Sleep Quality Is Associated With Severe Meibomian Gland Disruption in Dry Eye

Yirui Zhu,Xiuming Jin,Mengshu Di,Xiaodan Huang,Ruida Chen,Fei Fang,Lin Lin

doi:10.3389/fmed.2022.812705

Abstract

PurposeTo investigate the association between sleep quality and meibomian gland dropout characteristics in dry eye patients.MethodsThis cross-sectional study involved 172 dry eye patients with no history of conditions or factors that could confound dry eye disease (DED) and/or meibomian gland dropout. Participants underwent a comprehensive anterior eye assessment. The validated Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess sleep quality. The measured outcomes were dry eye symptoms via the Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), corneal fluorescein staining, meibomian gland function, and extent of meibomian gland dropout.ResultsOf the dry eye participants, 34.9% had severe meibomian gland dropout (SMD) and 41.3% of the subjects had poor sleep quality. Patients with poor sleep quality had greater Meibomian gland dropout while the sleep AIS and PSQI scores were significantly correlated with Meibomian gland dropout (r = 0.495, p < 0.001; r = 0.24, p = 0.002; respectively). SMD patients had worse scores on all components of the PSQI (all p < 0.001, corrected for age and sex). Use of sleep medication, poor habitual sleep efficiency, and sleep disturbance were particularly prevalent in SMD patients as compared to Non-severe meibomian gland dropout (NSMD) patients. Multivariate logistic regression analysis revealed that sleep quality was eventually associated with female gender (p = 0.042), OSDI (p = 0.004), TBUT (p = 0.036), and Meibomian gland dropout score (p < 0.001).ConclusionIt was found that greater meibomian gland dropout in poor sleep quality individuals is especially related to use of sleep medication, poor habitual sleep efficiency, and sleep disturbance. This finding suggests a need for long-term studies of anterior eye health in people with poor sleep quality.

Highlights

Sleep dysfunction leads to disruption of physiological systems essential to maintaining good health
Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability [3]
The chronic discomfort observed in DED directly decreases quality of life and interferes with the ability to carry out daily functions [4–6]

Summary

Introduction

Sleep dysfunction leads to disruption of physiological systems essential to maintaining good health Sleep disturbances, such as difficulties with sleep onset (sleep latency), efficiency, or duration, are highly prevalent in over one-third of the general population, with 8–27% reporting experiencing chronic or severe sleep problems, but are associated with increased risk for serious diseases and health conditions, dependence on medication, higher incidences of drugs or alcohol abuse, and greater utilization of medical services [1, 2]. MGD is characterized by terminal duct obstruction and altered meibum secretion These obstructions block the delivery of meibum into the lid margin and cause an increase in pressure within the gland. Meibomian gland dropout and altered quality of expressed meibum have been used to classify the severity of MGD [8]

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