Visual Impairment, Age-related Eye Disease, and Sleep Dysfunction in Older Adults
Alan Huang1, Joshua Ehrlich3, Ali Hamedani2
1Perelman School of Medicine at the University of Pennsylvania, 2Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 3Department of Ophthalmology and Visual Sciences, University of Michigan
Objective:
To examine the association between visual impairment, age-related eye disease, and sleep disturbances among older adults in the United States.
Background:
The visual system is involved in circadian rhythms and sleep, and visual impairment and sleep disturbances are both common in older adults. However, the relationship between age-related changes in vision and sleep remains poorly understood.
Design/Methods:
This cross-sectional study analyzed data from the 2021 National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries aged 65+. Vision was evaluated using self-reported measures and objective assessments of distance and near visual acuity, as well as contrast sensitivity. Diagnoses of age-related macular degeneration, glaucoma, diabetic retinopathy, and cataract were identified using linked Medicare claims data. Sleep disturbances were assessed by self-reported difficulties with sleep initiation, maintenance, and use of sleep medications. Logistic regression models were adjusted for demographic and clinical factors.
Results:
Among 3,817 participants (32% aged 75-79, 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 logistic regression models, self-reported visual impairment was associated with sleep initiation (OR 1.80, 95% CI: 1.43-2.29), 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 impairment remained significantly associated with sleep medication use (OR 1.40, 95% CI: 1.00-1.95). Near visual acuity and contrast sensitivity were associated with sleep initiation difficulties (OR 1.35, 95% CI 1.09-1.66; OR 1.34, 95% CI 1.10-1.64), but this did not remain significant after adjustment. There were no associations between ophthalmic diagnoses and sleep outcomes.
Conclusions:
Self-reported visual impairment is associated with an increased prevalence of sleep medication use in older adults. Because visual impairment and sleep medications are both associated with falls and cognitive decline, future studies should consider these comorbidity patterns.
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