Abstract
Purpose :
To examine the associations between glaucoma and glaucoma severity and circadian rhythm sleep disorders (CRSD) and any sleep disorders with glaucoma and glaucoma severity in California (CA) Medicare beneficiaries.
Methods :
This study included all 2019 CA Medicare beneficiaries who were ≥65 years old, had both Parts A & B coverage, and had ≥1 Part B claim. The primary exposures were glaucoma and glaucoma severity defined by International Classification of Diseases, 10th revision (ICD-10) codes. Glaucoma severity was determined by the ICD-10 7th digit severity modifier and was divided into mild, moderate, severe, and unknown (indeterminate and unspecified). The primary outcome was CRSD and the secondary outcome was any sleep disorder, defined by their respective ICD-10 codes. The associations between glaucoma/glaucoma severity and CRSD/any sleep disorders were estimated using multivariable logistic regression models adjusting for age, gender, race and ethnicity, and systemic disease burden defined by Charlson comorbidity index (CCI) score. The effect estimate was expressed as an adjusted odds ratio (aOR) with a 95% confidence interval (CI).
Results :
The study population included 2,717,346 CA Medicare beneficiaries who met the inclusion criteria. Of those, 220,662 (8.1%) had glaucoma, 3,202 (0.12%) had CRSD, and 355,390 (13.1%) had any sleep disorders. In the adjusted logistic regression models, beneficiaries with glaucoma had greater adjusted odds of CRSD (aOR=1.31; 95% CI: 1.16-1.47; p<0.001) and any sleep disorders (aOR=1.22; 95% CI: 1.21-1.24; p<0.001) compared to counterparts without glaucoma. When analyzing by glaucoma severity, compared to those without glaucoma, there were greater odds of CRSD for beneficiaries with severe glaucoma (aOR=1.48; 95% CI: 1.18-1.86; p<0.001) and those with unknown glaucoma severity (aOR=1.50; 95% CI: 1.22-1.86; p<0.001). Similarly, there were greater odds of any sleep disorders for all glaucoma severity levels (p<0.001).
Conclusions :
In the 2019 CA Medicare population, glaucoma was associated with greater likelihood of both CRSD and any sleep disorder. Such associations were stronger between severe glaucoma and CRSD, suggesting that worsening glaucoma severity might lead to an increased risk of CRSD. Further investigations are needed to further characterize and understand these associations.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.