Abstract
PURPOSE: To investigate the association between sleep disturbances, dry eye disease (DED) severity, and DED risk factors. METHODS: We conducted a secondary analysis of the Dry Eye Assessment and Management (DREAM) study, a randomized trial of 535 patients with moderate-to-severe DED. Participants self-reported sleep disturbances at baseline. DED symptoms were assessed using the Ocular Surface Disease Index (OSDI) and Brief Ocular Discomfort Index (BODI). DED signs were assessed using tear film break-up time, Schirmer test, corneal and conjunctival staining, tear osmolarity, and meibomian gland dysfunction assessment. Immune cells were assessed using conjunctival impression cytology. Outcomes were compared between participants with ongoing and no history of sleep disturbances, adjusting for confounders. RESULTS: Mean age was 58 years, with 81% female participants. Ongoing sleep disturbances (n=113) were significantly associated with older age (mean 60.5 vs. 57.4; p=0.03), smoking (39.8% vs. 28.7%; p=0.02), and DED treatment usage. Systemic conditions associated with sleep disturbances included thyroid dysfunction (26.5% vs.15.7% p=0.007), irritable bowel (18.6% vs. 5.4%; p<.0001), osteoarthritis (38.9% vs. 21.6%; p=0.0007), and depression (30.1% vs. 11.5%; p<.0001). Sleep disturbances were associated with lower conjunctival staining scores (2.46 vs. 2.77; p=0.03) and higher concentrations of dendritic cells in ocular surface white blood cells (12.0% vs. 8.1%; p=0.01). CONCLUSIONS: Sleep disturbances were associated with older age, smoking history, systemic diseases, and higher dendritic cell concentration among patients with moderate-to-severe DED. These findings support further investigation of sleep disturbances as a comorbidity of patients with DED. Additional research is needed to understand the mechanisms behind this relationship.