Sleep Disturbance as a Risk Factor for Retinal Neurodegeneration and Subsequent Glaucoma.
Akada Masahiro, Nakanishi Yuta, Ideyama Midori, Mori Yuki, Morino Kazuya, Nakano Eri, Numa Shogo, Nagasaki Tadao, Matsumoto Takeshi, Sunadome Hironobu
AI Summary
Insufficient sleep and sleep disorders (insomnia, sleep apnea) are linked to retinal nerve damage and increased glaucoma risk, suggesting sleep management may aid prevention.
Abstract
Purpose
To determine whether insufficient sleep, insomnia, and sleep-apnea syndrome (SAS) are associated with retinal nerve fiber layer (RNFL) thinning and incident glaucoma in adults.
Design
Community-based cross-sectional analysis and nationwide population-based retrospective cohort study.
Participants
The regional cohort included 5958 adults aged 40-80 years who underwent wrist actigraphy and optical coherence tomography. The nationwide cohort, comprised adults aged ≥40 years, totaling 985,136 patients with insomnia and 72,075 with sleep apnea syndrome, along with respective control groups without these disorders.
Methods
In the regional cohort, we conducted a cross-sectional analysis to assess the association between objectively measured sleep parameters and retinal nerve fiber layer (RNFL) thickness, using multivariable linear models. In the nationwide cohort, we performed a longitudinal analysis with up to 7.5 years of follow-up, estimating adjusted hazard ratios (aHR) for incident glaucoma using Cox proportional hazards models.
Results
In the regional cohort, RNFL thickness peaked at 6-7 h of actual sleep and declined with shorter duration; sleeping <6 h remained independently associated with thinner RNFL after adjustment for age, sex, intraocular pressure, and systemic factors. In the nationwide cohort, glaucoma risk was higher in patients with insomnia (aHR 1.30, 95% CI 1.28-1.32) and SAS (aHR 1.43, 95% CI 1.35-1.51) compared with controls.
Conclusions
Objective sleep insufficiency and clinically diagnosed sleep disorders correlate with retinal neurodegeneration and confer a higher risk of developing glaucoma. Integrating sleep evaluation and management into ophthalmic care may aid glaucoma prevention.
MeSH Terms
Shields Classification
Key Concepts4
In a regional cohort of 5958 adults aged 40-80 years, retinal nerve fiber layer (RNFL) thickness peaked at 6-7 hours of actual sleep and declined with shorter duration.
In a regional cohort of 5958 adults aged 40-80 years, sleeping less than 6 hours remained independently associated with thinner retinal nerve fiber layer (RNFL) after adjustment for age, sex, intraocular pressure, and systemic factors.
In a nationwide cohort, patients with insomnia (n=985,136) had a higher risk of incident glaucoma (adjusted hazard ratio 1.30, 95% CI 1.28-1.32) compared with controls over up to 7.5 years of follow-up.
In a nationwide cohort, patients with sleep apnea syndrome (SAS) (n=72,075) had a higher risk of incident glaucoma (adjusted hazard ratio 1.43, 95% CI 1.35-1.51) compared with controls over up to 7.5 years of follow-up.
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