Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, USA.
Am J Ophthalmol. 2011 Dec;152(6):989-998.e3. doi: 10.1016/j.ajo.2011.04.030.
To determine whether an association exists between sleep apnea and open-angle glaucoma, normal-tension glaucoma, nonarteritic ischemic optic neuropathy (NAION), papilledema, or idiopathic intracranial hypertension (IIH) and whether treatment with continuous positive airway pressure affects the development of these conditions.
Retrospective, longitudinal cohort study.
Billing records for beneficiaries 40 years of age and older enrolled in a large United States managed care network from 2001 through 2007 were reviewed. Incidence of open-angle glaucoma, normal-tension glaucoma, NAION, papilledema, and IIH were determined for the beneficiaries and were stratified by sleep apnea status. Cox regression analyses determined the hazard of each of these conditions developing among individuals with and without sleep apnea, with adjustment for sociodemographic, ocular, and medical conditions.
Among the 2 259 061 individuals in the study, 156 336 (6.9%) had 1 or more sleep apnea diagnoses. The hazard of open-angle glaucoma was no different among persons with sleep apnea either treated (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.82 to 1.18) or untreated with continuous positive airway pressure (HR, 1.01; 95% CI, 0.98 to 1.05) and individuals without sleep apnea. Similar findings were observed when assessing the hazard of normal-tension glaucoma developing (P > .05 for both comparisons). A significantly increased hazard of NAION developing (HR, 1.16; 95% CI, 1.01 to 1.33) and IIH (HR, 2.03; 95% CI, 1.65 to 2.49) was observed among individuals with sleep apnea who were not receiving continuous positive airway pressure therapy as compared with individuals without sleep apnea, although similar increased risks could not be demonstrated among continuous positive airway pressure-treated sleep apnea patients for these conditions (P > .05 for both comparisons).
Patients with untreated sleep apnea are at increased risk for IIH and NAION. Clinicians should consider appropriate screening for these conditions in sleep apnea patients.
确定睡眠呼吸暂停与开角型青光眼、正常眼压性青光眼、非动脉炎性前部缺血性视神经病变（NAION）、视盘水肿或特发性颅内高压（IIH）之间是否存在关联，以及持续气道正压通气治疗是否会影响这些疾病的发展。
回顾性、纵向队列研究。
对 2001 年至 2007 年期间参加美国大型管理式医疗网络的年龄在 40 岁及以上的受益人的计费记录进行了审查。确定了受益人的开角型青光眼、正常眼压性青光眼、NAION、视盘水肿和 IIH 的发病率，并按睡眠呼吸暂停状况进行分层。Cox 回归分析确定了有和没有睡眠呼吸暂停的个体中这些疾病的发展风险。
在研究的 2259061 名个体中，有 156336 名（6.9%）有 1 个或多个睡眠呼吸暂停诊断。接受持续气道正压通气治疗（调整后的危害比[HR]，0.99；95%置信区间[CI]，0.82 至 1.18）或未经治疗的睡眠呼吸暂停患者（HR，1.01；95%CI，0.98 至 1.05）与无睡眠呼吸暂停患者相比，患开角型青光眼的风险无差异。当评估正常眼压性青光眼发展的风险时，也观察到类似的发现（两种比较的 P 值均＞0.05）。与无睡眠呼吸暂停的个体相比，未接受持续气道正压通气治疗的睡眠呼吸暂停患者患 NAION（HR，1.16；95%CI，1.01 至 1.33）和 IIH（HR，2.03；95%CI，1.65 至 2.49）的风险显著增加，尽管不能证明接受持续气道正压通气治疗的睡眠呼吸暂停患者存在这些疾病的风险增加（两种比较的 P 值均＞0.05）。
未经治疗的睡眠呼吸暂停患者患 IIH 和 NAION 的风险增加。临床医生应考虑对睡眠呼吸暂停患者进行这些疾病的适当筛查。
