Multimodal neuro-ophthalmologic changes and the impact of CPAP therapy in severe obstructive sleep apnea: a prospective OCT, OCTA, and visual field study.

PURPOSE: To evaluate structural, microvascular, and functional neuro-ophthalmologic changes in severe obstructive sleep apnea syndrome (OSAS) and to investigate the effects of 6-month continuous positive airway pressure (CPAP) therapy using a multimodal approach.

METHODS

In this prospective case-control study, 38 patients with PSG-confirmed severe OSAS and 19 controls were enrolled. All participants underwent optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), and visual field (VF) testing (24-2 and 10-2). Thirty patients with adequate CPAP adherence were reassessed after 6 months. Baseline comparisons were additionally adjusted for body mass index (BMI), and false discovery rate (FDR) correction was applied for multiple comparisons.

RESULTS

Baseline neuro-ophthalmologic differences between OSAS patients and controls did not remain statistically significant after BMI adjustment and FDR correction. Following CPAP therapy, significant increases in average and inferior peripapillary retinal nerve fiber layer (RNFL) thickness were observed and remained significant after FDR correction. Significant improvements were also detected in 24-2 VF indices (VFI, MD, and PSD) and 10-2 PSD values after treatment. In contrast, OCTA-derived vascular parameters and macular thickness changes did not remain significant after correction for multiple comparisons. All polysomnographic parameters and Epworth Sleepiness Scale scores improved significantly after treatment.

CONCLUSIONS

Although baseline cross-sectional neuro-ophthalmologic differences were attenuated after BMI adjustment and multiple-comparison correction, longitudinal analyses demonstrated significant structural and functional improvement following CPAP therapy in severe OSAS. Multimodal assessment combining OCT and retinal and macular perimetry may provide a useful framework for monitoring treatment-related neuro-ophthalmologic changes in OSAS.