Dry Eye Disease (DED) is regarded as the most common ocular surface disease worldwide, entailing symptoms that have a major impact on the physical and psychological well-being of DED patients. In this context, the impact of sleep quality on DED has recently attracted attention. Indeed, although little is known about the mechanisms underlying the relationship between sleep and ocular surface diseases, recent evidence suggests that a reciprocal relationship exists between sleep quality and DED. Aim of the study was to investigate such relationship by means of both survey-based and instrumental analysis in a large population.
Patients and methods
The present cross-sectional study included 1182 DED patients who completed the Insomnia Severity Index (ISI) and the Ocular Surface Disease Index (OSDI) questionnaires. Moreover, tear break-up time (TBUT) and ocular surface staining (OSS) data of included patients were collected by physicians.
Results
According to the findings of this study, in DED patients, the severity of dry eye symptoms and signs, assessed by OSDI score, TBUT, and ocular surface staining, is associated with more severe insomnia symptoms. Furthermore, higher severity of DED symptoms seems to be associated with the occurrence of nocturnal awakenings rather than with problems in falling asleep.
Conclusions
Present work contributes to the understanding of the complex relationship between DED and insomnia by showing that in a large population of DED patients, the more severe the insomnia, the more severe the DED symptoms and signs.
MauryaRPSinghS. Sleep and dry eye disease. Indian J Clin Exp Ophthalmol2021; 7: 452–453.
2.
StapletonFAlvesMBunyaVY, et al.TFOS DEWS II epidemiology report. Ocul Surf2017; 15: 334–365.
3.
LiuJDongYWangY. Vitamin D deficiency is associated with dry eye syndrome: a systematic review and meta-analysis. Acta Ophthalmol2020; 98: 749–754.
4.
KojimaT. Contact lens-associated dry eye disease: recent advances worldwide and in Japan. Invest Ophthalmol Vis Sci2018; 59: DES102–DES108.
5.
BarabinoSLabetoulleMRolandoM, et al.Understanding symptoms and quality of life in patients with dry eye syndrome. Ocul Surf2016; 14: 365–376.
6.
JonasJBWeiWBXuL, et al.Self-rated depression and eye diseases: the Beijing eye study. PLoS One2018; 13: e0202132.
7.
Van der VaartRWeaverMALefebvreC, et al.The association between dry eye disease and depression and anxiety in a large population-based study. Am J Ophthalmol2015; 159: 470–474.
8.
LiMGongLSunX, et al.Anxiety and depression in patients with dry eye syndrome. Curr Eye Res2011; 36: 1–7.
9.
SzakátsISebestyénMNémethJ, et al.The role of health anxiety and depressive symptoms in dry eye disease. Curr Eye Res2016; 41: 1044–1049.
10.
McDonaldMPatelDAKeithMS, et al.Economic and humanistic burden of dry eye disease in Europe, North America, and Asia: a systematic literature review. Ocul Surf2016; 14: 144–167.
11.
UchinoMSchaumbergDA. Dry eye disease: impact on quality of life and vision. Curr Ophthalmol Rep2013; 1: 51–57.
12.
GoelNBasnerMRaoH, et al.Circadian rhythms, sleep deprivation, and human performance. Prog Mol Biol Transl Sci2013; 119: 155–190.
13.
ShortMALoucaM. Sleep deprivation leads to mood deficits in healthy adolescents. Sleep Med2015; 16: 987–993.
14.
SuttonEL. Psychiatric disorders and sleep issues. Med Clin North Am2014; 98: 1123–1143.
15.
KingCRKnutsonKLRathouzPJ, et al.Short sleep duration and incident coronary artery calcification. JAMA2008; 300: 2859–2866.
16.
KnutsonKLVan CauterERathouzPJ, et al.Association between sleep and blood pressure in midlife: the CARDIA sleep study. Arch Intern Med2009; 169: 1055–1061.
17.
AuroraRNPunjabiNM. Obstructive sleep apnoea and type 2 diabetes mellitus: a bidirectional association. Lancet Respir Med2013; 1: 329–338.
18.
PaivaTGasparTMatosMG. Sleep deprivation in adolescents: correlations with health complaints and health-related quality of life. Sleep Med2015; 16: 521–527.
19.
The epidemiology of dry eye disease: report of the epidemiology subcommittee of the international dry eye WorkShop (2007). Ocul Surf2007; 5: 93–107.
20.
GipsonIKArgüesoPBeuermanR, et al.Research in dry eye: report of the research subcommittee of the international dry eye WorkShop (2007). Ocul Surf2007; 5: 179–193.
21.
AyakiMKawashimaMNegishiK, et al.High prevalence of sleep and mood disorders in dry eye patients: survey of 1,000 eye clinic visitors. Neuropsychiatr Dis Treat2015; 11: 889–894.
22.
KawashimaMUchinoMYokoiN, et al.The association of sleep quality with dry eye disease: the osaka study. Clin Ophthalmol2016; 10: 1015–1021.
23.
