Sleep Disturbance as a Risk Factor for Retinal Neurodegeneration and Subsequent Glaucoma

Abstract

Purpose: To determine whether insufficient sleep, insomnia, and sleep-apnea syndrome (SAS) are associated with retinal nerve fiber layer (RNFL) thinning and incident glaucoma in adults.

Design: Community-based cross-sectional analysis and nationwide population-based retrospective cohort study.

Participants: The regional cohort included 5958 adults aged 40-80 years who underwent wrist actigraphy and optical coherence tomography. The nationwide cohort, comprised adults aged ≥40 years, totaling 985,136 patients with insomnia and 72,075 with sleep apnea syndrome, along with respective control groups without these disorders.

Methods: In the regional cohort, we conducted a cross-sectional analysis to assess the association between objectively measured sleep parameters and retinal nerve fiber layer (RNFL) thickness, using multivariable linear models. In the nationwide cohort, we performed a longitudinal analysis with up to 7.5 years of follow-up, estimating adjusted hazard ratios (aHR) for incident glaucoma using Cox proportional hazards models.

Results: In the regional cohort, RNFL thickness peaked at 6-7 h of actual sleep and declined with shorter duration; sleeping <6 h remained independently associated with thinner RNFL after adjustment for age, sex, intraocular pressure, and systemic factors. In the nationwide cohort, glaucoma risk was higher in patients with insomnia (aHR 1.30, 95% CI 1.28-1.32) and SAS (aHR 1.43, 95% CI 1.35-1.51) compared with controls.

Conclusions: Objective sleep insufficiency and clinically diagnosed sleep disorders correlate with retinal neurodegeneration and confer a higher risk of developing glaucoma. Integrating sleep evaluation and management into ophthalmic care may aid glaucoma prevention.