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.
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.
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.
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.
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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Allison K, Patel D, Alabi O. Epidemiology of glaucoma: the past, present, and predictions for the future. Cureus. 2020;12:e11686.
Anderson DR. Normal-tension glaucoma (low-tension glaucoma). Indian J Ophthalmol. 2011;59:S97–101.
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7:687–98.
Chaitanya A, Pai VH, Mohapatra AK, Ve RS. Glaucoma and its association with obstructive sleep apnea: a narrative review. Oman J Ophthalmol. 2016;9:125–34.
Muniesa MJ, Benitez I, Ezpeleta J, Sanchez de la Torre M, Pazos M, Milla E, et al. Effect of CPAP therapy on 24-hour intraocular pressure-related pattern from contact lens sensors in obstructive sleep apnea syndrome. Transl Vis Sci Technol. 2021;10:10.
Liu S, Lin Y, Liu X. Meta-analysis of association of obstructive sleep apnea with glaucoma. J Glaucoma. 2016;25:1–7.
Shi Y, Liu P, Guan J, Lu Y, Su K. Association between glaucoma and obstructive sleep apnea syndrome: a meta-analysis and systematic review. PLoS One. 2015;10:e0115625.
Girkin CA, McGwin G Jr., McNeal SF, Owsley C. Is there an association between pre-existing sleep apnoea and the development of glaucoma? Br J Ophthalmol. 2006;90:679–81.
Roberts TV, Hodge C, Graham SL, Burlutsky G, Mitchell P. Prevalence of nocturnal oxygen desaturation and self-reported sleep-disordered breathing in glaucoma. J Glaucoma. 2009;18:114–8.
Alvarez-Sala R, Garcia IT, Garcia F, Moriche J, Prados C, Diaz S, et al. Nasal CPAP during wakefulness increases intraocular pressure in glaucoma. Monaldi Arch Chest Dis. 1994;49:394–5.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.
Wells G, Shea B, O’Connell D, Peterson j, Welch V, Losos M, et al. The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. 2000.
Dikmen N, Cakmak AI, Urfalioglu S. The effect of positive airway pressure therapy on intraocular pressure and retina in severe obstructive apnea syndrome. Sleep Biol Rhythms. 2022;20:267–73.
Lin P-W, Lin H-C, Friedman M, Chang H-W, Salapatas AM, Lin M-C, et al. Effects of CPAP for patients with OSA on visual sensitivity and retinal thickness. Sleep Med. 2020;67:156–63.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.
Knapp G, Hartung J. Improved tests for a random effects meta-regression with a single covariate. Stat Med. 2003;22:2693–710.
Kadyan A, Asghar J, Dowson L, Sandramouli S. Ocular findings in sleep apnoea patients using continuous positive airway pressure. Eye. 2010;24:843–50.
Chen HY, Chang YC, Lin CC, Sung FC, Chen WC. Obstructive sleep apnea patients having surgery are less associated with glaucoma. J Ophthalmol. 2014;2014:838912.
Keenan TD, Goldacre R, Goldacre MJ. Associations between obstructive sleep apnoea, primary open angle glaucoma and age-related macular degeneration: record linkage study. Br J Ophthalmol. 2017;101:155–9.
Aptel F, Chiquet C, Tamisier R, Sapene M, Martin F, Stach B, et al. Association between glaucoma and sleep apnea in a large French multicenter prospective cohort. Sleep Med. 2014;15:576–81.
Batum M, Kisabay A, Mayali H, Goktalay T, Kurt E, Selcuki D, et al. Evaluation of effects of positive airway pressure treatment on retinal fiber thickness and visual pathways using optic coherence tomography and visual evoked potentials in the patients with severe obstructive sleep apnea syndrome. Int Ophthalmol. 2020;40:2475–85.
Asker S, Timucin OB, Ursavas A, Aslanci ME, Baykara M, Erturk H, et al. Obstructive sleep apnea syndrome and blood flow to the eyes. East J Med. 2013;18:165–71.
