| Identifier |
Obstructive_sleep_apnea_OSA_and_Neuro-Op |
| Title |
Obstructive Sleep Apnea (OSA) and Neuro-Ophthalmology |
| Creator |
Andrew G. Lee, MD; Jared Alexander |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JA) Class of 2021, Baylor College of Medicine, Houston, Texas |
| Subject |
OSA; Neuro-Ophthalmology; Pseudotumor |
| Description |
Dr. Lee lectures medical students on obstructive sleep apnea (OSA) and neuro-ophthalmology. |
| Transcript |
So we're going to be talking about obstructive sleep apnea. Obstructive sleep apnea is exactly what it says it is. It is apneic episodes where you stop breathing during sleep and caused by obstruction. The obstruction is caused by the glottis. So you have forced expiratory effort against the closed glottis. This results in the snoring sound and the apneic episode and they stop breathing. So this obstructive sleep apnea can come to neuro-ophthalmology. You need to know that the regular eye findings need to be addressed as well - dry eye, floppy eyelid syndrome, glaucoma. All of those things are associated with obstructive sleep apnea. This presentation is merely going to be covering the neuron pieces. So the neuro-ophth things from obstructive sleep apnea, as you can imagine, are related to both hypoxia, and that means ischemic events in the retina or in the optic nerve, including non-arteritic anterior ischemic optic neuropathy, central retinal vein occlusion, branch retinal vein occlusion, is ocular ischemic syndrome. All are going to be an increased risk in someone who has obstructive sleep apnea, not just because of the OSA but because of the comorbidities that usually accompany this - hypertension, diabetes, obesity, all of the vasculopathic risk factors that run with obstructive sleep apnea. But we also have to deal with the hypercapnia. And so we have increased CO2 that may lead to increased ICP and what looks like pseudotumor cerebri. So in addition to having the normal modified Dany criteria for IIH - a negative imaging study, a normal CSF content, and elevated opening pressure, and symptoms and signs related only to increased ICP, in patients who have IIH we should be asking about obstructive sleep apnea. And normally we start with screening questions - "Do you snore?" We have to ask the spouse that. Do you feel excessive daytime somnolence? And in those patients we will screen them with either the Berlin Questionnaire or a similar screening device to rate their risk of obstructive sleep apnea and refer those patients for a sleep study. But it's especially important to be thinking about obstructive sleep apnea in patients who are atypical for pseudotumor cerebri. So the men rather than the women, the thin person, the older patient, the younger patient. So if they're outside the parameters of normal demographics for IIH, we really should be thinking about doing a sleep study in that particular patient, but especially the men. So obstructive sleep apnea definitely is associated with ocular disease. The non neuro-ophthalmic conditions - dry eye, the keratoconus, the refractive error and refractive shifts, glaucoma - all of those things, including floppy eyelid syndrome, need to be addressed. But for neuro-ophthalmology really what we're thinking about is optic disc edema, NAION, central retinal vein occlusion, pseudotumor cerebri. But in every patient who has a risk factor for obstructive sleep apnea I would recommend screening them with some sort of questionnaire. We happen to use the Berlin Questionnaire, and sending those patients for sleep study. |
| Date |
2020-05-27 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6f5335w |
| Setname |
ehsl_novel_lee |
| ID |
1561512 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6f5335w |
