Tien Peng-Tai, Lai Chien-Yu, Lin Chun-Ju, Chen Wen-Lu, Lin Po-Kang, Muo Chih-Hsin, Tsai Yi-Yu, Wan Lei, Ho Wen-Chao, Lin Hui-Ju
Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.
J Ophthalmol. 2020 Feb 12;2020:1712503. doi: 10.1155/2020/1712503. eCollection 2020.
Patients with central serous chorioretinopathy (CSC) typically present with acute visual impairment and metamorphopsia. The disease previously has been associated with psychological stress. Population-based cohort studies on the risk of CSC among patients with nonorganic sleep disturbance (NOSD) are limited. An early sign of psychiatric disorder was probably sleep disturbance. Furthermore, psychological stress may be caused by sleep disturbance. We investigated the relationship between NOSD and the incidence of CSC.
Longitudinal cohort study. . We used the Longitudinal Health Insurance Database and collected the data of 53,743 NOSD patients without CSC between 2000 and 2005 as the study group. Four-fold controls were selected randomly from those without neither sleep disturbance nor a CSC history with frequency matching of age, sex, and index-year.
The difference in sex, age group, comorbidities, and steroid use between the two groups was analyzed by the test. Cox-proportional hazard regression was utilized to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for comparison of the two groups. Kaplan-Meier analysis was applied to measure the cumulative incidence of CSC. Furthermore, the log-rank test was used to test the incidence difference between the two groups. . The incidence rate of CSC in the following years until 2011 was detected.
During a mean follow-up of 7.36 ± 2.88 years, NOSD patients had a higher incidence of CSC than the controls (3.10 vs. 1.86 per 10,000 person-years; adjusted HR, 1.65; 95% CI, 1.34-2.02). Men had a higher risk of CSC than women. Sensitivity analyses stratified by sex, age group, or comorbidity condition showed consistently that NOSD patients had a higher risk of CSC than their controls. Dose-response showed that higher NOSD severity had even higher CSC risk.
NOSD is an independent indicator for the increased risk of subsequent CSC development.
中心性浆液性脉络膜视网膜病变（CSC）患者通常表现为急性视力损害和视物变形。该疾病此前一直与心理压力有关。关于非器质性睡眠障碍（NOSD）患者中CSC风险的基于人群的队列研究有限。精神障碍的一个早期迹象可能是睡眠障碍。此外，心理压力可能由睡眠障碍引起。我们调查了NOSD与CSC发病率之间的关系。
纵向队列研究。我们使用纵向健康保险数据库，收集了2000年至2005年间53743例无CSC的NOSD患者的数据作为研究组。从既无睡眠障碍也无CSC病史的人群中随机选取四倍数量的对照，按照年龄、性别和索引年份进行频率匹配。
通过卡方检验分析两组之间的性别、年龄组、合并症和类固醇使用情况的差异。采用Cox比例风险回归来估计风险比（HR）和95%置信区间（95%CI），以比较两组。应用Kaplan-Meier分析来测量CSC的累积发病率。此外，使用对数秩检验来检验两组之间的发病率差异。检测了直至2011年后续几年中CSC的发病率。
在平均7.36±2.88年的随访期间，NOSD患者的CSC发病率高于对照组（每10000人年分别为3.10例和1.86例；调整后HR为1.65；95%CI为1.34 - 2.02）。男性患CSC的风险高于女性。按性别、年龄组或合并症情况分层的敏感性分析一致显示，NOSD患者患CSC的风险高于其对照组。剂量反应表明，NOSD严重程度越高，CSC风险越高。
NOSD是后续发生CSC风险增加的独立指标。
