Associations between obstructive sleep apnea and age-related macular degeneration: a national cohort study

Abstract

Purpose : Obstructive sleep apnea (OSA) has been shown to be associated with the risk of age-related macular degeneration (AMD); however, specific associations with non-exudative vs exudative AMD have not been well-studied. We sought to determine the risks of non-exudative and exudative AMD associated with OSA.

Methods : Patients in the Taiwan National Health Insurance Research Database with an International Classification of Disease, 9th and 10th Revision (ICD-9 & ICD-10) diagnosis of OSA between 2000 and 2018 were identified. A non-OSA cohort was created using 1:1 propensity score matching (PSM) on age, sex, OSA diagnosis year, and comorbidities with the OSA cohort. Cox proportional hazard model was made to estimate the hazard ratio (HR) of AMD development in OSA vs. non-OSA groups. Sensitivity analysis was conducted by restricting the OSA group to patients who underwent uvulopalatopharyngoplasty (UPPP) by current procedural terminology (CPT) code, and 1:1 PSM matching was performed to create a matched non-OSA group. Cox proportional hazard model was made to estimate risk of AMD, and risk of exudative AMD in those with AMD.

Results : A total of 129,475 patients with a diagnosis of OSA and 129,475 matched non-OSA group were identified. Patients with OSA had an increased risk of developing AMD (hazard ratio [HR] 1.31, 95% confidence intervals [CI]: 1.26-1.35) compared to those without OSA. When the OSA group was limited to those with UPPP (n=5,975), the risk of AMD remained higher (HR 1.49. 95% CI 1.24-1.81). In all patients with non-exudative AMD in the UPPP OSA group (n=275), there was a trend towards a higher risk of exudative AMD in those with OSA versus non-OSA (HR 1.72, 95% CI 0.46-6.47).

Conclusions : Patients with OSA had a higher risk of AMD development. There was also a trend towards increased risk of progression to exudative AMD in patients with OSA. Ophthalmic assessments may be beneficial in people with OSA and further studies are needed to better understand the relationship between OSA and AMD progression.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Table 1. Incidence rates of AMD in OSA and matched non-OSA cohorts, and hazard ratios for risk of AMD and exudative AMD.

 

Figure 1. (a) Cumulative incidence of AMD in the UPPP-OSA cohort and PSM-matched non-OSA patients over follow-up period, and (b) cumulative incidence of exudative AMD in those with AMD in the UPPP-OSA cohort and PSM-matched non-OSA patients over follow-up period.