Occurrence of nocturnal hypotension in nonarteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis_Chinese Journal of Ocular Fundus Diseases

Authors：

Wang Yongping , Fu Junxia , Zhou Huanfen , Song Honglu , Yang Mo ,  Wei Shihui

Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China;

Corresponding author：

Wei Shihui, Email: weishihui706@hotmail.com

Keywords：

Optic neuropathy, ischemic; Hypotension; Meta-analysis

DOI：

10.3760/cma.j.cn511434-20210819-00448

Video：

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Objective To evaluate the occurrence of nocturnal hypotension (NHP) in nonarteritic anterior ischemic optic neuropathy (NAION). Methods A evidence-based medicine study. Chinese and English as search terms for NAION and NHP was used to search literature in PubMed of National Library of Medicine, Embase, Web of science, Cochrane Library, Clinical Trials, Wanfang, and China National Knowledge Infrastructure and China Biology Medicine disc. Incomplete or irrelevant literature and review literature were excluded. The literature was meta-analyzed using Review Manager 5.4 and STATA 15.0. The 95% confidence interval (CI) were selected as the estimated value of effect size, the occurrence of NHP in NAION was calculated, and sensitivity analysis and publication bias analysis were also performed to assess the robustness of pooled outcomes. Results According to the search strategy, 159 articles were initially retrieved, and 8 articles were finally included for meta-analysis, three prospective studies and five retrospective studies. The occurrence of NHP in NAION was 43% (95%CI, 0.36-0.50). Sensitivity analyses confirmed that the evidence was robust. Subgroup analyses showed that the occurrence of NHP in NAION nearly the same in White patients (47%, 95%CI 0.39-0.55) and Chinese patients (41%, 95%CI 0.32-0.51). The occurrence of NHP in NAION was higher in using night mean artery pressure (45%, 95%CI 0.31-0.60) as the diagnostic criteria than using night systolic blood pressure & night diastolic blood pressure (40%, 95%CI 0.32-0.50). Conclusions The occurrence of NHP in NAION was 43%; the occurrence was similar in patients of different ethnicities. The diagnosis rate could be improved by using nMAP ＜ 70 mm Hg (1 mm Hg=0.133 kPa) as a diagnostic criterion for NHP. Careful intervention should be taken for the blood pressure of patients with NAION and NHP.

Citation： Wang Yongping, Fu Junxia, Zhou Huanfen, Song Honglu, Yang Mo, Wei Shihui. Occurrence of nocturnal hypotension in nonarteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis. Chinese Journal of Ocular Fundus Diseases, 2021, 37(10): 795-802. doi: 10.3760/cma.j.cn511434-20210819-00448 Copy

