Findings from a recent study published in Eye evaluated the association between visual impairment (VI) and sleep quality across varying severities of VI and ocular conditions in adults.
Give me some background.
There is a growing body of evidence highlighting the link between VI and sleep health, with one review identifying 11 distinct eye health conditions associated with poor sleep quality:
- Blindness
- Glaucoma
- Diabetic retinopathy (DR)
- Low vision
- Cataract
- Retinitis pigmentosa
- Macular degeneration
- Optic neuropathy
- Visual field defects
- Ocular hypertension
- Retinal vein occlusion
In fact: One study found that after controlling for confounding factors, vision-related functional burden was significantly associated with sleep disorders (adjusted odds ratio [aOR]: 1.50, p<0.001).
What causes this association?
Researchers have proposed a few potential explanations for this relationship:
- Increased rates of depression in VI patients—likely from a reduced capacity to independently engage in necessary basic and desired activities of daily living, which could adversely affect sleeping such as sleep quality and duration.
- Plus: Limited outdoor activities can lead to reduced exposure to natural sunlight, potentially impacting dopamine secretion, which is involved in the regulation of wake and sleep.
- For completely blind individuals, continual circadian desynchrony through a failure of light information to reach the hypothalamic circadian clock may result in cyclical episodes of poor sleep and daytime dysfunction.
Now talk about the study.
In this cross-sectional observational study, 277 adults with VI and 278 age- and sex-matched controls were identified from two hospitals.
Participants underwent comprehensive ocular examinations and completed the Arabic version of the Pittsburgh Sleep Quality Index (PSQI).
Multivariate logistic regression models were utilized to evaluate the link between VI, its severity, ocular conditions, and poor sleep quality while adjusting for potential confounders.
Findings?
VI patients had worse sleep quality than controls (mean PSQI: 6.83±3.6 vs. 5.30±3.5, p<0.001), with 57.8% experiencing poor sleep (PSQI>5) compared to 36.7% of controls (p<0.001).
In multivariate analysis, patients with VI had significantly higher odds of poor sleep quality compared to controls (OR: 2.0, 95% confidence interval [CI]: 1.4-2.8, p<0.001).
Were there any ocular conditions associated with poor sleep quality?
Moderate VI (OR: 2.1, 95% CI: 1.4-3.2, p=0.001) and blindness (OR: 2.9, 95% CI: 1.4-5.9, p=0.004) were significantly associated with poor sleep quality.
Moreover: Diabetic retinopathy (OR: 2.2, 95% CI: 1.4-3.4, p<0.001) and combined ocular conditions (OR: 3.6, 95% CI: 1.4-9.3, p=0.009) were also significantly associated with poor sleep quality.
Expert opinion?
The study authors highlighted the importance of clinicians identifying the high burden of sleep problems in VI patients and incorporating routine screening into care and considering targeted strategies.
This could include sleep-hygiene programs and tools that strengthen environmental light cues for circadian regulation.
“Additionally, improving vision in individuals with VI can improve sleep quality by facilitating better light perception and circadian rhythm regulation,” they added.
Take home.
These findings demonstrate the complex nature and the significant association between VI and poor sleep quality, with the severity of impairment, underlying ocular conditions, and various sociodemographic factors playing crucial roles.
- Case in point: Poor sleep quality was associated with VI (particularly moderate VI), blindness, diabetic retinopathy, and combined ocular conditions.
As such: Integrating comprehensive management strategies from sleep medicine and public health into eye care may enable more effective strategies for addressing sleep in VI patients to improve their overall well-being.