High prevalence of glaucoma in patients with sleep apnea syndrome

Objective: To determine the prevalence of glaucoma in sleep apnea syndrome (SAS), an entity characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption with the risk of cardiovascular and neurologic sequelae, Design: Cross-sectional study. Participants: A total of 114 white patients consecutively referred for polysomnographic evaluation of suspected SAS, Intervention: Complete ophthalmologic examination, including computerized perimetry and simultaneous stereoscopic optic disc photographs. Main Outcome Measures: Spearman rank correlations between the respiratory disturbance index during night sleep (RDI), a value used to diagnose and grade SAS, and visual acuity, intraocular pressure (IOP), visual field indices, presence or absence of glaucomatous optic disc changes, and diagnosis of glaucoma. Each correlation was controlled for age and body mass index. To compare proportions of patients harboring glaucoma, the binomial test was used. Results: Sixty-nine (60.5%) of the 114 patients had an RDI greater than or equal to 10, which indicates SAS, Three patients had primary open-angle glaucoma, and two had normal-tension glaucoma. All patients with glaucoma had SAS. The observed prevalence of glaucoma in patients with SAS (5 of 69, 7.2%) was significantly higher than expected in a white population (2%) (P = 0.01), The RDI correlated positively with IOP (P = 0.025), visual field loss variance (P = 0.03), glaucomatous optic disc changes (P = 0.001), and diagnosis of glaucoma (P = 0.01), Conclusions: Patients with SAS constitute a high-risk population for glaucoma and should therefore be screened for glaucoma.