Prevalence of papilloedema in patients with sleep apnoea syndrome: a prospective study LAURE PETER 1 , MAUD JACOB 2 , PIERRE KROLAK-SALMON 1 , THIERRY PETITJEAN 3 , HE ´ LE ` NE BASTUJI 4 , JEAN-DANIEL GRANGE 2 and A L L A I N VIGHETTO 1 1 Service de Neurologie D, Hoˆ pital Neurologique; 2 Service dÕOphtalmologie, Hoˆ pital de la Croix Rousse; 3 Laboratoire des troubles respiratoires lie´ s au sommeil, Hoˆpital de la Croix-Rousse and 4 Unite´ dÕhypnologie, Service de Neurologie Fonctionnelle, Hoˆpital Neurologique, Lyon, France Accepted in revised form 2 May 2007; received 6 October 2006 SUMMARY The association of papilloedema (PO) with respiratory diseases and especially obstructive sleep apnoea (OSA) syndrome has been emphasised in many reports. The pathophysiology could rely on the episodic increase of intracranial pressure related to apnoeic episodes during night sleep. Nevertheless, prevalence of papilloedema in patient with OSA syndrome remains unknown. As this information could improve diagnosis and therapeutic strategies, the aim of the present study was to investigate the prevalence of PO in an OSA syndrome population. From 95 successive, recently diagnosed OSA patients, 35 answered a questionnaire about visual symptoms and underwent fundoscopic examination. Visual symptoms suggestive of PO were present in 40% of the patients, but none had PO. As a conclusion, PO does not seem to be frequently associated with OSA syndrome and systematic screening of PO in these patients does not seem to be warranted. Nevertheless, patients with visual complaints evocative of papilloedema should have their eye fundus checked since the association between OSA and PO exists. Further studies, including more patients, might be useful to establish which patients are at particular risk for this complication. keywords idiopathic intracranial hypertension, papilloedema, sleep apnoea INTRODUCTION Obstructive sleep apnoea (OSA) syndrome-associated disor- ders of the eye are more and more widely recognized. For instance, glaucoma and non-arteritic anterior ischaemic optic neuropathy seem to be associated with OSA syndrome (Mojon et al., 1999; Mojon et al., 2002; Onen et al., 2000). Some case reports and small series of patients with bilateral papilloedema (PO) and sleep apnoea have been published (Bloomfield et al., 1987; Bucci and Krohel, 1988; Jennum and Borgesen, 1989, Doyle and Tami, 1991, Purvin et al., 2000). The pathophys- iology has been supposed to rely on the episodic increase of intracranial pressure, related to apnoeic episodes during night sleep (Sugita et al., 1985; Lee, 2001). Generally, PO can occur as an isolated symptom or associated with headache and tinnitus in idiopathic intracranial hypertension (IIH), which can reveal an OSA syndrome. Prevalence of sleep apnoea syndrome among IIH has been investigated in retrospective studies; some authors have found obstructive respiratory events in 20–30% (Lee et al., 2002) and others in 24% (Marcus et al., 2001) of the patients suffering from IIH. Conversely, epidemiologic data are missing to appreciate, if PO in OSA syndrome is an anecdotal feature, or if it corresponds to a frequent under diagnosed disease. As this information could improve diagnosis and therapeutic strat- egies, the aim of this present study was to investigate the PO prevalence in an OSA syndrome population. This prospective study was performed, on recently diagnosed OSA patients by means of questionnaires on visual symptoms and a morning fundoscopic examination. METHODS The prospective study has been carried out at the Hoˆ pital de la Croix Rousse and the Hoˆ pital Neurologique, in Lyon, France, from January 2004 to April 2005. Correspondence: L. Peter, Service de Neurologie D (Pr VIGHETTO), Hoˆpital Neurologique, 59 Boulevard PINEL, 69394 Lyon, France. Tel.: 0033 4 72 11 80 71; fax: 0033 4 72 35 73 51; e-mail: laure.peter@wanadoo.fr J. Sleep Res. (2007) 16, 313–318 Ó 2007 European Sleep Research Society 313