The Association Between Obstructive Sleep Apnea and Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

Abstract

ABSTRACT Purpose: Nonarteritic anterior ischemic optic neuropathy (NAION) is a multifactorial disease, and recently epidemiologic studies have investigated the association between obstructive sleep apnea (OSA) and NAION. A systematic review of the association of OSA and NAION has not been performed. Therefore, the current meta-analysis was performed to assess such potential association between OSA and risk of NAION. Methods: A systematic search of PubMed and EMBASE databases was performed for published studies evaluating the association between OSA and NAION. The summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for categorical risk estimates. Sensitivity analyses and subgroup analyses were also performed to assess the robustness of pooled outcomes. Results: A total of four prospective cohort studies and one case–control study met our inclusion criteria. The pooled OR of developing NAION in the subjects with OSA was 6.18 (95% CI, 2.00–19.11) versus non-OSA controls. Sensitivity analyses showed that no matter one study excluded, the pooled OR did not change significantly, which indicated that the evidence was robust. In subgroup analyses, a significant association was seen in studies matched systemic risk factors (OR, 5.00; 95% CI, 2.22–11.25), but not in those non-matched. The magnitude and direction of effects were also affected by methodological variability, including study design, and diagnosis of OSA. Conclusions: The findings from this meta-analysis supported the robust evidence that OSA was a strong independent risk factor of NAION. Relative to non-OSA controls, the subjects with OSA were found to have a more than sixfold risk of NAION. In future, more well-designed studies are needed to confirm these findings.