睡眠体位对原发性开角型青光眼不对称发病机制的影响
摘要
目的通过测量原发性开角型青光眼(POAG)患者在不同体位下的眼压,研究眼压变化和睡眠体位的关系,探索POAG双眼不对称发病的机制。方法 109例确诊为POAG的患者被纳入研究,通过问卷调查了解患者睡眠体位倾向。经杯盘比(C/D)和视野缺损比较确立双眼不对称性。使用iCare手持回弹式眼压计测量不同体位状态的眼压值。对比双眼中较好眼和较差眼在不同体位下的眼压差异,观测侧卧位时低位眼和高位眼的眼压变化,分析双眼不对称性青光眼的发生是否与患者特定的睡眠倾向有关。结果 POAG患者以右侧卧位为主。在体位眼压测量中,右眼眼压由高到低依次为:右侧卧位>左侧卧位>平卧>坐位;左眼眼压由高到低依次为:左侧卧位>右侧卧位>平卧>坐位。POAG患者右侧卧位时,右眼眼压升高(7.15±4.52) mmHg(1 mmHg=0.133 kPa),左眼升高(5.97±4.20) mmHg(P=0.013),左侧卧位时左眼眼压升高(6.97±5.05) mmHg,右眼升高(5.50±5.04) mmHg(P=0.006)。在双眼不对称的31例POAG患者中,有特定侧位睡眠倾向的患者共25例,其中19例(76.0%)低位眼是病情较严重一侧眼;在此类患者群中,睡眠倾向与低位眼眼压升高有关(χ~2=7.675,P=0.041,Pearson列联系数为0.45)。结论 POAG患者侧卧位时低位眼眼压较高,长期固定侧位睡眠习惯可能导致低位眼发病较重,提示睡眠倾向可能是引起POAG不对称发病的原因之一。
引文
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[17] HONG J,XU J,WEI A,et al.Spectral-domain optical coherence tomographic assessment of Schlemm’s canal in Chinese subjects with primary open-angle glaucoma.Ophthalmology,2013,120(4):709-715.
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[19] LIU JH,SIT AJ,WEINREB RN.Variation of 24-hour intraocular pressure in healthy individuals-right eye versus left eye.Ophthalmology,2005,112(10):1670-1675.
[20] KIUCHI T,MOTOYAMA Y,OSHIKA T.Postural response of intraocular pressure and visual field damage in patients with untreated normal-tension glaucoma.J Glaucoma,2010,19(3):191-193.
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[22] KIUCHI T,MOTOYAMA Y,OSHIKA T.Relationship of progression of visual field damage to postural changes in intraocular pressure in patients with normal- tension glaucoma.Ophthalmology,2006,113(12):2150-2155.
[23] CHAN MP,GROSSI CM,KHAWAJA AP,et al.Associations with intraocular pressure in a large cohort:results from the UK Biobank.Ophthalmology,2016,123(4):771-782.
[24] GABELT BT,KAUFMAN PL.Changes in aqueous humor dynamics with age and glaucoma.Prog Retin Eye Res,2005,24(5):612-637.
[25] APTEL F,WEINREB RN,CHIQUET C,et al.24-h monitoring devices and nyctohemeral rhythms of intraocular pressure.Prog Retin Eye Res,2016,55:108-148[2018-05-31].https://doi.org/10.1016/j.preteyeres.2016.07.002.
[2] QUIGLEY HA,BROMAN AT.The number of people with glaucoma world wide in 2010 and 2020.Br J Ophthalmol,2006,90(3):262-267.
[3] MCMONNIES CW.The importance and potential for continuous monitoring of intraocular pressure.Clin Exp Optom,2017,100(3):203-207.
[4] GORDON MO,TORRI V,MIGLIOR S,et al.Validated prediction model for the development of primary open-angle glau- coma in individuals with ocular hypertension.Ophthalmology,2007,114(1):10-19.
[5] ASRANI S,ZEIMER R,WILENSKY J,et al.Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma.J Glaucoma,2000,9(2):134-142.
[6] VARMA R,HWANG LJ,GRUNDEN JW,et al.Inter-visit IOP range:an alternative parameter for assessing intraocular pressure control in clinical trials.Am J Ophthalmol,2008,145(2):336-342.
