In recent years we have more and more scientific evidence that sleep disturbances may be a risk factor and may aggravate various eye diseases.
That is why it is important to know which ophthalmological diseases are related to sleep disorders.
Among the most important in terms of their impact and the number of patients who suffer them we find the disease of Dry Eye, glaucoma, ischemic optic neuropathy previous, Diabetic retinopathy, loose eyelid syndrome, central serous retinopathy and retinal vein occlusion.
Dry eye and sleep
What is dry eye?
El Dry Eye It is a disorder of the ocular surface in which ocular lubrication is compromised, that is, a decrease in the quality or quantity of tears on the ocular surface. It affects millions of people around the world and has a variable severity.
It produces from discomfort to disabling pain that affects the quality of life by limiting activities such as driving or reading. It also influences labor productivity making it more difficult to use computers or read for extended periods (1)
What is the relationship between dry eye and sleeping sickness?
The results of several research papers suggest a reciprocal relationship between dry eye disease and sleep disorders.
Different studies measured the quality of sleep in patients with dry eye disease and observed a high number of patients with sleep problems. For example, in a study with 180 dry eye patients, 42% of patients had sleep problems. This percentage was higher than in other diseases such as glaucoma or Cataracts. In addition to this, they also found that depression and anxiety was greater in patients with dry eye indicating a possible relationship between sleep and mood disorders (2).
On the other hand, other studies observed that in a population with an average age of 63 years, the severity of dry eye symptoms correlated with the severity of insomnia symptoms. In other words, there was a direct relationship between dry eye severity and insomnia severity, indicating a relationship between both problems (3).
At present, the hypothesis of a reciprocal relationship in which the dry eye, when producing ocular pain, makes sleep difficult and this in turn would produce a worse tear film and worsen the dry eye.
Figure 1: Sleep and dry eye relationship hypothesis (2)
Eyelid drooping and sleepy
What is the loose eyelid?
It is a condition in which the upper eyelid easily everts when pulled upwards, which leads to discomfort and visual symptoms related to ocular exposure (4).
How is it related to sleeping sickness?
It has been described that sleep apneas can damage connective tissue (tissue that gives elasticity throughout the body). This tissue is key in the tissue structure of the eyelid and the fact that it is damaged would produce loose eyelid. On the other hand, it is believed that when sleeping on the side the eyelid is compressed on that side and if we add to this that the patient may have apnea when sleeping, all together decreases the amount of oxygen that reaches that eyelid impacting more potently on the elasticity of the eyelid (5).
The studies carried out demonstrate this bidirectional relationship, and thus, 96% of patients with lax eyelid syndrome have symptoms of sleep apnea syndrome (6) and vice versa, that is, 25.8% of patients with sleep apnea syndrome have loose eyelid syndrome, this percentage rises to 40% in patients with severe apnea (7)
What treatment is available?
The use of a CPAP device (continuous airway pressure used to treat sleep apnea) may improve symptoms of lax eyelid syndrome. Studies report successes in the use of CPAP to solve the symptoms of a loose eyelid. This fact is also supported by the observation that by not treating sleep apnea, relapse in the loose eyelid is more likely after a surgical intervention (6).
Non-arteritic anterior ischemic neuropathy and sleep disorder
What is non-arteritic anterior ischemic neuropathy?
It is a sudden, irreversible, painless loss of vision and often only one eye due to optic nerve head infarction. It is the second most frequent cause of injury to the optic nerve after glaucoma.
How is it related to sleeping sickness?
Apnea during sleep produces disturbances in blood flow. This occurs especially in highly vascular tissues such as the eyes, which could lead to infarction of the optic nerve head during sleep.
Studies done to date find that between 55-89% of people with optic neuropathy ischemic (not arteritic) have sleep apnea syndrome (8)
What consequences can sleep apneas have in this eye disease?
The fact of suffering from and not treating sleep apnea can lead to a higher risk of suffering from this eye disease and of having it in both eyes.
