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    Something we may be missing

    Ophthalmic referrals for sleep apnea patients may be vital


    Case referrals

    I miss Dave, and feel badly that I or someone else didn’t pick up on what was happening much earlier in the progression of his sleep apnea. He did have some extra pounds on board, but a lot of us men physicians lead fairly sedentary lives in our exam rooms and operating rooms and I never thought of him as particularly obese. And a lot of folks with sleep apnea are not obese.

    But what occurs to me is that, considering this is a disease that apparently afflicts 1 in 4 men, there are very few patients who I end up referring for workup of possible sleep apnea. I am probably missing a fair number of patients with this problem, because I am not routinely thinking about it unless a patient presents to me with floppy eyelid syndrome or keratoconus.

    Ophthalmologists seeing 40 patients per day should expect to see a handful of already diagnosed patients or refer that number each day for evaluation. If not, we’re probably blissfully ignorant of the problem in many of our patients.


    McNab AA. The eye and sleep apnea. Sleep Med Rev. 2007;11:269-276.
    Saidel MA et al. Prevalence of sleep apnea syndrome and high-risk characteristics among keratoconus patients. Cornea. 2012;31:600-603.

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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      If you quiz people with spontaneous subconjunctival hemorrhages you often find symptoms of snoring and sleep apnea. Also, should consider floppy eyelid syndrome and keratoconus as associated with sleep apnea, and not necessarily a cause and effect.


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