Burden of ophthalmologic disorders in obstructive sleep apnea

Although the impact of obstructive sleep apnea syndrome (OSA) on cardiovascular morbidity is well documented, ocular complications remain an uncertain topic. Eye diseases represent a problem of modern society, being one of the main causes of disability and decrease of quality of life.

The objective of this review is to analyze the specialized literature regarding ocular manifestations in OSA patients and the ophthalmological conditions associated with this sleep disorder. Underlying pathophysiological mechanisms and the impact of OSA treatment on ocular outcomes will also be discussed.

This work is a narrative review of articles published between 2000 and 2024 on databases such as PubMed, Google Scholar and HINARI. The articles were searched using combinations of the following keywords and search terms: obstructive sleep apnea, ocular complications, sleep disorders, eye disorders. Eligible publications were limited to English-language articles and comprised original research, reviews, meta-analyses, and clinical guidelines. Given the low prevalence of sleep apnea in children, only studies involving adult populations were included. Animal studies, non-English papers, case reports with insufficient data, and conference abstracts without full text were excluded.

OSA has been identified as a significant risk factor for various eye conditions, including glaucoma (GC), keratoconus, and diabetic retinopathy (DR). The prevalence of these conditions among patients with OSA is higher than in the general population. Although some studies suggest a link between OSA and ophthalmologic disorders, others dispute this association, as they can occur secondary to reduced blood flow through the internal carotid artery independent of OSA, such as in obesity, diabetes, and hypertension. However, positive dynamics were observed in GC and DR patients following CPAP treatment. The pathogeny involved in eye damage is uncertain, but studies suggest that both indirect and direct pathways are possible. Intermittent hypoxia induces hyperactivity of the sympathetic nervous system with the onset of vascular autonomic dysfunction, and the imbalance of vasoactive substances and oxidative stress disrupts the integrity of the blood-retinal barrier.

Although the correlation between OSA and eye diseases needs to be further studied, recognizing the potential of this association is essential for the prevention of ophthalmopathies.