Relationship of Obstructive Sleep Apnea with keratoconus: Literature review

Authors

Natalia Andrea Coy Ramírez Universidad El Bosque

DOI:

https://doi.org/10.33936/qkrcs.v7i3.6619

Keywords:

Córnea, Apnea obstructiva del sueño, Queratocono, Ectasia corneal, Superficie ocular.

Abstract

A literature review was conducted on the relationship between untreated the obstructive sleep apnea (OSA) and corneal changes. Corneal thickness, hysteresis and curvature are altered when there are recurrent episodes of oxygen disruption on the ocular surface. A search was conducted over the last 15 years, up to September 2023, using the DeCS terms “apnea” AND “cornea” and “apnea” AND “keratoconus” in the PubMed Central database with 193 and 921 articles respectively; in the ScienceDirect database 670 and 104; and Embase 259 and 83 articles. In this review, 2230 articles on the association between sleep apnea and keratoconus were analyzed using the PRISMA method. A bidirectional association was found between keratoconus and obstructive sleep apnea (OSA). The Berlin questionnaire can identify patients with keratoconus at risk for OSA. According to the literature studied, the OSA is associated with corneal changes and increased risk of the keratoconus. Corneal morphology and biomechanics can be affected by intermittent interruptions of oxygen in tissues, which can lead to the development of keratoconus. There is a correlation which may be mediated by various factors, such as eyelid laxity, body posture during sleep, reduced corneal elasticity and the severity of the apnea-hypopnea index.

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References

Referencias:

Chalkiadaki E, Andreanos K, Florou C, Droutsas K, Maniou C, Amfilochiou A, et al. Corneal Endothelial Morphology and Thickness Alterations in Patients With Severe Obstructive Sleep Apnea-Hypopnea Syndrome. Cornea. 2021;40(1):73–7. DOI: 10.1097/ICO.0000000000002373.

Bulloch G, Seth I, Alphonse S, Sathe A, Jennings M, Sultan D, et al. Prevalence of Obstructive Sleep Apnea With Floppy Eyelid Syndrome: A Systematic Review and Meta-analysis. Ophthalmic Plast Reconstr Surg. 2023;39(3):243–53. DOI: 10.1097/IOP.0000000000002298.

Zoumpou T, Samuel S, Torun N, Yadav P, Jones DB. Floppy Eyelid Syndrome: an Overlooked Comorbidity Among Bariatric Patients. Obes Surg. 2023 Feb 26;33(2):523–9. DOI: 10.1007/s11695-022-06410-4.

Lee SSY, Nilagiri VK, Mackey DA. Sleep and eye disease: A review. Clin Exp Ophthalmol. 2022 Apr 16;50(3):334–44. DOI: 10.1111/ceo.14071.

Karaca U, Akıncıoğlu D, Ayyildiz O, Dogan D, Ozge G, Usta G, et al. Comparison of obstructive sleep apnea syndrome and keratoconus patients on elevation maps. Int Ophthalmol. 2022 Mar 18;42(3):933-8. DOI: 10.1007/s10792-021-02074-8.

Lovatt M, Adnan K, Kocaba V, Dirisamer M, Peh GSL, Mehta JS. Peroxiredoxin-1 regulates lipid peroxidation in corneal endothelial cells. Redox Biol. 2020 Feb;30:101417. DOI: 10.1016/j.redox.2019.101417.

Stern JH, Tian Y, Funderburgh J, Pellegrini G, Zhang K, Goldberg JL, et al. Regenerating Eye Tissues to Preserve and Restore Vision. Cell Stem Cell. 2018 Jun;22(6):834–49. DOI: 10.1016/j.stem.2018.05.013.

Naderan M, Rezagholizadeh F, Zolfaghari M, Naderan M, Rajabi MT, Kamaleddin MA. Association between the prevalence of obstructive sleep apnoea and the severity of keratoconus. British Journal of Ophthalmology. 2015 Dec;99(12):1675–9. DOI: 10.1136/bjophthalmol-2015-306665.

Gupta PK, Stinnett SS, Carlson AN. Prevalence of Sleep Apnea in Patients With Keratoconus. Cornea. 2012 Jun;31(6):595–9. DOI: 10.1097/ICO.0b013e31823f8acd.

Pellegrini M, Bernabei F, Friehmann A, Giannaccare G. Obstructive Sleep Apnea and Keratoconus: A Systematic Review and Meta-analysis. Optometry and Vision Science. 2020 Jan;97(1):9–14. DOI: 10.1097/OPX.0000000000001467.

Pang K, Lennikov A, Yang M. Hypoxia adaptation in the cornea: Current animal models and underlying mechanisms. Animal Model Exp Med. 2021 Dec 28;4(4):300–10. DOI: 10.1002/ame2.12192.

Arriola-Villalobos P, Benito-Pascual B, Peraza-Nieves J, Perucho-González L, Sastre-Ibañez M, Dupré-Peláez MG, et al. Corneal Topographic, Anatomic, and Biomechanical Properties in Severe Obstructive Sleep Apnea–Hypopnea Syndrome. Cornea. 2020 Jan 12;39(1):88–91. DOI: 10.1097/ICO.0000000000002102.

