Sleep Apnoea Syndrome Correlated with Progression of Normal Tension Glaucoma

Abstract

Purpose : To evaluate the relationship between sleep apnoea status and the longitudinal structural and functional progression in normal tension suspect and early manifest glaucoma patients.

Methods : Three hundred and twenty-five suspect and early manifest glaucoma patients from the Progression Risk of Glaucoma: RElevant SNPs with Significant Association (PROGRESSA) study wore a pulse oximeter for three consecutive nights. Sleep apnoea syndrome was defined by the presence of an oxygen desaturation index (ODI) ≥ 10 on at least two nights of pulse oximetry monitoring. Patients were categorized to normal tension if they had no recorded intraocular pressures >21mmHg. In 173 normal tension participants a multivariate mixed effect regression analysis assessed the correlation between the presence of sleep apnoea syndrome and the retrospective rate of Spectral-Domain Optical Coherence Tomography (SD-OCT) macular ganglion cell-inner plexiform layer (mGCIPL) thinning. Secondary analysis assessed the correlation between the presence of sleep apnoea syndrome and visual field rate of change in mean deviation (MD/year). Age, gender, intraocular pressure and body mass index (BMI) were included as covariates.

Results : For normal tension participants in the PROGRESSA study, a sleep apnoea diagnosis conferred a 0.3 μm/year faster rate of mGCIPL thinning (β: -0.22 μm/year/SD 95% CI [-0.39, -0.06] P=0.009). This association persisted after adjustment for cardiovascular traits (hypertension, diabetes, smoking history) (β: -0.219 μm/year/SD 95% CI [-0.395, -0.042] P=0.017). Furthermore, a greater number of nights with an ODI ≥ 10 was associated with a faster rate of mGCIPL thinning (β: -0.08 μm/year/night 95% CI [-0.02, -0.14] P=0.01). In this normal tension cohort, a secondary analysis of visual field rate of change demonstrated participants with sleep apnoea syndrome exhibited faster rates of visual field deterioration (β: -0.16 dB/year 95% CI [-0.003, -0.31] P=0.045).

Conclusions : Normal tension suspect and early manifest glaucoma participants with sleep apnoea syndrome exhibited faster rates of mGCIPL thinning and faster visual field deterioration. These results implicate sleep apnoea as a relevant covariate of neuroretinal degeneration, which may be clinically relevant in normal tension glaucoma disease progression.

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