Prevalence and Predictors of Ocular Complications in Obstructive Sleep Apnea Patients: A Cross-sectional Case-control Study

Nesreen E. Morsy1, 9, Badawi E Amani2, Ahmad A Magda1, Awadalla J Nabil3, Seithikurippu R. Pandi-Perumal4, Ahmed S. BaHammam5, David Warren Spence6, Per O. Lundmark7, Nevin FW Zaki8, 9, *
1 Department of Pulmonary Medicine, Faculty of Medicine, Mansoura University, Egypt
2 Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
3 Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
4 Somnogen Canada Inc., College Street, Toronto, ON, Canada
5 Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
6 Independent Research Consultant, Toronto, Canada
7 Faculty of Health and Social Sciences, Department of Optometry, Radiography and Lighting Design, Campus Kongsberg (5346), Norway
8 Somnlogist, Sleep Research Unit, Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
9 Mansoura University Sleep Center, Mansoura, Egypt

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© 2019 Morsy et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Psychiatry, Faculty of Medicine, P.O. box: 35516 Mansoura University Mansoura-Dakahlia, Egypt; Tel: +201283339789; Fax: +2 050 2267016; Emails:,



This study sought to identify the magnitude and the possible risk factors of ocular complications in patients with Obstructive Sleep Apnea (OSA).


A hospital-based cross-sectional study with a nested case-control design was conducted. Qualifying study subjects were patients who had been diagnosed with moderate to severe OSA (AHI index of ≥ 5, n=80), and control subjects (n=20) who had an AHI index of ≤ 5 (“normal”). Study participants were recruited from Mansoura University Hospital’s Sleep Disorders Clinic in Mansoura, Egypt.Selected subjects were assessed for ocular complications at Mansoura Univerity Hospital Ophthalmic Center, (Mansoura), Egypt. An ophthalmic history was recorded, and opthalmic testing was carried out. The testing included unaided visual acuity measurement, refraction, best-corrected visual acuity measurement, slit lamp bio-microscopic evaluation of the anterior segment and anterior segment photography, dilated fundus examination, intraocular pressure measurement, fundus photo, and fluorescein angiography, and visual field assessment. Various tests of OSA symptoms were also monitored, including the AHI, lowest oxygen concentrations and desaturation index plus the overall severity index. .


It was found that OSA patients n=28 (35%), n=24 (30%), n=4 (5%) had senile cataract, normal tension glaucoma, and retinal ischemia, respectively, with an overall prevalence of 45%. Additionally, the OSA group had seven times greater risk (OR=7.36, 95%CI: 1.6-33.86) of vision-threatening disorders compared to the controls. OSA patients were observed to be at a greater risk of senile cataract 28 (35%), normal tension glaucoma 24 (30%), retinal ischemia 4 (5%) and conjunctival hyperemia and dry eye (OR=3.77, 95%CI: 1.02-13.95, OR=4.36, 95%CI: 1.26-17.08). Also, multivariate logistic regression analysis testing showed that the lowest oxygen saturation index was the only significant predictor negatively associated with vision-threatening disorders (OR=0.84, 95%CI: 0.75-0.93).


The risk of vision-threatening and non-threatening ocular disorders is higher among OSA cases. The lowest oxygen saturation index was the only significant predictor of vision-threatening disorders. These findings support the recommendation that a full ophthalmic examination should be carried out on patients with confirmed OSA.

Keywords: Eye, Desaturation, Glucoma, Intraocular pressure, Vision disorders, Hypoxia.