Ocular conditions associated with obstructive sleep apnea: Mechanisms and clinical implications

Abstract

Obstructive sleep apnea (OSA) is a well-established risk factor for various cardiovascular and neurological conditions. Increasing evidence suggests that OSA is also associated with a wide spectrum of ocular conditions, affecting nearly all anatomical structures of the eye, from the eyelids and ocular surface to the retina and optic nerve. These associations are largely driven by intermittent hypoxia, oxidative stress, inflammation, and vascular dysregulation. This narrative review summarizes current evidence on ocular conditions associated with obstructive sleep apnea, focusing on common underlying mechanisms and examining how continuous positive airway pressure (CPAP) therapy may influence disease progression and ocular outcomes. Targeted primarily toward sleep medicine specialists, ophthalmologists, and neuro-ophthalmologists, this review aims to raise awareness of ophthalmic manifestations in OSA and to emphasize the need for timely referral, either for ophthalmic evaluation when sleep apnea is suspected based on ocular findings, or for sleep studies when patients present with ocular conditions commonly associated with sleep-disordered breathing.

Keywords: Continuous positive airway pressure (CPAP) therapy; Intermittent hypoxia; Neuro-ophthalmologic conditions; Obstructive sleep apnea (OSA); Oxidative stress.