Psychological Stress and Intraocular Pressure in Glaucoma

IF 2.8 Q1 OPHTHALMOLOGY Ophthalmology. Glaucoma Pub Date : 2024-11-01 DOI:10.1016/j.ogla.2024.07.004

Nathalie Sena Ferreira MD , Vital Paulino Costa MD, PhD , Juliana Frange Miranda MD , Lucas Oliveira Cintra MD , Lucas Santos Barbosa MD , Maira Gomes Barbosa da Silva MD , Nayara Alves Abreu MD , Ricardo Yuji Abe MD, PhD

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Abstract

Purpose

To evaluate the intraocular pressure (IOP) behavior after applying a standardized protocol to induce psychological stress in patients with primary open-angle glaucoma (POAG).

Design

Randomized controlled trial.

Participants

A total of 39 patients with POAG were included: 18 in the stress group and 21 in the control group.

Methods

Patients were randomized to undergo the Trier Social Stress Test (TSST) or to be included in the control group. All participants were submitted to a modified diurnal tension curve (DTC) 1–4 weeks before randomization, with 3 IOP measurements performed between 8:00 am and 2:00 pm. We evaluated the response to the TSST by measuring the levels of salivary cortisol, salivary amylase, IOP, mean arterial pressure, and heart rate before, immediately after, and 40 minutes after the TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals.

Main Outcome Measures

Changes in IOP (mmHg), salivary cortisol and amylase, heart rate, mean arterial pressure, and STAI scores.

Results

At baseline, there were no significant differences between the groups regarding age (P = 0.661), sex (P = 0.669), salivary cortisol (P = 0.104), and mean DTC IOP for the right (P = 0.439) and left (P = 0.576) eyes. We observed a significant mean IOP increase of 3.8 mmHg (right eye; P < 0.001) and 4.1 mmHg (left eye; P < 0.001) when we compared IOP measurements obtained during the DTC and immediately after TSST. Salivary cortisol (5.9 nmol/L; P = 0.004), salivary amylase (323 388 UL; P = 0.004), mean arterial pressure (10.1 mmHg; P < 0.001), and heart rate (12.9 bpm; P < 0.001) also increased significantly after the TSST. In addition, 61.1% (11 of 18) of the patients in the TSST group showed an IOP increase > 4 mmHg following the test. The STAI-state score significantly increased after the TSST compared to baseline (P < 0.001) and decreased from poststress to the recovery period (P < 0.001).

Conclusions

Patients with POAG present significant elevations of IOP, salivary cortisol and amylase, mean arterial pressure, heart rate, and STAI scores after psychological stress induced by the TSST.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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青光眼患者的心理压力和眼压。随机对照试验。

目的：评估原发性开角型青光眼（POAG）患者在采用标准化方案诱导心理压力后的眼压（IOP）变化：设计：随机对照试验：共纳入 39 名 POAG 患者：方法：患者被随机分为压力组和对照组，压力组18人，对照组21人：患者被随机分配到特里尔社会压力测试（TSST）组或对照组。所有参与者在随机分组前 1 至 4 周均接受了改良的昼夜张力曲线 (DTC)，并在上午 8:00 至下午 2:00 之间进行了 3 次眼压测量。我们通过测量唾液皮质醇、唾液淀粉酶、眼压、平均动脉压和心率的水平来评估对 TSST 的反应。在相同的时间间隔内，采用国家特质焦虑量表（STAI）评估焦虑水平：主要结果测量：眼压（毫米汞柱）、唾液皮质醇和淀粉酶、心率、平均动脉压和 STAI 评分的变化：基线时，组间在年龄（P=0.661）、性别（P=0.669）、唾液皮质醇（P=0.104）和右眼（P=0.439）与左眼（P=0.576）的平均 DTC 眼压方面无明显差异。我们观察到平均眼压明显升高了 3.8 mmHg（右眼，PC 结论：POAG患者在接受TSST诱导的心理压力后，眼压、唾液皮质醇和淀粉酶、平均动脉压、心率和STAI评分均明显升高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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