The association between obstructive sleep apnea and keratoconus: a systematic review and meta-analysis

Session Details

Session Title: Moderated Poster Session: Cornea

Venue: Poster Village: Pod 2

First Author: : F.Bernabei ITALY

Co Author(s): :    M. Pellegrini   G. Giannaccare                    

Abstract Details

Purpose:

In recent years, the association between obstructive sleep apnea (OSA) and keratoconus has been increasingly studied, in order to elucidate the pathophysiology of both diseases and to corroborate previous observations of shorter life expectancy in patients with keratoconus. However, inconsistent and conflicting results were reported and to date, no synthesis of data with a meta-analysis has been performed. The purpose of this systematic review and meta-analysis was to evaluate the validity of the association between OSA and keratoconus.

Setting:

S.Orsola-Malpighi University Hospital, University of Bologna, Italy

Methods:

A systematic literature search was performed using Pubmed, Scopus and Web of Science databases. Case-control studies and cohort studies reporting data on the association between OSA and keratoconus were included in this study. Meta-analysis was conducted with a random-effects model, and relative risk with 95% confidence interval (CI) was used as the effect size. The Q and I2 tests were used to evaluate heterogeneity. Sensitivity analysis and assessment of publication bias were performed.

Results:

Following the screening of 46 articles that were initially identified, 5 studies (4 case-control studies and 1 cohort study), published between 2012 and 2016 and involving 33844 subjects (16922 patients with keratoconus; 16922 controls), were included in the meta-analysis. The presence of keratoconus was significantly associated with OSA, conferring a pooled risk ratio of 1.60 (95% CI: 1.14-2.42; P = 0.006). A significant heterogeneity was observed (Q = 13.9, I2 = 69.3%). There was no evidence of significant publication bias (P = 0.074). The sensitivity analysis indicated the stability of results.

Conclusions:

This meta-analysis provides significant evidence that keratoconus is associated with an increased risk for OSA. Several possible pathogenic mechanisms may exist behind this association, including the action of matrix metalloproteinases, increased oxidative stress, eye rubbing during sleep and genetic factors. Since unrecognized OSA leads to a significant increase in cardiovascular events and mortality, patients with keratoconus may benefit from proper screening for OSA, particularly if at high risk. Further prospective of studies are warranted to explore more in depth the casual relationship between the two conditions.

Financial Disclosure:

None