Correlation between structural progression in glaucoma and obstructive sleep apnea

Abstract

Background/objectives To investigate the correlation between obstructive sleep apnea (OSA) severity and the structural and functional progression in patients with glaucoma. Subjects/methods This retrospective comparative cohort study included subjects from the polysomnography database in Chang Gung Memorial Hospital between June 1, 2009, and June 1, 2017, by identifying patients who had received diagnoses of primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), or glaucoma suspect. Patients with follow-up time of <3 years and/or <3 consecutive reliable optical coherence tomography (OCT) or visual field (VF) tests were excluded. Progression of overall peripapillary retinal nerve fiber layer (RNFL) thickness on OCT scans and VF mean deviation (MD) or VF index (VFI) were determined through linear regression trend analysis. Results Thirty-two patients were included. There was a trend to higher percentage of progression on RNFL thickness and VF in higher OSAS severity. After stratifying patients to no OSA/mild OSA (group 1) and moderate/severe OSA (group 2), group 2 exhibited a significantly higher percentage of RNFL thickness progression than did group 1 (64.7% vs 26.7%, P = 0.042). Multivariate Cox regression analysis showed that severe OSA had an 8.448-fold higher risk of RNFL thickness progression after age, sex, diabetes mellitus, hypertension, hyperlipidemia, and body mass index adjustment (95% confidence interval, 1.464-48.752, P = 0.017). Conclusions Severe OSA is significantly correlated with a higher risk of structural deterioration in patients with glaucoma.

Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern®

“…37 Other factors that have been associated with POAG include migraine headache, sleep apnea, peripheral vasospasm (Raynaud's syndrome), cardiovascular disease, low corneal hysteresis, and systemic hypertension. 17,[58][59][60][61][62][63][64][65] However, the association between these risk factors and the development of glaucomatous optic nerve damage has not been demonstrated consistently. 17, 28, 32, 38, 66-71…”

Progression patterns of normal-tension glaucoma groups classified by hierarchical cluster analysis

“…The extent to which these factors affect NTG is equivocal [7][8][9][10][11]. The rate and pattern of progression are inconsistent, and individual differences exist [12][13][14].…”

<p>Neuro-Ophthalmological Manifestations of Obstructive Sleep Apnea: Current Perspectives</p>

“…In a cohort study of 32 patients, those with moderate and severe OSA had a statistically higher degree of retinal nerve fiber layer thinning than patients with no or mild OSA. 71 In addition, severe OSA had an increased risk of retinal nerve fiber layer thinning by a factor of 8.448 (95% CI, 1.464-48.752; P<0.017). 71 Overall, the evidence suggests that patients with OSA have an increased risk of developing glaucoma.…”

“…71 In addition, severe OSA had an increased risk of retinal nerve fiber layer thinning by a factor of 8.448 (95% CI, 1.464-48.752; P<0.017). 71 Overall, the evidence suggests that patients with OSA have an increased risk of developing glaucoma. This progressive ischemia of the optic nerve could be due to chronic hypoperfusion of the optic nerve head during the apnea episodes or dysregulation of vascular modulating cytokines as a result of OSA.…”