ArticleInternational ophthalmology2026
Association of obstructive sleep apnea and continuous positive airway pressure on risk of corneal ulceration and surgical interventions.
Article in International ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate whether obstructive sleep apnea (OSA) is associated with corneal ulceration and surgical intervention, and to assess the impact of continuous positive airway pressure (CPAP) therapy on these outcomes.
methodsThis retrospective cohort study used data from the TriNetX electronic health record database. Adults aged ≥ 18 years with ≥ 1 year of ophthalmology follow-up were analyzed using nearest-neighbor propensity score matching (demographics and comorbidities standardized mean differences < 0.1). Three matched analyses were performed: OSA versus controls without OSA (n = 287,572 per group), CPAP-treated OSA versus controls with OSA without CPAP treatment (n = 100,959 per group), and CPAP-treated OSA versus controls without OSA (n = 99,909 per group). Outcomes were assessed over 20 years, excluding individuals with prior diagnoses. Risk ratios (RRs) with 95% confidence intervals (CIs) and p-values were calculated.
resultsOSA was associated with higher incidence of corneal ulcer (0.98% vs 0.83%; RR 1.183, 95%CI 1.120-1.249), perforated corneal ulcer (0.15% vs 0.04%; RR 3.992, 95%CI 3.243-4.915), and keratoplasty (RR 1.556, 95%CI 1.427-1.696). Among OSA patients, CPAP was associated with lower incidence of perforated corneal ulcer (RR 0.730, 95%CI 0.584-0.913) and keratoplasty (RR 0.663, 95%CI 0.579-0.760), but higher incidence of dry eye (RR 1.189, 95%CI 1.172-1.206). Compared to controls, CPAP-treated OSA patients remained at elevated risk of corneal ulceration and surgical intervention.
conclusionsOSA was associated with higher incidence of corneal ulceration, severe ulcer-related sequelae, and corneal surgical interventions. CPAP was associated with fewer severe ulcer complications and reduced keratoplasty utilization, but higher dry eye burden. CPAP was associated with reduced but persistent ocular risk in patients with OSA.
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