title: Associations between obstructive sleep apnoea, primary open angle glaucoma and age-related macular degeneration: record linkage study.
abstract: Primary open angle glaucoma (POAG) is thought to be associated with obstructive sleep apnoea (OSA) but previous studies are conflicting and have methodological limitations. This potential relationship has implications for investigation and treatment strategies, and may provide insights into disease pathogenesis. The relationship between OSA and age-related macular degeneration (AMD) is unknown.
  
  
  
  A sleep apnoea cohort of 67 786 people was constructed from linked English hospital episode statistics (1999-2011). We compared this cohort with a reference cohort (2 684 131 people) for rates of subsequent POAG and AMD. A POAG cohort (comprising 87 435 people) and an AMD cohort (248 408 people) were also constructed and compared with the reference cohort for rates of subsequent sleep apnoea. All analyses were restricted to people aged 55 and over and, within this age range, were age standardised using 5-year age groups.
  
  
  
  Risk of POAG following sleep apnoea was not elevated: the rate ratio for POAG was 1.01 (95% CI 0.85 to 1.19). Similarly, the risk of sleep apnoea following POAG was not elevated: the rate ratio was 1.00 (0.86 to 1.17). These findings held true across subgroup analysis according to sex and age group. By contrast, the risk of AMD following sleep apnoea was significantly elevated, with rate ratio 1.44 (1.32 to 1.57).
  
  
  
  Although plausible mechanisms exist to consider a link between OSA and POAG, the two conditions are not positively associated. This holds true in either temporal direction. By contrast, OSA is positively associated with AMD. While potential confounding factors may contribute, obesity does not appear sufficient to explain this association.
authors.affiliation: University of Manchester, Manchester, UK.|Royal Bolton Hospital, Bolton, UK.
authors.forename: Tiarnan D L
authors.initials: TD
authors.lastname: Keenan
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Raph
authors.initials: R
authors.lastname: Goldacre
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005902:Glaucoma, Open-Angle / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008268:Macular Degeneration / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000453:epidemiology
keywords: Epidemiology; Glaucoma; Intraocular pressure; Macula; Public health