A recent UK Biobank study published in the journal BMJ Open suggests that poor sleep quality, including too much or too little sleep, daytime sleepiness, and snoring, may be associated with an increased risk of developing glaucoma, a condition that causes irreversible vision loss.
The findings highlight the importance of sleep therapy for those at high risk of the disease and eye exams for those with chronic sleep disorders to check for early signs of glaucoma
Glaucoma is a leading cause of blindness and will likely affect an estimated 112 million people worldwide by 2040. Characterized by progressive loss of light-sensitive cells in the eye and optic nerve damage, its causes and contributory factors are still poorly understood. But if left untreated, glaucoma can progress to irreversible blindness.
While population screening may not be cost-effective, targeted screening of high-risk groups might be, suggest the researchers. And previously published research suggests that sleep disorders may be an important risk factor. To explore these issues further, the researchers set out to ascertain the risk of glaucoma among people with different sleep behaviors: insomnia; too much or too little sleep; night or morning chronotypes (‘owls’ or ‘larks’); daytime sleepiness; and snoring.
They drew on 409,053 participants in the UK Biobank, all of whom were aged between 40 and 69 in 2006-10 when recruited, and who had provided details of their sleep behaviors.
Sleep duration was defined as normal (7 to less than 9 hours/day) and as too little or too much, outside this range. Chronotype was defined according to whether the person described themselves as more of a morning lark or night owl. Insomnia severity—trouble falling asleep at night or frequent waking—was classified as never/sometimes or usually, whereas subjective daytime sleepiness was categorized as never/rarely, sometimes, or frequent.
Background information on potentially influential factors was retrieved from the questionnaires filled in at recruitment: age (average 57), sex, race/ethnicity, educational attainment, lifestyle, weight (BMI), and residential area level of deprivation. Medical records and death registration data were used to track the health and survival of all the participants until the first diagnosis of glaucoma (hospital admission), death, emigration, or the end of the monitoring period (31 March 2021), whichever came first.
During an average monitoring period of just over 10.5 years, 8690 cases of glaucoma were identified. Those with glaucoma tended to be older and more likely to be male, an ever smoker, and to have high blood pressure or diabetes than those who weren’t diagnosed with the disease.
With the exception of chronotype, the other four sleep patterns/behaviors were all associated with varying degrees of heightened glaucoma risk. Short or long sleep duration was associated with an 8% heightened risk; insomnia 12%; snoring 4%; and frequent daytime sleepiness (20%).
And compared with those with a healthy sleep pattern, snorers and those who experienced daytime sleepiness were 10% more likely to have glaucoma, while insomniacs and those with a short/long sleep duration pattern were 13% more likely to have it.
The results were similar when categorized by different types of glaucoma.
This is an observational study, and as such, can’t establish cause. The researchers acknowledge that the study relied on self-reporting rather than objective measurement and reflected one point in time only. Glaucoma might itself influence sleep patterns, rather than the other way round, they add.
But there are potentially plausible biological explanations for the associations found between sleep disturbance and glaucoma, say the researchers. The internal pressure of the eye, a key factor in the development of glaucoma, rises when a person is lying down and when sleep hormones are out of kilter, as occurs in insomnia, explain the researchers.
Depression and anxiety, which often go hand in hand with insomnia, may also increase internal eye pressure, possibly because of dysregulated cortisol production, they suggest. Similarly, repetitive or prolonged episodes of low levels of cellular oxygen, caused by sleep apnoea (sudden stopping of breathing during sleep), might cause direct damage to the optic nerve, it has been suggested.
“As sleep behaviors are modifiable, these findings underscore the necessity of sleep intervention for individuals at high risk of glaucoma and potential ophthalmologic screening among individuals with chronic sleep problems to help prevent glaucoma,” conclude the researchers.
Reference: “Association of sleep behaviour and pattern with the risk of glaucoma: a prospective cohort study in the UK Biobank” by Cun Sun, Huazhen Yang, Yihan Hu, Yuanyuan Qu, Yao Hu, Yajing Sun, Zhiye Ying and Huan Song, 1 November 2022, BMJ Open.
The study was funded by the National Science Foundation of China.