Sleep Apnea Associated with Glaucoma

Glaucoma was 30% more common among sleep apnea patients in this study; however, the researchers caution that the study does not establish whether CPAP therapy itself increases or decreases glaucoma risk relative to untreated OSA. Photo: Mayo Clinic. Click image to enlarge. While there are benefits of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA), several studies have reported CPAP-associated fluctuations in intraocular pressure (IOP) as well as ocular irritation, raising concern regarding its use in patients at risk for glaucoma and other degenerative conditions. In a recent study, researchers from UC San Diego evaluated the association between OSA, CPAP device use and glaucoma in a large multicenter electronic health record cohort. They found that OSA is associated with a 30% higher risk of glaucoma. The findings were reported in Ophthalmology Glaucoma.The study included 12,516,607 adults aged 40 or older who were evaluated for OSA or underwent sleep testing between 2010 and 2025, had no prior glaucoma diagnosis and at least 180 days of follow-up. The patients were categorized into three groups:Sleep-tested controls without OSAOSA patients without a CPAP device recordOSA patients with a CPAP device recordPatients with OSA, both with and without a record of device use, exhibited higher rates of glaucoma compared to controls. Notably, untreated OSA patients had an approximately 30% higher hazard ratio. Further, OSA patients with a CPAP device had a twofold higher hazard compared with the same controls. However, the absolute cumulative incidence for OSA patients with or without the device remained low, and the absolute differences were small at five years and within a few percentage points at 10 years. Importantly, the higher hazard observed in the CPAP-record group should not be interpreted as evidence that the treatment itself increases glaucoma risk, the researchers stressed in their paper.The authors also noted that the elevated risk observed in the CPAP-recorded group should be interpreted cautiously. Because positive airway pressure is preferentially initiated in patients with more severe or symptomatic OSA, the higher hazard observed in the treatment group may reflect underlying OSA severity, treatment indication, adherence-related care pattern and related comorbidity burden rather than a harmful effect of CPAP itself. “Therefore, our data are more informative regarding the association between OSA and incident glaucoma than the causal effect of PAP itself,” the authors explained in their paper. “Without measures of OSA severity, such as the apnea-hypopnea index and objective adherence, it remains difficult to disentangle treatment effects from confounding by indication.”The finding that both treated and untreated OSA groups are at higher risk for glaucoma suggests that all patients with OSA may warrant closer ophthalmic attention. The persistence of elevated risk in the treatment group is also consistent with the possibility that OSA contributes to glaucoma through mechanisms beyond IOP. Proposed pathways include vascular dysregulation related to intermittent hypoxia, which may increase optic nerve vulnerability.Previous studies have shown that if intermittent hypoxia and vascular factors are important contributors, effective OSA treatment could plausibly attenuate risk through reductions in hypoxic stress and endothelial dysfunction, while any transient IOP effects may not translate into long-term damage in many patients. “This interpretation is also compatible with prior reports linking OSA to normal-tension glaucoma, which further support the view that non-IOP mechanisms may be clinically relevant in at least a subset of patients,” the authors wrote in their paper.Click here for the journal source. Nishida T, Mittal R, Weinreb RN. Positive airway pressure and long-term glaucoma risk in constructive sleep apnea: a real-world cohort study. Ophthalmol Glaucoma. May 26, 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.