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Elizabeth Wen Ling Lim, Miao Li Chee, Charumathi Sabanayagam, Shivani Majithia, Yijin Tao, Tien Y Wong, Ching-Yu Cheng, Louis Tong; Association between sleep and dry eye in Singapore Malays and Indians – a population-based study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2734. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Dry eye disease is a prevalent ocular condition affecting 12.3% of the Singapore population. Sleep disorders are also an emerging public health issue, but their relationship with dry eye symptoms (DES) has not been studied in the general population. In this population-based cross-sectional study, we aim to investigate the association between sleep (duration and quality) and DES in Singapore Malay and Indian adults.
A total of 3,303 subjects (aged ≥40 years) from the Singapore Malay Eye Study-2 (SiMES-2, n=1,191, 2011-13) and Singapore Indian Eye Study-2 (SINDI-2, n=2,112, 2013-15) were included. DES was defined as having ≥1 of 6 dry eye symptoms often or all the time. Sleep questionnaires used included the Epworth Sleepiness Scale, Berlin Questionnaire, STOP-bang questionnaire and Insomnia Severity Index. Poor sleep quality was defined as meeting the respective questionnaire thresholds for excessive daytime sleepiness, sleep apnea or insomnia. General health questionnaires (including sleep duration), standardized ocular and systemic tests were also used. Multiple logistic regression models were used in statistical analysis.
Out of the 3,303 participants studied (mean age 63.3 ± 9.7 years, 52.5% women, 8.0% had DES), 6.4% (211) had excessive sleepiness, 20.5% (677) had high risk for sleep apnea, 2.7% (88) had clinical insomnia, and 7.8% (256) had <5 hours of sleep. All these sleep factors were significantly associated with DES. After adjusting for relevant factors (age, gender, ethnicity, cardiovascular disease, current smoking status, history of asthma, history of anxiety/depression, medication use [anti-depressants, anti-convulsants and muscle relaxant]), the sleep factors were all still associated with higher odds of DES: excessive sleepiness [Epworth Sleepiness Scale: OR=1.77 (1.15–2.71)], high risk of sleep apnea [Berlin Questionnaire: OR=1.55 (1.17–2.07); STOP-Bang Questionnaire: OR=2.66 (1.53–4.61)], clinical insomnia [Insomnia Severity Index: OR=3.68 (2.17–6.26)] and < 5 hours of sleep: [OR=1.73 (1.17–2.57), reference sleep duration 5-9 hours]. Sleep apnea, insomnia and sleep duration were each shown to be independently associated with DES.
Short sleep duration and poor sleep quality are both significantly and independently associated with DES. Sleep intervention may potentially be beneficial in dry eye patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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