Sleep Apnea Increases AMD Risk

Not getting a consistent amount of sleep could mean you have a sleep disorder. Obstructive sleep apnea is one of the most prevalent sleep disorders to date. In North America alone, 15 to 30 percent of males are diagnosed and 10 to 15 percent of females. There are a variety of causes that contribute to sleep apnea with obesity, smoking and family history being the top three. 

Recently, researchers have found a connection between sleep apnea and age-related macular degeneration (AMD). As sleep apnea is a widely undiagnosed and untreated condition, many people may be at risk for developing AMD. 

Recognize the Signs

Understanding the signs of sleep apnea and macular degeneration may help you self-diagnose and get treated sooner than later. 

Sleep apnea is described by the Mayo Clinic as, 

“Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.”

Signs and symptoms of obstructive sleep apnea (OSA) include:

• Excessive daytime sleepiness
• Loud snoring
• Observed episodes of stopped breathing during sleep
• Abrupt awakenings accompanied by gasping or choking
• Awakening with a dry mouth or sore throat
• Morning headache
• Difficulty concentrating during the day
• Experiencing mood changes, such as depression or irritability
• High blood pressure
• Nighttime sweating
• Decreased libido

The Mayo Clinic recommends seeing a doctor about sleep apnea if you experience:

• Snoring loud enough to disturb your sleep or that of others
• Waking up gasping or choking
• Intermittent pauses in your breathing during sleep
• Excessive daytime drowsiness, which may cause you to fall asleep while you’re working, watching television or even driving a vehicle

When it comes to macular degeneration, it is a slow progression with patients reporting a steady loss of healthy vision. 

According to Healthline, the symptoms of AMD are:

Dry Form (affects 85-90% of people with AMD). Dry macular degeneration is the development of small yellow deposits called ‘drusen’ on the macula. 

• A reduction in central vision
• A distortion of straight lines in your field of vision
• The need for brighter lighting
• Difficulty adapting to low lights
• Blurriness
• Trouble recognizing faces
• Retinal damage

Wet form (affects 10-15% of people with AMD). Wet macular degeneration is the development of abnormal blood vessels that develop and leak on and into the retina and macula. 

• A blurry spot in your field of vision
• A dark spot in the center of your vision due to blood vessels bleeding or leaking fluid
• Hazy vision
• Rapidly worsening symptoms

These combined symptoms of sleep apnea and macular degeneration should be a distinct warning sign for you to visit your doctor. If treatment for both conditions can be addressed early there could be a prevention or slowing of future vision compromises. 

8 Year Research

Time is of the essence when it comes to researching the human body. Many health conditions linger under the radar for many years until one day you wake up and are surprised by a sudden onset of symptoms. On the other hand, it can be a ‘slow burn’ for some who deal with stagnant, barely noticeable signs of annoying health compromises until a diagnosis is determined and the damage has already been done. 

Recently, researchers from Australia unveiled results of an 8 year follow-up study of the connection between sleep apnea and macular degeneration. In addition, glaucoma was also found to be a risk associated with sleep apnea.

The study which was published in BMC Medicine on May 11th, 2021 describes the method and conclusion process:

Method: Middle-aged and older participants from the longitudinal United Kingdom (UK) Biobank (n = 502,505) and the Canadian Longitudinal Study on Aging (CLSA; n = 24,073) were included in this analysis. Participants in the UK Biobank and the CLSA were followed for 8 and 3 years, respectively. Participants with diagnosed glaucoma or AMD at baseline were excluded from the analysis. In the UK Biobank, sleep apnea and incident cases of glaucoma and AMD were identified through hospital inpatient admission, primary care records, and self-reported data.

Conclusion: In two large-scale prospective cohort studies, sleep apnea is associated with a higher risk of both glaucoma and AMD. These findings indicate that patients with sleep apnea might benefit from regular ophthalmologic examinations.

Past Research

In addition to this research study there have been several others that have shown the OSA/AMD link. Two studies cited in Eye, The Scientific Journal of The Royal College of Ophthalmologists look at OSA and anti-VEGF injections and those treated with intravitreal bevacizumab a targeted medication injection that slows AMD symptoms. 

The first study stated,

“Risk for OSA increased significantly with increasing number of injections [Anti-vascular endothelial growth factor injections]. In common with all the other studies discussed, cause and effect cannot be proven, but the importance of asking about OSA symptoms is highlighted.”

The second study stated,

“The treated OSA group achieved statistically significant better visual acuity…It is hypothesis generating and raises questions about identifying and treating OSA earlier in patients with exudative AMD to potentially yield better functional outcomes.”

These studies show the importance of testing for OSA before AMD treatment.

Treat Sleep Apnea and Prevent Macular Degeneration

Overall it is best to immediately treat OSA to avoid ocular stress which has been shown in these and many other studies to be a risk factor for AMD. 

These are some tips on how to treat OSA:

• Maintain healthy weight
• Exercise everyday, especially try yoga
• Avoid sleeping on your back
• Use a humidifier
• Avoid alcohol
• Avoid smoking
• Try anti-snoring tools like a C-PAP machine; mandibular advancement devices; or tongue stabilizing devices

Sleep is essential and when you are constantly struggling to breathe while you are sleeping, over years, you can be setting yourself up for a big health compromise. Now it looks like macula degeneration is on that list of health compromises along with cardiovascular risk, cognitive decline and weight gain. Talk to your doctor about some medical options and stay on top of your health by adapting some healthy lifestyle changes and protecting your vision at the same time.

Sources:

https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-01973-y

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944625/

https://www.healthline.com/health/home-remedies-for-sleep-apnea#outlook