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  • Obstructive Sleep Apnea and Exfoliation Syndrome

    By Jean Shaw
    Selected By: Henry D. Jampel, MD, MHS
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    Journal Highlights

    Ophthalmology Glaucoma, May/June 2021

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    Shumway et al. set out to investigate the association between obstructive sleep apnea and exfoliation syndrome (XFS). They found that patients with obstructive sleep apnea may be at increased risk of XFS, particularly if they also have hypertension.

    For this case-control, retrospective cohort study, the researchers used the Utah Population Database to identify subjects with obstructive sleep apnea (n = 81,735). For comparison, case control subjects (n = 319,939), also identified via the database, were matched on sex and birth year.

    The patients’ mean age at diagnosis of sleep apnea was 64.6 years, and the mean age at time of XFS diagnosis was 74.9 years. Those with sleep apnea were diagnosed between 1999 and 2017; those with XFS were diagnosed between 1996 and 2015.

    Odds ratios (ORs) were calculated from multivariable logistic regression models to estimate the risk of XFS in patients with sleep apnea compared with controls. Covariates potentially related to both obstructive sleep apnea and XFS—including obesity, hyper­tension, tobacco use, atrial fibrillation, and chronic obstructive pulmonary disease—were analyzed. The primary outcome was the risk of having an XFS diagnosis, including exfoliative glauco­ma (XFG), in tandem with a diagnosis of obstructive sleep apnea.

    Of those with sleep apnea, 248 (0.3%) had XFS, compared to 749 (0.2%) of controls. After accounting for matching variables and with covariate adjustment, the researchers observed a modest increased risk of XFS in pa­tients who had sleep apnea (OR, 1.27; 95% confidence interval [CI], 1.02-1.59; p = .03).

    With regard to specific covariates, patients with sleep apnea were more likely to be obese (45.9%, vs. 20.3% of controls), to have a history of atrial fibrillation (9.8%, vs. 2.9% of controls), and to have hypertension (26.8%, vs. 9.3% of controls). Patients with both sleep apnea and hypertension had an increased risk of XFS compared with patients who had hypertension without sleep apnea (OR, 2.67; 95% CI, 2.06-3.46; p < .0001).

    According to the researchers, these findings support the understanding that XFS is a genetically predisposed systemic illness that is affected by and correlated with various systemic co­morbidities.

    The original article can be found here.