Unrecognized severe obstructive sleep apnea as a dominant risk factor for non-arteritic anterior ischemic optic neuropathy in an apparently healthy patient

Katarina Katanić Pasovski; Martin  Popević; Viktor  Pasovski; Sanja  Petrović Pajić; Kristina  Iklozan; Nemanja  Rančić; Mirko  Resan; Ranko  Raičević

doi:10.2298/VSP241219028K

Katarina Katanić Pasovski Military Medical Academy, Clinic for Ophthalmology, Belgrade, Serbia
Martin Popević University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Viktor Pasovski Military Medical Academy, Clinic for Neurology, Belgrade, Serbia
Sanja Petrović Pajić Clinic for Eye Diseases, University Clinical Center of Serbia, Belgrade, Serbia
Kristina Iklozan Military Medical Academy, Clinic for Neurology, Belgrade, Serbia
Nemanja Rančić Military Medical Academy, Center for Clinical Pharmacology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Mirko Resan Military Medical Academy, Clinic for Ophthalmology, Belgrade, Serbia; ¶University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ranko Raičević Military Medical Academy, Clinic for Neurology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP241219028K

Ključne reči: dijagnoza;, neuropatija, optička, ishemička;, faktori rizika;, apneja u snu, opstruktivna

Sažetak

Uvod. Nearteritična prednja ishemijska optička neuropatija (non-arteritic anterior ischemic optic neuropathy – NAION) obično se manifestuje iznenadnim, bezbolnim gubitkom vida na jednom oku, često odmah po buđenju. Gubitak vida ostaje prilično stabilan tokom vremena, ali može biti praćen sličnim manifestacijama na drugom oku. Jedan od glavnih uzroka NAION-a je poremećena hemodinamska regulacija, praćena hipoperfuzijom prednjeg dela optičkog nerva. Prepoznati faktori rizika su arterijska hipertenzija, hiperlipidemija, dijabetes melitus, pušenje, itd. Prikaz bolesnika. Prikazan je 43-godišnji muškarac sa iznenadnim, bezbolnim gubitkom vida na desnom oku i tipičnim simptomima i znacima NAION-a. Pregled oftalmologa, praćen fluoresceinskom angiografijom i ispitivanjem vidnog polja, potvrdili su dijagnozu, dok u anamnezi nije otkriven nijedan od standardnih faktora rizika. Tokom hospitalizacije, medicinsko osoblje je primetilo da bolesnik hrče, budi se tokom noći sa osećajem nedostatka vazduha i da pokazuje dnevnu pospanost, što su kasnije članovi porodice potvrdili kao simptome prisutne već nekoliko meseci. Bolesnik je upućen specijalisti za poremećaje spavanja, koji je nakon dijagnostike konstatovao tešku nelečenu opstruktivnu apneju u snu (obstructive sleep apnea – OSA) i indikovao lečenje aparatom za kontinuirani pozitivni vazdušni pritisak (continuous positive air pressure – CPAP). Bolesnik je dobro reagovao na lečenje, pokazujući subjektivno i objektivno poboljšanje u dužini i kvalitetu sna. Nije zabeležena progresija NAION-a desnog oka ili oštećenja vida na levom oku posle 6 meseci od dijagnoze i uvođenja CPAP-a. Zaključak. Glavni i osnovni uzrok NAION-a kod prikazanog bolesnika je najverovatnije bila OSA. Ukazujemo na to da utvrđivanje OSA-e kod bolesnika sa visokim rizikom može doprineti ranoj dijagnozi i prevenciji NAION-a.

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Neotkrivena teška opstruktivna apneja u snu kao dominantan faktor rizika od nearteritične prednje ishemijske optičke neuropatije kod naizgled zdravog bolesnika

Sažetak

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