[Retinal vein occlusion and obstructive sleep apnea syndrome]

Obstructive sleep apnea syndrome (OSAS) is a very common disease and has recently been increasingly incriminated in the initiation and progression of numerous cardiovascular, neurologic, and ophthalmologic diseases. In ophthalmologic practice, it may be related to glaucoma, nonarteritic anterior ischemic optic neuropathy, visual field defects, papilledema, central serous chorioretinopathy, and floppy eyelid syndrome. Because of personal observations, we investigated its link with retinal vein occlusion (RVO).

We report the observations on three patients who presented with retinal vein occlusion and who were investigated positively for OSAS, including patients with no conventional vascular risk factors.

The local and systemic effects of OSAS could explain, in some patients, the occurrence and/or the aggravation of RVO. The first-stage effects of OSAS are nocturnal hypoxemia, hypercapnia, intrathoracic pressure changes, arousals, and sleep fragmentation. RVO could be a consequence of a slow-down of blood flow circulation secondary to hypoxemia and elevated nocturnal intracranial pressure. The arousals cause an additional acute increase in arterial blood pressure. Ancillary effects include increased platelet aggregability, increased sympathic activation, oxidative stress, vascular endothelial dysfunction, inflammation, and metabolic dysregulation.

This short series for the first time reports RVO patients presenting with OSAS. This suggests that OSAS, by acting on retinal microcirculation, could be an additional risk factor for the occurrence or the aggravation of RVO. Further studies are needed to confirm this possible relationship.