Obstructive Sleep Apnea in Patients With Primary-open Angle Glaucoma: No Role for a Screening Program

Abstract

Précis: In this study, we found a high prevalence of obstructive sleep apnea (OSA) among patients with primary open-angle glaucoma (POAG) but this was not different (nor was OSA more severe) to matched people without glaucoma. Rationale: It has been proposed that OSA might be a contributing factor in the development of POAG and by extension that there could be a role for screening people with POAG for OSA. Objectives: To assess whether the prevalence of OSA among patients with POAG is different from that in people without glaucoma and to examine for associations between apnea-hypopnea index (AHI) and markers of functional and structural changes in POAG. Methods: Unselected POAG patients and control subjects were consecutively recruited in a single center. A comprehensive ocular assessment and nocturnal multichannel cardiorespiratory monitoring were performed. Results: Data from 395 participants, 235 POAG patients, and 160 controls were analyzed. The prevalence of OSA was 58% [95% confidence interval (CI), 52-65] in POAG patients and 54% (95% CI, 47-62) in controls, with 22% (95% CI, 16-27) of POAG patients and 16% (95% CI, 11-22) of controls diagnosed with moderate or severe OSA. A total of 160 POAG participants were matched to the controls using propensity score matching. There was no significant difference in OSA prevalence between the matched groups (P=0.91 for AHI≥5 and P=0.66 for AHI≥15). The AHI was not associated with the severity of visual field defect or retinal nerve fiber layer thinning after adjustment for confounders. Conclusions: This study confirms a high prevalence of OSA among patients with POAG which is, however, not higher than in people without glaucoma matched for known OSA risk factors. Our results do not support screening for OSA in patients with POAG.

Optic Disc Measures in Obstructive Sleep Apnea: A Community-based Study of Middle-aged and Older Adults

“…Measures of OSA severity in this subset of participants also did not differ from the rest of the cohort. Likewise, Wozniak et al's recent case-control study 33 of over 300 middle-aged and older adults found similar rates of OSA in patients with open-angle glaucoma and controls (58% vs 54%). Findings from other large cohort [14][15][16] and casecontrol investigations 16,34 also do not support an association between the two conditions.…”

Relation between Obstructive Sleep Apnea-Hypopnea Syndrome and Glaucoma in a Sub-Saharan African Population

“…This female predominance was also found by Balbay et al in Turkey [29] and Onen et al in France [30], 54.3% and 57.1% respectively. On the other hand, there is a male predominance in the study conducted by Wozniak et al [31]. Our results could be justified by the fact that women are more numerically represented and more health conscious hence their high participation in the study.…”

“…Studies have shown that OSAHS is more frequent in glaucoma patients than in the control group. Indeed, Wozniak et al [31] reported that among patients with moderate and severe forms of OSAHS, glaucoma patients accounted for 22% compared to 16% among controls. It can also be noted that the high risk of OSAHS is prevalent in glaucoma patients compared to the low risk.…”

Prevalence of Obstructive Sleep Apnea in Glaucoma Patients: A Systematic Review and Meta-analysis

“… 14 , 15 All other studies included were comparative and included multiple groups. 11 , 16 – 22 For these studies, data on OSA from the glaucoma group were extracted for quantitative analysis. For studies with more than one glaucoma group, both groups were combined before data extraction.…”

“…For studies with more than one glaucoma group, both groups were combined before data extraction. Both studies by Wozniak et al were grouped as one so that only data from Wozniak et al was extracted being that it provided an updated data set to the study by Wozniak et al 16 , 21…”