Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan.
National Yang-Ming University School of Medicine, Taipei, Taiwan.
Acta Ophthalmol. 2020 Mar;98(2):e238-e244. doi: 10.1111/aos.14238. Epub 2019 Sep 8.
The decreased level of melatonin, the substance involved in the control of the sleep-wake cycle, has been reported among the patients with age-related macular degeneration (AMD). However, knowledge about the relationship between sleep disturbance and AMD is still limited. This longitudinal case-control study aims to investigate the risk of incident AMD among the patients with clinically diagnosed insomnia using the Taiwan National Health Insurance Research Database.
The insomnia cohort (n = 15 465) consisted of newly diagnosed insomnia cases aged ≥55 years between 2000 and 2009. Subjects without insomnia, matched for age, gender and enrolment time, were randomly sampled as the control cohort (n = 92 790). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of incident AMD for the two cohorts after adjusting for potential confounders.
Of the 108 255 sampled subjects, 2094 (1.9%) were diagnosed with AMD, including 214 (0.2%) with neovascular AMD, during a mean follow-up period of 5.1 ± 2.8 years. Insomnia patients were more likely to have subsequent AMD than those without insomnia (2.5% versus 1.8%, p < 0.001). Further, the incidence of exudative AMD was also higher in the insomnia cohort than the control cohort (0.3% versus 0.2%, p = 0.002). The adjusted HR was 1.33 (95% confidence interval [CI], 1.18-1.48, p < 0.001) for AMD and 1.67 (95% CI, 1.20-2.33, p = 0.002) for exudative AMD.
Clinically diagnosed insomnia is an independent indicator for the increased risk of subsequent AMD development.
有研究报道，褪黑素水平降低与年龄相关性黄斑变性（AMD）有关，褪黑素是控制睡眠-觉醒周期的物质。然而，关于睡眠障碍与 AMD 之间关系的知识仍然有限。本纵向病例对照研究旨在利用台湾全民健康保险研究数据库，调查经临床诊断患有失眠症的患者罹患 AMD 的风险。
失眠症队列（n=15465）由 2000 年至 2009 年间年龄≥55 岁的新诊断为失眠症的患者组成。没有失眠症、年龄、性别和入组时间相匹配的患者被随机抽取为对照组（n=92790）。采用 Cox 比例风险回归计算两组在调整潜在混杂因素后的 AMD 发病风险比（HR）。
在 108255 名抽样患者中，2094 名（1.9%）被诊断为 AMD，包括 214 名（0.2%）患有新生血管性 AMD，平均随访 5.1±2.8 年。与无失眠症者相比，失眠症患者更易罹患 AMD（2.5% vs. 1.8%，p<0.001）。此外，失眠症队列的渗出性 AMD 发病率也高于对照组（0.3% vs. 0.2%，p=0.002）。调整后的 HR 为 AMD 1.33（95%置信区间[CI]：1.18-1.48，p<0.001）和渗出性 AMD 1.67（95%CI：1.20-2.33，p=0.002）。
经临床诊断的失眠症是 AMD 发病风险增加的独立指标。
