Ayaki Masahiko, Toda Ikuko, Tachi Naoko, Negishi Kazuno, Tsubota Kazuo
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Department of Ophthalmology, Mimamiaoyama Eye Clinic, Tokyo, Japan.
Neuropsychiatr Dis Treat. 2016 Feb 16;12:329-37. doi: 10.2147/NDT.S94648. eCollection 2016.
Dry eye disease (DED) is potentially associated with sleep and mood disorders. This study evaluated sleep quality in patients with DED using a questionnaire-based survey before and after topical eyedrop treatment. The effectiveness of sleep and ophthalmic services in assisting with sleep problems in patients with eye disease was also assessed.
Seventy-one consecutive patients with DED visiting eight general eye clinics in various locations answered a questionnaire containing the Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. Photophobia and chronotype (morningness/eveningness) were also evaluated with two representative questions from established questionnaires (National Eye Institute Visual Function Questionnaire-25 and Morningness/Eveningness questionnaire). Follow-up evaluation was conducted by interview or mail 3-10 months after the initial evaluation. A sleep service was established in two eye clinics to identify possible ocular diseases related to sleep and mood disorders; it comprised a questionnaire, sleep diary, actigram, medical interviews, visual field testing, retinal ganglion cell layer thickness measurement, and DED examination.
Patients with newly diagnosed DED exhibited a greater improvement in sleep after DED treatment compared with patients with established DED. Improvement in Pittsburgh Sleep Quality Index was significant (P<0.05) and strongly correlated with improvement in Hospital Anxiety and Depression Scale (P<0.05) for new patients, but not for patients with established DED. Ten eye clinic patients visited the sleep service and nine of them had DED. They were successfully treated with eyedrops and sleep services, which included blue-light-shield eyewear and wearable blue-light therapy lamps according to their problem.
Sleep quality improved in patients with DED after topical treatment with or without the sleep service. Psychiatric treatment focusing on sleep disorders could be beneficial for patients with DED.
干眼症（DED）可能与睡眠和情绪障碍有关。本研究通过基于问卷的调查评估了局部滴眼液治疗前后干眼症患者的睡眠质量。还评估了睡眠和眼科服务对协助眼病患者解决睡眠问题的有效性。
连续71例在不同地点的8家普通眼科诊所就诊的干眼症患者回答了一份包含匹兹堡睡眠质量指数和医院焦虑抑郁量表的问卷。还通过既定问卷（国家眼科研究所视觉功能问卷-25和晨型/夜型问卷）中的两个代表性问题评估了畏光和昼夜节律类型（晨型/夜型）。在初次评估后3-10个月通过访谈或邮件进行随访评估。在两家眼科诊所设立了睡眠服务，以识别与睡眠和情绪障碍相关的可能眼病；它包括一份问卷、睡眠日记、活动记录、医学访谈、视野测试、视网膜神经节细胞层厚度测量和干眼症检查。
与已确诊的干眼症患者相比，新诊断的干眼症患者在干眼症治疗后睡眠改善更大。匹兹堡睡眠质量指数的改善具有显著性（P<0.05），并且与新患者的医院焦虑抑郁量表的改善密切相关（P<0.05），但已确诊的干眼症患者则不然。10名眼科诊所患者就诊了睡眠服务，其中9名患有干眼症。他们通过滴眼液和睡眠服务成功得到治疗，睡眠服务根据他们的问题包括蓝光防护眼镜和可穿戴蓝光治疗灯。
无论是否有睡眠服务，局部治疗后干眼症患者的睡眠质量均有改善。针对睡眠障碍的心理治疗可能对干眼症患者有益。
