Obstructive Sleep Apnea and Nonarteritic Anterior Ischemic Optic Neuropathy: Evidence for an Association

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most prevalent optic nerve disorder among patients over 50 years of age, characterized by sudden onset, painless visual loss, with an accompanying relative afferent pupillary defect and optic disc edema. Although the pathophysiology of NAION has not been fully elucidated, several risk factors have been considered, including advanced age, systemic hypertension, diabetes mellitus, and certain optic disc morphologies. An association between obstructive sleep apnea (OSA) and NAION has also been recognized. One prospective cohort study indicated that the relative risk of OSA among patients with NAION was 4.9; a later retrospective cohort study demonstrated that patients with OSA not treated with continuous positive airway pressure (CPAP) had a 16% increased hazard of developing NAION compared to patients without OSA. The following review will discuss the most recent understanding of the relationship between OSA and NAION, with implications for further research and prevention strategies.