1.	Levin LA, Danesh-Meyer HV. Hypothesis: a venous etiology for nonarteritic anterior ischemic optic neuropathy[J]. Arch Ophthalmol, 2008, 126(11): 1582-1585. DOI: 10.1001/archopht.126.11.1582.
2.	Hayreh SS. Blood supply of the optic nerve head[J]. Ophthalmologica, 1996, 210(5): 285-295. DOI: 10.1159/000310727.
3.	Hayreh SS. Ischemic optic neuropathy[J]. Prog Retin Eye Res, 2009, 28(1): 34-62. DOI: 10.1016/j.preteyeres.2008.11.002.
4.	Hayreh SS, Joos KM, Podhajsky PA, et al. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy[J]. Am J Ophthalmol, 1994, 118(6): 766-780. DOI: 10.1016/s0002-9394(14)72557-7.
5.	Palombi K, Renard E, Levy P, et al. Non-arteritic anterior ischaemic optic neuropathy is nearly systematically associated with obstructive sleep apnoea[J]. Br J Ophthalmol, 2006, 90(7): 879-882. DOI: 10.1136/bjo.2005.087452.
6.	Hayreh SS. Pathogenesis of nonarteritic anterior ischemic optic neuropathy[J]. Arch Ophthalmol, 2009, 127(8): 1082-1083. DOI: 10.1001/archophthalmol.2009.199.
7.	Bernstein SL, Johnson MA, Miller NR. Nonarteritic anterior ischemic optic neuropathy (NAION) and its experimental models[J]. Prog Retin Eye Res, 2011, 30(3): 167-187. DOI: 10.1016/j.preteyeres.2011.02.003.
8.	Miller NR. Current concepts in the diagnosis, pathogenesis, and management of nonarteritic anterior ischemic optic neuropathy[J/OL]. J Neuroophthalmol, 2011, 31(2): e1-e3[2011-06-30]. https://pubmed.ncbi.nlm.nih.gov/21593625/. DOI: 10.1097/WNO.0b013e31821f955c.
9.	Jacobson DM, Vierkant RA, Belongia EA. Nonarteritic anterior ischemic optic neuropathy. A case-control study of potential risk factors[J]. Arch Ophthalmol, 1997, 115(11): 1403. DOI: 10.1001/archopht.1997.01100160573008.
10.	Arnold AC. Pathogenesis of nonarteritic anterior ischemic optic neuropathy[J]. J Neuroophthalmol, 2003, 23(2): 157-163. DOI: 10.1097/00041327-200306000-00012.
11.	Preechawat P, Bruce BB, Newman NJ, et al. Anterior ischemic optic neuropathy in patients younger than 50 years[J]. Am J Ophthalmol, 2007, 144(6): 953-960. DOI: 10.1016/j.ajo.2007.07.031.
12.	Hayreh SS. Ischemic optic neuropathies-where are we now?[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(8): 1873-1884. DOI: 10.1007/s00417-013-2399-z.
13.	Hayreh SS, Zimmerman MB, Podhajsky P, et al. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders[J]. Am J Ophthalmol, 1994, 117(5): 603-624. DOI: 10.1016/s0002-9394(14)70067-4.
14.	Hayreh SS. Role of nocturnal arterial hypotension in the development of ocular manifestations of systemic arterial hypertension[J]. Curr Opin Ophthalmol, 1999, 10(6): 474-482. DOI: 10.1097/00055735-199912000-00017.
15.	王雷, 黄厚斌, 王伟, 等. 双眼非动脉炎性前部缺血性视神经病变的临床特征与危险因素[J]. 眼科, 2016, 25(6): 377-380. DOI: 10.13281/j.cnki.issn.1004-4469.2016.06.004.Wang L, Huang HB, Wang W, et al. Characteristics and risk factors of bilateral nonarteritic anterior ischemic optic neuropathy[J]. Ophthalmol CHN, 2016, 25(6): 377-380. DOI: 10.13281/j.cnki.issn.1004-4469.2016.06.004.
16.	江汉秋, 彭静婷, 张晓君, 等. 非动脉炎性前部缺血性视神经病变全身危险因素分析[J]. 中国卒中杂志, 2018, 13(1): 7-11. DOI: 10.3969/j.issn.1673-5765.2018.01.003.Jiang HQ, Peng JT, Zhang XJ, et al. General risk factors analysis of non-arteritic anterior ischemic optic neuropathy[J]. Chinese Journal of Stroke, 2018, 13(1): 7-11. DOI: 10.3969/j.issn.1673-5765.2018.01.003.