Casas P, Ascaso FJ, Vicente E, Tejero-Garcés G, Adiego MI, Cristóbal JA. Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS). Graefes Arch Clin Exp Ophthalmol. 2013;251:1625–34.
Casas P, Ascaso FJ, Vicente E, Tejero-Garcés G, Adiego MI, Cristóbal JA. Visual field defects and retinal nerve fiber imaging in patients with obstructive sleep apnea syndrome and in healthy controls. BMC Ophthalmol. 2018;18:66.
Çekiç B, Selçuk ÖT, Toslak İE, Osma Ü, Eyigör H, Erol MK. Does severe obstructive sleep apnea syndrome alter retrobulbar blood flow? A color Doppler ultrasound study. J Med Ultrason. 2018;45:487–92.
Lee SSY, McArdle N, Sanfilippo PG, Yazar S, Eastwood PR, Hewitt AW, et al. Associations between optic disc measures and obstructive sleep apnea in young adults. Ophthalmology. 2019;126:1372–84.
Lee SS, Sanfilippo PG, Hunter M, Yazar S, James A, Mackey DA. Optic disc measures in obstructive sleep apnea: a community-based study of middle-aged and older adults. J Glaucoma. 2020;29:337–43.
Ozge G, Dogan D, Koylu MT, Ayyildiz O, Akincioglu D, Mumcuoglu T, et al. Retina nerve fiber layer and choroidal thickness changes in obstructive sleep apnea syndrome. Postgrad Med. 2016;128:317–22.
Sagiv O, Fishelson-Arev T, Buckman G, Mathalone N, Wolfson J, Segev E, et al. Retinal nerve fibre layer thickness measurements by optical coherence tomography in patients with sleep apnoea syndrome. Clin Exp Ophthalmol. 2014;42:132–8.
Uslu H, Kanra AY, Sarac S. Structural assessment of the optic nerve in patients with obstructive sleep apnea syndrome: Case–control study. Eur J Ophthalmol. 2020;31:1741–8.
Cristescu TR, Mihălțan FD. Ocular pathology associated with obstructive sleep apnea syndrome. Rom J Ophthalmol. 2020;64:261–8.
Chambe J, Laib S, Erhardt C, Schroder C, Ruppert E, Bourcier T, et al. Prevalence of ocular disorders in patients affected with sleep apnea syndrome. Eur Sleep Res Soc. 2010;19:305.
Han X, Lee SS, Ingold N, McArdle N, Khawaja AP, MacGregor S, et al. Associations of sleep apnoea with glaucoma and age-related macular degeneration: an analysis in the United Kingdom Biobank and the Canadian longitudinal study on aging. BMC Med. 2021;19:104.
Lin CC, Hu CC, Ho JD, Chiu HW, Lin HC. Obstructive sleep apnea and increased risk of glaucoma: a population-based matched-cohort study. Ophthalmology. 2013;120:1559–64.
Friedlander AH, Graves LL, Chang TI, Kawakami KK, Lee UK, Grabich SC, et al. Prevalence of primary open-angle glaucoma among patients with obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radio. 2018;126:226–30.
Bagabas N, Ghazali W, Mukhtar M, AlQassas I, Merdad R, Maniyar A, et al. Prevalence of glaucoma in patients with obstructive sleep apnea. J Epidemiol Glob Health. 2019;9:198–203.
Pedrotti E, Demasi CL, Bruni E, Bosello F, Di Sarro PP, Passilongo M, et al. Prevalence and risk factors of eye diseases in adult patients with obstructive sleep apnoea: results from the SLE.E.P.Y cohort study. BMJ Open. 2017;7:e016142.
Zengin MO, Tuncer I, Karahan E. Retinal nerve fiber layer thickness changes in obstructive sleep apnea syndrome: one year follow-up results. Int J Ophthalmol. 2014;7:704–8.
Karakucuk S, Goktas S, Aksu M, Erdogan N, Demirci S, Oner A, et al. Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS). Graefes Arch Clin Exp Ophthalmol. 2008;246:129–34.