[7] MCMONNIES CW.The interaction between intracranial pressure,intraocular pressure and lamina cribrosa compression in glaucoma.Clin Exp Optom,2016,99(3):219-226.
[8] LIU JHK,WEINREB RN.Monitoring intraocular pressure for 24 h.Br J Ophthalmol,2011,95(5):599-600.
[9] FUJINO Y,ASAOKA R,MURATA H,et al.Evaluation of glaucoma progression in large-scale clinical data:the Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG).Invest Ophthalmol Vis Sci,2016,57(4):2012-2020.
[10] BROMAN AT,QUIGLEY HA,WEST SK,et al.Estimating the rate of progressive visual field damage in those with open-angle glaucoma,from cross-sectional data.Invest Ophthalmol Vis Sci,2008,49(1):66-76.
[11] 杨迪亚,王宁利.原发性开角型青光眼新防治技术的建立及应用.首都医科大学学报,2015,36(1):1-7.
[12] KIM KN,JEOUNG JW,PARK KH,et al.Effect of lateral decubitus position on intraocular pressure in glaucoma patients with asymmetric visual field loss.Ophthalmology,2013,120(4):731-735.
[13] SAWADA A,YAMAMOTO T.Comparison of posture-induced intraocular pressure changes in medically treated and surgically treated eyes with open-angle glaucoma.Invest Ophthalmol Vis Sci,2014,55(1):446-450.
[14] HONG S,SEONG GJ,HONG YJ.Long-term intraocular pressure fluctuation and progressive visual field deterioration in patients with glaucoma and low intraocular pressures after a triple procedure.Arch Ophthalmol,2007,125(8):1010-1013.
[15] MCMONNIES CW.The significance of intraocular pressure elevation during sleep-related postures.Clin Exp Optom,2014,97(3):221-224.
[16] KAPLOWITZ K,BLIZZARD S,BLIZZARD DJ,et al.Time spent in lateral sleep position and asymmetry in glaucoma.Invest Ophthalmol Vis Sci,2015,56(6):3869-3874.
[17] HONG J,XU J,WEI A,et al.Spectral-domain optical coherence tomographic assessment of Schlemm’s canal in Chinese subjects with primary open-angle glaucoma.Ophthalmology,2013,120(4):709-715.
[18] LEE TE,YOO C,LIN SC,et al.Effect of different head positions in lateral decubitus posture on intraocular pressure in treated patients with open-angle glaucoma.Am J Ophthalmol,2015,160(5):929-936.
[19] LIU JH,SIT AJ,WEINREB RN.Variation of 24-hour intraocular pressure in healthy individuals-right eye versus left eye.Ophthalmology,2005,112(10):1670-1675.
[20] KIUCHI T,MOTOYAMA Y,OSHIKA T.Postural response of intraocular pressure and visual field damage in patients with untreated normal-tension glaucoma.J Glaucoma,2010,19(3):191-193.
[21] LIU JHK,KRIPKE DF,TWA MD,et al.Twenty-four-hour pattern of intraocular pressure in young adults with moderate to severe myopia.Invest Ophthalmol Vis Sci,2002,43(7):2351-2355.
[22] KIUCHI T,MOTOYAMA Y,OSHIKA T.Relationship of progression of visual field damage to postural changes in intraocular pressure in patients with normal- tension glaucoma.Ophthalmology,2006,113(12):2150-2155.
[23] CHAN MP,GROSSI CM,KHAWAJA AP,et al.Associations with intraocular pressure in a large cohort:results from the UK Biobank.Ophthalmology,2016,123(4):771-782.
[24] GABELT BT,KAUFMAN PL.Changes in aqueous humor dynamics with age and glaucoma.Prog Retin Eye Res,2005,24(5):612-637.
[25] APTEL F,WEINREB RN,CHIQUET C,et al.24-h monitoring devices and nyctohemeral rhythms of intraocular pressure.Prog Retin Eye Res,2016,55:108-148[2018-05-31].https://doi.org/10.1016/j.preteyeres.2016.07.002.