Sleep duration modifies the association between obstructive sleep apnea risk and glaucoma: evidence from the Korea National Health and Nutrition Examination Survey

Background: This study aimed to investigate the combined effects of obstructive sleep apnea (OSA) risk and short sleep duration on glaucoma prevalence and intraocular pressure (IOP) using data from the 2019 to 2021 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: This cross-sectional study analyzed data from 7,732 KNHANES participants aged ≥ 40 years. OSA risk was assessed using the STOP-BANG questionnaire, with a high risk defined as a score ≥ 3. The diagnosis of glaucoma was based on the criteria of the International Society of Geographical and Epidemiological Ophthalmology. Multivariate logistic regression models were used to evaluate the associations among glaucoma prevalence, OSA risk, and sleep duration, adjusting for demographic and health-related variables. The interaction effects of OSA risk and sleep duration on glaucoma and IOP were also assessed. Results: Among the 7,732 participants, 5.28% (n = 408) were diagnosed with glaucoma. Individuals with a high risk of OSA had significantly higher odds of glaucoma compared to those with a low risk (odds ratio: 1.34, 95% confidence interval: 1.02–1.77; P < 0.05), with the STOP-BANG components “snoring”, “pressure”, and “age” being most associated with increased glaucoma risk. No significant association was observed between abnormal sleep duration (< 7 h or ≥ 9 h) alone and glaucoma prevalence (P > 0.05). Individuals with a high risk of OSA with a sleep duration < 9 h showed a significantly higher glaucoma prevalence than those with ≥ 9 h of sleep (P < 0.05), suggesting that sleep duration modifies the association between OSA risk and glaucoma. Similar trends were observed for IOP, with significant interaction effects between OSA risk and sleep duration. Conclusions: Our findings suggest that sleep duration modulates the association between OSA risk and both glaucoma prevalence and higher IOP, highlighting the importance of including sleep duration in glaucoma risk assessments for patients with OSA. Further research is required to clarify the mechanisms underlying the association between OSA, sleep duration, and glaucoma.