Multimodal Assessment of Ocular Parameters in Patients with Severe Obstructive Sleep Apnea with Emphasis on Retinal Structural Changes

Background: Obstructive sleep apnea (OSA) is increasingly recognized as a potential risk factor for glaucoma due to its association with intermittent hypoxia and vascular dysregulation. The aim of this study was to investigate early glaucomatous changes in the eyes of patients with OSA. Methods: This case–control study included 25 patients with OSA and 25 age- and sex-matched healthy controls. According to the STOP-Bang Questionnaire, patients with an intermediate or severe risk of OSA underwent polysomnography. Based on the apnea-hypopnea index, only patients with severe OSA were included in the study group. All participants underwent a full ophthalmological examination, with measurements of the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness performed using optical coherence tomography (OCT). Results: Statistical comparisons revealed that intraocular pressure (IOP) was slightly elevated, while central corneal thickness (CCT) was slightly reduced in patients with OSA compared to healthy controls. OCT measurements showed an overall reduction in both RNFL and GCL thicknesses in the OSA group. Among these findings, only the differences in average and minimum GCL thickness in the left eye reached statistical significance. Conclusions: The results of our study indicate significant thinning of the GCL in patients with OSA, suggesting possible early glaucomatous changes and a potential link between OSA and glaucoma. Given the increasing prevalence of OSA, further large-scale, long-term studies are needed to better understand this relationship and its clinical implications.