17.	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group[J]. JAMA, 2000, 283(15): 2008-2012. DOI: 10.1001/jama.283.15.2008.
18.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement[J/OL]. BMJ, 2009, 339: b2535[2009-07-21]. https://pubmed.ncbi.nlm.nih.gov/19622551/. DOI: 10.1136/bmj.b2535.
19.	陈月红, 杜亮, 耿兴远, 等. 无对照二分类数据的Meta分析在RevMan软件中的实现[J]. 中国循证医学杂志, 2014, 7(14): 889-896. DOI: 10.7507/1672-2531.20140147.Chen YH, Du L, Geng XY, et al. Implement meta-analysis with non-comparative binary data in RevMan software[J]. Chinese Journal of Evidence-Based Medicine, 2014, 7(14): 889-896. DOI: 10.7507/1672-2531.20140147.
20.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Stat Med, 2002, 21(11): 1539-1558. DOI: 10.1002/sim.1186.
21.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses[J]. BMJ, 2003, 327(7414): 557-560. DOI: 10.1136/bmj.327.7414.557.
22.	DerSimonian R, Laird N. Meta-analysis in clinical trials[J]. Control Clin Trials, 1986, 7(3): 177-188. DOI: 10.1016/0197-2456(86)90046-2.
23.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test[J]. BMJ, 1997, 315(7109): 629-634. DOI: 10.1136/bmj.315.7109.629.
24.	Hayreh SS, Podhajsky P, Zimmerman MB. Beta-blocker eyedrops and nocturnal arterial hypotension[J]. Am J Ophthalmol, 1999, 128(3): 301-309. DOI: 10.1016/s0002-9394(99)00160-9.
25.	闫洪欣, 魏世辉. 非动脉炎性前部缺血性视神经病变的发病相关因素分析[J]. 中国中医眼科杂志, 2013, 23(2): 123-126. DOI: 10.13444/j.cnki.zgzyykzz.003128.Yan HX, Wei SH. Analysis on relative factors of nonarteritic anteriorischemic optic neuropathy[J]. Chinese Journal of Chinese Ophthalmology, 2013, 23(2): 123-126. DOI: 10.13444/j.cnki.zgzyykzz.003128.
26.	Lacharme T, Almanjoumi A, Aptel F, et al. Twenty-four-hour rhythm of ocular perfusion pressure in non-arteritic anterior ischaemic optic neuropathy[J/OL]. Acta Ophthalmol, 2014, 92(5): e346-e352[2014-01-25].https://pubmed.ncbi.nlm.nih.gov/24460737/. DOI: 10.1111/aos.12352.
27.	Norscini J, Cuello Oderiz C, Cristiano E. Precipitating factors of non-arteritic anterior ischemic optic neuropathy[J]. Neurologia Argentina, 2015, 7(3): 161-165. DOI: 10.1016/j.neuarg.2015.02.005.
28.	陈莲, 何珂, 李晓清, 等. SAHS和夜间低血压与非动脉炎性前部缺血性视神经病变的相关性[J]. 国际眼科杂志, 2019, 19(10): 1672-1675. DOI: 10.3980/j.issn.1672-5123.2019.10.08.Chen L, He K, Li XQ, et al. Correlation between SAHS and nocturnal hypotension and nonarteritic inflammatory anterior ischmic optic neuropathy[J]. Int Eye Sci, 2019, 19(10): 1672-1675. DOI: 10.3980/j.issn.1672-5123.2019.10.08.
29.	Hayreh SS, Podhajsky PA, Zimmerman B. Ipsilateral recurrence of nonarteritic anterior ischemic optic neuropathy[J]. Am J Ophthalmol, 2001, 132(5): 734-742. DOI: 10.1016/s0002-9394(01)01192-8.
30.	Biousse V, Newman NJ. Ischemic optic neuropathies[J]. N Engl J, 2015, 372(25): 2428-2436. DOI: 10.1056/NEJMra1413352.
31.	Hayreh SS. The role of aspirin in non-arteritic anterior ischaemic optic neuropathy[J]. Neuroophthalmology, 2010, 34(1): 1-5. DOI: 10.3109/01658100903582811.
32.	Dong JY, Zhang YH, Qin LQ. Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies[J]. Atherosclerosis, 2013, 229(2): 489-495. DOI: 10.1016/j.atherosclerosis.2013.04.026.

