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Obstructive Sleep Apnea in Patients With Primary-open Angle Glaucoma

No Role for a Screening Program

Wozniak, Dariusz MD*,†; Bourne, Rupert MD†,‡,§; Peretz, Gil MD§; Kean, Jane BSc§; Willshire, Catherine PhD§; Harun, Shabbir MD§; Villar, Sofia PhD∥,¶; Chiu, Yi-Da PhD; Smith, Ian MD*

doi: 10.1097/IJG.0000000000001296
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Précis: In this study, we found a high prevalence of obstructive sleep apnea (OSA) among patients with primary open-angle glaucoma (POAG) but this was not different (nor was OSA more severe) to matched people without glaucoma.

Rationale: It has been proposed that OSA might be a contributing factor in the development of POAG and by extension that there could be a role for screening people with POAG for OSA.

Objectives: To assess whether the prevalence of OSA among patients with POAG is different from that in people without glaucoma and to examine for associations between apnea-hypopnea index (AHI) and markers of functional and structural changes in POAG.

Methods: Unselected POAG patients and control subjects were consecutively recruited in a single center. A comprehensive ocular assessment and nocturnal multichannel cardiorespiratory monitoring were performed.

Results: Data from 395 participants, 235 POAG patients, and 160 controls were analyzed. The prevalence of OSA was 58% [95% confidence interval (CI), 52-65] in POAG patients and 54% (95% CI, 47-62) in controls, with 22% (95% CI, 16-27) of POAG patients and 16% (95% CI, 11-22) of controls diagnosed with moderate or severe OSA. A total of 160 POAG participants were matched to the controls using propensity score matching. There was no significant difference in OSA prevalence between the matched groups (P=0.91 for AHI≥5 and P=0.66 for AHI≥15). The AHI was not associated with the severity of visual field defect or retinal nerve fiber layer thinning after adjustment for confounders.

Conclusions: This study confirms a high prevalence of OSA among patients with POAG which is, however, not higher than in people without glaucoma matched for known OSA risk factors. Our results do not support screening for OSA in patients with POAG.

*Respiratory Support and Sleep Centre

Research and Development, Royal Papworth Hospital

Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University

Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus

Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge

§Department of Ophthalmology, Hinchingbrooke Hospital, North West Anglia Foundation Trust, Huntingdon, UK

Supported by an unrestricted research grant awarded by Breas Medical, Unit A2, The Bridge Business Centre, Timothy’s Bridge Road, Stratford-Upon-Avon, Warwickshire, CV37 9HW, UK and the Fight for Sight (Small Grant Awards Schemes), 18 Mansell Street, London E1 8AA, UK. The study was also supported by the National Institute for Health Research via the Fight for Sight grant.

Disclosure: The authors declare no conflict of interest.

Reprints: Dariusz Wozniak, MD, Respiratory Support and Sleep Centre, Royal Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, UK (e-mail: dariusz.wozniak@nhs.net).

Received March 25, 2019

Accepted May 22, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.