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Sleep Pattern and Structural Damage in Older Adults with Glaucoma: A United States and China Study
Zhonghua Luo1, Zihao Lin1, Yuefeng Yu2
1Zhongshan Ophthalmic Center, WHO Collaborating Centre for Eye Care and Vision, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China.
Purpose:
To investigate sleep patterns in older adults with glaucoma and evaluate their associations with glaucomatous damage and emotional disturbances.
Design:
A cross-sectional observational study.
Participants:
Adults aged ≥60 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 in the United States (n = 3317) and the Elderly Glaucoma and Sleep Study (EGSS) in China (n = 200).
Methods:
Participants in NHANES and EGSS completed standardized sleep questionnaires and underwent ophthalmic examinations, while wearable derived-sleep measures and urinary melatonin metabolite assays were additionally performed in the EGSS cohort. In EGSS, multivariable linear regression models were used to examine associations of the Pittsburgh Sleep Quality Index (PSQI) global score with demographic, clinical, and ocular factors.
Main Outcome Measures:
Overall sleep disorder in NHANES and PSQI global score in EGSS.
Results:
In NHANES, older adults with glaucoma reported more frequent sleep disturbances than controls, showing higher odds of sleep disorders and difficulty initiating sleep, as well as longer sleep latency (all P < 0.05). In EGSS, patients with primary open-angle glaucoma (POAG) showed poorer sleep quality, higher device-estimated light sleep time, and a lower 6-sulfatoxymelatonin/creatinine ratio than controls (all P < 0.05), while no significant differences were found for primary angle-closure glaucoma. In multivariable analyses, higher 9-item Patient Health Questionnaire scores and thinner peripapillary retinal nerve fiber layer thickness were independently associated with higher PSQI scores in POAG (all P < 0.05).
Conclusions:
Older adults with glaucoma had poorer sleep quality. Participants with POAG showed poorer subjective sleep quality, a longer wearable-derived light sleep duration, and lower urinary melatonin metabolite levels. In POAG, poorer sleep quality was significantly associated with more severe glaucomatous structural damage and a greater depressive symptom burden.
Financial Disclosures:
The authors have no proprietary or commercial interest in any materials discussed in this article.
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