2018 年第 2 期 第 13 卷

阻塞性睡眠呼吸暂停综合征对眼底结构和功能的影响    

作者：辛晨孟忻王华王丽张蔚汪军

英文作者：

单位：100029首都医科大学附属北京安贞医院眼科（辛晨、孟忻、王华、汪军），呼吸科（王丽、张蔚）

英文单位：

关键词：阻塞性睡眠呼吸暂停综合征；视网膜；脉络膜；视神经；视野

英文关键词：

• 摘要：

• 目的    评价阻塞性睡眠呼吸暂停综合征（OSAS）对眼底结构和功能的影响。方法    选取2013年3—9月在首都医科大学附属北京安贞医院接受多导睡眠监测的患者99例，按呼吸暂停/低通气指数（AHI）将所有患者分为正常组（12例，AHI＜5 次/h）、轻度组(24例，AHI 5～15次/h)、中度组(25例，AHI ＞15～30次/h)和重度组(38例，AHI＞30 次/h)。选取每例患者右眼作为研究眼。比较各组患者间视野、视盘、视网膜及脉络膜结构相关指标，分析上述眼部指标与OSAS评价指标间的相关性，计算原发性开角型青光眼(POAG)的患病率。结果    重度组患者视野平均缺损显著重于正常组、轻度组和中度组［（-6.2±6.0）dB比（-1.5±1.3）、（-2.0±1.5）、（-2.2±2.9）dB］，而视野模式标准差（PSD）显著高于正常组、轻度组和中度组［（6.1±4.1）dB比（2.3±1.1）、（3.1±2.2）、（3.4±2.4）dB］（均P＜0.05）；轻中度组患者视盘下方神经纤维层厚度较正常组显著变薄［（119±18）、（112±30）μm比（136±13）μm］，而重度组［（124±22）μm］显著厚于中度组（均P＜0.05）；重度组患者黄斑中心凹厚度显著厚于正常组［（252±27）μm比（231±27）μm］（P＜0.05）；中重度组患者黄斑中心凹下脉络膜厚度（CTF）、黄斑中心凹鼻侧1 μm处脉络膜厚度（CT 1 μm）均显著薄于正常组［（249±39）、（223±57）μm比（287±39）μm；（239±58）、（227±59）μm比（282±46）μm］（均P＜0.05）；重度组患者眶部颅内压显著高于轻中度组［（16.4±3.9）mmHg（1 mmHg=0.133 kPa）比（15.1±4.2）、（15.1±2.9）mmHg］（均P＜0.05）。清晨舒张压水平、PSD值与氧减指数呈显著正相关（r=0.343,P=0.001；r=0.429,P＜0.001），CTF、CT 1 μm与氧减指数呈显著负相关（r=-0.395,P＜0.001；r=-0.198,P=0.049），视野平均缺损与夜间平均血氧饱和度呈显著正相关（r=0.436,P＜0.001）。所有OSAS患者中POAG共4例，患病率为4.6%（4/87）。结论    OSAS患者视野、视盘、视网膜及脉络膜结构均受到不同程度损害，OSAS可在一定程度上影响患者眼底结构和功能。

• Effect of obstructive sleep apnea syndrome on fundus structure and function

  Xin Chen, Meng Xin, Wang Hua, Wang Li, Zhang Wei, Wang Jun

  Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China(Xin C, Meng X, Wang H, Wang J); Department of Respiratory Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China(Wang L, Zhang W)

  Corresponding author: Wang Jun, Email: docwangjun@sina.com

  【Abstract】Objective    To analyze the effect of obstructive sleep apnea syndrome（OSAS） on fundus structure and function. Methods    Ninety-nine patients who had polysomnography from March to September 2013 in Beijing Anzhen Hospital, Capital Medical University were divided into 4 groups according to the apnea/hypopnea index（AHI）: normal group(n＝12, AHI＜5 times/h), mild group(n＝24, AHI 5-15 times/h), moderate group(n＝25, AHI 15-30 times/h) and severe group(n＝38, AHI＞30 times/h). Visual field, optic disk, retina and choroid of the right eye were examined in all patients. Relation between fundus indexes and OSAS indexes was analyzed. Prevalence rate of primary open angle glaucoma(POAG) was calculated. Results    Mean defect of visual field in severe group was more severe than that in normal group, mild group and moderate group［（-6.2±6.0）dB vs （-1.5±1.3）,（-2.0±1.5）,（-2.2±2.9）dB］(P＜0.05). Pattern standard deviation（PSD） in severe group was significantly higher than that in normal group, mild group and moderate group［（6.1±4.1）dB vs （2.3±1.1）,（3.1±2.2）,（3.4±2.4）dB］(P＜0.05). Thickness of inferior retinal nerve fiber layer in mild group and moderate group was significantly thinner than that in normal group［（119±18）,（112±30）μm vs （136±13）μm］; thickness of inferior retinal nerve fiber layer in severe group［（124±22）μm］ was significantly thicker than that in moderate group(P＜0.05). Thickness of macula central fovea in severe group was significantly thicker than that in normal group［（252±27）μm vs （231±27）μm］(P＜0.05). Thickness of subfoveal chorioid and thickness of chorioid 1 μm to the nasal side of macula central fovea in moderate group and severe group were significantly thinner than those in normal group［（249±39）,（223±57）μm vs （287±39）μm; （239±58）,（227±59）μm vs （282±46）μm］(P＜0.05). Orbital intracranial pressure in severe group was significantly higher than that in mild group and moderate group［（16.4±3.9）mmHg vs （15.1±4.2）,（15.1±2.9）mmHg］(P＜0.05). Diastolic pressure in the morning and PSD was positively related to oxygen desaturation index（r=0.343, P=0.001; r=0.429, P＜0.001）. Thickness of subfoveal chorioid and thickness of chorioid 1 μm to the nasal side of macula central fovea were negatively related to oxygen desaturation index（r=-0.395, P＜0.001; r=-0.198, P=0.049）. Mean defect of visual field was positively related to nocturnal mean oxygen saturation（r=0.436, P＜0.001）. The prevalence rate of POAG was 4.6%（4/87）. Conclusion    OSAS can damage visual field, optic disk, retina and choroid.

  【Key words】Obstructive sleep apnea syndrome；Retina；Choroid；Optic nerve；Visual field