Obstructive Sleep Apnea Accelerates Progression of Intermediate Age-Related Macular Degeneration: A Three-Year Prospective Cohort Study.

PURPOSE: Obstructive sleep apnea (OSA) and age-related macular degeneration (AMD) share pathophysiological mechanisms involving oxidative stress and inflammation. We investigated whether OSA accelerates AMD progression in patients with intermediate AMD.

METHODS

This prospective cohort study enrolled 470 patients aged ≥50 years with intermediate AMD and age-matched healthy controls. After baseline polysomnography and multimodal retinal imaging, 470 participants were enrolled and stratified into AMD+OSA (n = 185), AMD-noOSA (n = 185), and healthy controls (n = 100). Of these, 391 completed the 36-month follow-up (AMD+OSA n = 153; AMD-noOSA n = 158; controls n = 80). The primary endpoint was composite AMD progression (central geographic atrophy, neovascular AMD, or ≥15-letter vision loss) over 36 months. Secondary endpoints included changes in visual acuity, drusen volume, and geographic atrophy area.

RESULTS

Of 391 participants completing follow-up (83.2% retention), the AMD+OSA group showed significantly higher progression rates. The primary endpoint occurred in 31.4% (48/153) of AMD+OSA versus 15.2% (24/158) of AMD-noOSA patients (P = 0.002). Visual acuity worsened by 0.15 versus 0.06 logarithm of the minimum angle of resolution (P < 0.001), and drusen volume increased by 0.05 versus 0.02 mm3 (P < 0.001), respectively. Cox regression revealed a dose-dependent relationship: mild OSA (hazard ratio [HR] = 1.45; 95% confidence interval [CI], 0.95-2.20; P = 0.08), moderate OSA (HR = 2.10; 95% CI, 1.35-3.28; P = 0.001), and severe OSA (HR = 2.80; 95% CI, 1.75-4.47; P < 0.001) versus no OSA.

CONCLUSIONS

OSA is an independent, dose-dependent risk factor for accelerated AMD progression. Screening and treating OSA in patients with intermediate AMD may represent a novel strategy to preserve vision.