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Sleep and optic disc edema in spaceflight associated neuro-ocular syndrome (SANS)

Eye (2024)Cite this article

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Spaceflight associated neuro-ocular syndrome (SANS) represents a constellation of neuro-ocular changes observed in many astronauts after long-duration spaceflight (LDSF) missions. These findings include optic disc edema (ODE), globe flattening, chorioretinal folds, and a hyperopic refractive shift [1,2,3,4]. One of the hallmark features of SANS is ODE, observed in up to ~70% of all astronauts during LDSF [5]. The precise pathogenesis of ODE in SANS remains ill-defined, and several features of the ODE are atypical for terrestrial papilledema, including the often mild grade of ODE, the lack of other more characteristic symptoms of increased intracranial pressure (ICP), and optical coherence tomography (OCT) demonstration of both anterior and posterior displacement of the Bruch’s membrane opening (BMO). These unusual features of ODE in SANS likely reflects the complex and multifactorial nature of the disorder beyond increased ICP or microgravity-induced headward fluid shifts alone [5, 6].

Sleep plays a crucial role in regulating cerebrospinal fluid (CSF) circulation dynamics. The spaceflight environment presents unique challenges to maintaining adequate sleep duration. In addition, the loss of the terrestrial 24-h light/dark cycle impacts sleep dynamics during LDSF [7]. Previous studies highlighted that sleep deficiency was widely prevalent during spaceflight missions, with shorter sleep durations significantly associated with elevated indicators of stress [8, 9]. Christian et al. studied the effects of 30 days of strict 6° head-down tilt bed rest (HDTBR) in the setting of mildly elevated carbon dioxide (CO2) levels on sleep. Although sleep and 24-h core temperature were unaltered by the HDTBR and elevated CO2 conditions, shorter sleep duration and blunted core temperature amplitude were significantly associated with a higher likelihood of developing ODE [10].

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Author information

Authors and Affiliations

  1. Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, NY, USA

    Tuan Nguyen

  2. Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA

    Joshua Ong

  3. University of Cambridge, Cambridge, United Kingdom

    Ethan Waisberg

  4. Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA

    Andrew G. Lee

  5. Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA

    Andrew G. Lee

  6. The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA

    Andrew G. Lee

  7. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA

    Andrew G. Lee

  8. Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA

    Andrew G. Lee

  9. University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Andrew G. Lee

  10. Texas A&M College of Medicine, Bryan, TX, USA

    Andrew G. Lee

  11. Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Andrew G. Lee

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TN – Manuscript writing and literature review. JO – manuscript editing, idea synthesis. EW – manuscript editing, idea synthesis. AGL – manuscript editing, review, and intellectual support.

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Correspondence to Tuan Nguyen.

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AGL is a member of the Eye editorial board. The remaining authors declare no competing interests.

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Nguyen, T., Ong, J., Waisberg, E. et al. Sleep and optic disc edema in spaceflight associated neuro-ocular syndrome (SANS). Eye (2024). https://doi.org/10.1038/s41433-024-03119-9

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