1153 Can Untreated Obstructive Sleep Apnea Contribute to Progression of Chronic Relapsing Inflammatory Optic Neuropathy?

Abstract Introduction The role of untreated obstructive sleep apnea (OSA) in progression of chronic relapsing inflammatory optic neuropathy (CRION) is not very well understood. We report the case of progression of CRION with co-existing OSA. Report of Case A 43 year-old previously healthy female with family history of sarcoidosis and lupus, presented for evaluation in 2006 after acute onset of initially painful and, then painless, vision loss in her left eye (OS). Extensive neuro-ophthalmologic, immunologic, and rheumatologic workup was negative for other causes of optic neuropathy. She continued having recurrent, intermittent optic neuritis due to CRION, developed complete OS blindness in 2014, despite aggressive management with oral prednisone as outpatient as well as frequent hospitalizations for intravenous steroids, rituximab, and plasma exchange (PLEX). In September 2017, the patient was admitted for blurred vision in the right eye (OD), she presented with OD painless, optic neuropathy due to CRION, she was treated with methylprednisolone, and ofatumumab with no change in vision loss. The extensive work up was repeated and was negative for other causes of optic neuropathy. During hospital admission, sleep medicine was consulted for witnessed nocturnal apneic events. She complained of snoring, gasping, fatigue, and non-restorative sleep for 15 years. STOP-BANG 3. Physical exam revealed facial malocclusion class 3, Mallampati class IV, macroglossia with lateral scalloping, high-arched palate and neck measured 15 inches. She underwent in-lab split-night polysomnogram, which revealed an AHI of 28.1/hour, and was prescribed Auti BIPAP 15/6 cmH2O, PS -4 due to CPAP intolerance. Outpatient follow up with Sleep Medicine in December 2017 did not reveal any new symptoms, and no worsening in eye exam. Excellent subjective and objective BIPAP compliance was reported. Conclusion We report the case of CRION progression with co-existing OSA. Although, most of the cases of optic neuropathy in OSA patients were related to non-arteritic anterior ischemic optic neuropathy (NAION), there are no existing reports establishing the relationship between OSA and CRION progression. While no doubt exists that this relationship needs to be further evaluated, patients with CRION may benefit from OSA evaluation and management.