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Associations between obstructive sleep apnoea, primary open angle glaucoma and age-related macular degeneration: record linkage study
  1. Tiarnan D L Keenan1,2,
  2. Raph Goldacre3,
  3. Michael J Goldacre3
  1. 1University of Manchester, Manchester, UK
  2. 2Royal Bolton Hospital, Bolton, UK
  3. 3Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Tiarnan D L Keenan, University of Manchester, AV Hill Building, Oxford Road, Manchester M13 9PT, UK; tiarnan.keenan{at}


Background Primary open angle glaucoma (POAG) is thought to be associated with obstructive sleep apnoea (OSA) but previous studies are conflicting and have methodological limitations. This potential relationship has implications for investigation and treatment strategies, and may provide insights into disease pathogenesis. The relationship between OSA and age-related macular degeneration (AMD) is unknown.

Methods A sleep apnoea cohort of 67 786 people was constructed from linked English hospital episode statistics (1999–2011). We compared this cohort with a reference cohort (2 684 131 people) for rates of subsequent POAG and AMD. A POAG cohort (comprising 87 435 people) and an AMD cohort (248 408 people) were also constructed and compared with the reference cohort for rates of subsequent sleep apnoea. All analyses were restricted to people aged 55 and over and, within this age range, were age standardised using 5-year age groups.

Results Risk of POAG following sleep apnoea was not elevated: the rate ratio for POAG was 1.01 (95% CI 0.85 to 1.19). Similarly, the risk of sleep apnoea following POAG was not elevated: the rate ratio was 1.00 (0.86 to 1.17). These findings held true across subgroup analysis according to sex and age group. By contrast, the risk of AMD following sleep apnoea was significantly elevated, with rate ratio 1.44 (1.32 to 1.57).

Conclusions Although plausible mechanisms exist to consider a link between OSA and POAG, the two conditions are not positively associated. This holds true in either temporal direction. By contrast, OSA is positively associated with AMD. While potential confounding factors may contribute, obesity does not appear sufficient to explain this association.

  • Epidemiology
  • Glaucoma
  • Intraocular pressure
  • Macula
  • Public health

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  • Contributors TDLK had the idea for the paper. MJG oversaw data acquisition and designed the analysis. RG undertook the analysis. All authors interpreted the data. TDLK wrote the paper, and all authors revised it. MJG is guarantor.

  • Funding The Unit of Health-Care Epidemiology was funded by the English National Institute for Health Research to build the linked data set and to make it available for analysis. This study had no specific funding. The views expressed in this paper do not necessarily reflect those of the funding body.

  • Competing interests None declared.

  • Ethics approval Ethics committee approval for analysis of the record linkage study data was obtained from the Central and South Bristol Multi-Centre Research Ethics Committee, England (04/Q2006/176). The research adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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