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ABSTRACT: To determine the prevalence and risk factors for sleep apnea in a keratoconus population. Ninety-two keratoconus patients and 92 controls were classified as high risk or low risk for sleep apnea, using the Berlin Questionnaire (BQ) or individual history of sleep apnea. Logistic regression was used to investigate the risk factors associated with high risk of sleep apnea in keratoconus patients and controls. Of the 92 keratoconus patients, 18 (19.6%) had a positive known history for sleep apnea, and 49 (53.3%) were categorized to be at high risk by the BQ. Of the 92 control patients, 6 (6.5%) had a positive known history for sleep apnea, and 25 (27.2%) were categorized to be at high risk by the BQ. In keratoconus patients, body mass index was the only risk factor for sleep apnea, whereas in control patients, age, body mass index, and family history of sleep apnea were the risk factors for sleep apnea. Keratoconus patients are at increased risk for sleep apnea, and different risk factors are associated with sleep apnea in keratoconus patients and controls. Ophthalmologists should consider screening keratoconus patients for obstructive sleep apnea, if appropriate.