CPAP Therapy Raises Intraocular Pressure, Study Cautions Glaucoma risk
Continuous positive airway pressure (CPAP) therapy, which is the most common treatment for obstructive sleep apnea (OSA), may significantly increase intraocular pressure (IOP) in the long term and reduce ocular perfusion pressure. This was reported in the findings of a recent study published in the Journal of Clinical Sleep Medicine conducted by Papan K. and colleagues in Thailand.
OSA is a very common condition and carries a multitude of systemic and ocular complications. CPAP remains the standard treatment, yet its effects on ocular health, especially concerning IOP and ocular perfusion pressure, are controversial. The current systematic review and meta-analysis was performed to evaluate these effects by analyzing data from 15 studies involving 495 participants.
The study used data from Ovid Medline and Embase databases, supplemented by manual bibliography searches. Abstract screening, followed by a review of eligible full-text articles, was independently performed. Any disagreements in study inclusion were resolved through group discussion. This systematic approach ensured a comprehensive and unbiased evaluation of CPAP therapy's impact on ocular parameters in OSA patients.
Results
Intraocular Pressure (IOP):
• The pooled mean IOP following CPAP therapy did not differ significantly from the baseline values (MD: 0.58 mmHg, 95% CI: -0.33 to 1.19).
• A subgroup analysis demonstrated a significantly higher IOP following in-lab positive airway pressure titration (MD: 4.28 mmHg, 95% CI: 0.91 to 7.66) and after long-term CPAP use (MD: 0.45 mmHg, 95% CI: 0.07 to 0.83).
Ocular Perfusion Pressure (OPP):
• OP under CPAP decreased considerably (MD: -2.15 mmHg, 95% CI: -3.50 to -0.80).
Retinal and Macular Thickness:
• Retinal nerve fiber layer thickness and macular layer thickness were not significant in pooled data.
Long-term CPAP therapy in OSA patients was associated with a significant increase in intraocular pressure and decrease in ocular perfusion pressure without affecting other ophthalmologic parameters. These results indicate that caution is necessary when using CPAP therapy in patients with glaucoma or at risk for increased IOP. Complete ophthalmologic assessment and monitoring should be an integral part of the management of such patients.
Reference:
Kongchan P, Banhiran W, Chirapapaisan N, Kasemsuk N. The effect of continuous positive airway pressure therapy on intraocular pressure in patients with OSA: a systematic review and meta-analysis. J Clin Sleep Med. 2025 Jan 16. doi: 10.5664/jcsm.11552. Epub ahead of print. PMID: 39815722.
