Impact of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment on Dry Eye Disease: A Systematic Review and Meta-Analysis

Chung-Wei Lin,1,2,* Yung-Chun Su,3 Jin-Dien Liu,2,4 Hsiao-Chun Su,5 Ting-Yi Chiang,6 Li-Wen Chiu,7 Hsin-Ching Lin,1,8– 11,* Chun-Tuan Chang,9 Pei-Wen Lin7,8,10 1Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 5School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Department of Urology, Chi Mei Medical Center, Tainan, Taiwan; 7Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 8College of Medicine, Chang Gung University, Taoyuan, Kaohsiung, Taiwan; 9Department of Business Management, Institute of Healthcare Management, National Sun Yat-Sen University, Kaohsiung, Taiwan; 10Institute of Biomedical Science, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; 11Sleep Center, Robotic Surgery Center and Center for Quality Management Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan*These authors contributed equally to this workCorrespondence: Pei-Wen Lin, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 ext.2801, Fax +886-7-7777152, Email [email protected], [email protected]: Obstructive sleep apnea (OSA) has been reported to influence the ocular surface and may lead to dry eye disease (DED). Continuous positive airway pressure (CPAP) is the first-line conservative treatment for OSA. However, CPAP might also have mask-related side effects that could deteriorate DED simultaneously. This study investigated the impact of OSA on DED (Aim 1), and CPAP on DED (Aim 2). Five databases were searched for articles published up to May, 2024. OSA severity, CPAP usage, and DED parameters, including tear breakup time (TBUT), Schirmer test, Ocular Surface Disease Index (OSDI), and Corneal Fluorescence Staining Score (CFS), were analyzed. For Aim 1, the random-effects model was used for meta-analysis, and the leave-one-out method was used for sensitivity analysis. For Aim 2, a narrative synthesis with critical appraisal of the literature was performed. Eleven studies with 1,526 patients for Aim 1 and three studies with 180 patients for Aim 2 were included. For Aim 1, OSA patients had poorer dry eye profiles of TBUT, Schirmer test, and OSDI when compared to non-OSA patients. For Aim 2, it seemed that those wearing CPAP for less than half a year did not have enough improvement in dry eye status. Instead, those wearing CPAP for at least a year reached greater therapeutic effects for OSA and DED. We concluded that OSA patients may suffer from poorer dry eye condition compared to non-OSA patients. Besides, wearing CPAP for long enough duration (at least 1 year) seemed to have better improvement in DED.Keywords: Obstructive sleep apnea, continuous positive airway pressure, dry eye disease, meta-analysis