Carnero E, Bragard J, Urrestarazu E, Rivas E, Polo V, Larrosa JM, et al. Continuous intraocular pressure monitoring in patients with obstructive sleep apnea syndrome using a contact lens sensor. PLoS One. 2020;15:e0229856.
Chirapapaisan N, Likitgorn T, Pleumchitchom M, Sakiyalak D, Banhiran W, Saiman M, et al. Diurnal changes in retinal nerve fiber layer thickness with obstructive sleep apnea/hypopnea syndrome. Int J Ophthalmol. 2016;9:979–83.
Ekinci M, Huseyinoglu N, Cagatay HH, Ceylan E, Keles S, Gokce G. Is there a relationship between sleep apnea and central corneal thickness? Curr Eye Res. 2013;38:1104–9.
Ferrandez B, Ferreras A, Calvo P, Abadia B, Fogagnolo P, Wang Y, et al. Retinal sensitivity is reduced in patients with obstructive sleep apnea. Invest Ophthalmol Vis Sci. 2014;55:7119–25.
Ferrandez B, Ferreras A, Calvo P, Abadia B, Marin JM, Pajarin AB. Assessment of the retinal nerve fiber layer in individuals with obstructive sleep apnea. BMC Ophthalmol. 2016;16:40.
Gharraf H, Zidan MH, ElHoffy A. Association between obstructive sleep apnea hypopnea syndrome and normal tension glaucoma. Egypt J Chest Dis Tuberculosis. 2016;65:239–49.
Gutierrez-Diaz E, Perez-Rico C, de Atauri MJ, Mencia-Gutierrez E, Blanco R. Evaluation of the visual function in obstructive sleep apnea syndrome patients and normal-tension glaucoma by means of the multifocal visual evoked potentials. Graefes Arch Clin Exp Ophthalmol. 2012;250:1681–8.
Huseyinoglu N, Ekinci M, Ozben S, Buyukuysal C, Kale MY, Sanivar HS. Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome. Sleep Breath. 2014;18:95–102.
Küçük B, Sırakaya E, Delibaş Ş. Posterior segment assessment in patients with obstructive sleep apnea syndrome. Sleep Breath. 2019;23:997–1005.
Lin PW, Friedman M, Lin HC, Chang HW, Pulver TM, Chin CH. Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea/hypopnea syndrome. Graefes Arch Clin Exp Ophthalmol. 2011;249:585–93.
Lin PW, Friedman M, Lin HC, Chang HW, Wilson M, Lin MC. Normal tension glaucoma in patients with obstructive sleep apnea/hypopnea syndrome. J Glaucoma. 2011;20:553–8.
Moghimi S, Ahmadraji A, Sotoodeh H, Sadeghniat K, Maghsoudipour M, Fakhraie G, et al. Retinal nerve fiber thickness is reduced in sleep apnea syndrome. Sleep Med. 2013;14:53–7.
Mojon DS, Hess CW, Goldblum D, Fleischhauer J, Koerner F, Bassetti C, et al. High prevalence of glaucoma in patients with sleep apnea syndrome. Ophthalmology. 1999;106:1009–12.
Morsy NE, Amani BE, Magda AA, Nabil AJ, Pandi-Perumal SR, BaHammam AS, et al. Prevalence and predictors of ocular complications in obstructive sleep apnea patients: a cross-sectional case-control study. Open Respir Med J. 2019;13:19–30.
Ngoo QZ, A NF, A B, Wh WH. Evaluation of retinal nerve fiber layer thickness and optic nerve head parameters in obstructive sleep apnoea patients. Korean J Ophthalmol. 2021;35:223–30.
Zengin MO, Öztura I, Arikan G, Günenç Ü, Parlak M, Ergin MH. The relationship between obstructive sleep apnea syndrome and glaucoma. Turkiye Klinikleri Tip Bilimleri Derg. 2012;32:990–6.
