— Retrospective analysis suggests OSA triples glaucoma risk, even though overall risk remains low
October 12, 2026 • 3 min read
NEW ORLEANS -- Obstructive sleep apnea (OSA) in young children tripled the likelihood of new-onset glaucoma, a large retrospective analysis showed.
Though still an uncommon condition in children, an unadjusted analysis showed that glaucoma was four to five times more common in children with OSA. After propensity matching, the adjusted risk for new-onset glaucoma was 2.97, essentially threefold higher. Preglaucoma and suspected glaucoma also were more common in children with OSA.
Understanding of the mechanisms linking OSA to glaucoma in children remains incomplete, but the results are consistent with data in adults, who have a significantly higher risk of glaucoma with OSA, reported Ching-Chieh Lin, MD, of Kaohsiung Veterans General Hospital in Taiwan, at the American Academy of Ophthalmologyopens in a new tab or window meeting.
"This is the first large-scale, real-world study focusing on this topic," said Lin. "The large sample size allowed us to investigate glaucoma, which is a relatively rare but very important pediatric ocular disease... . Importantly, all of the participants in this study, their visual function remained preserved, which is particularly important in children because they are still in a critical period of visual development. Early recognition may therefore provide an opportunity for surveillance and timely management of OSA."
During a discussion, session moderator Victoria Addis, MD, of Penn Medicine in Philadelphia, asked whether the data allowed for exploration of relationships between OSA and different glaucoma subtypes.
Lin said an unadjusted analysis suggested an association between OSA and open-angle glaucoma, but the association disappeared after propensity matching.
"Based on previous studies and proposed mechanisms, we think the [open-angle subtype] will be more prominent," he said.
OSA has a well-established association with glaucoma in adults, but this study was the first to look specifically at the association in children in a large cohort, said Lin. Glaucoma in children is rare, and most cases occur before 1 year.
OSA in younger children often is associated with adenotonsillar hypertrophy, which has been linked to reduced parafoveal vascularization. Some evidence suggests improvement after adenotonsillectomy, said Lin. Pediatric OSA also has been linked to changes in the retinal nerve fiber layer, but reports have been inconsistent. Pediatric OSA might be associated with early, subclinical ocular changes, he added. OSA in older children and adolescents often occurs in association with obesity.
For this study, Lin and colleagues relied on data from the U.S. Collaborative Network of the TriNetX clinical research platform for the years 2016-2020. They identified pediatric patients with newly diagnosed OSA confirmed by polysomnography within 1 year, followed by a new diagnosis of glaucoma.
The database query yielded 80,496 patients with OSA and 2.6 million patients without. A comparison of those two cohorts showed 70 cases of glaucoma (0.1%) in the OSA group and 652 (<0.1%) in the control group, which translated into a hazard ratio of 4.30. The OSA group had a higher risk of all glaucoma subgroups, as well as preglaucoma and glaucoma suspect.
After propensity matching, data analysis involved two cohorts with 77,812 patients each. The median age of each cohort was about 7.5 years. The results showed 66 glaucoma diagnoses in the OSA group (0.1%) and 30 (<0.1%) in the control group, translating into a hazard ratio of 2.97. Most glaucoma diagnoses were unspecified subtype (HR 3.10). The OSA group also had more preglaucoma (0.3% vs 0.2%; HR 1.88, 95% CI 1.54-2.29) and glaucoma suspect (0.5% vs 0.4%; HR 1.59, 95% CI 1.37-1.84).
"We need to know whether treating OSA can actually reduce the long-term risk of glaucoma, and if the reversible component observed in previous studies is confirmed, if early identification of OSA may provide an opportunity to intervene before irreversible glaucomatous damage develops," said Lin.