title: Association between glaucoma and obstructive sleep apnea syndrome: a meta-analysis and systematic review.
abstract: BACKGROUND
  Obstructive sleep apnea syndrome (OSAS) is a common disease that increases the risk of diabetes, heart disease, and stroke. However, studies of an association between OSAS and glaucoma neuropathy have reported controversial findings.
  
  
  OBJECTIVE
  The main purpose of this study was to evaluate whether a significant association exists between OSAS and glaucoma by performing a meta-analysis of previous studies.
  
  
  METHODS
  A comprehensive literature search using the PubMed and Embase databases was performed to identify cross-sectional, case-control, and cohort studies related to the topic. We estimated a pooled odds ratio (OR) for the association between OSAS and glaucoma, by a fixed- or random-effects model.
  
  
  RESULTS
  In total, 16 studies with 2,278,832 participants met the inclusion criteria: one retrospective cohort study reported an adjusted hazard ratio of glaucoma of 1.67 (95% CI = 1.30-2.17). Using a fixed-effects model, the pooled OR of six case-control studies was 1.96 (95% CI = 1.37 2.80). A significant association was also identified in a meta-analysis of nine cross-sectional studies using a random-effects model, which showed a pooled OR of 1.41 (95% CI = 1.11 1.79). However, the reported pooled estimates for case control studies and cross-sectional studies were based on unadjusted ORs.
  
  
  CONCLUSIONS
  Our results suggest that OSAS is associated with the prevalence of glaucoma. However, this result was based only on unadjusted estimates. Prospective cohort studies designed to take into consideration potential confounders, or examination of data from interventional trials to determine whether a reduction in OSAS status is associated with a reduced incidence of glaucoma, are needed to clarify whether OSAS is an independent risk factor for glaucoma.
authors.affiliation: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Panpan
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.affiliation: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Kaiming
authors.initials: K
authors.lastname: Su
mesh_terms: D015897:Comorbidity; D005901:Glaucoma / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*