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Rukhsana Safa, John Salmon, Susan Downes, Stuart Peirson, Russell Foster, Katharina Wulff; Assessment of sleep in patients with Primary Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4337.
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Photosensitive retinal ganglion cells (pRGCs) mediate a number of non-visual responses to light including entrainment of 24h circadian physiology, sleep/wake cycle, increased alertness in response to light and pupil constriction. Advanced glaucoma can cause pRGC dysfunction as shown in one clinical study that assessed pupil response to light. Here we investigate the impact of primary open angle glaucoma on sleep by studying patients with glaucoma with varying degrees of severity. These individuals were assessed for both sleep quality and axonal damage using visual field measures.
Patients with moderate to severe bilateral primary open angle glaucoma (POAG) with no other significant ocular comorbidity were asked to complete the self-rated Pittsburgh Sleep Quality Index (PSQI) to assess their subjective sleep quality. The PSQI measures seven sleep variables on a scale of 0 to 3 providing a global sum of 0 to 21; with ≥5 indicating poor sleep. Exploratory analyses of different sleep variables of the PSQI in relation to disease severity, sex and age were carried out in SPSS.
In this ongoing study, 35 patients with POAG have completed the PSQI to date. 19 men and 16 women with a mean age of 70.03 years (range 43-89 years) took part. Their mean PSQI global score was 5.543. 46% of the patients (16 out of 35 participants) reported poor sleep quality; with a PSQI mean global score of 8.437. There was a significant difference in the global score between women and men, with women reporting poorer sleep than men (p=0.049). No significant difference was found in the global score when comparing those aged above and below 65 years (43-65 and >65), or when comparing between moderate and severe POAG.
This is a pilot study to assess the sleep quality in POAG. 46% of the patients reported abnormal sleep, with women more affected than men. These preliminary results are consistent with previous data suggesting sleep disruption occurs in patients with POAG, possibly due to pRGC dysfunction. At present, the small number of participants in this ongoing pilot study lacks sufficient power to detect small differences. Further study with a larger cohort of subjects will allow us to draw a more definitive conclusion.
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