Obstructive sleep apnoea (OSA) is a condition characterised by repeated cessation of breathing during sleep, caused by collapse of the upper airway due to relaxation of the surrounding tissue. The intermittent drops in blood oxygen levels present in OSA are thought to impair ocular perfusion, contributing to optic nerve damage related to glaucoma. Significant attention has been given to this potential association as positive airway pressure therapy (PAP) — a first-line treatment for moderate to severe OSA — is thought to inadvertently direct airflow towards the eyes if the device’s mask is not secured correctly, which can disrupt the ocular surface and contribute to eye irritation. Nishida and colleagues’ recent publication in Ophthalmology Glaucoma sheds new light on these potential associations, finding that people diagnosed with OSA were more likely to develop glaucoma than controls. The strongest associations in this potential relationship were observed in patients with a record of PAP therapy.
The study’s retrospective cohort drew on a multi-centre electronic healthcare record database covering over 12.5 million patients predominantly from the US between 2010 and 2025. Sleep-tested controls were compared to patients with OSA, both with and without a record of PAP treatment. Patients were followed for an average of 5.2 years, and characteristics such as sex, age, healthcare utilisation, and comorbidities were controlled for in the analysis. When compared to controls, those with OSA undergoing PAP treatment had a 2.1 times higher risk of developing glaucoma. Comparatively, patients with OSA not receiving PAP treatment had a 1.27 times higher risk when compared to controls. The authors caution against interpreting these findings as evidence that PAP treatment is causally related to glaucoma, as those requiring PAP treatment often have more severe OSA.
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The findings that OSA patients demonstrate a heightened risk of incident glaucoma suggests that patients with OSA may require closer ophthalmic monitoring. According to the World Health Organization (WHO), glaucoma is one of the leading causes of blindness. GlobalData epidemiologists forecast that total prevalent cases of primary open-angle glaucoma across seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan) will increase from 17,100,000 cases in 2026 to 18,300,000 cases by 2033. Consequently, continued focus on understanding its full risk profile will be crucial in supporting screening, diagnosis, and treatment efforts.
