Long-term effect of continuous positive air pressure therapy on intraocular pressure in patients with primary open-angle glaucoma with obstructive sleep apnea

Abstract

Purpose: Prevalence of glaucoma is higher in obstructive sleep apnea (OSA) patients. The gold standard technique to treat OSA is continuous positive airway pressure (CPAP) therapy. The influence of long-term CPAP therapy on intraocular pressure (IOP), blood pressure, ocular perfusion pressure (OPP), and glaucoma progression in primary open-angle glaucoma (POAG) patients was evaluated. Design: Prospective study. Materials and methods: In this study, we enrolled 12 eyes from six POAG patients aged >35 years, with newly diagnosed OSA and with indication for CPAP therapy. The CPAP was performed for 12 months. We monitored the IOP every 3 months. Visual field was determined at baseline and 12 months. Results: The mean IOP after CPAP therapy for 12 months was significantly higher than the mean baseline IOP (average IOP 3 months before CPAP therapy) (19.08 ± 3.47 vs 17.83 ± 2.88 mm Hg; p = 0.006). The IOP rising rate was 0.69 ± 0.47/years (p = 0.138) before CPAP therapy and increased to 1.13 ± 0.47/years (p = 0.016) after CPAP therapy. The OPP after 12 months of CPAP was significantly lower than the baseline (42.21 ± 5.29 vs 45.24 ± 7.09 mm Hg; p = 0.06). Results showed that the pattern standard deviation (PSD) value of 24-2 short wavelength automated perimetry (SWAP) visual field was reduced from 5.34 ± 3.92 to 4.77 ± 3.73 (p = 0.025). Antiglaucoma medication was administered to a patient due to increased IOP without glaucoma progression evidence. Conclusion: The POAG and OSA patients demonstrated significant IOP rising after CPAP therapy but did not show progression of glaucomatous damage. Mean deviation (MD), PSD, and visual field index (VFI) were not significantly different after CPAP therapy. Précis: Prospective study of POAG and OSA patients demonstrated significant IOP rising after CPAP therapy for a year. The study did not show progression of glaucomatous damage.