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Association Between Sleep Quality, Mood Status, and Ocular Surface Characteristics in Patients With Dry Eye Disease

Wu, Mengliang MD*,†; Liu, Xin MD; Han, Jing MD*,†; Shao, Tingting MD, PhD*,†; Wang, Yan MD, PhD*,†

doi: 10.1097/ICO.0000000000001854
Clinical Science

Purpose: To evaluate sleep and mood status in patients with dry eye disease (DED) and analyze the association between sleep quality, mood status, and ocular surface characteristics.

Methods: Consecutive patients with DED (N = 106) and age- and sex-matched healthy controls (N = 50) were enrolled. Tear fluid break up time (TBUT), corneal fluorescein staining, and Schirmer I tests were performed in the order listed here to evaluate dry eye. A visual analog scale was used to assess dry eye symptom severity. All subjects also completed the Pittsburgh Sleep Quality Index (PSQI, scores ≥5.5 indicated poor sleep), Patient Health Questionnaire (scores ≥5 indicated depression), and General Anxiety Disorder Scale (scores ≥5 indicated anxiety).

Results: Mean Pittsburgh Sleep Quality Index global score was significantly higher in patients with DED than that in controls (7.8 ± 3.9 vs. 5.4 ± 3.0, respectively; P < 0.001). Patients with DED demonstrated higher respective depression and anxiety scores compared with controls (P < 0.001 and 0.013, respectively). In the DED group, patients with poor sleep quality had more severe DED indicated by shorter TBUT and lower Schirmer I findings. A significant correlation was found between sleep quality and mood status in patients with DED. Regression analysis revealed that shorter TBUT and lower Schirmer I test results were associated with poorer sleep quality (adjusted p = 0.011 and 0.037, respectively). More severe symptoms of dry eye were significantly associated with a higher level of anxiety in patients with DED (adjusted p = 0.011).

Conclusions: Sleep quality may play an important role in the development of DED by influencing tear secretion and tear film stability and/or by indirectly aggravating anxiety and depression, leading to higher self-reported symptom scores. It is also possible that DED contributes to reduced sleep quality, as well as the development of anxiety and depression.

*Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China;

Key Laboratory of Myopia, Ministry of Health, Shanghai, China; and

Department of Ophthalmology, Dachang Hospital of Baoshan District, Shanghai, China.

Correspondence: Yan Wang, MD, PhD, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Rd, Xuhui District, Shanghai 200031, China (e-mail:

The National Natural Science Foundation of China provided financial support in the form of National Science Foundation for Young Scientists of China (No. 81100636).

The authors have no conflicts of interest to disclose.

M. Wu and X. Liu contributed equally to this work.

Received June 17, 2018

Accepted November 23, 2018

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