Obstructive Sleep Apnea as a Potentiator of Primary Open Angle Glaucoma and Necessity for Interventional Therapy.

Abstract

Purpose: To evaluate the rate of progression of primary open-angle glaucoma (POAG) in patients with obstructive sleep apnea (OSA) compared to non-OSA mild-moderate POAG comparators and to assess the utilization of surgical and laser intervention.

Design: A retrospective cohort study of the TriNetX US Collaborative network was conducted by analyzing international electronic health record (EHR) data from January 2004 to October 2024.

Participants: Patients in the TriNetX US Collaborative Network with a diagnosis of mild-moderate POAG, stratified with respect to OSA status.

Methods: Patients were assessed for outcomes at 3-, 5-, and 10 years. Propensity score matching (PSM) was conducted between cohorts matched for baseline demographics, comorbidities, and medication use. Odds ratios (OR) and 95% confidence intervals (CI) were subsequently calculated.

Main outcome measures: Risk of development of severe POAG.

Results: After PSM, 5,277 patients with, and 5,277 patients without OSA were included in final analysis. At 3 (OR 2.791, 95% CI: 2.289 - 3.403), 5 (OR 2.300, 95% CI: 1.947 - 2.717), and 10 years (OR: 2.198, 95% CI: 1.873 - 2.578), the OSA cohort demonstrated significantly higher odds of developing severe POAG compared to the non-OSA comparators. Secondary outcomes of minimally-invasive glaucoma surgery (MIGS) and trabeculectomy surgery yielded no significant difference between both cohorts (P > 0.05) at all follow-up times. However, laser therapy and tube shunt surgery demonstrated a significantly greater incidence in the OSA cohort at each time point.

Conclusions: The rate of glaucoma surgery appears similar between POAG patients with and without OSA, despite those with OSA demonstrating a greater risk for rapid progression and vision loss. Future practice patterns should pay special attention to OSA patients and consider offering more aggressive or earlier intervention, which may aid in limiting disease progression.