Sleep Pattern and Structural Damage in Older Adults with Glaucoma: A United States and China Study.

PURPOSE: To investigate sleep patterns in older adults with glaucoma and evaluate their associations with glaucomatous damage and emotional disturbances.

DESIGN

A cross-sectional observational study.

PARTICIPANTS

Adults aged ≥60 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 in the United States (n = 3317) and the Elderly Glaucoma and Sleep Study (EGSS) in China (n = 200).

METHODS

Participants in NHANES and EGSS completed standardized sleep questionnaires and underwent ophthalmic examinations, while wearable derived-sleep measures and urinary melatonin metabolite assays were additionally performed in the EGSS cohort. In EGSS, multivariable linear regression models were used to examine associations of the Pittsburgh Sleep Quality Index (PSQI) global score with demographic, clinical, and ocular factors.

MAIN OUTCOME MEASURES: Overall sleep disorder in NHANES and PSQI global score in EGSS.

RESULTS

In NHANES, older adults with glaucoma reported more frequent sleep disturbances than controls, showing higher odds of sleep disorders and difficulty initiating sleep, as well as longer sleep latency (all P < 0.05). In EGSS, patients with primary open-angle glaucoma (POAG) showed poorer sleep quality, higher device-estimated light sleep time, and a lower 6-sulfatoxymelatonin/creatinine ratio than controls (all P < 0.05), while no significant differences were found for primary angle-closure glaucoma. In multivariable analyses, higher 9-item Patient Health Questionnaire scores and thinner peripapillary retinal nerve fiber layer thickness were independently associated with higher PSQI scores in POAG (all P < 0.05).

CONCLUSIONS

Older adults with glaucoma had poorer sleep quality. Participants with POAG showed poorer subjective sleep quality, a longer wearable-derived light sleep duration, and lower urinary melatonin metabolite levels. In POAG, poorer sleep quality was significantly associated with more severe glaucomatous structural damage and a greater depressive symptom burden.

FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.