Association of polysomnography findings of obstructive sleep apnea with non-arteritic anterior ischemic optic neuropathy manifestations

Purpose: While prior research suggests a relationship between obstructive sleep apnea (OSA) and non-arteritic anterior ischemic optic neuropathy (NAION), detailed associations remain unclear. This study investigated how polysomnography (PSG) parameters of OSA are associated with clinical features of acute NAION. Methods: We conducted a retrospective analysis of 66 patients diagnosed with concurrent NAION and OSA between 2015 and 2023. Data on demographics, medical history, PSG results, ophthalmologic evaluations, and follow-up outcomes were analyzed. Univariate and multivariate linear regression analyses were performed to assess associations between OSA characteristics and NAION manifestations, adjusting for key confounders. Results: The cohort included 30 men and 36 women (mean age: 60 years). Comorbidities included hypertension (51.6%), dyslipidemia (43.8%), diabetes mellitus (DM; 32.8%), and cardiovascular diseases (17.2%). Seventeen patients (26.6%) were current smokers, and the mean body mass index (BMI) was 24.5 kg/m². Univariate regression revealed significant associations: Diminished visual fields were associated with older age, DM, and elevated Apnea– Hypopnea index (AHI) (p=0.01, 0.02, and 0.01 respectively); reduced visual acuity was linked to older age, increased shallow sleep, and lower oxygen saturation (p=0.03, 0.01, and 0.02, respectively). Increased peripapillary retinal nerve fiber layer (RNFL) thickness was associated with prolonged shallow sleep (p=0.01) which remained statistically significant after adjusting for age, sex, BMI, and smoking status. Conclusion: PSG parameters of OSA, particularly AHI, sleep stage distribution, and oxygen saturation levels, are significantly associated with NAION clinical features. Comprehensive OSA assessment and management may help mitigate NAION risk and improve patient outcomes.