Abstract
PurposeSleep is an important determinant of health and quality of life. This study aimed to clarify the association between dry eye and sleep quality using a large population-based cohort. Methods71,761 participants (19–94 yrs, 59.4% female) from the Lifelines cohort in the Netherlands were assessed for dry eye using the Women's Health Study Dry Eye Questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was used to examine the relationship between poor sleep quality (PSQI score >5) and dry eye, while correcting for age, sex, BMI, education, income, and 51 possible confounding comorbidities, including autoimmune diseases and psychiatric disorders. ResultsOverall, 8.9% of participants had dry eye. Of these, 36.4% had poor sleep quality compared to 24.8% of controls (OR 1.52 (95%CI 1.44–1.60), P < 0.0001, corrected for age and sex). After correcting for all comorbidities, dry eye was still associated with poor sleep (OR 1.20 (95%CI 1.11–1.28), P < 0.0001). This relationship was seen across all ages and sexes. Patients with dry eye scored worse on all subcomponents of the PSQI. Almost one-in-two (44.9%) persons with dry eye symptoms “often” or “constantly” had poor sleep quality. This proportion was similar to participants with sleep apnea and osteoarthritis. Additionally, increasing symptom frequency was tied to increased prevalence of poor sleep quality. ConclusionsAll components of sleep quality were significantly reduced in participants with dry eye, even after correcting for comorbidities. These results indicate the substantial impact of dry eye on patients' lives, especially for those with frequent symptoms.
Highlights
Dry eye disease (DED) is a multifactorial disease affecting the ocular surface and tear film
A total of 8.9% of participants were classified as having dry eye, as defined by the Women’s Health Study (WHS) dry eye questionnaire
Almost 1 in 2 (44.9%) of those with highly symptomatic dry eye had poor sleep quality (OR 2.06 (95%CI 1.85–2.30), corrected for age and sex only, P < 0.0001)
Summary
Dry eye disease (DED) is a multifactorial disease affecting the ocular surface and tear film. Recent studies on sleep and DED have indicated that patients with DED have poorer sleep [9,10,11,12,13,14,15,16,17], and that patients with sleep disorders are more likely to have DED [18,19,20]. Most of these studies were small or done in the setting of an eye clinic, where selection bias could affect results. No population-based study concerning sleep quality and DED has been conducted in a sample of European ancestry to date
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