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Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis

Eye volume 37, pages 3065–3083 (2023)Cite this article

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Abstract

Introduction

Obstructive sleep apnoea (OSA) has been thought to be associated with glaucoma, however there are many conflicting studies on this topic. With many new studies having been published since the previous meta-analysis, we believe it is important to clarify this association. Hence, in this study we meta-analyse the recent literature regarding the association between OSA and glaucoma.

Methods

Pubmed, Embase, Scopus and Cochrane Library were searched from inception till the 28th February 2022 for observational as well as cross-sectional studies examining the association between OSA and glaucoma. Two reviewers selected studies, extracted data, graded the quality of included non-randomized studies using the Newcastle-Ottawa scale. The overall quality of evidence was assessed using GRADE. Random-effects models were used to meta-analyse the maximally covariate- adjusted associations.

Results

48 studies were included in our systematic review, with 46 suitable for meta-analysis. Total study population was 4,566,984 patients. OSA was associated with a higher risk of glaucoma (OR 3.66, 95% CI 1.70 to 7.90, I2 = 98%, p < 0.01). After adjustment for various important confounders including age, gender and patient comorbidities such as hyperlipidaemia, hypertension, cardiovascular diseases and diabetes, patients with OSA had up to 40% higher odds of glaucoma. Substantial heterogeneity was eliminated through subgroup and sensitivity analyses after consideration of glaucoma subtype, OSA severity and adjustment for confounders.

Conclusions

In this meta-analysis, OSA was associated with higher risk of glaucoma, as well as more severe ocular findings characteristic of the glaucomatous disease process. We suggest more clinical studies looking into the effects of OSA treatment on the progression of glaucoma to help clinical decision making for patients.

摘要

引言: 阻塞性睡眠呼吸暂停 (OSA) 被认为与青光眼有关, 但是关于这个问题有许多结论相反的研究。自之前meta分析以来, 已有许多新的研究发表, 我们认为研究这种关联性是很重要的。因此, 在这项研究中, 我们对最近关于OSA和青光眼之间的关系的文献进行了元分析。

方法: 在Pubmed、Embase、Scopus和Cochrane图书馆检索了从开始到2022年2月28日的观察性研究以及研究OSA和青光眼之间关系的横断面研究。两位评审员选择研究, 提取数据, 使用纽卡斯尔-渥太华量表对纳入的非随机研究的质量进行分级。使用GRADE对证据的总体质量进行评估。使用随机效应模型对最大协变量调整后的关联进行荟萃分析。

结果: 48项研究纳入系统回顾, 其中46项适合进行meta分析。总研究人群为4,566,984名患者。OSA与较高的青光眼风险有关 (OR 3.66, 95% CI 1.70至7.90, I2 = 98%, P < 0.01) 。 在调整了各种重要的混杂因素, 包括年龄、性别和患者的合并症, 如高脂血症、高血压、心血管疾病和糖尿病后, OSA患者患青光眼的几率高达40%。在考虑了青光眼亚型、OSA严重程度和调整了混杂因素后, 通过亚组和敏感性分析消除了大量的异质性。

结论: 在这项meta分析中, OSA与较高的青光眼风险以及青光眼疾病过程中特有的更严重的眼部病变相关。建议进一步开展临床研究, 观察OSA治疗对青光眼进展的影响, 以帮助针对患者的临床决策。

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Fig. 1: Unadjusted odds ratio for the risk of glaucoma in patients with OSA.
Fig. 2: Unadjusted odds ratios for the risk of glaucoma in patients with OSA, stratified by glaucoma subtype.
Fig. 3: Adjusted odds ratios for the risk of glaucoma in patients with OSA.
Fig. 4: Adjusted hazards ratios for the risk of glaucoma in patients with OSA.
Fig. 5: Mean difference in cup-disc ratio.
Fig. 6: Mean difference in visual field MD.
Fig. 7: Mean difference in visual field PSD.
Fig. 8: Mean difference in intraocular pressure.
Fig. 9: Mean difference intraocular pressure stratified by OSA severity.
Fig. 10: Mean difference in retinal nerve fibre layer thickness.
Fig. 11: Mean difference retinal nerve fibre layer thickness, stratified by OSA severity.
Fig. 12: Mean difference retinal nerve fibre layer thickness in non-glaucomatous eyes, comparing patients with OSA against patients without OSA, stratified by OSA severity.

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Author notes

  1. These authors contributed equally: Alex Jia Yang Cheong, Sean Kang Xuan Wang, Chang Yi Woon.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore

    Alex Jia Yang Cheong, Sean Kang Xuan Wang, Chang Yi Woon, Ki Han Yap, Kevin Joo Yang Ng & Flora Wen Xin Xu

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel

    Uri Alkan

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Uri Alkan

  4. Department of Otorhinolaryngology–Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore

    Adele Chin Wei Ng, Anna See, Shaun Ray Han Loh & Song Tar Toh

  5. Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore

    Tin Aung

  6. Duke-NUS Medical School, Singapore, Singapore

    Tin Aung & Song Tar Toh

  7. Surgery Academic Clinical Program, SingHealth, Singapore, Singapore

    Song Tar Toh

  8. Singhealth Duke-NUS Sleep Centre, Singhealth, Singapore, Singapore

    Song Tar Toh

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Contributions

AJYC, SKXW, CYW, TA and STT designed the study, study protocol and tools. AJYC, SKXW, CYW, KHY, KJYN and FWXX conducted the data collection. AJYC, UA, ACWN, AS, SRHL, TA and STT were responsible for analysing and interpreting the data and wrote the manuscript. All authors read and approved the final manuscript.

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Cheong, A.J.Y., Wang, S.K.X., Woon, C.Y. et al. Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis. Eye 37, 3065–3083 (2023). https://doi.org/10.1038/s41433-023-02471-6

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  • DOI: https://doi.org/10.1038/s41433-023-02471-6

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