The Emerging Link Between Obstructive Sleep Apnea and Retinal Vein Occlusion in Young Adults

A large retrospective cohort from the TriNetX US Collaborative Network (2005–2025) found that obstructive sleep apnea associates with higher rates of retinal vein occlusion in adults aged 55 and younger, a signal driven predominantly by branch retinal vein occlusion (BRVO).

The association persisted after propensity matching and adjustment for common vascular comorbidities, indicating younger patients with OSA may represent an underrecognized RVO risk group.

Investigators matched roughly 2.09 million patients with and without obstructive sleep apnea (OSA) on age, sex, race, BMI, and baseline comorbidities. Incident RVO occurred in 547 patients with OSA versus 475 controls (RR 1.15; HR 1.22), while BRVO showed a stronger association (RR ~1.29; HR ~1.37). Unlike prior research centered on older cohorts, this analysis highlights a younger-age signal that supports considering OSA in RVO risk stratification for adults under 55.

Pathophysiology offers a coherent explanation: intermittent hypoxia, endothelial dysfunction, and prothrombotic changes described in OSA can predispose to retinal venous thrombosis. Repeated oxygen desaturation raises sympathetic tone and systemic inflammation; endothelial activation increases local vascular vulnerability; and coagulation and platelet changes raise thrombotic propensity. These converging mechanisms align with the predominance of BRVO, where focal venous compression and endothelial susceptibility interact.

In patients younger than 55 who present with RVO, screen for clinical features that raise pretest probability for OSA—habitual snoring, witnessed apneas, excessive daytime sleepiness, elevated BMI, and increased neck circumference. Use validated questionnaires (STOP‑Bang or Epworth) and consider overnight pulse oximetry as accessible triage tools; abnormal results should prompt referral to sleep medicine and consideration of diagnostic polysomnography. Formalize ophthalmology–sleep medicine collaboration with shared EHR alerts, standardized referral forms, and pathway templates that specify screening thresholds and follow-up timelines to streamline evaluation and risk modification.

Key Takeaways:

• Add focused OSA history and basic screening for adults ≤55 with new RVO—the cohort showed a modest but significant increased RVO risk, driven by BRVO, creating an actionable screening opportunity.
• Prioritize patients with snoring, daytime somnolence, high BMI, or abnormal oximetry for expedited sleep‑medicine evaluation; these features enrich the subgroup most likely to benefit from testing.
• Establish coordinated referral pathways (EHR alerts, standardized forms, shared templates) between ophthalmology and sleep clinics to accelerate diagnosis and enable targeted risk-reduction interventions.