Alexander Iona, Cuthbertson Fiona M, Ratnarajan Gokulan, Safa Rukhsana, Mellington Faye E, Foster Russell G, Downes Susan M, Wulff Katharina
Nuffield Laboratory of Ophthalmology, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
Royal United Hospital Bath NHS Trust, Combe Park, Bath, United Kingdom.
Invest Ophthalmol Vis Sci. 2014 Jun 26;55(8):4999-5004. doi: 10.1167/iovs.14-14054.
Although visual impairment is a well-recognized consequence of cataract development, little is known about the ability of the melanopsin-based photosensitive retinal ganglion cells (pRGCs) to regulate sleep-wake timing in the presence of cataract. In this study, we replaced a cataractous natural crystalline lens with two different types of artificial intraocular lenses, a UV-blocking lens or a blue-filtering lens. We investigated the level of sleep disturbance before cataract surgery and any change in sleep due to improved light transmission following surgery and compared this in both types of intraocular lens.
Quality of sleep in 961 patients undergoing cataract surgery was assessed by administering the validated self-reported Pittsburgh Sleep Quality Index (PSQI) questionnaire. The PSQI distinguishes good sleepers from poor sleepers by scoring seven different sleep components over the last month, which are combined to produce an overall score for sleep quality. Patients received either an ultraviolet-blocking (UVB) clear intraocular lens (IOL) or a blue-filtering (BF) IOL. Questionnaires were completed four times: 1 month preoperatively and again 1, 6 (UVB-IOL only), and 12 months postoperatively.
Half of the patients reported poor sleep in the presence of cataract in both the UVB-IOL (mean PSQI = 6.35; SD = 3.82) and BF-IOL (mean PSQI = 6.39; SD = 4.04) groups. Cataract removal improved overall sleep quality significantly 1 month postoperatively in the UVB-IOL (mean PSQI = 5.89; SD = 3.71) and BF-IOL (mean PSQI = 6.08; SD = 3.88) groups. Sleep latency also improved for the UVB-IOL (preoperative mean = 1.16; SD = 1.003) and BF-IOL (preoperative mean = 1.17; SD = 1.03) groups at 1 month (UVB-IOL group mean = 1.01; SD = 0.923 and BF-IOL group mean = 1.00; SD = 0.95), which was sustained at 6 months for the UVB-IOL group (mean = 1.02; SD = 0.93) and 12 months for both the UVB-IOL and BF-IOL groups (6 months: UVB-IOL group mean = 0.96; SD = 0.92 and for the BF-IOL group mean = 0.99; SD = 0.96).
Overall sleep quality and sleep latency improves after removal of cataract irrespective of the type of IOL implanted. These data show that implantation of BF-IOL does not have a negative impact on the sleep-wake cycle.
虽然视力损害是白内障发展的一个公认后果，但对于基于黑视蛋白的光敏感视网膜神经节细胞（pRGCs）在白内障存在的情况下调节睡眠-觉醒时间的能力知之甚少。在本研究中，我们用两种不同类型的人工晶状体，即紫外线阻断晶状体或蓝光滤过晶状体，替换了白内障患者的天然晶状体。我们调查了白内障手术前的睡眠障碍水平以及手术后由于光透射改善导致的睡眠变化，并在两种类型的人工晶状体中进行了比较。
通过发放经过验证的自我报告的匹兹堡睡眠质量指数（PSQI）问卷，评估961例接受白内障手术患者的睡眠质量。PSQI通过对过去一个月七个不同的睡眠成分进行评分，将睡眠良好者与睡眠不佳者区分开来，这些成分综合起来产生一个睡眠质量的总体评分。患者接受紫外线阻断（UVB）透明人工晶状体（IOL）或蓝光滤过（BF）IOL。问卷共完成四次：术前1个月以及术后1、6（仅UVB-IOL组）和12个月。
UVB-IOL组（平均PSQI = 6.35；标准差 = 3.82）和BF-IOL组（平均PSQI = 6.39；标准差 = 4.04）中，一半的患者在白内障存在时报告睡眠不佳。白内障摘除术后1个月，UVB-IOL组（平均PSQI = 5.89；标准差 = 3.71）和BF-IOL组（平均PSQI = 6.08；标准差 = 3.88）的总体睡眠质量显著改善。UVB-IOL组（术前平均 = 1.16；标准差 = 1.003）和BF-IOL组（术前平均 = 1.17；标准差 = 1.03）在1个月时的睡眠潜伏期也有所改善（UVB-IOL组平均 = 1.01；标准差 = 0.923，BF-IOL组平均 = 1.00；标准差 = 0.95），UVB-IOL组在6个月时保持改善（平均 = 1.02；标准差 = 0.93），UVB-IOL组和BF-IOL组在12个月时均保持改善（6个月：UVB-IOL组平均 = 0.96；标准差 = 0.92，BF-IOL组平均 = 0.99；标准差 = 0.96）。
无论植入何种类型的IOL，白内障摘除术后总体睡眠质量和睡眠潜伏期均有所改善。这些数据表明，植入BF-IOL对睡眠-觉醒周期没有负面影响。
