Impact of Sleep Apnea on Retinal Vein Occlusion in Individuals Under 55: A Retrospective Cohort Study

Purpose: Sleep apnea (SA) is a systemic vascular risk factor, but its association with retinal vein occlusion (RVO) in younger adults is unclear. This study evaluated the relationship between SA and RVO, including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO), in individuals ≤55 years. Methods: A retrospective cohort study was conducted using the TriNetX US Collaborative Network (August 2005–2025). Patients ≤55 years with SA (N = 2,087,539) were propensity score–matched 1:1 with controls (N = 2,087,539) by age, sex, race, BMI, and comorbidities. Outcomes included incident RVO, CRVO, and BRVO. Risk ratios (RR), hazard ratios (HR), and Kaplan–Meier survival analyses with log-rank tests were performed. Results: Among 2,087,539 patients per group, 547 SA patients (0.026%) and 475 controls (0.023%) developed RVO (RR = 1.152, 95% CI: 1.018–1.302; p = 0.024; HR = 1.219, 95% CI: 1.078–1.378; χ 2 = 9.958; p = 0.002). BRVO occurred in 305 SA patients (0.015%) vs 237 controls (0.011%) (RR = 1.287, 95% CI: 1.086–1.525; p = 0.003; HR = 1.367, 95% CI: 1.153–1.619; χ 2 = 13.109; p < 0.001). Conclusions: SA was associated with increased risk of RVO in younger adults, primarily driven by BRVO. These findings highlight the need for early recognition and management of SA to mitigate retinal vascular complications.