Risk of obstructive sleep apnea in open-angle glaucoma versus controls using the STOP-Bang questionnaire

Prevalence of Obstructive Sleep Apnea in Glaucoma Patients: A Systematic Review and Meta-analysis

Aim and objective

Obstructive sleep apnea (OSA) is a known systemic risk factor associated with glaucoma. The purpose of the study was to determine the overall prevalence of sleep apnea among patients with glaucoma.

Design

A systematic review and meta-analysis.

Participants

Not applicable.

Materials and methods

A systematic literature search was performed through MEDLINE, EMBASE, and CINAHL and gray literature using Clinical Trials.gov, and ProQuest Dissertations and Theses and conferences held through the Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology was done until June 10, 2020. Eligible articles were identified by reviewing the retrieved results. Data extracted included the total number of patients with glaucoma and the proportion of glaucoma patients with a co-occurring diagnosis of OSA. STATA 15.0 was used to perform the meta-analysis.

Results

544 articles were gathered from the databases and 40 records were collected via the gray literature search. Ten studies with 956 subjects were included for analysis. The results of the meta-analysis demonstrated a significant rate of OSA among glaucoma patients (ES = 0.17; CI: [0.08, 0.25]).

Conclusion

We examine the prevalence of OSA in glaucoma patients and conclude that the prevalence of OSA in glaucoma patients is higher.

Clinical significance

The findings in the ongoing investigation on the link between glaucoma and OSA continue to be unclear. The results from this study contribute to evidence of an association between the two diseases.

How to cite this article

Yu BE, Cheung R, Hutnik C, et al. Prevalence of Obstructive Sleep Apnea in Glaucoma Patients: A Systematic Review and Meta-analysis. J Curr Glaucoma Pract 2021;15(3):109–116.

The Associations of Obstructive Sleep Apnea and Eye Disorders: Potential Insights into Pathogenesis and Treatment

Purpose of Review

Obstructive sleep apnea (OSA) patients are at significantly increased risks for cardiovascular and cerebrovascular morbidities. Recently, there has been heightened interest in the association of OSA with numerous ocular diseases and possible improvement of these conditions with the initiation of OSA treatment. We reviewed the current evidence with an emphasis on the overlapping pathogeneses of both diseases.

Recent Findings

Currently available literature points to a substantial association of OSA with ocular diseases, ranging from those involving the eyelid to optic neuropathies and retinal vascular diseases. Since the retina is one of the highest oxygen-consuming tissues in the body, the intermittent hypoxia and hypercapnia ensuing in OSA can have deleterious effects on ocular function and health. Tissue hypoxia, autonomic dysfunction, microvascular dysfunction, and inflammation all play important roles in the pathogenesis of both OSA and ocular diseases. Whether OSA treatment is capable of reversing the course of associated ocular diseases remains to be determined. It is anticipated that future therapeutic approaches will target the common underlying pathophysiologic mechanisms and promote favorable effects on the treatment of known associated ocular diseases.

Summary

Emerging evidence supports the association of ocular diseases with untreated OSA. Future studies focusing on whether therapeutic approaches targeting the common pathophysiologic mechanisms will be beneficial for the course of both diseases are warranted.

The association between visual impairment and fatigue: a systematic review and meta-analysis of observational studies

PURPOSE

The aim was to compare fatigue levels between patients with visual impairment and controls with normal sight and to examine the association between fatigue and vision loss severity.

METHODS

A systematic literature search was performed using databases of PubMed, Embase, PsycINFO and Cochrane to identify observational studies with outcomes related to fatigue (e.g. vitality subscale of the Short-Form 36, Fatigue Assessment Scale). A meta-analysis was performed using standardised mean differences (SMDs) and odds ratios (OR) to quantitatively summarise the association between visual impairment and fatigue. Sources of heterogeneity were explored by subgroup and sensitivity analyses. Study quality was assessed with the Newcastle-Ottawa scale.

RESULTS

After reviewing 4477 studies, 22 studies with a total of 40 004 participants were included, of which 18 contributed to meta-analysis. Among these, eight were assessed as moderate quality studies and 10 as high quality studies. Pooled analysis involving 2500 patients and 8395 controls showed higher fatigue severity levels (S.M.D. = -0.36, 95% CI -0.50 to -0.22, 14 studies) among visually impaired patients compared to normally sighted controls. This effect size was small and persisted in sensitivity analyses that involved study quality, fatigue assessment tools and visual acuity data. Furthermore, pooled analysis of four studies including 2615 patients and 5438 controls showed a significant association between visual impairment and fatigue (OR = 2.61, 95% CI 1.69 to 4.04). Secondary meta-analysis of four studies showed no significant difference in fatigue severity (S.M.D. = 0.01, 95% CI -0.37 to 0.39) between patients with moderate visual impairment and patients with severe visual impairment or blindness.

CONCLUSIONS

Current moderate to high quality evidence suggest that patients with visual impairment experience more severe fatigue symptoms than persons with normal sight. However, a limited number of available studies indicates that fatigue is not associated with severity of vision loss. Future studies are required to determine which factors and underlying mechanisms may explain the association between visual impairment and fatigue. Discussing fatigue at an early stage and developing intervention options for vision-related fatigue should be considered within the field of low vision rehabilitation.