuseppina Palmieri, Mariangela Pierantozzi, Massimo Cesareo, Andrea Romigi, Francesca Izzi, Maria Grazia Marciani, Corrado Oliva, Nicola Biagio Mercuri, Fabio Placidi, Optic Nerve Dysfunction in Obstructive Sleep Apnea: An Electrophysiological Study, Sleep, Volume 39, Issue 1, January 2016, Pages 19–23, https://doi.org/10.5665/sleep.5308
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Abstract
The aim of this study was to evaluate the integrity of the visual system in patients affected by obstructive sleep apnea (OSA) by means of electroretinogram (ERG) and visual evoked potential (VEP).
We performed electrophysiological study of the visual system in a population of severe OSA (apnea-hypopnea events/time in bed ≥ 30/h) patients without medical comorbidities compared to a group of healthy controls similar for age, sex, and body mass index. Patients and controls did not have visual impairment or systemic disorders with known influence on the visual system. ERG and VEP were elicited by a reversal pattern generated on a television monitor at low (55') and high (15') spatial frequencies stimulation. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) in both patients and controls.
In comparison with healthy controls (n = 27), patients with OSA (n = 27) showed a significant latency delay coupled with a significant amplitude reduction of P100 wave of VEP at all spatial frequencies in both eyes. No significant differences between groups were detected as concerning ERG components. No correlations were found between polygraphic parameters, ESS scores, or VEP and ERG components in OSA patients.
This study documented that patients with OSA, without medical comorbidities, present VEP alteration as documented by lower amplitude and longer latency of the P100 component than healthy controls. These altered electrophysiological findings may be the expression of optic nerve dysfunction provoked by hypoxia, acidosis, hypercarbia and airway obstruction, frequently observed in patients with OSA. Hence, we hypothesize that OSA per se may impair optic nerve function.
Obstructive sleep apnea patients without medical comorbities show alterations in visual evoked potentials consistent with subclinical optic nerve dysfunction, which may be provoked by hypoxia, acidosis, hypercarbia and airway obstruction. Since visual evoked potentials are considered sensitive instruments able to recognize early dysfunction of the optic nerve, we hypothesize that obstructive sleep apnea may directly impair optic nerve function before the appearance of other medical pathologies, which could additionally negatively involve optic nerve. Therefore, this report reinforces the importance of early identification and treatment of obstructive sleep apnea, which may prevent the occurrence or progression of optic nerve dysfunction.
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