The effect of continuous positive airway pressure therapy on intraocular pressure in patients with OSA: a systematic review and meta-analysis.

Study objectives: To assess the effect of continuous positive airway pressure (CPAP) therapy on intraocular pressure in Obstructive sleep apnea (OSA) patients.

Methods: The search was performed in Ovid Medline and Embase database then followed by a manual bibliography search. Abstract search and screening were independently performed followed by eligible full-text versions reviewed. Then disagreements were discussed in a group.

Results: This systematic review and meta-analysis considered 15 studies with 495 participants. The pooled mean intraocular pressure after CPAP therapy shows no significant difference compared to the baseline (MD, 0.58 mmHg; 95% CI, -0.33 to 1.19). Subgroup analysis shows significantly higher intraocular pressure after in-lab PAP titration and after long-term CPAP used (MD, 4.28 mmHg; 95% CI, 0.91 to 7.66; MD, 0.45 mmHg; 95% CI, 0.07 to 0.83; respectively). Ocular perfusion pressure was also significantly decreased after CPAP therapy. (MD, -2.15 mmHg; 95% CI, -3.50 to -0.80). The pooled data showed no significant difference in RNFL thickness and macular layer thickness.

Conclusions: After long-term treatments CPAP therapy, there is a significant increase in intraocular pressure in patients with OSA and a decrease in ocular perfusion pressure but did not show a significant difference in other ophthalmologic parameters. For this reason, CPAP usage in glaucoma patients necessitates to be done cautiously.

Systematic review registration: This systematic review protocol was registered with PROSPERO (registration number CRD42022370734).