Is There an Association Between Dry Eye Disease and Sleep Quality?

Patients with dry eye disease had worse sleep quality, longer sleep latency, and a higher risk of unhealthy sleep duration compared with healthy study participants, according to the results of a recent meta-analysis. However, researchers cautioned that there was insufficient evidence to establish a causal relationship between dry eye disease and sleep disorder.

Researchers searched PubMed, EMBASE, Cochrane, Web of Science, and grey literature databases for observational studies published before April 2023. A meta-analysis was performed using STAT15 software. Gu and colleagues included a total of 21 studies with 419,218 participants—152,567 with dry eye disease, and 266,651 were healthy controls.

One-third of the included studies assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), a self-reported questionnaire that assesses sleep quality and disturbances over a 1-month time interval (higher the score, the worse the sleep quality). The results showed that the PSQI scores of the patients with dry eye disease were significantly higher than healthy controls (weighted mean difference [WMD] = 1.78, [95% CI, 1.06 to 2.50]; P < 0.001).

Although patients with dry eye disease scored higher than the control group in sleep quality, sleep latency, and sleep disturbance in PSQI, there was no difference between the two groups regarding sleep duration, sleep efficiency, daytime dysfunction, and sleep medication scores.

Still, the risk of sleep disorders was significantly higher for patients with dry eye disease compared with healthy patients (relative risk = 2.20 [95% CI, 1.78 to 2.72]; P < 0.001). Additionally, the risk of insufficient sleep and the prevalence of excessive sleepiness was higher for those with dry eye disease compared with the control subjects. Patients with dry eye disease scored significantly higher on the Epworth sleepiness scale (a scale to determine daytime sleepiness) than those in the control group (WMD = 3.02 [95% CI, 2.43 to 3.60]; P < 0.01).

This study had limitations, most notably, that most of the studies included questionnaires to determine whether patients had dry eye disease or sleep disorders. which could be subjective.

“Our meta-analysis indicates that dry eye patients have a lower sleep quality than the healthy population, with poorer subjective sleep quality, longer sleep latency, and a higher risk of unhealthy sleep duration such as insufficient sleep or excessive sleep,” Gu and colleagues concluded. “However, so far, there is not enough evidence to establish a causal relationship and related mechanisms between dry eye and sleep disorder. In the future, more large-scale prospective studies are needed to provide more assistance in patient management and treatment.”

Reference
Gu Y, Cao K, Li A, et al. Association between sleep quality and dry eye disease: a literature review and meta-analysis. BMC Ophthalmol. 2024;24(1):152. doi:10.1186/s12886-024-03416-7