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Same rate of sleep apnea seen in those with, without glaucoma
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Researchers found no evidence of a relationship between obstructive sleep apnea and primary open angle glaucoma.
As a result, they do not recommend systematic screening of POAG patients for sleep apnea.
Obstructive sleep apnea (OSA) has been shown to contribute to the progression of diabetic retinopathy and nonarteritic anterior ischemic optic neuropathy, and OSA screening has been recommended as part of the glaucoma work-up.
The authors believe that a number of factors should be considered before implementing a screening program, including the cost of testing, risks, benefits, causality and strength of the association between the two conditions.
To address this, they conducted an observational, cross-sectional study involving patients with primary open angle glaucoma (POAG) who attended a glaucoma clinic and their family members and friends as controls.
The researchers included 235 patients with POAG and 160 control subjects and conducted refractions, visual field testing, biomicroscopy, gonioscopy, Goldmann applanation tonometry, central corneal thickness measurement, corneal hysteresis and fundus photography. Subjects were also evaluated with an at-home sleep study.
They diagnosed OSA in 58% of the patients with POAG and 54% of controls. They found moderate to severe OSA in 22% of POAG patients and in 16% of controls, and no significant difference in the prevalence of OSA in the normal and high tension glaucoma groups.
“In our study of unselected POAG patients prospectively examined with a diagnostic test for sleep-disordered breathing in a real-world clinic scenario, we found no evidence that patients with POAG are more likely to suffer from OSA or have more severe OSA than control subjects,” the researchers concluded in the study.
A routine OSA screening program conducted among glaucoma patients would yield no different results than if conducted among a general population of middle-aged to elderly people, they said.
They concluded with no recommendation for systematic screening for OSA in patients with POAG. – by Nancy Hemphill, ELS, FAAO
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
Obstructive sleep apnea has been cited as a potential contributor to a number of systemic and ocular diseases, including diabetes, heart disease, stroke, anterior ischemic optic neuropathy and glaucoma, the latter particularly at low IOPs.
In theory, the episodic hypoxia, ischemia and reperfusion that characterize OSA could contribute to the onset and progression of glaucomatous optic neuropathy, akin to primary vascular dysregulation and (iatrogenic) systemic hypotension.
Still, whether OSA is truly causative or simply a comorbidity remains to be definitively determined. In this cross-sectional analysis, Wozniak and colleagues found no significant difference in the prevalence or severity of OSA in patients with glaucoma vs. controls, nor in patients with glaucoma at low or high IOPs, and conclude that routine screening for OSA in patients with POAG is not warranted.
However, the authors go on to note that a longitudinal study to assess the impact of OSA on disease progression is warranted, and this may be where the clinical benefit is realized. That is, in individual patients progressing at low IOPs, further investigation (including 24-hour IOP and blood pressure measurement, neuroimaging and polysomnography) is warranted and may reveal other potentially modifiable hazards above and beyond absolute IOP itself.
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Wozniak D, et al. J Glaucoma. 2019;doi:10.1097/IJG.0000000000001296.
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