Associations Between Obstructive Sleep Apnea Syndrome, Dry Eye Disease, and CPAP Usage Among Taiwanese Patients: A Retrospective Analysis

Abstract

Yuan-Kai Fu,1 Chi-chin Sun,2,3 Kuan-Jen Chen,1,3 Yu-Jr Lin,4 Chee-Jen Chang,4– 6 Shu-Chen Chang,4 Ming-Hui Sun1,3 1Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 2Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 3College of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan; 5Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; 6Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, TaiwanCorrespondence: Ming-Hui Sun, Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan, 333, Taiwan, Tel [phone] ext 8666, Fax [phone], Email [email protected] Objectives: To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED.Methods: This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer’s test, lacking tear break-up time values, or with a history of refractive surgery, Sjögren’s syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared.Results: In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 ± 23.4, patients without DED: 17.9 ± 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47– 10.49, P = 0.006).Conclusion: OSA severity is associated with DED and might be attributed to the use of CPAP.Keywords: dry eye disease, obstructive sleep apnea, continuous positive airway pressure

Keywords

• dry eye disease
• obstructive sleep apnea
• continuous positive airway pressure