Effects of Different Sleeping Postures on Intraocular Pressure and Ocular Perfusion Pressure in Healthy Young Subjects

doi:10.1016/j.ophtha.2013.01.011

Ophthalmology

Volume 120, Issue 8, August 2013, Pages 1565-1570

https://doi.org/10.1016/j.ophtha.2013.01.011 Get rights and content

Objective

To investigate the effects of different sleeping positions of head and body on intraocular pressure (IOP) and ocular perfusion pressure (OPP) in healthy, young subjects.

Design

Prospective, comparative case series.

Participants

Twenty healthy young Korean subjects.

Methods

We measured IOP and blood pressure (BP) with the subjects seated and recumbent, including supine, right lateral decubitus, left lateral decubitus, prone with right head turn, and prone with left head turn positions. We measured IOP using an Icare tonometer in both eyes 5 minutes after assuming each position in a randomized sequence. We calculated the OPP using the formulas based on the mean BP adjusted for the height of the eye over the heart. The eye on the lower side in the lateral decubitus or prone with head turn position was termed the dependent eye.

Main Outcome Measures

Difference in IOP and OPP of the dependent and nondependent eyes during changes of sleeping positions of body and head.

Results

Mean IOP of right and left eyes while sitting was significantly lower than that measured in each recumbent position (all P<0.001). The OPPs in both eyes were significantly higher in all recumbent positions than in a sitting position (all P<0.001). Mean IOP of the dependent eyes was higher than that of the nondependent eyes in the lateral decubitus positions and in the prone positions with head turns (all P<0.001). No significant intereye difference in OPP was found for any position. Among IOPs measured in the recumbent positions, mean IOP of the dependent eye in the lateral decubitus position or in the prone position with head turn was significantly higher than that of the ipsilateral eye in the supine position (all P<0.0001).

Conclusions

All sleeping positions of head and body resulted in an elevation of IOP and an increase in the calculated OPP compared with the sitting position in healthy, young subjects. The postural change from supine to lateral decubitus or prone with head turn position increased the IOP of the dependent eyes without significant alteration in OPP in healthy awake subjects. Further research is needed under nocturnal conditions in a sleep laboratory.

Financial Disclosures

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Materials and Methods

This is a prospective, observational study. Ethical approval was obtained from the institutional review board of the Korea University Ansan Hospital. The study was conducted in adherence to the tenets of the World Medical Association's Declaration of Helsinki. Written, informed consent was obtained from each subject before participating in the study. We recruited healthy Korean adult volunteers <40 years old. Each participant underwent a general physical checkup within 1 year, demonstrating the

Results

Eleven subjects were male and 9 were female, with a mean age of 27.8±1.74 years. Refractive errors (mean values ± standard deviations of spherical equivalent: right eye, −4.14±2.43 diopters, left eye, −3.88±2.30 diopters; P = 0.112), mean IOPs measured by Goldmann applanation tonometer (right eye, 14.1±1.1 mmHg, left eye, 13.9±1.1 mmHg; P = 0.102), and mean axial lengths (right eye, 25.02±1.11 mm, left eye, 24.90±1.20 mm; P = 0.131) did not differ between fellow eyes of the subjects.

Table 1

Discussion

This study confirmed the earlier observations that IOP increases with postural changes from sitting to recumbent positions, which include the supine, lateral decubitus, or prone positions.7, 8, 9, 10, 11, 12, 13, 16, 17, 18, 19, 20, 21 Previous studies have regarded the supine position as the standard habitual recumbent posture and have focused on IOPs measured in the supine position to investigate the nocturnal IOP alterations in glaucoma.9, 10, 11 However, other postures (lateral or prone)

