The Assessment of Sleep Apnoea as a Risk Factor in Glaucoma

Abstract

Background: The risk of developing open angle glaucoma increases in the presence of associated disorders such as hypertension, Diabetes mellitus and migraine. In recent years, sleep apnoea is also being investigated as a risk factor in the development of open angle glaucoma. Aim:To ascertain the significance of sleep apnoea as a risk factor in patients with glaucoma. Study Setting and Design:A non -randomised, cross sectional study was undertaken at an urban teaching hospital. Material and Methods:A sleep disturbance questionnaire and the Epworth sleepiness scale were used to screen the potential cases of sleep apnoea amongst 40 glaucomatous subjects, with both Primary Open Angle Glaucoma (POAG) and Normotensive Glaucoma (NTG), as well as 40 controls. Those which gave a positive response to the questionnaire were subjected to polysomnography for the diagnosis of sleep apnoea, with the calculation of the Apnoea Hypopnoea Index. The data was analysed by using the Chi-square test and the odds ratio calculations.

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 study population and data source were from a single hospital in 12 studies (6 case-control studies and 6 cross-sectional studies). The patients in five case-control studies were diagnosed glaucoma patients at an eye clinic [ 15 , 18 , 19 , 24 , 25 ]; the other case-control study was from a hospital-based database [ 17 ]. In contrast, all patients in the cross-sectional studies with suspected OSAS were from sleep centers [ 13 , 20 , 26 , 27 , 30 , 31 ].…”

“…Thus, a subgroup analysis of the case control studies according to region was also conducted. The pooled ORs of the studies from United States + Europe [ 15 , 17 , 24 ] and other countries [ 18 , 19 , 25 ] were 1.80 (95% CI = 1.21–2.69, P = 0.004) and 2.64 (95% CI = 1.21–5.77, P = 0.02), respectively. Thus, both comparisons showed a positive association between OSAS and glaucoma.…”

“…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 ]. Thus, we performed this meta-analysis to evaluate whether there is a significant positive association between OSAS and the prevalence of glaucoma.…”