Glaucoma and its association with obstructive sleep apnea: A narrative review

Abstract

Obstructive sleep apnea (OSA) is one of the systemic risk factors for glaucoma which causes irreversible visual field (VF) damage. We reviewed the published data of all types of studies on the association between these two conditions and papers regarding functional and structural changes related to glaucomatous damage using Scopus, web of science, and PubMed databases. There is evidence that the prevalence of glaucoma is higher in OSA patients, which independent of intraocular pressure (IOP). Studies have reported thinning of retinal nerve fiber layer (RNFL), alteration of optic nerve head, choroidal and macular thickness, and reduced VF sensitivity in patients of OSA with no history glaucoma. A negative correlation of apnea-hypopnea index with RNFL and VF indices has been described in some studies. Raised IOP was noted which is possibly related to obesity, supine position during sleep, and raised intracranial pressure. Diurnal fluctuations of IOP show more variations in OSA patients before and after continuous positive airway pressure (CPAP) therapy when compared with the normal cases. The vascular factors behind the pathogenesis include recurrent hypoxia with increased vascular resistance, oxidative stress damage to the optic nerve. In conclusion, comprehensive glaucoma evaluation should be recommended in patients with OSA and should also periodically monitor IOP during CPAP treatment which may trigger the progression of glaucomatous damage.

Reduced Macular Vessel Density and Capillary Perfusion in Glaucoma Detected Using OCT Angiography

“…The association of glaucoma with age, ethnicity and genetic associations, hypotension, diabetes mellitus, migraine, sleep apnoea and primary vasospasm has been reported. [2][3][4] Elevated IOP is important but not the sole factor responsible for retinal ganglion cell (RGC) death and optic nerve damage. 5 Many studies have revealed reduced ocular blood flow and perfusion pressure as risk factors for glaucoma, 6,7 with underlying mechanisms including endothelial cell dysfunction and impaired neurovascular unit.…”

Late-onset bleb-associated endophthalmitis and continuous positive airway pressure

“…OSA is well known to be a risk factor in glaucoma 36 and in a 2008 study, CPAP use was observed to elevate nocturnal IOP and induce larger night-time IOP fluctuations compared to subjects with OSA who did not use CPAP 37 . Therefore, there is a concern that CPAP users may be at a greater risk to develop glaucoma-induced optic neuropathy 38 , increasing the likelihood of undergoing surgical procedures such as trabeculectomy.…”

Glaucoma suspects: A practical approach

“…A history of steroid use in any form is also pertinent as steroid-induced glaucoma is liable to be missed at times, unless specifically asked for. [ 52 53 ]…”