ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA SEVERITY AND GLAUCOMA: A HOSPITAL-BASED CROSS-SECTIONAL STUDY
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Keywords
obstructive sleep apnea, glaucoma, primary open-angle glaucoma, apnea–hypopnea index, nocturnal hypoxemia, intraocular pressure, retinal nerve fiber layer, OCT
Abstract
Background: Obstructive sleep apnea (OSA) is characterized by recurrent upper-airway obstruction during sleep, intermittent hypoxemia and sleep fragmentation. Repeated nocturnal hypoxemia and vascular stress may affect the optic nerve and retinal circulation. Glaucoma, particularly primary open-angle glaucoma (POAG), is a chronic optic neuropathy in which vascular and pressure-related mechanisms may interact. The possible association between OSA severity and glaucoma is therefore clinically relevant to both respiratory medicine and ophthalmology.
Aim: To assess the association between OSA severity and glaucoma-related ophthalmic parameters in adults undergoing evaluation for suspected or confirmed OSA.
Methods: A hospital-based cross-sectional observational study was structured according to data collected. A fixed cohort of 100 adults with polysomnography-confirmed OSA was evaluated. Demographic data, BMI, smoking status, Epworth Sleepiness Scale (ESS), apnea–hypopnea index (AHI), oxygen-desaturation index (ODI), minimum nocturnal oxygen saturation, intraocular pressure (IOP), optic disc findings and optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness were recorded. Glaucoma was defined using a combined ophthalmic assessment including characteristic optic nerve/RNFL changes and corresponding visual-field abnormality, with IOP considered as a risk-related parameter.
Results: The cohort had a mean age of 56.7 ± 9.4 years and mean BMI of 29.1 ± 4.5 kg/m². Mild, moderate and severe OSA were present in 28%, 36% and 36%, respectively. Glaucoma was identified in 15% overall. Prevalence increased from 3.6% in mild OSA to 13.9% in moderate OSA and 25.0% in severe OSA (p=0.031). Mean IOP was 15.8 ± 2.4, 16.7 ± 2.6 and 18.1 ± 3.0 mmHg in mild, moderate and severe OSA, respectively. Mean global RNFL thickness was progressively lower with increasing OSA severity. AHI and ODI were inversely correlated with global RNFL thickness and positively associated with IOP.
Conclusion: Greater OSA severity was associated with a higher prevalence of glaucoma and adverse ophthalmic parameters in this cohort. Nocturnal hypoxemia may represent an important pathway linking OSA to optic nerve vulnerability.
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