Key Takeaways

  • In a study of more than 12.5 million adults, obstructive sleep apnea (OSA) was associated with a significantly higher risk of developing glaucoma compared with sleep-tested patients without OSA
  • Patients with OSA who had a record of positive airway pressure (PAP) therapy showed the highest glaucoma incidence
  • The findings do not prove that PAP therapy causes glaucoma, but they suggest that patients undergoing evaluation or treatment for OSA may benefit from regular ophthalmic monitoring

Researchers found that people diagnosed with obstructive sleep apnea (OSA) were more likely to develop glaucoma than patients who underwent sleep testing but were not diagnosed with the condition. The highest rates were observed among patients with records indicating use of positive airway pressure (PAP) therapy, a common treatment for OSA.1

The findings, published in Ophthalmology Glaucoma, suggest that patients being evaluated or treated for sleep apnea may benefit from closer ophthalmic monitoring, although the researchers cautioned that the study does not establish whether PAP therapy itself influences glaucoma risk.

"Our findings indicate an association between OSA and future glaucoma development, but the observed differences among treatment groups should be interpreted cautiously," the study authors wrote.

The retrospective cohort study drew on data from Epic Cosmos, a multicenter electronic health record database. Investigators identified adults who underwent evaluation for OSA between Jan. 1, 2010, and Oct. 31, 2025. Patients with a prior glaucoma diagnosis were excluded.

The final study population included more than 12.5 million patients with a mean age of 60.4 years, of whom 43.7% were women. Participants were divided into three groups: sleep-tested controls without OSA, patients with OSA who did not have a PAP device record, and patients with OSA who had a PAP device record within 180 days of evaluation.

Patients were followed for an average of 5.2 years, during which researchers identified 153,083 new cases of glaucoma.

The study found a clear gradient in glaucoma incidence across the three groups.

Crude incidence rates per 1,000 person-years were:

  • 1.74 among sleep-tested controls
  • 2.38 among patients with OSA without a PAP device record
  • 3.39 among patients with OSA with a PAP device record

After adjusting for baseline characteristics, researchers found that patients with OSA remained at elevated risk of developing glaucoma.

Compared with controls, patients with OSA and no PAP device record had a 27% higher risk of incident glaucoma (hazard ratio [HR] 1.27; 95% confidence interval [CI], 1.22–1.32). Patients with OSA who had a PAP device record had more than double the risk of developing glaucoma (HR 2.10; 95% CI, 1.80–2.45). At 10 years, cumulative glaucoma incidence reached 1.58% in controls, 2.30% in the untreated OSA group, and 3.86% in the PAP-record group.

Although glaucoma risk was highest among patients with documented PAP use, the researchers stressed that the study was not designed to determine whether PAP treatment increases or decreases glaucoma risk. Patients receiving PAP therapy often have more severe sleep apnea, making it difficult to separate the effects of treatment from the effects of underlying disease severity. The authors noted that residual confounding related to treatment indication likely influenced the results.

Researchers say the study should not be interpreted as evidence that PAP therapy causes glaucoma, but rather the findings highlight a broader association between OSA and eye health, and underscore the need for further research to clarify how sleep apnea severity, treatment patterns and ocular outcomes interact. Future studies with more detailed measures of OSA severity, PAP adherence and ophthalmic outcomes may help determine whether specific treatment approaches modify glaucoma risk.

Reference

1. Nishida T, Mittal R, Weinreb RN, et al. Positive airway pressure and long-term glaucoma risk in obstructive sleep apnea: a real-world cohort study. Ophthalmol Glaucoma. Published online 2026. doi:10.1016/j.ogla.2026.04.001.