Study reveals need for multi-specialty collaboration
The recommended treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP) ventilation, or other nasal mask therapy (NMT) device use.1 However, these patients may be at risk for eye irritation secondary to airflow from mask leakage or retrograde nasolacrimal air escape — especially if they are new users.2-4
Here, I discuss the study, “The prevalence and incidence of dry eye disease among patients using continuous positive airway pressure or other nasal mask therapy devices to treat sleep apnea,”5 with the goal of outlining the need for sleep physicians and ophthalmic practitioners to collaborate to provide comprehensive treatment plans for these patients.
Overview
In this retrospective, descriptive analysis, we used data from the IBM MarketScan Commercial and Medicare Supplemental Databases, which contain inpatient, outpatient, and the outpatient prescription-drug experience of several million patients covered under a variety of fee-for-service, capitated health plans, and individuals with Medicare supplemental insurance paid by employers. The 330,926 patients who were selected for the study had no diagnosis of dry eye disease (DED) prior to their first CPAP or NMT device claim.
The majority of patients (65%) were male, and the median age was 53 years. The investigation revealed that the 1-year, 2-year, and 3-year incidence rates of DED were 4.0%, 7.3%, and 10.3%, respectively. Incidence increased with age, with 1-year incidence ranging from 1.6% in patients ages 18 to 24, to 11.2% in patients ≥75 years of age. Women had a higher 1-year incidence of DED compared with men (5.8% versus 3.0%). Of note: Incidence of DED was higher among patients who had comorbid metabolic or inflammatory conditions.
Value
Sleep apnea affects approximately 13% to 14% of men, and 5% to 6% of women in the United States, and has increased substantially in recent years,6 with many CPAP and NMT patients developing secondary ocular disorders.1 With this in mind, it becomes essential for eye care providers to query their patients about sleep apnea and CPAP or NMT device use when they present with ocular surface issues or DED for patient comfort, and long-term corneal health. In fact, a study that evaluated the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on the meibomian glands, ocular surface, and tear parameters showed significantly greater loss in the meibomian glands was seen in both the upper and lower eyelids of the sleep apnea group compared with the control group.7 There was also a significant correlation between the severity of sleep apnea and total meibomian gland loss percentage.7
As research on this topic continues to grow, it makes sense for eye care specialists to endeavor to collaborate with sleep specialists when treating patients who have sleep apnea. CP
References:
- Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335-343
- Kadyan A, Ashgar J, Dowson L, Sandramouli S. Ocular findings in sleep apnoea patients using continuous positive airway pressure. Eye (Lond). 2010;24(5):843-850.
- Stauffer JL, Fayter N, Maclurg BJ. Conjunctivitis from nasal CPAP apparatus. Chest. 1984;86(5):802.
- Fayers T, Simcock DE, Wilkins MR. Reactivation of recurrent corneal erosion syndrome by continuous positive pressure ventilation. Cornea. 2007;26(10):1292.
- Matossian C, Song X, Chopra I, Sainski-Nguyen A, Ogundele A. The prevalence and incidence of dry eye disease among patients using continuous positive airway pressure or other nasal mask therapy devices to treat sleep apnea. Clin Ophthalmol. 2020;14:3371-3379.
- Peppard PE, Young T, Barnet JH, Palta M, Wagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013 1;177(9):1006-1014.
- Muhafiz E, Ölçen M, Erten R, Bozkurt E. Evaluation of Meibomian Glands in Obstructive Sleep Apnea-Hypopnea syndrome. Cornea. 2020;39(6):685-690.