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The association between ophthalmologic diseases and obstructive sleep apnea: a systematic review and meta-analysis

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Abstract

Purpose

The purpose of this study was to evaluate the association between obstructive sleep apnea (OSA) and ophthalmologic diseases, specifically glaucoma, nonarteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), central serous chorioretinopathy (CSR), and floppy eyelid syndrome (FES), by performing a systematic review and meta-analysis of published studies.

Methods

PubMed, Embase, and Scopus databases were searched for observational studies on OSA and its association with select ophthalmologic diseases. Data was pooled for random-effects modeling. The association between OSA and ophthalmologic diseases was summarized using an estimated pooled odds ratio with a 95 % confidence interval.

Results

Relative to non-OSA subjects, OSA subjects have increased odds of diagnosis with glaucoma (pooled odds ratio (OR) = 1.242; P < 0.001) and floppy eyelids syndrome (pooled OR = 4.157; P < 0.001). In reverse, the overall pooled OR for OSA was 1.746 (P = 0.002) in the glaucoma group, 3.126 (P = 0.000) in the NAION group, and 2.019 (P = 0.028) in the CSR group. For RVO, one study with 5965 OSA patients and 29,669 controls demonstrated a 1.94-fold odds increase in OSA patients.

Conclusions

Our results suggest significant associations between OSA and glaucoma, NAION, CSR, and FES. Screening for OSA should be considered in patients with glaucoma, NAION, CSR, or FES.

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Acknowledgments

This study was led by Dr. Leh-Kiong Huon while she was a visiting scholar in Sleep Surgery and Sleep Medicine at Stanford University School of Medicine. No funding was received for this research. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speaker’s bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements,) or non-financial interest (personal or professional relationships, affiliations, and knowledge or beliefs) in the subject matter or materials discussed in this manuscript. As this is a bibliographic research, it was considered “exempt” from IRB approval.

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan

    Leh-Kiong Huon

  2. School of Medicine, Fu Jen Catholic University, Taipei, Taiwan

    Leh-Kiong Huon

  3. Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA

    Leh-Kiong Huon, Macario Camacho & Christian Guilleminault

  4. Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, CA, USA

    Leh-Kiong Huon, Stanley Yung-Chuan Liu & Macario Camacho

  5. Division of Sleep Surgery and Medicine, Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA

    Macario Camacho

  6. Stanford University Sleep Medicine Division, 450 Broadway Street, MC 5704, Redwood City, CA, 94063, USA

    Christian Guilleminault

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  1. Leh-Kiong Huon
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  2. Stanley Yung-Chuan Liu
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  4. Christian Guilleminault
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Correspondence to Christian Guilleminault.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Comments

This meta-analysis emphasize the association of sleep disordered breathing and ophthalmologic disorders caused or propagated by variable pathologic mechanism; therefore, clinicians should consider this evidence a reason to pay more attention in their clinical practices of ophthalmology and consider screening patients for sleep disorders or referring patients to sleep disorders evaluation when clinically appropriate.

Rashid Nadeem

Illinois, USA

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Huon, LK., Liu, S.YC., Camacho, M. et al. The association between ophthalmologic diseases and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 20, 1145–1154 (2016). https://doi.org/10.1007/s11325-016-1358-4

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