温州青光眼进展研究报告之四:睡眠体位与其青光眼视神经损害及其进展的关系  

No.4 report of Wenzhou Glaucoma Progression Study:association between sleeping position and glaucomatous optic nerve damage and its progression

作　　者：潘霞飞 林仲 江俊宏 左菁菁 周堃 冯克谜 胡海双 陈洁[4] 梁远波 PAN Xiafei;LIN Zhong;JIANG Junhong;ZUO Jingjing;ZHOU Kun;FENG Kemi;HU Haishuang;CHEN Jie;LIANG Yuanbo(Department of Ophthalmology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120;Department of Glaucoma,School of Ophthalmology and Optometry,Eye Hospital,Wenzhou Medical University,Wenzhou Zhejiang 325027;Institute of glaucoma,Wenzhou Medical University,Wenzhou Zhejiang 325027;Department of Low Vision,School of Ophthalmology and Optometry,Eye Hospital,Wenzhou Medical University,Wenzhou Zhejiang 325027,China)

机构地区：[1]中山大学孙逸仙纪念医院眼科,广州510120 [2]温州医科大学附属眼视光医院青光眼科,浙江温州325027 [3]温州医科大学青光眼研究所,浙江温州325027 [4]温州医科大学附属眼视光医院低视力科,浙江温州325027

出　　处：《眼科学报》2021年第6期457-464,共8页Eye Science

基　　金：浙江省卫生高层次创新人才计划(2016025);温州医科大学附属眼视光医院院内创新课题(YNCX201308)。

摘　　要：目的:探讨正常眼压性青光眼(normal tension glaucoma,NTG)患者睡眠体位与其双眼不对称损害的关系。方法:纳入2014年1月至2018年9月在温州青光眼进展研究(Wenzhou Glaucoma Progression Study,WGPS)项目中的NTG患者。眼部主要检查有视野和光学相干断层扫描(optical coherence tomography,OCT)。睡眠体位数据通过基线睡眠体位问卷获得。根据侧卧位睡眠偏好,将NTG患者眼部参数分为卧位高侧眼和卧位低侧眼进行讨论;根据双眼不对称损害,将患者眼部参数分为较好眼和较差眼讨论。双眼不对称损害定义为双眼视野平均偏差(mean deviation,MD)差值>6 dB或杯盘比差值>0.2。结果:共纳入158例NTG患者,最长随访时间为48个月,其中122例(77.22%)患者存在睡眠偏好;存在睡眠偏好的患者中,83例(68.03%)患者存在侧卧位偏好;存在侧卧位偏好的患者中,大多数患者偏好右侧卧位[右vs左:59(71.1%)vs 24(28.9%),P<0.001]。对存在侧卧位偏好的患者进行分析,发现卧位高侧眼与卧位低侧眼眼部参数之间,差异无统计学意义(P>0.05);卧位低侧眼的视野进展速率[视野指数(visual field index,VFI)、MD]慢于卧位高侧眼(0.48%±1.66%/年vs−0.45%±3.07%/年;0.54±0.96 dB/年vs 0.2±1.15 dB/年),差异无统计学意义(P=0.086,P=0.308)。对同时存在侧卧位偏好及双眼不对称损害的患者进行分析,发现卧位高侧眼与卧位低侧眼的眼部参数之间,差异无统计学意义(P>0.05);卧位低侧较好眼的个数及占比高于卧位低侧较坏眼[23(57.5%)vs 17(42.5%)],但差异无统计学意义(P=0.132);卧位低侧眼的视野进展速率(VFI、MD)也慢于卧位高侧眼(1.19%±1.65%/年vs−0.86%±3.65%/年;0.71±1.13 dB/年vs 0.13 dB/年),但差异无统计学意义(P=0.064,P=0.419)。结论:存在睡眠体位偏好的NTG患者中,约68%存在侧卧位偏好;存在侧卧位偏好的患者中,约70%偏好右侧卧位。但本研究并未发现睡眠体位与青光眼患者双眼不对称损害�Objective: To investigate the association between lateral decubitus position (LDP) and asymmetric loss in normal tension glaucoma (NTG) patients. Methods: NTG patients were enrolled from Wenzhou Glaucoma Progression Study (WGPS) in Jan. 2014 to Sep. 2018. The main eye examinations included visual field test and optical coherence tomography (OCT). A questionnaire to determine the preferred sleeping position was administered to each patient in the baseline. According to the LDP, the eye parameters were divided into non-dependent eyes (higher lateral eyes) and dependent eyes (lower lateral position eyes) for discussion. According to the asymmetric damage, the ocular parameters of the patients were divided into the better eyes and the worse eyes for analysis. Asymmetric loss was defined as a difference in mean deviation (MD) between the 2 eyes of at least 6 dB or disc/ cup >0.2. Results: One hundred and twenty-two patients (77.22%) had sleep preferences among the 158 NTG patients who was finally recruited and the longest follow up time was 48 months. Among the patients with sleep preference, 83 patients (68.03%) preferred the lateral decubitus position. Patients who had the lateral decubitus position mostly preferred the right lateral position [59 (71.1%) vs 24 (28.9%), P<0.001]. For patients who had the lateral decubitus position, the ocular parameters between the dependent eyes and the non-dependent eyes had no statistical difference(P>0.05);the rate of visual field progression in the dependent eyes was slower than that in non-dependent eyes, but there was no statistical difference between the two groups (0.48%±1.66%/year vs −0.45%±3.07%/year;0.54±0.96 dB/year vs 0.2±1.15 dB/year;P=0.086, P=0.308, respectively). For patients who had the lateral decubitus position and asymmetric damage, the ocular parameters between the dependent eyes and the non-dependent eyes had also no statistical difference (P>0.05);the number and ratio of the dependent-better eye and the dependent-worse eye were 48 and 41, respectively [

关 键 词：正常眼压性青光眼 睡眠体位 不对称视野损害 

分 类 号：R775[医药卫生—眼科]