The Associations Between Glaucoma and Circadian Rhythm Sleep Disorders in California Medicare Beneficiaries

To examine the associations between glaucoma, circadian rhythm sleep disorders (CRSD), and any sleep-wake disorders in California (CA) Medicare beneficiaries.

Cross-sectional study.

All 2019 CA Medicare beneficiaries who were ≥65 years old, had both Parts A & B coverage, and had ≥1 Part B claim.

The primary exposure was a diagnosis of glaucoma as defined by International Classification of Diseases, 10th revision codes. The primary outcome was CRSD, and the secondary outcome was any sleep-wake disorder, defined by International Classification of Diseases, 10th revision codes. The associations between glaucoma, CRSD, and any sleep-wake disorders were estimated using multivariable logistic regression models adjusting for age, sex, race and ethnicity, age-related macular degeneration, diabetic retinopathy, cataracts, pseudophakia, and systemic disease burden defined by Charlson Comorbidity Index score. The effect estimate was expressed as an adjusted odds ratio (aOR) with a 95% confidence interval (CI).

Odds ratios between exposures and outcomes.

The study population included 2,717,346 CA Medicare beneficiaries meeting inclusion criteria. Of those, 220,662 (8.1%) had glaucoma, 3,202 (0.12%) had CRSD, and 355,390 (13.1%) had any sleep-wake disorder. In the adjusted logistic regression models, beneficiaries with glaucoma had greater adjusted odds of CRSD (aOR: 1.20; 95% CI: 1.06-1.35; P = .0031) and of any sleep-wake disorder (aOR: 1.12; 95% CI: 1.11-1.13; P < .001) compared to beneficiaries without glaucoma.

In the 2019 CA Medicare population, beneficiaries with glaucoma had increased likelihood of CRSD and of any sleep-wake disorder. Further investigations are needed to characterize mechanisms of these associations and to examine the impact of glaucoma treatment on sleep-wake disorders.