阻塞性睡眠呼吸暂停低通气综合征与青光眼关联性的Meta分析

The association between obstructive sleep apneahypopnea syndrome and glaucoma：a Meta analysis

背景已有研究表明阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与青光眼相关，但这些结论仍存在争议。目的采用Meta分析方法分析OSAHS是否为青光眼的危险因素。方法以“sleepingapnea”和“glaucoma”为主题词检索PubMed数据库的英文文献，检索文献类型为病例对照研究和前瞻性队列研究，发表时间限制在1982年1月1日至2015年1月30日。采用ReviewManager5．2统计学软件进行Meta分析，计算总效应量的比值比（OR）和95％可信区间（CI）以评价OSAHS与青光眼间的关联强度。结果共纳入12篇回顾性病例对照研究文献，包括11592例OSAHS患者和25931名非OSAHS对照者，纽卡斯尔渥太华量表（NOS）评分法表明纳入文献质量为6～8分。12个研究存在明显的异质性（X2=34．20，P〈0．05，I2=68％），随机效应模型分析显示OSAHS组与对照组比较青光眼的发病率增加（OR=1．87，95％CI：1．21～2．90），2个组间差异有统计学意义（Z=2．82，P〈0．05）。轻、中、重度OSAHS亚组患者中青光眼的发生率均明显高于对照组（轻度：OR=3．61，95％C1：0．56～23．43；中度：OR=4．17，95％C1：0．47～36．91；重度：OR=6．95，95％CI．1．14～42．26）。敏感性分析显示，OR值波动范围为1．74～2．16。漏斗图示分析显示，纳入的文献可能存在发表偏倚。结论OSAHS是青光眼的危险因素之一，且OSAHS的病情严重程度与青光眼发病率有关，OSAHS病情越重，合并青光眼的可能性也越大。

Background Studies have showed an increasing prevalence of glaucoma in patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）. However,this view remains controversial. Objective This Meta analysis was to assess whether there is an association between glaucoma and OSAHS. Methods A systematic search in PubMed database was carried out with the subject headings ＂ sleeping apnea＂ and ＂ glaucoma＂. The literature type was limited to cases-controlled studies and prospective cohort studies with the publishing duration from January 1,1982 to January 30,2015 in English. The risk of glaucoma among OSAHS patients was analyzed, and Review Manager 5.2 was applicated for Meta analysis. The pooled odds ratio （OR） and 95% confidence interval （CI） was calculated to assess the strength of the association. Results Twelve independent retrospective cases- controlled studies were included in this review,including 11 592 subjects in the OSAHS group and 25 931 subjects in the control group. The study quality was scored 6-8 by Newcastle-Ottawa Scale which was acceptable. The random effects model was accepted because of the heterogeneity among the studies （X2 = 34.20, P〈0.05,12 = 68% ）. The prevalence of glaucoma was higher in the OSAHS group than that in the control group （ OR = 1.87,95% CI： 1.21 - 2.90,Z=2.82,P〈0.05）. The subgroup analysis of OSAHS showed that the OR （95% CI ） of mild,moderate and severe OSAHS groups versus control group was 3.61 （0.56-23.43）,4.17 （0.47-36.91） and 6.95 （1.14-42.26） ,respectively. Sensitivity analysis confirmed that the OR value fluctuated in 1.74-2.16 and closed to 1.87. Funnel graphy exhibited a asymmetry appearance among the literatures, which suggested a possible publication bias. Conclusions OSAHS is one of the risk factors of glaucoma. The serious OSAHS is associated with an increased risk of glaucoma.