Gürsel Özkurt Z, Demir M, Yıldırım Y, Balsak S, Karaalp Ü. Evaluation of subclinical papilledema in patients with obstructive sleep apnea syndrome. East J Med. 2019;24:74–9.
Salzgeber R, Iliev ME, Mathis J. Do optic nerve head and visual field parameters in patients with obstructive sleep apnea syndrome differ from those in control individuals? Klin Monbl Augenheilkd. 2014;231:340–3.
Sergi M, Salerno DE, Rizzi M, Blini M, Andreoli A, Messenio D, et al. Prevalence of normal tension glaucoma in obstructive sleep apnea syndrome patients. J Glaucoma. 2007;16:42–6.
Ucak T, Unver E. Alterations in parafoveal and optic disc vessel densities in patients with obstructive sleep apnea syndrome. J Ophthalmol. 2020;2020:4034382.
Xin C, Zhang W, Wang L, Yang D, Wang J. Changes of visual field and optic nerve fiber layer in patients with OSAS. Sleep Breath. 2015;19:129–34.
Yazgan S, Erboy F, Celik HU, Ornek T, Ugurbas SH, Kokturk F, et al. Peripapillary choroidal thickness and retinal nerve fiber layer in untreated patients with obstructive sleep apnea-hypopnea syndrome: a case–control study. Curr Eye Res. 2017;42:1552–60.
Doyle CK, Zamba GJ, Johnson CA, Wall M. The repeatability of mean deviation with size III and size V standard automated perimetry. Investigative Ophthalmol Vis Sci. 2011;52:5523–23.
Chouchou F, Pichot V, Pepin JL, Tamisier R, Celle S, Maudoux D, et al. Sympathetic overactivity due to sleep fragmentation is associated with elevated diurnal systolic blood pressure in healthy elderly subjects: the PROOF-SYNAPSE study. Eur Heart J. 2013;34:2122–31.
Peled N, Greenberg A, Pillar G, Zinder O, Levi N, Lavie P. Contributions of hypoxia and respiratory disturbance index to sympathetic activation and blood pressure in obstructive sleep apnea syndrome. Am J Hypertens. 1998;11:1284–9.
Smagula SF, Stone KL, Redline S, Ancoli-Israel S, Barrett-Connor E, Lane NE, et al. Actigraphy- and polysomnography-measured sleep disturbances, inflammation, and mortality among older men. Psychosom Med. 2016;78:686–96.
Perez-Rico C, Gutierrez-Diaz E, Mencia-Gutierrez E, Diaz-de-Atauri MJ, Blanco R. Obstructive sleep apnea-hypopnea syndrome (OSAHS) and glaucomatous optic neuropathy. Graefes Arch Clin Exp Ophthalmol. 2014;252:1345–57.
Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40:408–19.
Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004;43:678–83.
Phillips CL, Yang Q, Williams A, Roth M, Yee BJ, Hedner JA, et al. The effect of short-term withdrawal from continuous positive airway pressure therapy on sympathetic activity and markers of vascular inflammation in subjects with obstructive sleep apnoea. J Sleep Res. 2007;16:217–25.
Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003;107:1129–34.
Blondeau P, Tetrault JP, Papamarkakis C. Diurnal variation of episcleral venous pressure in healthy patients: a pilot study. J Glaucoma. 2001;10:18–24.
Kiekens S, Veva DeG, Coeckelbergh T, Tassignon MJ, van de Heyning P, Wilfried DeB, et al. Continuous positive airway pressure therapy is associated with an increase in intraocular pressure in obstructive sleep apnea. Invest Ophthalmol Vis Sci. 2008;49:934–40.
Pépin JL, Chiquet C, Tamisier R, Lévy P, Almanjoumi A, Romanet JP. Frequent loss of nyctohemeral rhythm of intraocular pressure restored by nCPAP treatment in patients with severe apnea. Arch Ophthalmol. 2010;128:1257–63.
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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 (2023). https://doi.org/10.1038/s41433-023-02471-6