1. Levin LA, Danesh-Meyer HV. Hypothesis: a venous etiology for nonarteritic anterior ischemic optic neuropathy[J]. Arch Ophthalmol, 2008, 126(11): 1582-1585. DOI: 10.1001/archopht.126.11.1582.
2. Hayreh SS. Blood supply of the optic nerve head[J]. Ophthalmologica, 1996, 210(5): 285-295. DOI: 10.1159/000310727.
3. Hayreh SS. Ischemic optic neuropathy[J]. Prog Retin Eye Res, 2009, 28(1): 34-62. DOI: 10.1016/j.preteyeres.2008.11.002.
4. Hayreh SS, Joos KM, Podhajsky PA, et al. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy[J]. Am J Ophthalmol, 1994, 118(6): 766-780. DOI: 10.1016/s0002-9394(14)72557-7.
5. Palombi K, Renard E, Levy P, et al. Non-arteritic anterior ischaemic optic neuropathy is nearly systematically associated with obstructive sleep apnoea[J]. Br J Ophthalmol, 2006, 90(7): 879-882. DOI: 10.1136/bjo.2005.087452.
6. Hayreh SS. Pathogenesis of nonarteritic anterior ischemic optic neuropathy[J]. Arch Ophthalmol, 2009, 127(8): 1082-1083. DOI: 10.1001/archophthalmol.2009.199.
7. Bernstein SL, Johnson MA, Miller NR. Nonarteritic anterior ischemic optic neuropathy (NAION) and its experimental models[J]. Prog Retin Eye Res, 2011, 30(3): 167-187. DOI: 10.1016/j.preteyeres.2011.02.003.
8. Miller NR. Current concepts in the diagnosis, pathogenesis, and management of nonarteritic anterior ischemic optic neuropathy[J/OL]. J Neuroophthalmol, 2011, 31(2): e1-e3[2011-06-30]. https://pubmed.ncbi.nlm.nih.gov/21593625/. DOI: 10.1097/WNO.0b013e31821f955c.
9. Jacobson DM, Vierkant RA, Belongia EA. Nonarteritic anterior ischemic optic neuropathy. A case-control study of potential risk factors[J]. Arch Ophthalmol, 1997, 115(11): 1403. DOI: 10.1001/archopht.1997.01100160573008.
10. Arnold AC. Pathogenesis of nonarteritic anterior ischemic optic neuropathy[J]. J Neuroophthalmol, 2003, 23(2): 157-163. DOI: 10.1097/00041327-200306000-00012.
11. Preechawat P, Bruce BB, Newman NJ, et al. Anterior ischemic optic neuropathy in patients younger than 50 years[J]. Am J Ophthalmol, 2007, 144(6): 953-960. DOI: 10.1016/j.ajo.2007.07.031.
12. Hayreh SS. Ischemic optic neuropathies-where are we now?[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(8): 1873-1884. DOI: 10.1007/s00417-013-2399-z.
13. Hayreh SS, Zimmerman MB, Podhajsky P, et al. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders[J]. Am J Ophthalmol, 1994, 117(5): 603-624. DOI: 10.1016/s0002-9394(14)70067-4.
14. Hayreh SS. Role of nocturnal arterial hypotension in the development of ocular manifestations of systemic arterial hypertension[J]. Curr Opin Ophthalmol, 1999, 10(6): 474-482. DOI: 10.1097/00055735-199912000-00017.
15. 王雷, 黄厚斌, 王伟, 等. 双眼非动脉炎性前部缺血性视神经病变的临床特征与危险因素[J]. 眼科, 2016, 25(6): 377-380. DOI: 10.13281/j.cnki.issn.1004-4469.2016.06.004.Wang L, Huang HB, Wang W, et al. Characteristics and risk factors of bilateral nonarteritic anterior ischemic optic neuropathy[J]. Ophthalmol CHN, 2016, 25(6): 377-380. DOI: 10.13281/j.cnki.issn.1004-4469.2016.06.004.
16. 江汉秋, 彭静婷, 张晓君, 等. 非动脉炎性前部缺血性视神经病变全身危险因素分析[J]. 中国卒中杂志, 2018, 13(1): 7-11. DOI: 10.3969/j.issn.1673-5765.2018.01.003.Jiang HQ, Peng JT, Zhang XJ, et al. General risk factors analysis of non-arteritic anterior ischemic optic neuropathy[J]. Chinese Journal of Stroke, 2018, 13(1): 7-11. DOI: 10.3969/j.issn.1673-5765.2018.01.003.
17. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group[J]. JAMA, 2000, 283(15): 2008-2012. DOI: 10.1001/jama.283.15.2008.
18. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement[J/OL]. BMJ, 2009, 339: b2535[2009-07-21]. https://pubmed.ncbi.nlm.nih.gov/19622551/. DOI: 10.1136/bmj.b2535.
19. 陈月红, 杜亮, 耿兴远, 等. 无对照二分类数据的Meta分析在RevMan软件中的实现[J]. 中国循证医学杂志, 2014, 7(14): 889-896. DOI: 10.7507/1672-2531.20140147.Chen YH, Du L, Geng XY, et al. Implement meta-analysis with non-comparative binary data in RevMan software[J]. Chinese Journal of Evidence-Based Medicine, 2014, 7(14): 889-896. DOI: 10.7507/1672-2531.20140147.
20. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Stat Med, 2002, 21(11): 1539-1558. DOI: 10.1002/sim.1186.
21. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses[J]. BMJ, 2003, 327(7414): 557-560. DOI: 10.1136/bmj.327.7414.557.
22. DerSimonian R, Laird N. Meta-analysis in clinical trials[J]. Control Clin Trials, 1986, 7(3): 177-188. DOI: 10.1016/0197-2456(86)90046-2.
23. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test[J]. BMJ, 1997, 315(7109): 629-634. DOI: 10.1136/bmj.315.7109.629.
24. Hayreh SS, Podhajsky P, Zimmerman MB. Beta-blocker eyedrops and nocturnal arterial hypotension[J]. Am J Ophthalmol, 1999, 128(3): 301-309. DOI: 10.1016/s0002-9394(99)00160-9.
25. 闫洪欣, 魏世辉. 非动脉炎性前部缺血性视神经病变的发病相关因素分析[J]. 中国中医眼科杂志, 2013, 23(2): 123-126. DOI: 10.13444/j.cnki.zgzyykzz.003128.Yan HX, Wei SH. Analysis on relative factors of nonarteritic anteriorischemic optic neuropathy[J]. Chinese Journal of Chinese Ophthalmology, 2013, 23(2): 123-126. DOI: 10.13444/j.cnki.zgzyykzz.003128.
26. Lacharme T, Almanjoumi A, Aptel F, et al. Twenty-four-hour rhythm of ocular perfusion pressure in non-arteritic anterior ischaemic optic neuropathy[J/OL]. Acta Ophthalmol, 2014, 92(5): e346-e352[2014-01-25].https://pubmed.ncbi.nlm.nih.gov/24460737/. DOI: 10.1111/aos.12352.
27. Norscini J, Cuello Oderiz C, Cristiano E. Precipitating factors of non-arteritic anterior ischemic optic neuropathy[J]. Neurologia Argentina, 2015, 7(3): 161-165. DOI: 10.1016/j.neuarg.2015.02.005.
28. 陈莲, 何珂, 李晓清, 等. SAHS和夜间低血压与非动脉炎性前部缺血性视神经病变的相关性[J]. 国际眼科杂志, 2019, 19(10): 1672-1675. DOI: 10.3980/j.issn.1672-5123.2019.10.08.Chen L, He K, Li XQ, et al. Correlation between SAHS and nocturnal hypotension and nonarteritic inflammatory anterior ischmic optic neuropathy[J]. Int Eye Sci, 2019, 19(10): 1672-1675. DOI: 10.3980/j.issn.1672-5123.2019.10.08.
29. Hayreh SS, Podhajsky PA, Zimmerman B. Ipsilateral recurrence of nonarteritic anterior ischemic optic neuropathy[J]. Am J Ophthalmol, 2001, 132(5): 734-742. DOI: 10.1016/s0002-9394(01)01192-8.
30. Biousse V, Newman NJ. Ischemic optic neuropathies[J]. N Engl J, 2015, 372(25): 2428-2436. DOI: 10.1056/NEJMra1413352.
31. Hayreh SS. The role of aspirin in non-arteritic anterior ischaemic optic neuropathy[J]. Neuroophthalmology, 2010, 34(1): 1-5. DOI: 10.3109/01658100903582811.
32. Dong JY, Zhang YH, Qin LQ. Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies[J]. Atherosclerosis, 2013, 229(2): 489-495. DOI: 10.1016/j.atherosclerosis.2013.04.026.

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Occurrence of nocturnal hypotension in nonarteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis

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