Sleep Apnea and Eye Health
Obstructive Sleep Apnea (OSA) is a condition where breathing repeatedly stops and starts during sleep due to airway obstruction. It leads to intermittent hypoxia, oxidative stress, systemic inflammation, and increased sympathetic activity. These mechanisms can significantly impact the eyes, making OSA an important risk factor for several ocular diseases.
Eye Diseases Associated with Sleep Apnea
1. Glaucoma (Especially Normal-Tension Glaucoma)
Patients with OSA have a higher risk of developing glaucoma.
Intermittent hypoxia and vascular dysregulation may damage the optic nerve.
OSA-related nocturnal hypoxemia worsens optic nerve perfusion.
Studies show prevalence of glaucoma in OSA patients is up to 27%.
2. Floppy Eyelid Syndrome (FES)
Strongly associated with OSA.
Characterized by loose, easily everted upper eyelids leading to chronic conjunctivitis, keratoconjunctivitis, and irritation.
Up to 90% of FES patients have undiagnosed OSA.
3. Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)
OSA is an independent risk factor for NAION.
Mechanism: reduced nocturnal blood flow and oxygen delivery to optic nerve head.
Recurrence risk in fellow eye is significantly higher in OSA patients.
4. Papilledema and Raised Intracranial Pressure
OSA can cause idiopathic intracranial hypertension due to recurrent hypoxia and CO₂ retention.
Leads to papilledema, transient visual obscurations, and visual field loss.
5. Retinal Vascular Disorders
OSA increases risk of:
Diabetic Retinopathy progression (due to oxidative stress and hypoxia).
Central Serous Chorioretinopathy (CSCR) – linked to elevated cortisol levels.
Retinal Vein Occlusion – higher incidence in OSA due to hypercoagulability and vascular dysfunction.
6. Dry Eye Disease
Poor eyelid closure during sleep and use of CPAP (Continuous Positive Airway Pressure) therapy can worsen dry eye.
Air leakage from CPAP masks can cause exposure keratopathy.
7. Keratoconus
OSA and keratoconus share associations with connective tissue disorders.
Higher prevalence of OSA seen in keratoconus patients, possibly due to collagen abnormalities and systemic associations.
Key Takeaways
Sleep apnea is not just a respiratory disorder—it has serious ocular implications.
Eye diseases linked with OSA include glaucoma, floppy eyelid syndrome, NAION, papilledema, retinal disorders, dry eye, and keratoconus.
Screening for OSA should be considered in patients presenting with these ocular diseases, especially if they have risk factors like obesity, snoring, or daytime sleepiness.
Treating OSA with CPAP can help stabilize or slow progression of some eye conditions (e.g., glaucoma, diabetic retinopathy).