By The Eye PracticePublished On: 23 November 20185 min read

Loud snoring, gasping or choking noises while sleeping, morning headaches or dry mouth, irritability, concentration problems; does this sound like you or your partner?

If so, sleep apnoea (also called obstructive sleep apnoea or OSA) could be your house guest. This is a very common condition (affecting 1 in 4 men and 1 in 10 women) and it is associated with several eye conditions.

Your optometrist’s role

You probably know by now that your optometrist could save your eyesight – that’s part of their job. But did you know that they could also save your life? By recognising the eye conditions that might be associated with sleep apnoea, the disease can be picked up early and managed. This can literally be the difference between life and death for some people.

A comprehensive eye examination can allow your optometrist to detect a range of pathological conditions in your eyes. But, even more importantly, they can also refer you appropriately for diagnosis and management of potentially life-threatening conditions (such as heart disease and stroke).

Tell your optometrist if you have a family history of OSA or if any of the following apply:

loud snoring
gasping or choking noises while sleeping
morning headaches, dry mouth or sore throat
irritability
tiredness, even in the mornings
concentration problems
falling asleep / feeling sleep while watching TV, driving, at work

Some people have other risk factors that make them more likely to suffer from OSA, including:

obesity
male gender
race (African-American, Pacific Islander, Asian, Hispanic)

What happens during sleep apnoea?

During sleep, the muscles in the tongue, soft palate and other airways should remain active to keep the airways open. But in sleep apnoea, these muscles relax. Breathing in causes suction on the walls of the airways, which are pulled inwards, narrowing or obstructing them.

This reduces the oxygen reaching the lungs. This drop (or see-saw) in oxygen levels causes a range of negative effects on the body and is implicated in serious diseases including heart attack, stroke, high blood pressure, dementia, diabetes and more.

Sleep apnoea and the eye

The following eye conditions are associated with sleep apnoea. Diagnosis of one of these conditions may be the reason your optometrist refers you for further assessment or sleep studies:

Keratoconus: This is a progressive eye disease where a normal rounded cornea thins and begins to bulge into a cone-like shape. In a recent study published April 2018, researchers found that people suffering with keratoconus, could be 10-20 times more likely to also suffer from sleep apnoea.

Glaucoma: Some studies have shown a link between sleep apnoea and glaucoma.

Central serous retinopathy: This is a retinal condition most often seen in steroid users or middle-aged men under stress. Fluid accumulates under the central retina (much like a wallpaper blister) and disrupts vision. OSA can raise stress hormones in the body and increase the risk of this condition. Sleep apnoea treatment can speed your recovery.

Retinopathy: When your retina doesn’t get enough oxygen, blood vessels don’t function properly and leak fluid into the retina. This can clearly be seen during a comprehensive eye examination. This is more likely to occur if you already suffer from high blood pressure (hypertension) or diabetes. Your optometrist may see haemorrhages or ‘cotton wool spots’ when they examine the back of your eyes. These cotton wool spots usually signify retinal disease (e.g. from diabetes or hypertension) but sleep studies can reveal that they are caused by spikes in blood pressure due to OSA.
Papilloedema (optic nerve head swelling): This occurs due to increased pressure within your skull (intercranial hypertension). While rare, it’s most often seen in young women. Lack of oxygen during sleep can lead to dilated veins within the head, which increase pressure on the optic nerve from behind.

Floppy eyelid syndrome: This is where the eyelids are so lax that they can open or fold back during sleep. They can rub against pillows and bedding and become inflamed and sore. The sufferer doesn’t wake up from this sensation but has to deal with sore, inflamed eyes during the day. There is a STRONG association between this condition and sleep apnoea.

Retinal vein occlusion is a serious eye condition where your retinal vein becomes blocked and leaks blood into the eye. It is known to be associated with OSA. Managing the sleep apnoea can decrease the risk of further retinal vessel occlusions.
NAION: This is a sudden painless vision loss (when you wake up). It’s a rare but very serious eye condition caused by lack of oxygen to the retina. It is strongly associated with sleep apnoea. Treating the OSA can help prevent NAION from occurring in your other eye.

What’s the treatment?

Eye conditions associated with OSA can be individually managed by your eye-care practitioner. (E.g. topical treatment may help relieve symptoms of floppy eyelid syndrome).

Getting to the underlying problem, however, is essential to restore good general health. Sleep apnoea is officially diagnosed by a medical doctor, who will assess how severe it is and what sort of treatment is required.

Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. It involves wearing a close-fitting mask over the mouth and / or nose during sleep. These use a pump to deliver oxygen under light pressure through the airways to the lungs. The pressure can be continuous or automatic (depending on your needs).

What else can be done?

As above, your sleep apnoea needs to be managed by your doctor (and not your optometrist).

Losing excessive weight has many health benefits – not just with OSA.
Giving up smoking and avoiding or reducing alcohol can also help.
Specially designed dental plates (worn during sleep) can improve airflow through the airways
Surgery (tonsil removal etc) is the most invasive option and not always a success.