阻塞性睡眠呼吸暂停低通气综合征对视网膜神经纤维层厚度的影响

Evaluation of retinal nerve fiber layer thickness in patients with obstructive sleep apnea-hypopnea syndrome

摘要:

目的：比较不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome，OSAHS)患者与正常对照组的视神经纤维层(retinal nerve fiber layer， RNFL)厚度的差异。

方法：病例对照研究。选取2014-01/2015-12期间表现为打鼾及白天嗜睡的可疑患者79例在上海中山医院青浦分院呼吸科接受多导睡眠监测(polysomnography， PSG)，进行OSAHS 的诊断和严重程度分级，然后转诊到眼科进行眼部检查。测量眼内压(intraocular pressure，IOP)、RNFL厚度等。

结果：共有73例被纳入本研究，对照组(无OSAHS)20例，OSAHS组53例。中度、重度OSAHS组的IOP比对照组高(均P<0.05)。中度、重度OSAHS组的平均RNFL及上方RNFL较对照组薄(均P<0.05)。AHI与上方RNFL及平均RNFL呈负相关(r=-0.316、-0.205， 均P<0.01)。上方RNFL与氧饱和度指数(oxygen desaturation index， ODI)呈负相关(r=-0.24， P=0.005)，与平均血氧分压(SaO₂)呈正相关(r=0.277，P=0.001)。

结论：OSAHS患者的RNFL变薄，OSAHS病情越严重RNFL丢失越多。上方RNFL受OSAHS影响较大。

Abstract:

AIM: To compare the retinal nerve fiber layer(RNFL)thickness in patients with different severities of obstructive sleep apnea-hypopnea syndrome(OSAHS)versus normal controls.

METHODS: This was an observational case-control study. Totally 79 patients presenting with snoring and daytime sleepiness who underwent overnight polysomnography(PSG)to determine OSAHS severity were recruited, and subsequently referred for ophthalmologic evaluation. The data including intraocular pressure(IOP), RNFL thickness etc was collected.

RESULTS: A total of 73 subjects were recruited, including 53 patients with OSAHS and 20 normal control subjects. IOP was significantly higher for the moderate and severe OSAHS group than for the control group(both P<0.05). The RNFL in the average and superior quadrants were significantly thinner for the moderate and severe OSAHS group than for the control group(both P<0.05). AHI was negatively correlated with RNFL thickness in the superior quadrants, and with average RNFL thickness(r=-0.316, -0.205; both P<0.01). Negative correlations were also identified between RNFL thickness in the superior quadrants and the ODI(r=-0.24, P=0.005). Positive correlations were identified between SaO₂ on PSG and RNFL thickness in the superior quadrants(r=0.277, P=0.001).

CONCLUSION: RNFL of the patients with OSAHS is thinned. Furthermore, it is observed that the greater severity of OSAHS, the greater the loss of RNFL. Among the four quadrants observed, the most affected quadrant was the superior quadrant.