Three Questions on the Role of Sleep Apnea Syndrome in Optic Disc Edema

In a recent ARCHIVES article, Purvin et al¹ report papilledema and obstructive sleep apnea syndrome (SAS). In their report the authors describe 4 patients, 3 of whom had optic neuropathy and visual loss. They cite the following possible risk factors for visual loss in SAS: older age, nocturnal apnea and hypoxia, epinephrine-induced platelet activation, and systemic fluctuations in blood pressure. Sleep apnea syndrome has been associated with ischemic events such as stroke, heart attack, and ischemic optic neuropathy. Although the authors postulate that optic disc edema in these 4 cases was caused by papilledema (generally defined as optic disc edema due to increased intracranial pressure), 3 patients had concomitant optic neuropathy. My questions for the authors are as follows: