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Cheong AJY, Wang SKX, Woon CY, Yap KH, Ng KJY, Xu FWX, Alkan U, Ng ACW, See A, Loh SRH, Aung T, Toh ST. Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis. Eye (Lond) 2023; 37:3065-3083. [PMID: 36977937 PMCID: PMC10564942 DOI: 10.1038/s41433-023-02471-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
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.
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Affiliation(s)
- Alex Jia Yang Cheong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Sean Kang Xuan Wang
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Chang Yi Woon
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Ki Han Yap
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Kevin Joo Yang Ng
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Flora Wen Xin Xu
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Uri Alkan
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adele Chin Wei Ng
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shaun Ray Han Loh
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tin Aung
- Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Surgery Academic Clinical Program, SingHealth, Singapore, Singapore.
- Singhealth Duke-NUS Sleep Centre, Singhealth, Singapore, Singapore.
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Glaucoma Is Associated with the Risk of Obstructive Sleep Apnea: A Population-Based Nationwide Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12122992. [PMID: 36552999 PMCID: PMC9776797 DOI: 10.3390/diagnostics12122992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
The association between glaucoma and the risk of obstructive sleep apnea (OSA) has not been fully evaluated. Therefore, this study aimed to investigate the prospective association between glaucoma and OSA. In total, 1437 patients with glaucoma and 5748 patients without glaucoma were enrolled after 1:4 propensity score matching using a nationwide cohort sample. We investigated OSA events during a 10-year follow-up period. Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, disease-free survival rate, and hazard ratio (HR). The incidence of OSA was 12,509.0 person-years among those with glaucoma. The adjusted HR for patients with glaucoma developing OSA events during the follow-up period was 1.52 (95% confidence interval [CI]: 0.64-3.621) after other covariates. In a subgroup analysis, primary angle-closure glaucoma (PACG) showed a significantly increased adjusted HR for OSA events (5.65, 95% CI: 1.65-19.41), whereas we could not find any significant association between primary open-angle glaucoma (POAG) and OSA. The adjusted HR of OSA events in POAG was considerably increased 4 years after POAG diagnosis. PACG may be associated with an increased incidence of OSA. Clinicians should pay attention to early detection of OSA in patients with PACG.
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Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings. J Clin Med 2022; 11:jcm11030815. [PMID: 35160269 PMCID: PMC8837143 DOI: 10.3390/jcm11030815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings, such as macula layer thickness, the peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS, using optical coherence tomography (OCT); it also aims to monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: once before treatment, and again after six months of treatment. In mild–moderate patients, where retinal swelling had been demonstrated, retinal thicknesses decreased [fovea (p = 0.026), as did inner ring macula (p = 0.007), outer ring macula (p = 0.015), and macular volume (p = 0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p < 0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help to monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment.
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