Moderate Obstructive Sleep Apnea coexisting with Keratoconus in a 39-Year-Old Female: A Case Report

Keratoconus is a progressive, non-inflammatory ectatic corneal disorder that may require keratoplasty in advanced stages. Obstructive sleep apnea (OSA), a common sleep-related breathing disorder, has been increasingly associated with keratoconus, potentially through mechanisms involving hypoxia, mechanical stress, and systemic inflammation. However, limited data exist regarding the impact of OSA on corneal graft outcomes. We report a case of a 39-year-old unmarried female with bilateral keratoconus, and a subsequent diagnosis of moderate OSA. The patient underwent PK at age 24 for advanced disease progression with contact lens intolerance. At age 37, she was diagnosed with moderate OSA (AHI: 23 events/hour) confirmed by polysomnography and was initiated on continuous positive airway pressure (CPAP) therapy. There were no episodes of graft rejection or failure. Ocular and systemic symptoms improved with regular CPAP use. This case highlights a potential interaction between OSA and keratoconus, particularly in a post-keratoplasty context. Given the shared pathophysiological factors, including oxidative stress and mechanical trauma, ophthalmologists should maintain a high index of suspicion for OSA in keratoconus patients and coordinate multidisciplinary care to optimize both ocular and systemic outcomes.