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Sarah Ruth Stevenson, Colm Andrews, Iona Alexander, Marcela Votruba, Patrick Yu-Wai-Man, Susan Downes, Russell Foster; The Impact of Optic Nerve Disorders on Sleep Wake. Invest. Ophthalmol. Vis. Sci. 2018;59(9):619. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Sleep deprivation and disordered sleep increases the risk of cardiovascular and metabolic disorders, cancer, accidental injury, and has negative social and psychiatric consequences. Sleep is mediated by photic input from photosensitive retinal ganglion cells (pRGCs) via the retinohypothalamic tract to the suprachiasmatic nuclei (SCN) which modulates circadian rhythms. Damage to these pathways, including the optic nerve, directly influences circadian biology. Although previous studies have shown increased circadian dysfunction in ocular disorders and blindness, no large-scale studies demonstrating the impact of optic nerve disorders on sleep have been performed.We hypothesise that damage to the optic nerve affects pRGC input to the suprachiasmatic nuclei, potentially leading to disturbance of circadian rhythm.
Following exclusion, 101 optic nerve (ON) participants completed sleep questionnaires including subjective sleep quality (Pittsburgh Sleep Quality Index (PSQI)), Morningness-Eveningness (MEQ), General Health Questionnaire (GHQ) and the Hospital Anxiety and Depression Scale (HADS). In addition, 100 ON participants completed the Epworth Sleepiness Scale (ESS). Best visual acuity (BVA) (of the better eye) was also recorded. Results were compared to those from 236 control participants.
Sleep quality was significantly worse in ON (mean 7.45, SD4.21) compared to controls (mean 4.76, SD 3.04)(p=9.38x10-12 adjusted R2 = 0.12). Poor sleep ( PSQI>5) was observed in 63.37% of ON participants, compared to 32.6% of controls. Depression scores (HADS-D) were significantly worse in ON (p=7.05x10-10). Anxiety scores (HADS-A) were comparable between ON and controls (p=0.81) but significantly worse in younger participants (p=0.0051). No significant difference was found in chronotype (MEQ) between ON and controls (p=0.52). ESS was significantly worse in ON compared to controls (p=0.019). No significant relationship was found between BVA and PSQI (p=0.28). Many ON participants had a chronic systemic condition (63.37%).
Sleep dysfunction may be increased in subjects with ON disorder. It may be beneficial for clinicians to be aware of this, so that it can be discussed and managed. Those with disrupted sleep may benefit from an intervention such as light or melatonin. Patients with ON disorders may have co-existing systemic conditions, which may also contribute to their sleep disorder.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
PRGCs. Credit: Steven Hughes, Russell Foster.
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