Abstract
Purpose: :
There is conflicting evidence in the literature regarding the association between the presence of obstructive sleep apnea (OSA) and open angle glaucoma (OAG). Numerous risk factors for glaucoma are postulated to explain a positive correlation with OSA including vascular dysregulation, recurrent transient hypoxia and hypercapnea, and disruption of the circadian-hormonal axis. To control for these variables, we compared the occurrence of various types of glaucoma across two sleep disturbances, OSA and restless legs syndrome (RLS). RLS is not considered a risk factor for glaucoma and the occurrence of various types of glaucoma in this patient group should approach that of the general population. In order to better elucidate the potential link between OSA and OAG, we evaluated the occurrence of various types of glaucoma including OAG, normal tension glaucoma (NTG), ocular hypertension (OHT), OAG suspect, pseudoexfoliation, pigment dispersion and angle closure glaucoma.
Methods: :
A retrospective cohort analysis was performed using CPT codes for OSA & RLS provided by sleep specialists and those for various types of glaucoma provided by ophthalmologists at the Ochsner Clinic Foundation from January 2000 through December 2009. We identified a total of 12,043 patients with OSA and 2,584 patients with RSL. We then determined the frequency of occurrence of various types of glaucoma in these two sleep disturbance groups.
Results: :
A Chi-Square analysis revealed that the occurrence of various types of glaucoma did not significantly differ between OSA & RLS cohorts. In particular, the relationship between primary-OAG and OSA was not significant (df=1; p=0.81). The frequency of occurrence for the various glaucomas in the OSA and RLS cohorts, respectively was primary OAG 2.83 vs. 2.93, NTG 0.30 vs 0.30, OHT 2.37 vs. 2.56, OAG suspect 4.16 vs. 4.12 and angle closure glaucoma 0.33 vs. 0.26. However, age and ethnicity were each significantly associated with primary-OAG (p<0.0001). Multivariate logistic regression demonstrated that African American compared to White American ethnicity provided an increased risk for primary-OAG (Odds ratio 4.64 vs. 1.20).
Conclusions: :
Although the association between OSA and OAG is enticing, our analysis does not support a strong relationship between the presence of a sleep disturbance and various forms of open or closed angle glaucomas. Our data is consistent with previous findings that increasing age and African American ethnicity is associated with an elevated risk for primary-OAG.
Keywords: intraocular pressure