Lin Chung-Wei, Su Yung-Chun, Liu Jin-Dien, Su Hsiao-Chun, Chiang Ting-Yi, Chiu Li-Wen, Lin Hsin-Ching, Chang Chun-Tuan, Lin Pei-Wen
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Nat Sci Sleep. 2024 Dec 6;16:1921-1935. doi: 10.2147/NSS.S495883. eCollection 2024.
Obstructive sleep apnea (OSA) has been reported to influence the ocular surface and may lead to dry eye disease (DED). Continuous positive airway pressure (CPAP) is the first-line conservative treatment for OSA. However, CPAP might also have mask-related side effects that could deteriorate DED simultaneously. This study investigated the impact of OSA on DED (Aim 1), and CPAP on DED (Aim 2). Five databases were searched for articles published up to May, 2024. OSA severity, CPAP usage, and DED parameters, including tear breakup time (TBUT), Schirmer test, Ocular Surface Disease Index (OSDI), and Corneal Fluorescence Staining Score (CFS), were analyzed. For Aim 1, the random-effects model was used for meta-analysis, and the leave-one-out method was used for sensitivity analysis. For Aim 2, a narrative synthesis with critical appraisal of the literature was performed. Eleven studies with 1,526 patients for Aim 1 and three studies with 180 patients for Aim 2 were included. For Aim 1, OSA patients had poorer dry eye profiles of TBUT, Schirmer test, and OSDI when compared to non-OSA patients. For Aim 2, it seemed that those wearing CPAP for less than half a year did not have enough improvement in dry eye status. Instead, those wearing CPAP for at least a year reached greater therapeutic effects for OSA and DED. We concluded that OSA patients may suffer from poorer dry eye condition compared to non-OSA patients. Besides, wearing CPAP for long enough duration (at least 1 year) seemed to have better improvement in DED.
据报道，阻塞性睡眠呼吸暂停（OSA）会影响眼表，并可能导致干眼症（DED）。持续气道正压通气（CPAP）是OSA的一线保守治疗方法。然而，CPAP也可能有与面罩相关的副作用，同时可能会使干眼症恶化。本研究调查了OSA对DED的影响（目标1）以及CPAP对DED的影响（目标2）。检索了五个数据库，查找截至2024年5月发表的文章。分析了OSA严重程度、CPAP使用情况以及DED参数，包括泪膜破裂时间（TBUT）、泪液分泌试验、眼表疾病指数（OSDI）和角膜荧光素染色评分（CFS）。对于目标1，采用随机效应模型进行荟萃分析，并采用留一法进行敏感性分析。对于目标2，则对文献进行批判性评估并进行叙述性综合分析。纳入了针对目标1的11项研究（共1526例患者）和针对目标2的3项研究（共180例患者）。对于目标1，与非OSA患者相比，OSA患者在TBUT、泪液分泌试验和OSDI方面的干眼状况较差。对于目标2，似乎使用CPAP不到半年的患者干眼状况改善不足。相反，使用CPAP至少一年的患者对OSA和DED的治疗效果更佳。我们得出结论，与非OSA患者相比，OSA患者可能患有更严重的干眼状况。此外，长时间（至少1年）使用CPAP似乎对DED有更好的改善效果。
