Study Links Obstructive Sleep Apnea to Increased Glaucoma Risk

A recent cohort study published in *Ophthalmology Glaucoma* reinforced this concern, revealing that individuals with OSA exhibit higher rates of glaucoma incidence, irrespective of their use of positive airway pressure (PAP) devices. OSA is characterized by repeated upper airway collapse during sleep, leading to episodes of oxygen desaturation and disturbed sleep. These episodes raise concerns about how intermittent hypoxia and vascular issues could potentially affect the optic nerve.

While managing intraocular pressure (IOP) is critical for glaucoma treatment, other vascular and non-IOP factors may also influence the risk and progression of the disease. The study focused on how PAP therapy, a standard treatment for OSA, could relate to glaucoma risk. Previous research has raised questions about whether continuous positive airway pressure (CPAP) treatment might impact IOP in specific patients.

For this study, researchers analyzed data from Epic Cosmos, a large electronic health record database. They classified participants into three groups: sleep-tested controls without OSA, patients with OSA but no PAP device recorded, and those with OSA who had used a PAP device within 180 days. The follow-up began 180 days post-evaluation and continued until incidents of glaucoma, death, or last patient encounter.

The research included 12,516,607 adults who had an initial assessment for OSA from January 1, 2010, to October 31, 2025. Participants had to have no prior glaucoma diagnosis and a minimum follow-up of 180 days. The mean age of the cohort was 60.4 years, with 43.7% identifying as women.

The study found 153,083 new glaucoma cases over an average follow-up period of 5.2 years. Crude incidence rates per 1,000 person-years were reported as follows: 1.74 among sleep-tested controls, 2.38 for OSA patients without a PAP device record, and 3.39 for those with a PAP device record. Adjusted glaucoma risk significantly increased in both OSA groups compared to controls, with a hazard ratio of 1.27 for those without PAP records and 2.10 for those with them. After ten years, the cumulative glaucoma incidences were 1.58% in controls, 2.30% in OSA patients without a PAP device, and 3.86% in patients using a PAP device.

However, the study authors cautioned against interpreting the increased risk in the PAP group as direct evidence that PAP therapy causes glaucoma. The association could reflect the severity of OSA, treatment indications, comorbidities, or variations in follow-up rather than suggesting a detrimental effect of PAP usage. PAP therapy is still commonly recommended for many OSA patients.

The relationship between OSA and glaucoma is not fully understood, although possible mechanisms could involve intermittent hypoxia leading to vascular dysregulation and oxidative stress, which may impact optic nerve resilience. Previous studies have also indicated links between OSA and normal-tension glaucoma, underscoring the importance of considering factors beyond IOP.

Limitations of the study include its observational design, which only establishes associations rather than causation, and reliance on coding for PAP use rather than direct measurement of device usage.

Ultimately, the study concluded that OSA is associated with an increased risk of glaucoma compared to sleep-tested controls, suggesting that patients with OSA should undergo ophthalmic monitoring. However, this does not imply that all individuals with OSA will develop glaucoma, as the overall absolute risk remains low. Eye care professionals are encouraged to be vigilant about glaucoma risk in OSA populations.