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Sleep apnea may be a risk factor for glaucoma

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LAS VEGAS — Sleep apnea may be a significant risk factor for developing glaucoma, according to a speaker here.

Parag A. Gokhale, MD, discussed the results of a meta-analysis evaluating the association between sleep apnea and glaucoma at Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting. Sleep apnea is defined as a complete cessation of airflow lasting 10 seconds or more during sleep. Several studies support the association between glaucoma and the sleep disorder, he said.

A Swedish study including 114 subjects suspected of sleep apnea found that 69 patients had sleep apnea, and of those, five had glaucoma. In a second study, the same researchers examined 30 patients with primary open-angle glaucoma and found that six patients also had sleep apnea, Dr. Gokhale said.

Dr. Gokhale also described an American study that reviewed sleep histories of patients with either normal-tension glaucoma or suspected normal-tension glaucoma. They compared the findings to a control group of healthy subjects.

The researchers found that seven of 23 glaucoma patients and three of 14 glaucoma suspect patients had sleep apnea, but none of the 30 control patients had the condition, he said.

A Chinese study further supports the association, he said. This study found that both abnormal visual fields and suspicious optic discs were more common in patients with severe obstructive sleep apnea than in age-matched controls. Similarly, another study found that 34 patients with sleep apnea had thinner retinal nerve fiber layers than age-matched controls, Dr. Gokhale said.

On the other hand, two recent larger-scale studies found no association between sleep apnea and glaucoma. But despite this conflicting evidence, Dr. Gokhale said he believes sleep apnea is a risk factor for glaucoma.

"In my glaucoma patients, I do take a brief sleep history and refer these patients for sleep studies if the symptoms are positive," he said. He urged the audience to do the same.

Dr. Gokhale noted that the most likely etiology to explain the association is ischemic damage to the optic nerve, possibly related to abnormal blood flow autoregulation, hypoxia, hypertension or arteriosclerotic disease.