Circadian Rhythm Sleep Disorders Linked to Increased Risk of Dry Eye Disease

What's new

New research indicates a strong association between circadian rhythm sleep disorders (CRSD) and an elevated risk of developing dry eye disease (DED). A comprehensive retrospective cohort study, utilizing real-world clinical data from a vast U.S. network, found that patients with CRSD were more than twice as likely to be diagnosed with DED compared to those without such sleep disorders. This association persisted across one, three, and five-year follow-up periods, suggesting a sustained impact of circadian disruption on ocular health [1].

The science behind it

Researchers analyzed electronic health records from the TriNetX U.S. Collaborative Network, identifying over 48,000 adult patients with a CRSD diagnosis and a control group of more than 24,000 individuals without CRSD. To ensure a fair comparison, the study employed propensity score matching, balancing demographic, clinical, and pharmacological factors between the groups. After matching, nearly 20,000 patients were included in each cohort for analysis [1].

CRSD encompasses conditions where the body's internal clock is misaligned with the external environment, leading to irregular sleep patterns. The study specifically looked at the risk of new DED diagnoses in these patients. The findings were statistically significant: at one year, 0.58% of the CRSD group developed DED compared to 0.22% of the control group, corresponding to an adjusted hazard ratio (aHR) of 2.31. This increased risk remained substantial at three years (aHR 2.12) and five years (aHR 2.04). The study also examined a broader outcome, including DED diagnosis or the initiation of DED medication, and found a consistently higher cumulative incidence in the CRSD group at all time points [1].

The biological mechanisms underpinning this link are thought to involve the systemic effects of circadian dysregulation. The body's circadian clock influences various physiological processes, including inflammation, metabolism, and neuroendocrine function. These pathways are known to intersect with ocular surface homeostasis, which is crucial for maintaining tear film stability and corneal health. Disruptions in the circadian rhythm can affect tear secretion, alter the repair mechanisms of the ocular surface, and contribute to neuroimmune dysfunction, all of which are factors in DED development [1].

What it means in practice

For healthcare providers, these findings suggest that patients presenting with circadian rhythm sleep disorders may warrant closer monitoring for symptoms of dry eye disease. Integrating questions about ocular discomfort into the assessment of individuals with CRSD could facilitate earlier diagnosis and management of DED, potentially improving patient comfort and preventing disease progression. Conversely, patients experiencing chronic dry eye symptoms might benefit from an evaluation of their sleep patterns and circadian health [1].

For individuals, understanding this connection underscores the importance of addressing sleep health. While CRSD are specific diagnoses, maintaining a consistent sleep schedule and optimizing sleep hygiene can support overall circadian rhythm stability. If experiencing symptoms of dry eye, such as dryness, irritation, or blurred vision, alongside sleep disturbances, it may be beneficial to discuss both concerns with a healthcare professional. Lifestyle adjustments aimed at promoting better sleep could potentially have a positive impact on ocular surface health [1].

Caveats

It is important to interpret these findings within the context of the study's design. As a retrospective cohort study, it identifies an association rather than proving a direct cause-and-effect relationship. While the researchers used propensity score matching to control for many confounding variables, there may be other unmeasured factors that could influence both CRSD and DED development. The diagnosis of CRSD and DED relied on ICD-10 codes from electronic health records, which might not capture the full spectrum or severity of these conditions. Further prospective studies and research into the specific biological pathways are needed to fully elucidate the causal links and mechanisms involved [1].

Source: [1] https://www.nature.com/articles/s41598-026-67958-0