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Rupert R A Bourne, Dariusz R Wozniak, Gil Peretz, Jane Kean, Russell Foster, Susan Downes, Ian Smith; Is Obstructive Sleep Apnoea Associated with Glaucoma Progression?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5091.
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To determine whether Obstructive Sleep Apnoea (OSA) is a risk factor for progression in patients with primary open-angle glaucoma (POAG).
Patients with POAG in the POSAG study (Prevalence of Obstructive Sleep Apnoea in Glaucoma, NCT02713152) underwent nocturnal multi-channel respiratory polygraphy, cardiovascular assessment and medical history review. Retrospective data on progression from the diagnosis of POAG to the study visit were collected. Enrolment required 5+ reliable visual fields (VF; Humphrey Visual Field Analyzer 24-2) and 3+ years of follow up data. Patients were categorised as progressors and non-progressors based on European Glaucoma Society guidelines (EGS) and PROGRESSOR pointwise linear regression (Medisoft, Inc). Rate of VF loss was determined by slope of progression for the whole VF (ProgressorSlope) and decline in mean deviation per year (MD/year). For each patient, the eye with the more severe VF defect (worse MD) was selected, unless only one eye was eligible. OSA was diagnosed based on apnoea-hypopnoea index (AHI) ≥5 (Moderate to severe OSA: AHI≥15). Statistics: independent t test, chi-square, binomial & linear regression.
159 patients with POAG were included (Mean observation period: 9.5+/-4.3 yrs, mean of 10.6 +/-4.4 VFs per eye. 47.8% of eyes were classified as progressing based on EGS criteria and 51.6% based on PROGRESSOR criteria, with good agreement between the two classifications (κ = 0.61, p=0.00). Within 5 years leading up the diagnostic test for OSA, 37.3% (EGS) and 49% (PROGRESSOR) eyes progressed. Overall, 56.6% of patients were diagnosed with OSA (moderate to severe in 22% of all patients). OSA was not a significant predictor of glaucoma progression irrespective of the classification used or follow up period: odds ratio=1.0 (0.53-1.88), p=0.99 for EGS from baseline, odds ratio=1.39 (0.74-2.6), p=0.31 for PROGRESSOR from baseline. Nor were people with moderate and severe OSA at higher risk of progression in comparison with people without OSA: odds ratio=1.1 (0.72-1.6) for EGS and odds ratio=0.96 (0.64-1.44), p=0.83 for PROGRESSOR. AHI score was not a significant predictor of the rate of progression measured by ProgressorSlope (R2=0.001, p=0.78) or MD/year decline (R2=0.00, p=0.87).
OSA was not a significant contributor to glaucoma progression. Patients with OSA and POAG can be reassured they do not appear to be at any extra risk.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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