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Is Obstructive Sleep Apnea Associated With Progressive Glaucomatous Optic Neuropathy?

Swaminathan, Swarup, S., MD*; Bhakta, Amitabha, S., PhD*; Shi, Wei, MS*; Feuer, William, J., MS*; Abreu, Alexandre, R., MD; Chediak, Alejandro, D., MD; Greenfield, David, S., MD*

doi: 10.1097/IJG.0000000000000837
Original Studies

Purpose: The purpose of this study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) and glaucoma progression, and to examine the correlation between OSAS severity and rate of visual field (VF) loss.

Methods: Patients with concurrent diagnoses of open-angle glaucoma and OSAS between 2010 and 2016 were identified. Enrollment criteria consisted of glaucomatous optic neuropathy and VF loss, ≥5 reliable VFs, ≥2 years of follow-up, and polysomnography (PSG) within 12 months of final VF. PSG parameters including apnea-hypopnea index (AHI) and oxygen saturation (SpO2) were collected. Eyes were classified as “progressors” or “nonprogressors” based upon event analysis using Glaucoma Progression Analysis criteria. Two-tailed t test comparisons were performed, and correlations between rates of VF loss and PSG parameters were assessed.

Results: A total of 141 patients with OSAS and glaucoma were identified. Twenty-five patients (age 67.9±7.6 y) with OSAS (8 mild, 8 moderate, 9 severe) were enrolled. Eleven eyes (44%) were classified as progressors, and had more severe baseline VF loss (P=0.03). Progressors and nonprogressors had nonsignificantly different (P>0.05) age (69.9±8.7 vs. 66.4±6.6 y), follow-up (4.4±0.7 vs. 4.3±1.0 y), intraocular pressure (13.1±2.8 vs. 14.9±2.5 mm Hg), mean ocular perfusion pressure (49.7±5.5 vs. 48.8±9.0 mm Hg), AHI (31.3±18.6 vs. 26.4±24.0), body-mass index (27.8±5.5 vs. 28.8±5.6), and SpO2 (94.1±1.6% vs. 94.0±1.6%). AHI was not correlated with slopes of VF mean deviation (r, −0.271; P, 0.190) or pattern standard deviation (r, 0.211; P, 0.312), and no substantial increase in risk of progression was found with increase in AHI.

Conclusions: This study does not support a relationship between OSAS and glaucomatous progression. No correlation was observed between OSAS severity and rate of VF loss.

*Department of Ophthalmology, Bascom Palmer Eye Institute

Department of Pulmonology, University of Miami Miller School of Medicine, Miami, FL

Supported by P30EY014801 University of Miami core grant; Research to Prevent Blindness Unrestricted grant, New York, NY; an unrestricted grant from Mr and Mrs Thorne B. Donnelley, Chicago, IL, and the Maltz Family Endowment for Glaucoma Research, Cleveland, OH.

Disclosure: D.S.G. serves as a consultant to Aerie Pharmaceuticals, Alcon, Allergan, Bausch + Lomb, Quark Pharmaceuticals, and Glaukos. The remaining authors declare no conflict of interest.

Reprints: David S. Greenfield, MD, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 7101 Fairway Drive, Palm Beach Gardens, FL 33418 (e-mail:

Received September 12, 2017

Accepted November 5, 2017

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