Huang Alan Y, Ehrlich Joshua R, Hamedani Ali G
Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
Eye (Lond). 2025 Apr 12. doi: 10.1038/s41433-025-03777-3.
BACKGROUND/OBJECTIVES: The visual system affects circadian rhythms, and both visual and sleep difficulties are common in older adults. This study examines the association between visual impairment, age-related eye disease, and sleep disturbances among older adults in the United States.
SUBJECTS/METHODS: This cross-sectional study used Round 11 of the National Health and Aging Trends Study (NHATS). Vision was assessed using self-report and objective assessments (distance and near acuity, contrast sensitivity). Medicare claims data were used to identify diagnoses of age-related macular degeneration, glaucoma, diabetic retinopathy, and cataract. Primary outcomes included self-reported sleep disturbances, defined by difficulties in sleep initiation, maintenance, and medication use. Logistic regression models were adjusted for demographic and clinical variables.
Among 3817 participants (56% female), difficulty with sleep initiation, maintenance, and medication use were reported by 41.7%, 44.2%, and 26.5% of the cohort, respectively. In unadjusted models, self-reported visual difficulty was associated with sleep initiation (OR 1.80, 95% CI: 1.43-2.29) and maintenance difficulties (OR 1.53, 95% CI: 1.16-2.02) and sleep medication use (OR 1.68, 95% CI: 1.27-2.24). After adjusting for covariates, self-reported visual difficulty remained significantly associated with sleep medication use (OR 1.40, 95% CI: 1.00-1.95). Near acuity and contrast sensitivity were associated with sleep initiation difficulties but did not remain significant after adjustment. No associations were found between ophthalmic diagnoses and outcomes.
Self-reported visual difficulty is associated with increased sleep medication use in older adults. Because visual impairment and sleep medications are associated with falls and cognitive decline, future studies should consider these comorbidity patterns.
背景/目的：视觉系统会影响昼夜节律，而视力和睡眠问题在老年人中都很常见。本研究调查了美国老年人视力障碍、年龄相关性眼病与睡眠障碍之间的关联。
对象/方法：这项横断面研究使用了美国国家健康与老龄化趋势研究（NHATS）的第11轮数据。通过自我报告和客观评估（远视力和近视力、对比敏感度）来评估视力。利用医疗保险理赔数据来确定年龄相关性黄斑变性、青光眼、糖尿病性视网膜病变和白内障的诊断情况。主要结局包括自我报告的睡眠障碍，通过入睡困难、维持睡眠困难和使用助眠药物来定义。逻辑回归模型针对人口统计学和临床变量进行了调整。
在3817名参与者（56%为女性）中，分别有41.7%、44.2%和26.5%的队列报告了入睡困难、维持睡眠困难和使用助眠药物的情况。在未调整的模型中，自我报告的视力困难与入睡困难（比值比1.80，95%置信区间：1.43 - 2.29）、维持睡眠困难（比值比1.53，95%置信区间：1.16 - 2.02）以及使用助眠药物（比值比1.68，95%置信区间：1.27 - 2.24）相关。在调整协变量后，自我报告的视力困难仍与使用助眠药物显著相关（比值比1.40，95%置信区间：1.00 - 1.95）。近视力和对比敏感度与入睡困难相关，但调整后不再显著。未发现眼科诊断与结局之间存在关联。
自我报告的视力困难与老年人使用助眠药物增加有关。由于视力障碍和助眠药物与跌倒及认知衰退有关，未来的研究应考虑这些共病模式。
