Summary Goals Given the role of intraocular pressure in glaucoma, the patient’s sleep pattern could contribute to the development and progression of glaucoma. We conducted a study to understand the association between sleep behaviors and glaucoma. Design Our study was a prospective cohort study. Ambit This was a prospective cohort study in the UK Biobank. Self-reported data on five sleep behaviors were collected using a questionnaire at baseline. We identified four sleep patterns based on a cluster analysis of sleep behaviors. Participants In the UK Biobank, 409,053 participants were recruited between 2006 and 2010 and followed for a glaucoma diagnosis. Glaucoma was identified as any hospital admission with a diagnosis of glaucoma, based on UK Biobank inpatient hospital data. People who withdrew from the UK Biobank, or who were diagnosed with glaucoma before recruitment, or who underwent surgery or laser treatment for glaucoma, or who had no information on sleep behaviors, were excluded . Primary and secondary outcome measures We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox proportional hazards models to estimate the associations of different sleep behaviors, as well as identified sleep patterns, with the risk of glaucoma, adjusting for for multiple confounders. Results Compared with people who had a healthy sleep pattern, an excess risk of any glaucoma was observed among people with snoring and daytime sleepiness (HR 1.11, 95% CI 1.03 to 1.19) or insomnia and short or long duration sleep (HR 1.13, 95% CI 1.06 to 1.20), but not late chronotype sleep pattern (HR 0.98, 95% CI 0.93 to 1.03). Conclusion Snoring, daytime sleepiness, insomnia and short/long duration, individually or together, were associated with glaucoma risk. These findings underscore the need for sleep intervention for people at high risk of glaucoma, as well as possible ophthalmological evaluation among people with chronic sleep problems for glaucoma prevention. |
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Poor quality sleep, including too much or too little sleeping, daytime sleepiness and snoring, may be linked to an increased risk of developing irreversible vision loss (glaucoma), a large UK Biobank study published in the journal suggests. open access journal at BMJ Open .
The findings underscore the need for sleep therapy in people at high risk for the disease, as well as eye screening among those with chronic sleep disorders to detect early signs of glaucoma, the researchers conclude.
Glaucoma is a leading cause of blindness and will likely affect about 112 million people worldwide by 2040.
Characterized by the progressive loss of light-sensitive cells in the eye and damage to the optic nerve, its causes and contributing factors are still poorly understood. But if left untreated, glaucoma can progress to irreversible blindness.
While population screening may not be cost-effective, targeted screening of high-risk groups could be, the researchers suggest. And previously published research suggests that sleep disorders may be a major risk factor.
To further explore these issues, researchers set out to determine the risk of glaucoma among people with different sleep behaviors: insomnia; sleeping too much or too little; nocturnal or morning chronotypes (’owls’ or ’larks’); daytime sleepiness; and snoring.
They turned to 409,053 participants in the UK Biobank, all of whom were aged between 40 and 69 in 2006-10 when they were recruited, and who had provided details of their sleep behaviours.
Sleep duration was defined as normal (7 to less than 9 hours/day) and as too little or too much, outside this range. Chronotype was defined by whether the person described themselves as a morning lark or a night owl.
Insomnia severity ( difficulty falling asleep at night or frequent awakening) was classified as never/sometimes or usually, while subjective daytime sleepiness was classified as never/rarely, sometimes, or often.
Background information on potentially influential factors was retrieved from questionnaires completed at the time of recruitment: age (average 57), sex, race/ethnicity, educational level, lifestyle, weight (BMI), and level of health deprivation. residential area.
Medical records and death registry data were used to track the health and survival of all participants until a first glaucoma diagnosis (hospital admission), death, emigration, or the end of the follow-up period (31 March 2021), whichever comes first.
During an average follow-up period of just over 10.5 years , 8,690 glaucoma cases were identified.
Those with glaucoma tended to be older and more likely to be male, have ever smoked, and have high blood pressure or diabetes than those who were not diagnosed with the disease.
With the exception of chronotype, the other four sleep patterns/behaviors were associated with varying degrees of increased glaucoma risk.
Short or long sleep duration was associated with an 8% increased risk ; insomnia 12%; snoring 4%; and frequent daytime sleepiness (20%).
And compared to those with a healthy sleep pattern, snorers and those who experienced daytime sleepiness were 10% more likely to have glaucoma, while insomniacs and those with a short- or long-duration sleep pattern were 10% more likely to have glaucoma. 13% more likely to have it.
The results were similar when classified by different types of glaucoma.
This is an observational study and as such cannot establish cause. The study relied on self-report rather than objective measurement and reflected a single point in time, the researchers acknowledge. Glaucoma itself may influence sleep patterns, rather than the other way around, they add.
But there are potentially plausible biological explanations for the associations found between sleep disturbance and glaucoma, the researchers say.
Internal eye pressure, a key factor in the development of glaucoma, increases when a person is lying down and when sleep hormones are unbalanced, as occurs in insomnia, the researchers explain.
Depression and anxiety, which often go hand in hand with insomnia, can also increase internal eye pressure, possibly due to dysregulated cortisol production, they suggest.
Similarly, it has been suggested that repetitive or prolonged episodes of low cellular oxygen levels, caused by sleep apnea (sudden stopping of breathing during sleep), could cause direct damage to the optic nerve.
“Given that sleep behaviors are modifiable, these findings underscore the need for sleep intervention for people at high risk for glaucoma and possible ophthalmologic screening among people with chronic sleep problems to help prevent glaucoma,” they conclude. the researchers.
