NEW ORLEANS — Obstructive sleep apnea (OSA) in young children has been found to triple the likelihood of developing new-onset glaucoma, according to a large retrospective analysis.
Athough glaucoma is still an uncommon condition in the pediatric population, initial analyses indicate that it is four to five times more prevalent in children afflicted with OSA. After adjusting for confounding variables through propensity matching, the risk of newly diagnosed glaucoma was found to be 2.97 times higher, indicating a substantial increase. Additionally, cases of preglaucoma and suspected glaucoma were also observed to be more prevalent among these children.
The precise mechanisms linking OSA to glaucoma in children are not fully understood, but this data aligns with findings in adults, who exhibit a considerably higher risk of glaucoma associated with OSA, as presented by Dr. Ching-Chieh Lin from Kaohsiung Veterans General Hospital in Taiwan at a recent American Academy of Ophthalmology meeting.
Dr. Lin noted, “This is the first large-scale, real-world study focusing on this topic. The large sample size allowed us to investigate glaucoma, a relatively rare yet critically important ocular disease in children. Importantly, the visual function of all study participants remained preserved, a key factor since children are in a vital phase of visual development. Early detection may facilitate surveillance and timely management of OSA.”
During the discussion, session moderator Dr. Victoria Addis from Penn Medicine queried whether the data permitted exploration of relationships between OSA and various glaucoma subtypes. Dr. Lin responded that preliminary data suggested a relationship between OSA and open-angle glaucoma, though this link disappeared after propensity matching.
“Based on previous studies and proposed mechanisms, we hypothesize that the open-angle subtype could be more prevalent,” he stated.
While the link between OSA and glaucoma is well-established in adults, this study is unprecedented in its evaluation of this relationship in children across a large cohort. Cases of glaucoma in children are rare, typically presenting before the age of 1 year.
In younger children, OSA is often associated with adenotonsillar hypertrophy, which has been correlated with reduced parafoveal vascularization. Some evidence suggests potential improvements in ocular health following adenotonsillectomy, continued Dr. Lin. Pediatric OSA has also been linked to alterations in the retinal nerve fiber layer, although findings have been inconsistent. He indicated that pediatric OSA might be associated with early, subclinical ocular changes, while in older children and adolescents, it frequently co-occurs with obesity.
The study utilized data from the U.S. Collaborative Network of the TriNetX clinical research platform covering the years 2016-2020, focusing on pediatric patients diagnosed with OSA via polysomnography within one year, followed by a new diagnosis of glaucoma.
The analysis revealed 80,496 patients with OSA compared to 2.6 million patients without. A side-by-side comparison found 70 cases of glaucoma (0.1%) in the OSA group versus 652 (<0.1%) in the control group, resulting in a hazard ratio of 4.30. The OSA group displayed a higher risk across all glaucoma subtypes, including preglaucoma and glaucoma suspect.
After propensity matching, analysis included two cohorts of 77,812 patients each, with a median age of approximately 7.5 years. The results indicated 66 diagnoses of glaucoma in the OSA cohort (0.1%) versus 30 (<0.1%) in the control group, leading to a hazard ratio of 2.97. Most glaucoma diagnoses were of unspecified subtype (HR 3.10). Furthermore, the OSA group had a higher occurrence of preglaucoma (0.3% vs 0.2%; HR 1.88, 95% CI 1.54-2.29) and glaucoma suspect (0.5% vs 0.4%; HR 1.59, 95% CI 1.37-1.84).
“It is crucial to determine whether treating OSA can actually mitigate the long-term risk of glaucoma. If prior studies confirm a reversible aspect to the condition, it may provide an essential window for intervention before irreversible glaucomatous damage occurs,” Dr. Lin concluded.
Disclaimer: This content is for informational purposes only and should not be construed as medical advice. Please consult a healthcare professional for personalized guidance and treatment options.
Fuente: https://www.medpagetoday.com/meetingcoverage/aao/123365
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