Study shows high incidence of dry eye in patients with sleep apnea
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ROME — Patients with obstructive sleep apnea who use a continuous positive airway pressure device or other nasal mask therapy device are predisposed to develop dry eye disease, according to a study presented at OSN Italy.
In the United States, the prevalence of sleep apnea has increased significantly in recent decades. Sleep apnea has also been associated with ocular disorders in studies.
“CPAP and NMT users may be at risk for eye and eyelid irritation secondary to airflow from mask leakage or retrograde nasolacrimal air escape,” Cynthia A. Matossian, MD, FACS, said. Over time, this might exacerbate dry eye disease (DED).
In addition, sleep apnea is often associated with metabolic or inflammatory conditions, which are known to predispose to DED.
In a real-world retrospective study, Matossian and co-authors evaluated the prevalence of eye-related conditions in a group of 330,926 patients included in the IBM MarketScan database who were prescribed continuous positive airway pressure (CPAP) or nasal mask therapy (NMT) between 2013 and 2018. None of these patients had a DED diagnosis before the device use.
Overall, 13,176 patients had DED. The overall prevalence of DED in CPAP or other NMT device users at 12 months, 24 months and 36 months was 6.2%, 10% and 13%, respectively. The overall incidence was 4%, 7.3%, and 10.3%. The prevalence at 36 months was double the prevalence rates of DED in the general U.S. population.
“Incidence of DED was higher among patients with comorbid metabolic or inflammatory conditions such as diabetes, psoriasis, chronic obstructive pulmonary disease, rheumatoid arthritis and irritable bowel syndrome,” Matossian said. “It was also significantly higher in patients who received antidepressants, anxiolytics and antihypertensives.”
Incidence increased with age and was higher in women than in men. In patients with comorbidities, it also increased based on the length of time using the CPAP device.
“In patients with concomitant psoriasis, the incidence increased from 9.1% at 1 year to 22.4% at 3 years,” Matossian said.
The rising prevalence and incidence of DED in patients with sleep apnea highlight a need for collaboration between sleep physicians and ophthalmologists. Further studies are needed, but meanwhile, “when dealing with patients with dry eye, ask them if they have sleep apnea and whether they use a CPAP device,” Matossian said.
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Matossian C. CPAP and its effect on the ocular surface. Presented at: OSN Italy; July 10-11, 2021; Rome.
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