One study found that people who already have one eye affected by the disease and suffer from severe sleep apnea syndrome, if left untreated, would have a 5.5 times higher risk of suffering from the eye disease in the healthy eye (9).
What treatment is available?
The treatment of sleep apnea-hypopnea syndrome using the CPAP device can reduce the risk of suffering from this eye disease or of suffering it in both eyes.
Glaucoma and sleep problems
What is glaucoma?
El glaucoma It is a chronic and progressive disease that affects the optic nerve causing deficits in the campor visual. It is the second leading cause of blindness in the world. This disease has variants that are open angle glaucoma, closed angle y normotensive.
What is your relationship with sleeping sicknesses?
The Open angle and normotensive glaucoma have been linked to sleep apnea syndrome. It has been described that alterations in blood flow in the eyes during sleep apnea make these susceptible to glaucoma even under normal intraocular pressures. In this sense, different studies find an increased probability of having sleep apnea in patients with glaucoma (between 1,1 to 2.5 times more risk)
Sleep apnea and glaucoma
It has been determined that the progression of glaucoma is faster in those patients with hardly sleep syndrome (10)
What treatment is available?
The treatment of sleep apnea-hypopnea syndrome using the CPAP device may decrease the risk of suffering from this eye disease and may slow its evolution.
Treatment of eye diseases and sleep problems
You could suffer a sleep disturbance that is impacting your ophthalmic health. To find out if your dream is correct, ask yourself these questions:
- Are you having trouble falling asleep, staying asleep, or waking up earlier than you would like?
- Do you experience excessive sleep during the day? You are sleepy or fall asleep in inappropriate situations or sleep more during the day than in the past.
- Have you been told that you snore or hold your breath while sleeping?
If one or more of your answers is YES, we advise you to visit a sleep medicine specialist so you can evaluate your case and it is also advisable to consult with your ophthalmologist.
En Área Oftalmológica Avanzada We specialize in eye diseases and sleep disorders. If you suffer from an ophthalmic pathology and have sleep problems, do not hesitate to contact us, we are happy to assist you!
REFERENCES
- Clayton JA. Dry eye. new engl J Med Rev. 2018; 378: 2212 – 23.
- Ayaki M, Tsubota K, Kawashima M, Kishimoto T, Mimura M, Negishi K. Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye. Investig Ophtalmol Vis Sci. 2018; 59 (14): 17 – 23467.
- Mcclellan AL, Felix ER, Levitt RC. insomnia in US veterans. Eye Contact Lens 2019; 44 (Suppl 1): 1 – 19.
- Santos M, Hofmann RJ. Ocular Manifestations of Obstructive Sleep Apnea. J Clin Sleep Med. 2017; 13 (11): 11 – 4.
- Miyamoto C, Espirito Santo LC, Roisman L, Moreno Pde A, Cariello AJ, Osaki MH. Floppy eyelid syndrome: review. Arq Bras Oftalmol. 2011; 74 (1): 64 – 66.
- McNab AA. The eye and sleep apnea. Sleep Med Rev. 2007; 11 (4): 269 – 276.
- Chambe J, Laib S, Hubbard J, et al. Floppy eyelid syndrome is associated with obstructive sleep apnoea: a prospective study on 127 patients. J Sleep Res. 2012; 21 (3): 308 – 315.
- BilginG, KobanY, ArnoldAC.Nonarteriticanteriorischemicopticneuropathyan obstructive sleep apnea. J Neuro-Ophthalmol Off J NorthAmNeuro-Ophthalmol Soc 2013; 33: 232-4.
- Aptel F, Khayi H, P_epin JL, Tamisier R, Levy P, Romanet JP, et al. Association of nonarteritic ischemic optic neuropathy with obstructive sleep apnea syndrome: consequences for obstructive sleep apnea screening and treatment. JAMA Ophthalmol 2015; 133: 797-804.
- Yuan-Yao Fan, et al. Correlation between structural progression in glaucoma and obstructive sleep apnea. The Royal College of Ophthalmologists 2019.
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