A multi-institutional cohort study on risk of sleep disorders in dry eyes patients using TriNetX

To explore the relationship between DED and sleep disorders and examine the impact of DED's duration on sleep disorders. This multi-institutional, retrospective cohort study used the TriNetX database. We recruited participants with and without DED diagnosis from 2004 to 2023. Dry eye patients were propensity-matched to individuals from our non-DED cohort (1:1 ratio) based on variables such as age (every 5 year), sex, ethnicity, race, and relevant comorbidities. The Cox proportional hazards regression model was utilized to assess the impact of variables on sleep disorder risk, reporting hazard ratios (HRs) with 95% confidence intervals (CI). Kaplan-Meier survival analysis and log-rank tests were applied to estimate the cumulative incidence of sleep disorder. A total of 688,413 DED adult patients (64.91% female; mean age at index 56.96 ± 15.93) and 688,413 propensity-matched non-DED comparators (64.92% female; mean age at index 56.96 ± 15.93) were recruited. Our analysis showed an overall increased risk of uveitis among DED patients at 5-year time points (HR = 1.04) and all-year (19 years) follow-up durations (HR = 1.03). We observed a higher risk of sleep apnea in DED individuals irrespective of follow-up intervals. Further analyses revealed this increased risk specifically in those diagnosed with Sjögren syndrome (HR = 1.22). This study highlights the significant link between sleep disorders and DED, emphasizing the role of sleep apnea in DED patients. Aqueous-deficient DED has a more pronounced impact on sleep disturbances compared to evaporative DED, while the influence of DED on non-physiological insomnia may be overstated.