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

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, -0.33 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, -2.15 mmHg; 95% confidence interval, -3.50 to -0.80). 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.

Systematic review registration: Registry: PROSPERO; Name: International Prospective Register of Systematic Reviews; URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022370734; Identifier: CRD42022370734.

Citation: 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;21(5):907-915.