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Obstructive Sleep Apnea in Neuro-Ophthalmology

Wong, Brendon MD; Fraser, Clare L. MMed, FRANZCO

Section Editor(s): Costello, Fiona MD; Prasad, Sashank MD

doi: 10.1097/WNO.0000000000000728
State-of-the-Art Review

Background: Obstructive sleep apnea (OSA) is a common pulmonary disorder with many systemic sequelae. Its association with diseases seen in neuro-ophthalmology is being increasingly recognized. Treatment of OSA with continuous positive airway pressure (CPAP) may reverse the pathology in some eye diseases.

Evidence Acquisition: We conducted a search of the literature using the Ovid Medline database and Google Scholar, focusing on articles that explored the association between OSA and ophthalmic conditions. These included hypertensive retinopathy, diabetic retinopathy, central serous retinopathy (CSR), retinal vein occlusion (RVO), nonarteritic anterior ischemic optic neuropathy (NAION), glaucoma, idiopathic intracranial hypertension (IIH), papilledema, and stroke.

Results: There is evidence of an independent association between OSA, and both hypertension and Type 2 diabetes mellitus, as well as the retinopathy associated with each disease. Evidence also suggests a link between OSA and CSR, NAION, and stroke. The evidence remains controversial or insufficient for convincing causative association with RVO, glaucoma, and IIH. However, in patients presenting with CSR, and IIH, underlying OSA is a common finding. CPAP reverses some pathological changes, but the evidence is limited.

Conclusions: OSA is associated with many diseases seen in neuro-ophthalmology clinics. More studies are required to assess the real ability of CPAP to reverse pathological changes. Ophthalmologists can screen for undiagnosed OSA in patients presenting with certain eye diseases.

Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia; Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

Address correspondence to Clare L. Fraser, MMed, FRANZCO, Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, NSW 2000, Australia; Email:

The authors report no conflicts of interest.

© 2019 by North American Neuro-Ophthalmology Society