Koseoglu HI, Kanbay A, Ortak H, Karadağ R, Demir O, Demir S, et al. Effect of obstructive sleep apnea syndrome on corneal thickness. Int Ophthalmol. 2016 Jun 21;36(3):327–33. DOI: 10.1007/s10792-015-0122-2.

Ekinci M, Huseyinoglu N, Cagatay HH, Ceylan E, Keles S, Gokce G. Is there a Relationship Between Sleep Apnea and Central Corneal Thickness? Curr Eye Res. 2013 Nov 30;38(11):1104–9. DOI: 10.3109/02713683.2013.804578.

Bojarun A, Vieversyte Z, Jaruseviciene R, Galgauskas S, Asoklis R, Zablockis R. Effect of Obstructive Sleep Apnea on Corneal Morphological Characteristics. Cornea. 2019 Dec 23;38(12):1576–81. DOI: 10.1097/ICO.0000000000002069.

Nadarajah S, Samsudin A, Ramli N, Tan CT, Mimiwati Z. Corneal Hysteresis Is Reduced in Obstructive Sleep Apnea Syndrome. Optometry and Vision Science. 2017 Oct;94(10):981–5. DOI: 10.1097/OPX.0000000000001117.

Saidel MA, Paik JY, Garcia C, Russo P, Cao D, Bouchard C. Prevalence of Sleep Apnea Syndrome and High-Risk Characteristics Among Keratoconus Patients. Cornea. 2012;31(6):600–3. DOI: 10.1097/ICO.0b013e318243e446.

Gencer B, Ozgurhan EB, Kara S, Tufan HA, Arikan S, Bozkurt E, et al. Obesity and Obstructive Sleep Apnea in Patients With Keratoconus in a Turkish Population. Cornea. 2014;33(2):137–40. DOI: 10.1097/ICO.0000000000000024.

Panossian LA, Veasey SC. Daytime Sleepiness in Obesity: Mechanisms Beyond Obstructive Sleep Apnea—A Review. Sleep. 2012 May;35(5):605–15. DOI: 10.5665/sleep.1812.

Naismith S, Winter V, Gotsopoulos H, Hickie I, Cistulli P. Neurobehavioral Functioning in Obstructive Sleep Apnea: Differential Effects of Sleep Quality, Hypoxemia and Subjective Sleepiness. J Clin Exp Neuropsychol. 2004 Jan 9;26(1):43–54. DOI: 10.1076/jcen.26.1.43.23929.

Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. 2010 Dec 28;7(12):677–85. DOI: 10.1038/nrcardio.2010.145.

Sun J, He J, Liang Z. Comparison of ocular surface assessment outcomes between healthy controls and patients with obstructive sleep apnea–hypopnea syndrome: a meta-analysis of the literature. Front Physiol. 2023 May 5;14. DOI: 10.3389/fphys.2023.1163947.

Karaca I, Yagci A, Palamar M, Tasbakan MS, Basoglu OK. Ocular surface assessment and morphological alterations in meibomian glands with meibography in obstructive sleep apnea Syndrome. Ocul Surf. 2019 Oct;17(4):771–6. DOI: 10.1016/j.jtos.2019.06.003.

Acar M, Firat H, Acar U, Ardic S. Ocular surface assessment in patients with obstructive sleep apnea–hypopnea syndrome. Sleep and Breathing. 2013 May 5;17(2):583–8. DOI: 10.1007/s11325-012-0724-0.

Gelir E, Budak MT, Ardic S. The relationship between CPAP usage and corneal thickness. PLoS One. 2014;9(1):1–6. DOI: 10.1371/journal.pone.0087274.

Katz I, Zamel N, Slutsky AS, Rebuck AS, Hoffstein V. Tracheal hysteresis in sleep apnea. J Appl Physiol. 1989 Oct 1;67(4):1349–53. DOI: 10.1152/jappl.1989.67.4.1349.

Pihlblad MS, Schaefer DP. Eyelid Laxity, Obesity, and Obstructive Sleep Apnea in Keratoconus. Cornea. 2013 Sep;32(9):1232–6. DOI: 10.1097/ICO.0b013e318281e755.

Mazharian A, Panthier C, Courtin R, Jung C, Rampat R, Saad A, et al. Incorrect sleeping position and eye rubbing in patients with unilateral or highly asymmetric keratoconus: a case-control study. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2020 Nov 10;258(11):2431–9. DOI: 10.1007/s00417-020-04771-z.

Norouzpour A, Mehdizadeh A. A novel insight into keratoconus: mechanical fatigue of the cornea. Med Hypothesis Discov Innov Ophthalmol. 2012;1(1):14–7. PMID: 24600612.

Collier SA. Is the corneal degradation in keratoconus caused by matrix‐metalloproteinases? Clin Exp Ophthalmol. 2001 Dec 10;29(6):340–4. DOI: 10.1046/j.1442-9071.2001.d01-17.x.

Mackiewicz Z, Määttä M, Stenman M, Konttinen L, Tervo T, Konttinen YT. Collagenolytic Proteinases in Keratoconus. Cornea. 2006 Jun;25(5):603–10. DOI: 10.1097/01.ico.0000208820.32614.00.