Obstructive Sleep Apnea in patients with Primary-Open Angle Glaucoma: prevalence and associations.

Rationale: Obstructive sleep apnea (OSA) has been implicated in the pathophysiology of primary open-angle glaucoma (POAG) but its prevalence in this population is unknown. Objectives: To assess whether the prevalence of OSA among patients with POAG is different than in people without glaucoma and to examine potential associations between apnea hypopnea index (AHI) and markers of functional and structural deficits in POAG. Methods: Unselected POAG patients and control subjects were consecutively recruited in a single center. A comprehensive ocular assessment and nocturnal multichannel cardiorespiratory monitoring were performed. OSA was diagnosed based on AHI≥5. Results: A total of 395 participants, 235 POAG patients and 160 controls were included. The prevalence of OSA was 58% (95% CI:52-65) in POAG patients and 54% (95% CI:47-62) in controls. 22% (95% CI:16-27) of POAG patients and 16% (95% CI:11-22) controls were diagnosed with moderate to severe OSA (AHI≥15). 160 POAG participants were matched to the controls using propensity score matching. There was no significant difference in OSA prevalence between the matched groups (p=0.91 for AHI≥5, p=0.66 for AHI≥15). The AHI was not associated with glaucoma severity defined by a functional deficit classification. Nor was it a significant predictor of Retinal Nerve Fiber Layer thinning after adjustment for confounders. Conclusions: This study confirms a high prevalence of OSA in patients with POAG which is however not higher than in people without glaucoma who otherwise share the same risk factors for OSA. Our findings do not support the hypothesized association between these two conditions.