Obstructive sleep apnea and risk of age-related macular degeneration: A systematic review and meta-analysis

We evaluated whether obstructive sleep apnea (OSA) is associated with an increased risk of age-related macular degeneration (AMD). The population included adults with and without OSA. Outcomes included overall AMD risk and AMD stage-specific outcomes, including neovascular AMD (nAMD), non-neovascular AMD, late AMD with geographic atrophy (GA), and anti-VEGF therapy requirement.

AMD is a leading cause of irreversible vision loss worldwide. OSA, characterized by intermittent hypoxia, oxidative stress, and vascular dysregulation, shares key pathogenic mechanisms with AMD. Understanding whether OSA increases AMD risk could help identify high-risk populations for earlier detection, monitoring, and intervention.

We conducted a systematic review and meta-analysis of observational studies. PubMed, Web of Science, and Scopus were searched to June 27, 2025, supplemented by Google Scholar and citation tracking. Eligible studies reported AMD outcomes in both OSA and non-OSA groups. Methodological quality was assessed using the National Institutes of Health Quality Assessment Tool. Random-effects models were used to pool odds ratios (ORs) and adjusted hazard ratios (aHRs). Certainty of evidence was evaluated with the GRADE framework. The protocol was registered in PROSPERO (CRD420251119881).

Eight studies (3,536,314 participants; 207,130 with OSA) were analyzed. In crude analyses, OSA was associated with higher odds of AMD (OR = 1.45; 95%CI: 1.13-1.84; low certainty) with similar increases for nAMD (OR = 1.76; 95%CI: 1.06-2.93; low certainty) and non-neovascular AMD (OR = 1.95; 95%CI: 1.04-3.66; low certainty). No significant associations were observed in subgroups without confounder adjustment (low certainty) or with regression adjustment (low certainty), whereas propensity-score matched studies indicated higher odds (OR = 1.92; 95%CI: 1.05-3.52; low certainty). Adjusted analyses confirmed the association (aOR = 1.44; 95%CI: 1.11-1.77; moderate certainty) with no heterogeneity. Time-to-event analyses showed an increased hazard of AMD (aHR = 1.66; 95%CI: 1.13-2.19; low certainty), though stage-specific analyses for neovascular and non-neovascular AMD were not significant (very low certainty).

OSA may be associated with an increased risk of AMD, though the certainty of evidence ranges from moderate to very low. Variability in diagnostic criteria for OSA and AMD, high heterogeneity in several analyses, and reliance on observational data limit the strength of inference.