The effect of continuous positive airway pressure therapy on intraocular pressure in patients with OSA: a systematic review and meta-analysis

Abstract

Study Objectives: To assess the effect of continuous positive airway pressure (CPAP) therapy on intraocular pressure in patients with obstructive sleep apnea. Methods: The search was performed in Ovid Medline and Embase database, then followed by a manual bibliography search. Abstract search and screening were independently performed followed by eligible full-text versions reviewed. Then disagreements were discussed in a group. Results: This systematic review and meta-analysis considered 15 studies with 495 participants. The pooled mean intraocular pressure after CPAP therapy shows no significant difference compared to the baseline (mean difference, 0.58 mmHg; 95% confidence interval, 20.33 to 1.19). Subgroup analysis shows significantly higher intraocular pressure after in-laboratory positive airway pressure titration and after long-term CPAP use (mean difference, 4.28 mmHg; 95% confidence interval, 0.91–7.66; mean difference, 0.45 mmHg; 95% confidence interval, 0.07–0.83; respectively). Ocular perfusion pressure was also significantly decreased after CPAP therapy (mean difference, 22.15 mmHg; 95% confidence interval, 23.50 to 20.80). The pooled data showed no significant difference in retinal nerve fiber layer thickness and macular layer thickness. Conclusions: After long-term treatment CPAP therapy, there is a significant increase in intraocular pressure in patients with obstructive sleep apnea and a decrease in ocular perfusion pressure, but no significant difference in other ophthalmologic parameters is shown. For this reason, CPAP usage in patients with glaucoma necessitates to be done cautiously.