AyakiMTsubotaKKawashimaM, et al.Sleep disorders are a prevalent and serious comorbidity in dry eye. Invest Ophthalmol Vis Sci2018; 59: DES143–DES150.
24.
LimEWLCheeMLSabanayagamC, et al.Relationship between sleep and symptoms of tear dysfunction in Singapore Malays and Indians. Invest Ophthalmol Vis Sci2019; 60: 1889–1897.
25.
AyakiMTodaITachiN, et al.Preliminary report of improved sleep quality in patients with dry eye disease after initiation of topical therapy. Neuropsychiatr Dis Treat2016; 12: 329–337.
26.
AyakiMKawashimaMNegishiK, et al.Sleep and mood disorders in dry eye disease and allied irritating ocular diseases. Sci Rep2016; 6: 22480.
27.
LeeWLimSSWonJU, et al.The association between sleep duration and dry eye syndrome among Korean adults. Sleep Med2015; 16: 1327–1331.
28.
KaracaEEAkçamHTUzunF, et al.Evaluation of ocular surface health in patients with obstructive sleep apnea syndrome. Turk J Ophthalmol2016; 46: 104–108.
29.
KaracaIYagciAPalamarM, et al.Ocular surface assessment and morphological alterations in meibomian glands with meibography in obstructive sleep apnea syndrome. Ocul Surf2019; 17: 771–776.
30.
MorsyNEAmaniBEMagdaAA, et al.Prevalence and predictors of ocular complications in obstructive sleep apnea patients: a cross-sectional case-control study. Open Respir Med J2019; 13: 19–30.
31.
YuXGuoHLiuX, et al.Dry eye and sleep quality: a large community-based study in Hangzhou. Sleep2019; 42: zsz160.
32.
HanKTNamJHParkEC. Do sleep disorders positively correlate with dry eye syndrome? Results of national claim data. Int J Environ Res Public Health2019; 16: 878.
33.
AlmutairiRAlgezlanSBayaminR, et al.The association between dry eye and sleep quality among the adult population of Saudi Arabia. Cureus2022; 14: e22736.
34.
ZhengQLiSWenF, et al.The association between sleep disorders and incidence of dry eye disease in Ningbo: data from an integrated health care network. Front Med (Lausanne)2022; 9: 832851.
35.
MagnoMSUtheimTPSniederH, et al.The relationship between dry eye and sleep quality. Ocul Surf2021; 20: 13–19.
36.
SackRABeatonASatheS, et al.Towards a closed eye model of the pre-ocular tear layer. Prog Retin Eye Res2000; 19: 649–668.
37.
GalorASeidenBEParkJJ, et al.The association of dry eye symptom severity and comorbid insomnia in US veterans. Eye Contact Lens2018; 44(Suppl 1): S118–S124.
38.
LeeYBKohJWHyonJY, et al.Sleep deprivation reduces tear secretion and impairs the tear film. Invest Ophthalmol Vis Sci2014; 55: 3525–3531.
39.
LiSNingKZhouJ, et al.Sleep deprivation disrupts the lacrimal system and induces dry eye disease. Exp Mol Med2018; 50: e451.
40.
Von TreuerKNormanTRArmstrongSM. Overnight human plasma melatonin, cortisol, prolactin, TSH, under conditions of normal sleep, sleep deprivation, and sleep recovery. J Pineal Res1996; 20: 7–14.
41.
PalmaJA. Autonomic dysfunction in sleep disorders: introduction to the series. Clin Auton Res2018; 28: 507–508.
42.
TangLWangXWuJ, et al.Sleep deprivation induces dry eye through inhibition of PPARα expression in corneal epithelium. Invest Ophthalmol Vis Sci2018; 59: 5494–5508.
43.
DarttDA. Neural regulation of lacrimal gland secretory processes: relevance in dry eye diseases. Prog Retin Eye Res2009; 28: 155–177.
44.
PronoFBernardiKFerriR, et al.The role of vitamin D in sleep disorders of children and adolescents: a systematic review. Int J Mol Sci2022; 23: 1430.
45.
RolandoMBarabinoS. Dry eye disease: what is the role of vitamin D?Int J Mol Sci2023; 24: 1458.
46.
NaKSHanKParkYG, et al.Depression, stress, quality of life, and dry eye disease in Korean women: a population-based study. Cornea2015; 34: 733–738.
47.
JeongHHanSBHyonJY, et al.414 depression is associated with symptomatic dry eye disease. Asian J Psychiatr2011; 4: S57.
48.
KuangTMTsaiSYLiuCJ, et al.Association between dry eye and depressive symptoms in an elderly Chinese population in Taiwan: the Shihpai eye study. Eye (Lond)2021; 35: 2826–2833.
49.
KimKWHanSBHanER, et al.Association between depression and dry eye disease in an elderly population. Invest Ophthalmol Vis Sci2011; 52: 7954–7958.
50.
LiangCYCheangWMWangCY, et al.The association of dry eye syndrome and psychiatric disorders: a nationwide population-based cohort study. BMC Ophthalmol2020; 20: 123.
