BMJ Open Ophthalmology · 5 authors, 4 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This cross-sectional study of 141 veterans found that dry eye symptoms and ocular pain were strongly associated with sleep disturbances, particularly waking at night, while objective signs of dry eye showed weaker correlations with sleep quality. The strongest association was between the Ocular Surface Disease Index (OSDI) and sleep disturbances (r=0.49, p<0.0005). These findings suggest that addressing sleep disturbances may be a holistic approach to managing dry eye symptoms.
**Background:** Dry eye (DE) disease is a multifactorial condition that significantly impacts quality of life. Prior research has linked DE to sleep disturbances, but the specific components of sleep most closely related to DE symptoms versus signs remain unclear. This study aimed to investigate relationships between DE metrics (symptoms and signs) and various aspects of sleep quality, using the Pittsburgh Sleep Quality Index (PSQI).
**Methods:** This cross-sectional study included 141 veterans (mean age 56±5 years, 87% male) from the Miami Veterans Affairs eye clinic, enrolled between November 2018 and July 2023. Exclusion criteria included use of any eye drops beyond artificial tears, eye conditions affecting DE testing, and medical conditions precluding independent questionnaire completion. DE symptoms were assessed using the 5-Item Dry Eye Questionnaire (DEQ-5), Ocular Surface Disease Index (OSDI), Numerical Rating Scale (NRS) for ocular pain, Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-E), and Convergence Insufficiency Symptoms Survey (CISS). DE signs included ocular surface inflammation (matrix metalloproteinase-9), meibum quality, tear break-up time, Schirmer test, corneal staining, and others. Sleep quality was measured using the PSQI, which yields a global score (0-21) and seven subscores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Statistical analyses included Pearson correlations and forward stepwise linear regression adjusting for demographics, smoking, medications, mental health (PHQ-9, PCL-M), fatigue (MFIS), and comorbidities.
**Key Results:** Most participants (76%) reported mild or greater DE symptoms (DEQ-5 ≥6). Individuals with DE symptoms had significantly higher mental health and fatigue scores. Ocular symptoms were more strongly related to sleep metrics than signs. The strongest association was between OSDI and sleep disturbances (PSQI subscore 5: r=0.49, p<0.0005). For DE signs, ocular surface inflammation and meibum quality were related to subjective sleep quality (PSQI subscore 1: r=0.29, p=0.03 for both). On linear regression, sleep disturbances remained significantly associated with most symptom metrics: NRS worst over 1 week (beta=0.52, p<0.0005), DEQ-5 (beta=0.36, p<0.0005), OSDI (beta=0.31, p<0.0005), and NRS average over 1 week (beta=0.33, p<0.0005). For signs, ocular surface inflammation (beta=0.26, p=0.01) and meibum quality (beta=0.46, p<0.0005) remained associated with subjective sleep quality.
**Clinical Implications:** This study demonstrates that dry eye symptoms and ocular pain are closely linked to sleep disturbances, particularly nighttime awakenings, while objective signs show weaker associations. The findings suggest that sleep disturbances may be a modifiable factor in managing dry eye symptoms. Clinicians should consider holistic approaches that address both ocular symptoms and sleep quality, potentially through interventions like exercise therapy or topical DE treatments, which have shown promise in improving sleep. However, due to the cross-sectional design, causality cannot be determined, and further research is needed to explore directionality and underlying mechanisms.