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Review
. 2024 Dec 6:16:1921-1935.
doi: 10.2147/NSS.S495883. eCollection 2024.

Impact of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment on Dry Eye Disease: A Systematic Review and Meta-Analysis

Chung-Wei Lin #  1   2 , Yung-Chun Su  3 , Jin-Dien Liu  2   4 , Hsiao-Chun Su  5 , Ting-Yi Chiang  6 , Li-Wen Chiu  7 , Hsin-Ching Lin #  1   8   9   10   11 , Chun-Tuan Chang  9 , Pei-Wen Lin  7   8   10
Affiliations
Review

Impact of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment on Dry Eye Disease: A Systematic Review and Meta-Analysis

Chung-Wei Lin et al. Nat Sci Sleep. .

Abstract

Obstructive sleep apnea (OSA) has been reported to influence the ocular surface and may lead to dry eye disease (DED). Continuous positive airway pressure (CPAP) is the first-line conservative treatment for OSA. However, CPAP might also have mask-related side effects that could deteriorate DED simultaneously. This study investigated the impact of OSA on DED (Aim 1), and CPAP on DED (Aim 2). Five databases were searched for articles published up to May, 2024. OSA severity, CPAP usage, and DED parameters, including tear breakup time (TBUT), Schirmer test, Ocular Surface Disease Index (OSDI), and Corneal Fluorescence Staining Score (CFS), were analyzed. For Aim 1, the random-effects model was used for meta-analysis, and the leave-one-out method was used for sensitivity analysis. For Aim 2, a narrative synthesis with critical appraisal of the literature was performed. Eleven studies with 1,526 patients for Aim 1 and three studies with 180 patients for Aim 2 were included. For Aim 1, OSA patients had poorer dry eye profiles of TBUT, Schirmer test, and OSDI when compared to non-OSA patients. For Aim 2, it seemed that those wearing CPAP for less than half a year did not have enough improvement in dry eye status. Instead, those wearing CPAP for at least a year reached greater therapeutic effects for OSA and DED. We concluded that OSA patients may suffer from poorer dry eye condition compared to non-OSA patients. Besides, wearing CPAP for long enough duration (at least 1 year) seemed to have better improvement in DED.

Keywords: Obstructive sleep apnea; continuous positive airway pressure; dry eye disease; meta-analysis.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Figure 1
Figure 1
(a) The PRISMA flowchart of the literature selection regarding the impact of OSA on DED. (b) The PRISMA flowchart of the literature selection regarding the impact of CPAP on DED.
Figure 2
Figure 2
(a) The results of meta-analysis regarding TBUT when comparing OSA patients to non-OSA patients. (b) The results of meta-analysis regarding Schirmer test when comparing OSA patients to non-OSA patients. (c) The results of meta-analysis regarding OSDI when comparing OSA patients to non-OSA patients. (d) The results of meta-analysis regarding CFS when comparing OSA patients to non-OSA patients.
See this image and copyright information in PMC

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