Poor quality sleep may be linked to increased risk of irreversible vision loss

Summary: Those who suffer from poor sleep quality, including daytime sleepiness, snoring, or sleeping too much or too little, are at increased risk of developing glaucoma.

Source: BMJ

Poor quality sleep, including too many or too few eyes closed, daytime sleepiness and snoring, may be linked to an increased risk of developing irreversible vision loss (glaucoma), a large UK Biobank study suggests published in the open access journal BMJ open.

The findings underscore the need for sleep therapy in people at high risk for the disease as well as eye checks in people with chronic sleep disorders to check for early signs of glaucoma, the researchers conclude.

Glaucoma is one of the leading causes of blindness and will likely affect around 112 million people worldwide by 2040.

Characterized by progressive loss of light-sensitive cells in the eye and damage to the optic nerve, its causes and contributing factors are still poorly understood. But if left untreated, glaucoma can progress to irreversible blindness.

While population screening may not be cost-effective, targeted screening of high-risk groups might be, the researchers suggest. And previously published research suggests sleep disturbances may be a significant risk factor.

To dig deeper into these questions, researchers set out to determine the risk of glaucoma in people with different sleep behaviors: insomnia; too much or too little sleep; nocturnal or morning chronotypes (“owls” or “larks”); Daytime sleepiness; and snoring.

They relied on 409,053 UK Biobank participants, all aged 40-69 in 2006-10 when recruited, who had provided details of their sleep behaviors.

Sleep duration was defined as normal (7 to less than 9 hours/day) and too much or too little outside this range. The chronotype was defined according to whether the person described himself more as a morning lark or a night owl.

Severity of insomnia—difficulty falling asleep at night or frequent awakenings—was categorized as never/sometimes or usually, while subjective daytime sleepiness was categorized as never/rarely, sometimes or frequent.

General information on potentially influencing factors was extracted from questionnaires completed at the time of recruitment: age (mean 57 years), sex, race/ethnicity, level of education, lifestyle, weight (BMI) and level of deprivation of the residential area.

Medical records and death registration data were used to track the health and survival of all participants until first diagnosis of glaucoma (hospital admission), death, emigration or end of period. Supervisory Board (March 31, 2021), whichever comes first.

During an average follow-up period of just over 10.5 years, 8690 cases of glaucoma were identified.

People with glaucoma tended to be older and more likely to be male, smoke and have high blood pressure or diabetes than those who had not been diagnosed with the disease.

With the exception of chronotype, the other four sleep patterns/behaviors were all associated with varying degrees of increased risk for glaucoma.

Short or long sleep duration was associated with an 8% increased risk; insomnia 12%; snoring 4%; and frequent daytime sleepiness (20%).

And compared to those with a healthy sleep pattern, snorers and those who suffered from daytime sleepiness were 10% more likely to have glaucoma, while insomniacs and those with a short/long sleep pattern were 13%. % more likely to have.

The results were similar when categorized by different types of glaucoma.

This is an observational study, and as such cannot establish cause. The study relied on self-report rather than objective measurement and reflected only a single moment in time, the researchers acknowledge. Glaucoma itself could influence sleep patterns, rather than the other way around, they add.

It shows a woman sitting on a bed
Glaucoma is a leading cause of blindness and will likely affect around 112 million people worldwide by 2040. Image is in the public domain

But there are potentially plausible biological explanations for the associations found between sleep disturbance and glaucoma, the researchers say.

Internal pressure in the eye, a key factor in the development of glaucoma, increases when a person lies down and when sleep hormones go haywire, as occurs in insomnia, the researchers explain.

Depression and anxiety, which often go hand in hand with insomnia, can also increase internal eye pressure, possibly due to dysregulated cortisol production, they suggest.

Likewise, repeated or prolonged episodes of low cellular oxygen levels, caused by sleep apnea (sudden cessation of breathing during sleep), could directly damage the optic nerve, it has been suggested.

“Because sleep behaviors are modifiable, these results underscore the need for sleep intervention for those at high risk of glaucoma and for potential eye screening in people with chronic sleep problems to help prevent glaucoma. glaucoma,” the researchers conclude.

About this sleep and visual neuroscience research news

Author: BMJ Media Relations
Source: BMJ
Contact: BMJ Media Relations – BMJ
Image: Image is in public domain

Original research: Free access.
“Association of behavior and sleep pattern with glaucoma risk: a prospective cohort study in the UK Biobank” by Cun Sun et al. BMJ open


Association of sleep behavior and pattern with glaucoma risk: a prospective cohort study in the UK Biobank

See also

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Given the role of intraocular pressure in glaucoma, the patient’s sleep pattern could contribute to the development and progression of glaucoma. We conducted a study to understand the association between sleep behaviors and glaucoma.


Our study was a prospective cohort study.


This was a prospective cohort study from the UK Biobank. Self-reported data on five sleep behaviors were collected using a questionnaire at baseline. We identified four sleep patterns based on a cluster analysis of sleep behaviors.


In the UK Biobank, 409,053 participants were recruited between 2006 and 2010 and followed up for a diagnosis of glaucoma. We identified glaucoma as any hospital admission with a diagnosis of glaucoma, based on UK Biobank hospital data. People who withdrew from the UK Biobank, or who were diagnosed with glaucoma before recruitment, or who had surgery or laser treatment for glaucoma, or who had no information about the behaviors of sleep were excluded.

Primary and secondary outcome measures

We estimated hazard ratios (HR) with 95% confidence intervals (CI) using Cox proportional hazards models to estimate associations of different sleep behaviors, as well as identified sleep patterns, with glaucoma risk, adjusting for multiple confounders.


Compared to people who had a healthy sleep pattern, an excess risk of any glaucoma was observed in people 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 the late chronotype sleep pattern (HR 0.98, 95% CI 0, 93 to 1.03).


Snoring, daytime sleepiness, insomnia, and short/long duration, individually or in combination, were all associated with glaucoma risk. These findings underscore the need for sleep intervention for those at high risk for glaucoma as well as potential ophthalmological screening in people with chronic sleep problems for the prevention of glaucoma.

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