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However, the uveoscleral outflow is reduced during the nighttime, so that nocturnal IOP usually is elevated. The sleeping position also increases the episcleral venous pressure, which is also a major cause of nocturnal IOP increase.16-18 The present data are consistent with previous reports that exhibited elevated nocturnal IOP in both healthy and glaucomatous eyes.
To investigate 24-hour nyctohemeral intraocular pressure (IOP)-related patterns with contact lens sensors (CLSs) in eyes with primary open-angle glaucoma (POAG) with normal baseline IOP (i.e., normal-tension glaucoma [NTG]) and healthy controls.
Prospective, case-control study.
Thirty eyes of 30 patients with NTG, who had had a wash-out period for their IOP-lowering treatment, and 20 eyes of 20 healthy volunteer subjects.
Patients and subjects were hospitalized for the purposes of 24-hour CLS (SENSIMED Triggerfish; Sensimed AG, Lausanne, Switzerland) measurement. The IOP-related patterns during wake and sleep times over the course of the 24 hours were compared between the 2 groups. The 24-hour ambulatory blood pressure and posture were monitored simultaneously. A generalized linear model was used to find the factors associated with NTG.
The IOP-related patterns, including mean and standard deviation (SD) of measurements, amplitude of cosine-fit curve, acrophase (signal peak), and bathyphase (signal trough) values (millivolt equivalents [mVEq]).
The SDs of the 24-hour CLS measurements were significantly greater in NTG eyes than in healthy controls (112.51±26.90 vs. 85.18±29.61 mVEq, P = 0.002). The amplitudes of cosine-fit curve (141.88±39.96 vs. 106.08±41.49 mVEq, P = 0.004) and acrophase values (277.74±129.80 vs. 190.58±127.88 mVEq, P = 0.024), mostly measured during nocturnal period, were significantly greater in NTG eyes than in healthy controls. The NTG subjects slept longer in the lateral decubitus posture than the healthy controls (199.1±137.8 vs. 113.2±86.2 minutes, P = 0.009). In the multivariable generalized linear model, the greater amplitude of cosine-fit curve (β = 0.218, P = 0.012) and greater time of decubitus posture during sleep (β = 0.180, P = 0.004) were found to be significantly associated with NTG.
Continuous monitoring of 24-hour IOP-related values with CLS can be useful for assessment of glaucoma risk, especially for patients with NTG whose IOP appears to be in the normal range. Fluctuation of 24-hour IOP-related values and posture during sleep time might be associated with NTG.
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Second, as the study was conducted in the daytime, the findings may not reflect accurately important features of the physiological and environmental sleeping status of our participants. Third, we did not assess the posture-induced changes in ocular perfusion14 and cerebrospinal fluid pressure,42 which may play a compensatory role in IOP variation. Fourth, we did not make comparisons between NTG and POAG.
To investigate localization in glaucomatous visual field defects that are vulnerable to posture-induced intraocular pressure (IOP) changes.
Prospective cross-sectional study.
Ninety-three eyes of 93 newly diagnosed cases with normal tension glaucoma were examined. The IOP was measured in both the sitting and lateral decubitus positions with an Icare rebound tonometer. Visual field tests were performed with a Humphrey Field Analyzer with the Central 30-2 program using Swedish Interactive Threshold Algorithm standard strategies. The total deviation (TD) map values of 51 tested points were used for the analysis. A regression analysis was conducted to investigate relationships between TD in each point or cluster and posture-induced IOP changes. A linear mixed-effects model was used to identify factors associated with TD changes in each visual field cluster. Main outcome measures included the relationship between posture-induced IOP changes and localization of visual field defects.
There were 54 women and 39 men (mean age, 53.4 ± 12.5 years). The mean IOP per Icare rebound tonometer was 15.5 ± 3.2 mm Hg in the sitting position and 18.8 ± 3.1 mm Hg in the lateral decubitus position. The postural IOP difference was 3.3 ± 1.8 mm Hg (P < .001; range, −1.0 to 7.7 mm Hg). There was a significant negative correlation between TD and posture-induced IOP changes in 4 contiguous central points located just above the horizontal meridian. A linear mixed-effects model revealed a significant association between the difference in postural IOP change and decreased TD in the superior paracentral visual field according to multivariate analysis (P = .010).
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: Manuscript no. 2012-1489.

: Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

: Supported by a grant K1131751 from Korea University, Seoul, Korea. The funding organization had no role in the design or conduct of this research.

View full text

Original articleEffects of Different Sleeping Postures on Intraocular Pressure and Ocular Perfusion Pressure in Healthy Young Subjects

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosures

Section snippets

Materials and Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial

Arch Ophthalmol

The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma

Arch Ophthalmol

Factors for glaucoma progression and the effect of treatment: the Early Manifest Glaucoma Trial

Arch Ophthalmol

Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma

J Glaucoma

Intraocular pressure fluctuation: an independent risk factor for glaucoma?

Arch Ophthalmol

Intraocular pressure fluctuation: a risk factor for visual field progression at low intraocular pressures in the Advanced Glaucoma Intervention Study

Ophthalmology

Circadian rhythm of intraocular pressure

J Glaucoma

Nocturnal elevation of intraocular pressure in young adults

Invest Ophthalmol Vis Sci

Postural change of IOP in normal persons and in patients with primary wide open-angle glaucoma and low-tension glaucoma

Br J Ophthalmol

Twenty-four-hour intraocular pressure pattern associated with early glaucomatous changes

Invest Ophthalmol Vis Sci

Postural response of intraocular pressure and visual field damage in patients with untreated normal-tension glaucoma

J Glaucoma

Sleep positions and position shifts in five age groups: an ontogenetic picture

Sleep

Body position changes and periodic movements in sleep

Sleep

Effects of prone and reverse Trendelenburg positioning on ocular parameters

Anesthesiology

Original article
Effects of Different Sleeping Postures on Intraocular Pressure and Ocular Perfusion Pressure in Healthy Young Subjects