Abstract
OBJECTIVE: The visual system plays a crucial role in regulating sleep by providing cues that synchronize the circadian rhythm. Consequently, ophthalmic diseases-particularly diabetic retinopathy (DMR), age-related macular degeneration (AMD), epiretinal membrane (EM), and glaucoma-may influence sleep duration through circadian disruption and disease-related psychological stress. However, large-scale studies examining the relationship between these conditions and sleep duration remain limited. This study investigated these associations in a nationwide, population-based sample. METHODS: This cross-sectional study analyzed data from the 2019 and 2020 the Korea National Health and Nutrition Examination Survey. Ophthalmic diseases were diagnosed through fundoscopy, and sleep duration on weekdays and weekends was self-reported. The study included 8,395 participants aged 40 years or older who underwent fundoscopy. Statistical models were adjusted for demographic and clinical covariates, including age, sex, body mass index, and comorbidities. RESULTS: Patients with DMR and EM had significantly reduced sleep duration, with reductions of 0.3 hours to 0.5 hours on weekdays and weekends compared to individuals without these conditions. No significant differences in sleep duration were observed for AMD or glaucoma. After covariate adjustment, the associations between shorter sleep duration and DMR or EM remained significant. CONCLUSION: This nationwide population-based study using fundus photography revealed that DMR and EM are significantly associated with reduced sleep duration, while AMD and glaucoma are not. These findings suggest a differential sleep impact by disease type and support the need for targeted evaluation and management of sleep in patients with ophthalmic diseases. Further research is warranted to clarify underlying mechanisms and guide public health strategies.