Association between Obstructive Sleep Apnea and Age-related Macular Degeneration Development and Progression.

Objective: Evaluate the risk of age-related macular degeneration (AMD) development and progression in individuals with diagnosed obstructive sleep apnea (OSA).

Design: Retrospective cohort study.

Subjects: 60,652 and 1,173,723 individuals with OSA or not, respectively, were included in the study before propensity score matching (PSM). After PSM and applying inclusion/exclusion criteria, 58,700 individuals in each cohort were subsequently analyzed.

Methods: Collected data using TriNetX (Cambridge, MA, USA), a deidentified electronic health records research network. Individuals with an ICD-10 code for OSA confirmed with polysomnography and an additional code for CPAP use were compared to individuals without diagnosed OSA (control cohort) for the development of main outcome measures at five years. Secondary analyses were included to assess non-advanced AMD progression in individuals with and without diagnosed OSA at five years.

Main Outcome Measures: The main outcome measures were the incidence of AMD, macular hemorrhage, legal blindness, and requiring anti-vascular endothelial factor (VEGF) intervention at five years. Individuals with non-advanced AMD with and without an OSA diagnosis were separately analyzed for progression to late AMD, and the development of macular hemorrhage, legal blindness, and requiring anti-VEGF therapy at five years.

Results: At five years, individuals with diagnosed OSA had a significantly elevated risk of nonexudative AMD (HR, 2.64, 95% CI, 2.37 - 2.96; P<.001), exudative AMD (HR, 2.48, 95% CI, 1.99 - 3.11; P=.002) and requiring anti-VEGF therapy (HR, 2.85, 95% CI, 2.26 - 3.59; P<.001) compared to the control cohort. In the secondary analysis, individuals with non-advanced AMD with diagnosed OSA were associated with an elevated risk of geographic atrophy (GA; HR, 7.00, 95% CI, 4.47 - 11.0; P=.03), exudative AMD (HR, 2.87, 95% CI, 2.37 - 3.48; P=.03), and requiring anti-VEGF injections (HR, 4.72, 95% CI, 3.59 - 6.22; P=.02) compared to those with non-advanced AMD without diagnosed OSA CONCLUSIONS: In a large, heterogenous database, an elevated risk of developing AMD and progression to later stages of the disease was observed among individuals with diagnosed OSA.