title: The Association Between Obstructive Sleep Apnea and Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: a Department of Ophthalmology, Shanghai Changzheng Hospital , Second Military Medical University , Shanghai , P.R. China.|b Department of Ophthalmology , Jinling Hospital , Nanjing , Jiangsu , P.R. China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: c Department of Nursing , The 100th Hospital of PLA , Suzhou , Jiangsu , P.R. China.
authors.forename: Li-Mei
authors.initials: LM
authors.lastname: Zhou
authors.affiliation: a Department of Ophthalmology, Shanghai Changzheng Hospital , Second Military Medical University , Shanghai , P.R. China.
authors.forename: Heng
authors.initials: H
authors.lastname: Lou
authors.affiliation: a Department of Ophthalmology, Shanghai Changzheng Hospital , Second Military Medical University , Shanghai , P.R. China.
authors.forename: Jin-Wei
authors.initials: JW
authors.lastname: Cheng
authors.affiliation: a Department of Ophthalmology, Shanghai Changzheng Hospital , Second Military Medical University , Shanghai , P.R. China.
authors.forename: Rui-Li
authors.initials: RL
authors.lastname: Wei
mesh_terms: D006801:Humans; D018917:Optic Neuropathy, Ischemic / Q000209:etiology*; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis
keywords: Meta-analysis; nonarteritic anterior ischemic optic neuropathy; obstructive sleep apnea; risk factors