Visual impairment, age-related eye disease, and sleep dysfunction in older adults

The visual system affects circadian rhythms, and both visual and sleep difficulties are common in older adults. This study examines the association between visual impairment, age-related eye disease, and sleep disturbances among older adults in the United States.

This cross-sectional study used Round 11 of the National Health and Aging Trends Study (NHATS). Vision was assessed using self-report and objective assessments (distance and near acuity, contrast sensitivity). Medicare claims data were used to identify diagnoses of age-related macular degeneration, glaucoma, diabetic retinopathy, and cataract. Primary outcomes included self-reported sleep disturbances, defined by difficulties in sleep initiation, maintenance, and medication use. Logistic regression models were adjusted for demographic and clinical variables.

Among 3817 participants (56% female), difficulty with sleep initiation, maintenance, and medication use were reported by 41.7%, 44.2%, and 26.5% of the cohort, respectively. In unadjusted models, self-reported visual difficulty was associated with sleep initiation (OR 1.80, 95% CI: 1.43-2.29) and maintenance difficulties (OR 1.53, 95% CI: 1.16-2.02) and sleep medication use (OR 1.68, 95% CI: 1.27-2.24). After adjusting for covariates, self-reported visual difficulty remained significantly associated with sleep medication use (OR 1.40, 95% CI: 1.00-1.95). Near acuity and contrast sensitivity were associated with sleep initiation difficulties but did not remain significant after adjustment. No associations were found between ophthalmic diagnoses and outcomes.

Self-reported visual difficulty is associated with increased sleep medication use in older adults. Because visual impairment and sleep medications are associated with falls and cognitive decline, future studies should consider these comorbidity patterns.