Sia Josh Tjunrong, Lee Ester P X, Cheung Chui Ming Gemmy, Fenwick Eva K, Laude Augustinus, Ho Kam Chun, Fenner Beau J, Wong Tien Y, Milea Dan, Lamoureux Ecosse L, Man Ryan E K, Najjar Raymond P
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
Clin Exp Ophthalmol. 2022 Dec;50(9):1025-1037. doi: 10.1111/ceo.14146. Epub 2022 Aug 31.
Age-related macular degeneration, a prevalent degenerative retinal disease, is associated with non-visual and psychosocial impairments that may affect sleep. In this systematic review, we evaluated associations between age-related macular degeneration (AMD) and sleep, highlighted knowledge gaps and provided evidence-based recommendations to clinicians to enable holistic management of AMD patients.
We searched PubMed, Embase and the Cochrane Central registries for papers published before May 2022. Non-English, qualitative studies and grey literature were excluded. Studies evaluating the association between AMD and sleep (including sleep disorders like insomnia and sleep apnea), and vice versa, were included. The quality of shortlisted studies was evaluated using the Newcastle Ottawa Scale.
Six (two case-control studies, three longitudinal cohort studies and one cross-sectional study) of 551 studies were included in this review. Four studies found that AMD was associated with increased rates of sleep apnea and poorer reported sleep quality, while five studies showed that patients with sleep apnea or insomnia were at higher risk of developing AMD. Associations between self-reported sleep quantity and AMD were conflicting. No study evaluated the relationship between AMD and sleep using objective sleep assessment tools.
Only a limited number of studies investigated associations between AMD and sleep. These studies suggest a bidirectional relationship between AMD and sleep dysfunction yet disagree on the relationship between sleep quantity and the likelihood of AMD. Additional studies, using objective characterisation of sleep in patients with AMD are required to confirm these findings.
年龄相关性黄斑变性是一种常见的视网膜退行性疾病，与可能影响睡眠的非视觉和心理社会障碍相关。在本系统评价中，我们评估了年龄相关性黄斑变性（AMD）与睡眠之间的关联，突出了知识空白，并为临床医生提供基于证据的建议，以实现对AMD患者的整体管理。
我们检索了PubMed、Embase和Cochrane中心注册库，查找2022年5月之前发表的论文。排除非英文、定性研究和灰色文献。纳入评估AMD与睡眠（包括失眠和睡眠呼吸暂停等睡眠障碍）之间关联以及反之关联的研究。使用纽卡斯尔渥太华量表评估入围研究的质量。
本评价纳入了551项研究中的6项（2项病例对照研究、3项纵向队列研究和1项横断面研究）。4项研究发现AMD与睡眠呼吸暂停发生率增加和报告的睡眠质量较差相关，而5项研究表明睡眠呼吸暂停或失眠患者发生AMD的风险更高。自我报告的睡眠量与AMD之间的关联存在矛盾。没有研究使用客观睡眠评估工具评估AMD与睡眠之间的关系。
只有少数研究调查了AMD与睡眠之间的关联。这些研究表明AMD与睡眠功能障碍之间存在双向关系，但在睡眠量与AMD可能性之间的关系上存在分歧。需要更多使用客观方法描述AMD患者睡眠的研究来证实这些发现。
