Association between glaucoma and obstructive sleep apnea syndrome: a meta-analysis and systematic review

PLoS One. 2015 Feb 23;10(2):e0115625. doi: 10.1371/journal.pone.0115625. eCollection 2015.


Background: Obstructive sleep apnea syndrome (OSAS) is a common disease that increases the risk of diabetes, heart disease, and stroke. However, studies of an association between OSAS and glaucoma neuropathy have reported controversial findings.

Objective: The main purpose of this study was to evaluate whether a significant association exists between OSAS and glaucoma by performing a meta-analysis of previous studies.

Methods: A comprehensive literature search using the PubMed and Embase databases was performed to identify cross-sectional, case-control, and cohort studies related to the topic. We estimated a pooled odds ratio (OR) for the association between OSAS and glaucoma, by a fixed- or random-effects model.

Results: In total, 16 studies with 2,278,832 participants met the inclusion criteria: one retrospective cohort study reported an adjusted hazard ratio of glaucoma of 1.67 (95% CI = 1.30-2.17). Using a fixed-effects model, the pooled OR of six case-control studies was 1.96 (95% CI = 1.37 2.80). A significant association was also identified in a meta-analysis of nine cross-sectional studies using a random-effects model, which showed a pooled OR of 1.41 (95% CI = 1.11 1.79). However, the reported pooled estimates for case control studies and cross-sectional studies were based on unadjusted ORs.

Conclusions: Our results suggest that OSAS is associated with the prevalence of glaucoma. However, this result was based only on unadjusted estimates. Prospective cohort studies designed to take into consideration potential confounders, or examination of data from interventional trials to determine whether a reduction in OSAS status is associated with a reduced incidence of glaucoma, are needed to clarify whether OSAS is an independent risk factor for glaucoma.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Comorbidity
  • Glaucoma / epidemiology*
  • Humans
  • Incidence
  • Prevalence
  • Risk
  • Sleep Apnea, Obstructive / epidemiology*

Grants and funding

This study was supported by the Fund of the Shanghai Municipal Health Bureau (Grant No. 20124450), the Science and Engineering Research Fund of Shanhai Jiaotong University of China (Grant No. 09XJ21004), and the Project of the Shanghai Committee of Science and Technology (14DZ1940704).