Subgroup analyses revealed that the prevalence and severity of depression are greatest in pSS (described below). They reported that DED was associated with an increased prevalence of depression (OR, 2.92) and anxiety (OR, 2.80). 71 conducted a systematic review and meta-analysis of 22 studies that reported the prevalence, incidence, and/or severity grading of depression and/or anxiety in patients with DED. 3 reviewed the literature and reported that the highest prevalence of depression among ophthalmic patients was in those with DED (29%), followed by glaucoma (25%), age-related macular degeneration (24%), and cataract (23%), evaluated with the Beck Depression Inventory, Center for Epidemiologic Studies Depression Scale, and HADS. 2, 3, 71 – 86 This is an important point, since depression is closely associated with sleep disorders. Using the PSQI global score, the severity of sleep disorders between men and women with DED is similar however, the HADS score for men is not different between the DED and non-DED groups, suggesting depression and anxiety may have a stronger impact on the sleep of women with DED than on men with DED.ĭepression as a comorbidity of DED has been described extensively, including in three systematic reviews and meta-analyses.
In addition, men with DED exhibited a poorer daytime dysfunction score and shorter sleep duration than men without DED. The men with DED showed significantly poorer results for the PSQI global score and subjective sleep score than men without DED. Using the same cohort as above, the PSQI and HADS scores were calculated for 114 men without and 38 with DED, aged 30 to 69 years (unpublished data). 48 The HADS score also is worse for women with (11.36 ± 6.27) than without (9.93 ± 5.40) DED.
Sleep disorders in women with DED aged 30 to 69 years are characterized by a poor PSQI global score (4.92 ± 2.71 for non-DED vs. Ophthalmologists caring for women who are taking or considering HRT should be aware of this potential adverse effect. 34 – 36 One study 37 suggested that HRT may be effective for DED however, this finding is controversial since other strictly controlled studies 38 – 40 have suggested that women who use HRT, particularly estrogen alone, are at increased risk of DED. 33 Hormone replacement therapy (HRT) with estrogen is known to be effective for menopausal symptoms, including sleep. 31 Sleep latency and anxiety are correlated with depression 32 and sleep medicine is effective. 29 Vasomotor symptoms, major symptom during menopause, may lead to a sleep disorder, 30 but sleep disorders in menopausal women are associated more closely with depression than vasomotor symptoms. 28 Circadian rhythm disorders complicated with sleep disorders increase the risk of breast cancer by as much as 1.5-fold. Topical medication and lid heating also may be advantageous for sleep quality in DED.ĭED develops predominantly in menopausal women and they are at risk for a variety of health problems, including sleep and mood disorders, 27 and sleep apnea syndrome. Reciprocal effects may be expected and consultation-liaison psychiatry is recommended for the management of sleep disorders in DED. Possible explanations for sleep disorders in DED may be depression, pain, and eye exposure at night. Primary Sjögren's syndrome includes arthritis and other rheumatic disease causing pain and fatigue however, how sicca contributes to sleep disorders is not known. Sleep disorders are documented in primary Sjögren's syndrome and an association with sleep apnea and depression is suggested. The severity of mood disorders, including anxiety and depression, is correlated strongly with sleep disorders in DED, and the symptoms and signs of DED, especially pain, also are correlated with sleep quality. Two studies reported that approximately half of patients with DED suffer from poor sleep. We reviewed the literature for studies investigating sleep and health, eyes and sleep, and DED and sleep, in terms of systemic and eye health, especially in women.
Moreover, sleep quality in DED is worse than in other eye diseases, including glaucoma, retinal diseases, cataract, and allergic and chronic conjunctivitis.
DED and sleep disorders are more prevalent in women than men. Sleep disorders are a prominent, but overlooked problem in patients with dry eye disease (DED), characterized by a poor sleep index, short sleep duration, long sleep latency, and poor subjective sleep. Sleep is an essential life habit and closely associated with lifespan, diabetes, hypertension, and mental health.
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