title: Intrinsically photosensitive retinal ganglion cell activity is associated with decreased sleep quality in patients with glaucoma.
abstract: OBJECTIVE
  To use the pupillary light reflex and polysomnography to evaluate the function of intrinsically photosensitive retinal ganglion cells (ipRGCs) and to correlate this function with structural damage in glaucoma.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A study was conducted on both eyes of 45 participants (32 patients with glaucoma and 13 healthy subjects).
  
  
  METHODS
  For the pupillary reflex evaluation, patients were tested in the dark using a Ganzfeld system (RETIport; Roland Consult, Brandenburg, Germany); pupil diameter was measured with an eye tracker system. To preferentially stimulate ipRGCs, we used a 1-second 470-nm flash with a luminance of 250 cd/m(2). To stimulate different retinal photoreceptors, we used a 1-second 640-nm flash with a luminance of 250 cd/m(2). All of the subjects underwent polysomnography. Subjects underwent standard automated perimetry and optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec Inc, Dublin, CA).
  
  
  METHODS
  Correlations between ipRGC activity, as measured by the pupillary light reflex, and polysomnography parameters, and correlations between retinal nerve fiber layer (RNFL) thickness and the pupillary light reflex and polysomnography parameters.
  
  
  RESULTS
  The mean patient ages in the healthy and glaucoma groups were 56.8±7.8 years and 61.5±11.6 years, respectively (P = 0.174). Patients with glaucoma had significantly lower average total sleep time, sleep efficiency, and minimum oxyhemoglobin saturation compared with the healthy subjects (P  = 0.008, P = 0.002, and P = 0.028, respectively). Patients with glaucoma had significantly higher arousal durations after falling asleep and more periodic limb movements (P = 0.002 and P = 0.045, respectively). There was an inverse correlation between the rapid eye movement latency and the peak of the pupillary response to the blue flash (P = 0.004). The total arousals were inversely correlated with the sustained blue flash response (P = 0.029). The RNFL thickness was associated with the peak and sustained responses to the blue flash (P  <  0.001 for both comparisons); however, RNFL thickness was only associated with the mean oxygen desaturation index among the polysomnography parameters (P = 0.023).
  
  
  CONCLUSIONS
  This study demonstrated that decreased ipRGC function caused by glaucoma affected pupillary response and sleep quality.
authors: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil. Electronic address: carolepm@gmail.com.
authors: Carolina P B
authors: CP
authors: Gracitelli
authors: Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, Brazil.
authors: Gloria Liliana
authors: GL
authors: Duque-Chica
authors: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil.
authors: Marina
authors: M
authors: Roizenblatt
authors: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil; Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, Brazil.
authors: Ana Laura de Araújo
authors: AL
authors: Moura
authors: Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, Brazil.
authors: Balazs V
authors: BV
authors: Nagy
authors: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil.
authors: Geraldine
authors: G
authors: Ragot de Melo
authors: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil.
authors: Paula Delegrego
authors: PD
authors: Borba
authors: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil.
authors: Sérgio H
authors: SH
authors: Teixeira
authors: Sleep Medicine Division, Psychobiology Department, Federal University of São Paulo, São Paulo, Brazil.
authors: Sergio
authors: S
authors: Tufik
authors: Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, Brazil.
authors: Dora Fix
authors: DF
authors: Ventura
authors: Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil.
authors: Augusto
authors: A
authors: Paranhos
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D008027:Light; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D010775:Photic Stimulation; D017286:Polysomnography; D012025:Reflex, Pupillary / Q000502:physiology; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000503:physiopathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents