OSA Linked to Increased Risk of AMD

Intermittent hypoxia, a characteristic of obstructive sleep apnea, is known to induce oxidative stress, inflammation and endothelial dysfunction—pathways implicated in the pathogenesis of AMD. Photo: NEI. Click image to enlarge. Obstructive sleep apnea (OSA) shares key pathogenic mechanisms with age-related macular degeneration (AMD) and understanding whether OSA increases AMD risk could help identify high-risk populations for earlier detection, monitoring and intervention. Researchers evaluated this in a recent meta-analysis and found a possible association between the two, but caution that the results should be interpreted as hypothesis-generating. The findings were reported recently in American Journal of Ophthalmology.Eight studies consisting of 3,536,314 participants—including 207,130 (5.9%) with OSA—were analyzed. Outcomes included overall AMD risk and AMD stage–specific outcomes, including neovascular AMD, non-neovascular AMD, late AMD with geographic atrophy and anti-VEGF therapy requirement.OSA may be associated with an increased risk of AMD, the researchers propose, though they acknowledge that the certainty of evidence ranged from moderate to very low. This association is biologically plausible, they assert. Intermittent hypoxia, a hallmark of OSA, is known to induce oxidative stress, inflammation and endothelial dysfunction, pathways implicated in the pathogenesis of AMD. Repeated nocturnal desaturation events may exacerbate retinal ischemia, disrupt the RPE and promote choroidal neovascularization.“Furthermore, increased sympathetic activation and systemic vascular dysregulation associated with OSA can compromise ocular perfusion, potentially accelerating degenerative retinal changes,” the authors explained in their paper. OSA-induced hypoxia could exacerbate complement-mediated retinal inflammation, thereby accelerating AMD progression in genetically susceptible individuals.An important clinical implication of this association is that OSA represents a potentially modifiable systemic condition. Unlike many established risk factors for AMD such as age and genetic susceptibility, OSA can be treated through well-established interventions, including CPAP therapy, mouth guards, weight reduction, positional therapy and some surgeries.From a practical standpoint, although these findings don’t justify routine screening for OSA in patients with AMD, they may support greater clinical awareness, the researchers propose. Eye doctors encountering patients with AMD “could consider asking brief, targeted questions regarding sleep quality, loud habitual snoring, witnessed apneas, excessive daytime sleepiness or morning headaches and advise referral to a general practitioner or sleep specialist if symptoms are suggestive,” the authors wrote in their paper.While these findings suggest a possible association between OSA and AMD, they shouldn’t be interpreted as conclusive, the authors cautioned. “The current evidence base does not support routine cross-specialty screening or diagnostic testing. Nevertheless, given that patients with AMD often fall within an age group at increased risk for this common and treatable condition, greater awareness of OSA and its symptoms” may be appropriate while additional studies are undertaken, they concluded.Click here for the journal source. Yaldo L, Ngo A, Yaldo M, et al. Obstructive sleep apnea and risk of age-related macular degeneration: a systematic review and meta-analysis. Am J Ophthalmol. February 10, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.