Sleep Apnea Syndrome Represents a Risk for Glaucoma in a Veterans' Affairs Population

Abstract

Purpose. To determine whether the diagnosis of sleep apnea syndrome (SAS) represents a risk-factor for glaucoma. Design. Retrospective records review. Methods. Records in an electronic database which exists at the Birmingham, Alabama Veterans' Affairs Medical Center (BVAMC) permit data retrieval and sorting based on diagnostic and procedural codes. Deidentified data of those having had an eye examination and a diagnostic code (ICD-9) for either sleep apnea or glaucoma were included. Statistical Analyses. SPSS version 19 was used to produce crosstabs and to conduct a bivariate logistic regression that examined the relationship between SAS and glaucoma. Results. A total of 70,960 unique records were included for analysis. Of the 2,725 patients with a diagnosis of sleep apnea, 228 (8.37%) also had a diagnosis of glaucoma. Diagnosis of glaucoma was present in 3,410 patients among 68,235 patients (5.00%) without sleep apnea. Bivariate logistic regression analysis yielded an odds ratio of 1.736 (P < 0.001) suggesting that individuals with SAS are more likely to have a coexisting diagnosis of glaucoma than individuals without SAS. Conclusions. Results of this investigation suggest that SAS may represent a significant risk factor for glaucoma and this should be considered when managing patients who report that diagnosis.

Association between Glaucoma and Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Systematic Review

“…There were 23 studies focusing on the association between OSAS and glaucoma, but only 16, with a total of 2,278,832 participants, were included in the analysis according to the criteria above ( Table 1 ). These consisted of one retrospective cohort study [ 14 ], six case-control studies with OSAS as exposure [ 15 , 17 , 18 , 19 , 24 , 25 ], and nine cross-sectional studies comparing glaucoma in OSAS and non-OSAS groups [ 13 , 16 , 20 , 26 , 27 , 28 , 29 , 30 , 31 ] ( Table 1 ). In a study reporting the prevalence of both open-angle glaucoma (OAG) and normal-tension glaucoma (NTG) in sleep apnea patients, data for NTG were excluded because the two sets of data overlapped and could not be merged, while the sample size for OAG was considerably larger than that for NTG [ 28 ].…”

“…Regarding the diagnostic methods for glaucoma, the included reports used two criteria; 10 used systematic eye examinations, including visual field, optic nerve head cupping, anterior chamber angle, and intraocular pressure [ 13 , 15 , 18 , 19 , 20 , 25 , 26 , 27 , 30 , 31 ], while 6 were based on database or billing records [ 14 , 16 , 17 , 24 , 28 , 29 ]. Regarding the diagnostic criteria for OSAS, nine used objective evaluations, such as PSG and oximetry monitoring [ 13 , 18 , 19 , 20 , 25 , 26 , 27 , 30 , 31 ], five were based on database or billing records [ 14 , 16 , 17 , 24 , 29 ], and one was based only on a sleep questionnaire [ 15 ].…”

“…The pooled OR ranged from 1.21(95%CI = 1.18–1.28, P<0.0001) to 1.55 (95% CI = 1.12–2.13, P = 0.007). After removing the study of Boyle 2011 [ 16 ], which enrolled patients from a veterans’ electronic medical database, the variation across the studies disappeared and the I 2 statistic dropped from 73% to 0% (heterogeneity test χ 2 = 5.29, P = 0.62). This study suggested that the diagnosis rate of glaucoma was 8.4% in patients with sleep apnea and 5% in those without, markedly higher than in the two other large-sample studies.…”

“…Whether there is an association between sleep apnea and glaucomatous neuropathy has long been controversial in the literature. Some studies have confirmed the existence of a relationship between sleep apnea and normal-tension glaucoma (NTG), and/or open-angle glaucoma (OAG) [ 13 , 14 , 15 , 16 ]. However, other studies have shown no relationship [ 17 , 18 , 19 , 20 ].…”

Schlafstörungen und schlafassoziierte Erkrankungen beim Glaukom

“…Einige Studien mit Patientenkollektiven von 89-228 Patienten fanden keine signifikant erhöhte Glaukomrate bei an OSAS erkrankten Pa-tienten [13,14]. Die Prävalenz lag hier bei 2 % [13] sowie 3,4 % (3/ 89) [14], was in etwa der Prävalenz von 2-6,7 % an Glaukom erkrankter Patienten in der Normalbevölkerung (Kontrollgruppen) entspricht [15,16].…”