Eye Exam,Eye Health,Glaucoma,Medical News

A woman sleeping peacefully in a cozy bedroom, enveloped by soft white sheets, under the gentle glow of night lighting.

Obstructive sleep apnea (OSA) and glaucoma may seem unrelated, but research has revealed a significant degree of connection between these two health conditions. For patients diagnosed with sleep apnea, understanding this relationship may be crucial for protecting your vision and eye health.

What is Obstructive sleep apnea (OSA)?

OSA is characterized by repeated episodes of complete (apnea) or partial (hypopnea) collapse of the upper airway during sleep.1 This disruption leads to fragmented, non-restorative sleep and can significantly impact your overall health.

Common symptoms of OSA Include:1

  • Loud and disruptive snoring
  • Witnessed pauses in breathing during sleep
  • Excessive daytime sleepiness
  • Disrupted sleep
  • Morning headaches

OSA affects nearly one billion people worldwide and is associated with numerous health concerns beyond sleep disruption.2 Risk factors include obesity, hypertension, advanced age, being male, sleeping on your back, alcohol use, smoking, and use of certain medications.1

What is Glaucoma?

Glaucoma is an eye condition that damages the optic nerve, which is vital for sending visual information from your eye to your brain. This damage is often often associated with increased intraocular pressure inside the eye.

For More Information on Glaucoma

What makes glaucoma particularly concerning is that many forms have no warning signs in early stages. Symptoms include gradual blurring and loss of vision, especially peripheral vision as well as contrast loss. Glaucoma can affect people of any age but is more common in older adults, making it one of the leading causes of blindness for people over 60.3

Glaucoma is considered multifactorial with various contributing elements including poor vascular perfusion, genetics, anatomical factors, and immune responses. Currently, intraocular pressure (IOP) is the primary modifiable risk factor for the development and progression of glaucoma.

What is the Link Between these Two Conditions?

A comprehensive meta-analysis published found that OSA was associated with a substantially high risk of developing glaucoma.4 After adjusting for various important confounders including age, gender, and patient co-morbidities such as hyperlipidemia, hypertension, cardiovascular diseases, and diabetes, patients with OSA had up to 40% higher odds of developing glaucoma compared to those without OSA.4

The connection appears particularly strong with specific types of glaucoma where individuals with OSA were:4

  • Approximately 6.7x more likely to develop Normal Tension Glaucoma (NTG)
  • About 2x more likely to develop Primary Open Angle Glaucoma (POAG)

Although the reason for this association is not truly known, two main theories explain this association:4,6

  1. Vascular Theory: Repeated breathing pauses during sleep reduce blood oxygen levels, triggering oxidative stress and inflammation that damage retinal ganglion cells and the optic nerve head This hypoxic stress is particularly harmful in normal-tension glaucoma (NTG), where optic nerve degeneration occurs despite normal intraocular pressure (IOP).
  2. Mechanical Theory: The supine sleeping position common in OSA patients increases episcleral venous pressure, reducing aqueous humor outflow and elevating IOP at night-a critical period for glaucoma progression. CPAP therapy may exacerbate this mechanical effect in some patients by further raising intrathoracic pressure.

CPAP Therapy and Your Eye Health

Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA. While essential for managing sleep apnea, patient should be aware that CPAP therapy may potentially affect eye pressure in some individuals.5

Studies have shown mixed results regarding CPAP’s effect on intraocular pressure.5 One study found that the mean IOP in CPAP and non-CPAP groups was comparable (19.2 vs. 19.69 mm Hg). However, the same study noted that mean IOP increased significantly to 23.75 mm Hg with CPAP in patients who already had glaucoma. This suggests that CPAP therapy may not be equally safe for all patients, particularly those with pre-existing glaucoma.

This doesn’t mean you should stop using your CPAP if prescribed-the benefits of treating OSA usually outweigh the risks. However, it does highlight the importance of regular eye examinations for OSA patients, especially those using CPAP therapy.6

Recommendations For Our Patients

If you have been diagnosed with OSA, here are important steps to protect your eye health:

1. Inform Your Eye Doctor About Your Sleep Apnea

Always share your complete medical history, including your OSA diagnosis, with your optometrist or ophthalmologist. This information helps your eye doctor provide more comprehensive care and allows for targeted screening and monitoring.

2. Schedule Regular Comprehensive Eye Exams

Complete ocular health evaluation should be advised at every follow-up for patients with OSA. These examinations will include:

  • Intraocular pressure measurements
  • Visual field testing
  • Optic nerve and retinal nerve fiber layer evaluation

3. Consider a Sleep Evaluation if You Have Glaucoma

If you’ve been diagnosed with glaucoma, especially normal-tension glaucoma, and have risk factors for sleep apnea such as obesity, your eye doctor may recommend an evaluation for OSA. 

Taking Action to Protect Your Vision

By understanding the connection between sleep apnea and glaucoma and taking proactive steps, you can help protect your vision for years to come. Our practice is committed to providing you with expert care that considers all aspects of your health to preserve your precious gift of sight.

Contact our office today to schedule your comprehensive eye examination.

References

  1. Slowik JM, Sankari A, Collen JF. Obstructive Sleep Apnea. [Updated 2025 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459252/
  2. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7:687–98.
  3. https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839
  4. Cheong, A.J.Y., Wang, S.K.X., Woon, C.Y. et al. Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis. Eye 37, 3065–3083 (2023). https://doi.org/10.1038/s41433-023-02471-6
  5. Fukutome T, Kuze M. Effects of continuous positive air pressure on intraocular pressure in patients with obstructive sleep apnea during the split-night study: An open-label randomized controlled trial. Medicine (Baltimore). 2023 Apr 25;102(17):e33566. doi: 10.1097/MD.0000000000033566. PMID: 37115064; PMCID: PMC10146050.
  6. Fukutome T, Kuze M. Effects of continuous positive air pressure on intraocular pressure in patients with obstructive sleep apnea during the split-night study: An open-label randomized controlled trial. Medicine (Baltimore). 2023 Apr 25;102(17):e33566. doi: 10.1097/MD.0000000000033566. PMID: 37115064; PMCID: PMC10146050.