High Pillow Position Linked to Increased IOP in Glaucoma

For patients with glaucoma, a high pillow position is associated with increased intraocular pressure (IOP) and reduced ocular perfusion pressure, according to a study published online Jan. 27 in the British Journal of Ophthalmology.

Tong Liu, from the Eye Center at Zhejiang University in Hangzhou, China, and colleagues measured IOP in 144 patients with glaucoma and compared it between a high pillow position (head elevated by 25 to 35 degrees using two pillows) and the supine position. Ultrasonography was used to evaluate changes in jugular venous lumen in response to postural variation in 20 healthy volunteers.

The researchers found that the high pillow position was associated with significantly elevated IOP, increased 24-hour IOP fluctuation, and reduced ocular perfusion pressure compared with the supine position. Younger individuals and those with primary open-angle glaucoma (POAG) had greater postural IOP fluctuation. Thicker central corneal thickness and the presence of POAG (versus normal-tension glaucoma) were positive predictors of larger fluctuations in IOP in a multiple regression analysis. In healthy volunteers, ultrasonography revealed significant constriction of the internal and external jugular venous lumen in the high pillow position, which was accompanied by an increase in maximum blood flow velocity of the internal jugular vein.

“Patients with glaucoma may therefore benefit from avoiding sleeping postures that induce jugular venous compression to mitigate postural IOP elevation,” the authors write. “Such behavioral adjustments represent a simple yet potentially effective adjunctive strategy for optimizing long-term IOP management in clinical practice.”