A large study with more than 400 000 participants found a link between poor sleep and an increased risk of glaucoma, which can lead to irreversible vision loss, particularly among older men who have high blood pressure,.
Insomnia, sleeping less than seven hours or longer than nine, and snoring were all associated with raised glaucoma risk, found the scientists, who said that the study also suggested that participants who developed glaucoma tended to be older, male, have smoked, and have diabetes or high blood pressure.
“Inadequate sleep amount or poor quality sleep is linked to many chronic health problems, such as heart disease, stroke, kidney disease, high blood pressure, diabetes, stroke, obesity, depression and, as pointed out in this article, glaucoma,” said Thomas Kilkenny, MS, DO, director of the Institute of Sleep Medicine at Staten Island University Hospital, part of Northwell Health in New York, told Healthline.
The study was published in The BMJ Open.
“Glaucoma is eye pressure-related damage to the optic nerve that slowly leads to vision loss, starting in the periphery initially before affecting the central vision,” said Dr Brian Boxer Wachler, ophthalmologist and medical reviewer at All About Vision.
The most common type of glaucoma is open-angle glaucoma, and a less common type is low-tension glaucoma.
Other less common types include angle-closure glaucoma and congenital glaucoma.
“Risk factors include (being) over 55, male, a smoker, African American, Asian and Hispanic, a family history of glaucoma, high blood pressure, diabetes, migraine headaches, and sickle cell anaemia,” he said.
Researchers analysed data from more than 400 000 participants in the UK Biobank, who were between 40 and 69 when they participated from 2006 to 2010, and provided details of their sleep patterns.
The study defined normal sleep duration as anywhere from seven to less than nine hours per day.
Anything outside this range was considered as under or oversleeping. The researchers, from universities in China and Iceland, also categorised participants by chronotype, whether they were morning people or “night owls”, and if they snored.
Findings show that during the average monitoring period (about 10.5 years), there were 8 690 cases of glaucoma diagnosed among study participants.
The findings also indicate that participants who developed glaucoma tended to be older, male, have smoked, and have high blood pressure or diabetes compared to those who didn’t.
“This is an excellent observational study that opens up opportunities for future studies to try to better understand the mechanisms behind its findings,” said Wachler.
According to the Centres for Disease Control and Prevention (CDC), about 3m Americans have glaucoma, the second leading cause of blindness worldwide.
Daytime sleepiness linked to greater risk
Researchers grouped participants by the degree of insomnia severity, such as trouble falling asleep at night or frequently waking, which was classified as never, sometimes, or usually. Daytime sleepiness was categorised as never, rarely, sometimes, or frequent.
Questionnaires filled during recruitment were used to discover potentially influential factors, including age, sex, race/ethnicity, educational attainment, lifestyle, and weight.
Researchers looked at medical records and death registration data to track the health and survival of all the participants until the first diagnosis of glaucoma, death, emigration, or the end of the monitoring period (31 March 2021) – whichever came first.
Researchers discovered that sleeping less than seven hours or longer than nine was associated with an 8% increased glaucoma risk.
They also found while insomnia increased risk by 12% and snoring by four – daytime sleepiness raised that risk by 20%.
“In the analyses of sleep pattern, we found that compared with individuals with a healthy sleep pattern, a risk elevation of glaucoma was observed among individuals with snoring and daytime sleepiness,” the study authors wrote.
They also found that being a day or night person had no effect on glaucoma risk, and the results were similar when categorised by different types of glaucoma.
What causes poor sleep?
Kilkenny said there is a “multitude of reasons” why a person has poor sleep.
“First is taking sleep for granted,” he said. “Many people do not realise how important sleep is for good health. If you were never allowed to sleep, you would die.”
Kilkenny said too much caffeine can disrupt sleep, especially in the evening, and that eating too late or eating close to bedtime could cause a full feeling in the chest and trigger heartburn, making it difficult to fall asleep.
Exercise and blue light can disrupt sleep
“Exercising too close to sleep time or even exposure to blue light from computer games and TV can disturb sleep if these devices are used too close to bedtime.”
Stress was another most common issue, he continued. “We need a period of relaxation in the evening to wind down before sleep.”
Medical disorders such as insomnia, sleep apnea, and restless legs syndrome can also easily disrupt sleep, and are all common, needing to be treated by a physician.
Oversleeping linked to poorer health outcomes
Kilkenny said sleeping more than nine hours a night is called hypersomnia and is associated with many medical conditions.
These include increased inflammation in the body, decreased immune function, and increased risk of chronic diseases such as obesity, depression, coronary heart disease, diabetes, and stroke. “Combined, this leads to a 20% to 30% higher mortality risk than someone who sleeps the usual seven hours a night,” he said.
Study details
Association of sleep behaviour and pattern with the risk of glaucoma: a prospective cohort study in the UK Biobank
Cun Sun, Huazhen Yang, Yihan Hu, Yuanyuan Qu, Yao Hu, Yajing Sun, Zhiye Ying, Huan Song
Published in BMJ Volume 12 Issue 11
Abstract
Objectives
Given the role of intraocular pressure in glaucoma, the patient’s sleeping pattern might contribute to the development and progression of glaucoma. We performed a study to understand the association between sleep behaviours and glaucoma.
Design
Our study was a prospective cohort study.
Setting
This was a prospective cohort study in the UK Biobank. Self-reported data on five sleep behaviours were collected using a questionnaire at baseline. We identified four sleep patterns based on a cluster analysis of the sleep behaviours.
Participants
In the UK Biobank, 409 053 participants were recruited between 2006 and 2010 and followed for a diagnosis of glaucoma. We identified glaucoma as any hospital admission with a diagnosis of glaucoma, based on UK Biobank inpatient hospital data. Individuals who withdrew from the UK Biobank, or were diagnosed with glaucoma before recruitment, or had self-reported surgery or laser treatment for glaucoma, or had no information on sleep behaviours were excluded.
Primary and secondary outcome measures
We estimated hazard ratios (HRs) with 95% confidence intervals (CI) using Cox proportional hazards models to estimate the associations of different sleep behaviours, as well as identified sleep patterns, with the risk of glaucoma, adjusting for multiple confounders.
Results
Compared with individuals who had a healthy sleep pattern, an excess risk of any glaucoma was observed among individuals with snoring and daytime sleepiness (HR 1.11, 95% CI 1.03 to 1.19) or insomnia and short/long sleep duration (HR 1.13, 95% CI 1.06 to 1.20), but not late chronotype sleep pattern (HR 0.98, 95% CI 0.93 to 1.03).
Conclusion
Snoring, daytime sleepiness, insomnia, and short/long duration, individually or jointly, were all associated with the risk of glaucoma. These findings underscore the need for sleep intervention for individuals at high risk of glaucoma as well as potential ophthalmologic screening among individuals with chronic sleep problems for glaucoma prevention.
Healthline article – Glaucoma: Poor Sleep, Insomnia and Snoring May Increase Risk (Open access)
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