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ISSN : 1229-6457(Print)
ISSN : 2466-040X(Online)
The Korean Journal of Vision Science Vol.23 No.4 pp.555-565
DOI : https://doi.org/10.17337/JMBI.2021.23.4.555

The Association between Sleep Duration and Dry Eyes by General Characteristics: The 7th Korea National Health and Nutrition Examination Survey

Hye-Won Park1), Tae-Hun Kim2,3)
1)Dept. of Optometry, Kookje University, Professor, Pyeongtaek
2)Dept. of Visual Optics, Graduate School of Health and Welfare, Baekseok University, Professor, Seoul
3)Dept. of Visual Optics, Division of Health Science, Baekseok University, Professor, Cheonan
* Address reprint requests to Tae-Hun Kim (https://orcid.org/0000-0002-2840-650X) Dept. of Visual Optics, Baekseok University, Cheonan
TEL: +82-41-550-2259, E-mail: kth@bu.ac.kr
November 22, 2021 December 27, 2021 December 27, 2021

Abstract


Purpose : This study was performed to evaluate the correlation between sleep duration and the prevalence of dry eyes in Korean adults over the age of 40.



Methods : Among the 16,119 adults who participated in the 7th Korean National Health and Nutrition Examination Survey, and 2,506 adults were enrolled in our study. The collected data were analyzed composite samples, with the calculations for mean, standard deviation, t-test, ANOVA. The correlation between sleep duration and dry eyes was analyzed by chi-square test. Logistic regression analysis was performed to analyze the effect of general characteristics on dry eyes. We controlled for Variables including gender, age, education, household income, job, work time zone, BMI, smoking, and drinking.



Results : As a result of the analysis, the overall sleep duration was 7 hours. Sleep duration and dry eyes have been found to be related. As a result of logistic regression analysis of factors affecting dry eyes, dry eyes increased more in shorter than 5 hours than in 7 hours of sleep duration (OR 1.93 [95% CI: 1.38-2.71]). Dry eye increased in women than men (OR 0.40 [95% CI: 0.32-0.49]). The odds ratio increased obesity compared to low weight (OR 1.89 [95% CI: 1.11-3.19]), and dry eyes increased in more than 4 times a week on drinking (OR 2.43 [95% CI: 1.42-4.16]).



Conclusion : The association between dry eyes and sleep duration was confirmed. Therefore, it is necessary to prevent dry eyes through proper sleep duration.


Dry eyes , Female , National health and nutrition examination survey , Prevention , Sleep duration

일반적 특성에 따른 수면시간과 안구건조의 관련성: 제7차 국민건강영양조사

박 혜원1), 김 태훈2,3)
1)국제대학교 안경광학과, 교수, 평택
2)백석대학교 보건복지대학원 안경광학과, 교수, 서울
3)백석대학교 안경광학과, 교수, 천안

    Ⅰ. Introduction

    Sleep is a basic physiological need of humans, and rest due to sleep restores mental and physical fatigue and plays a role in maintaining good health.1) Further, it also affects recovery from disease.2) If the human do not sleep normally, the homeostasis of the human body may be disrupted and diseases may occur.2,3) Repeated sleep disorders can disrupt biological rhythms and cause insomnia, which can lead to continuous sleep disorders.4,5) In addition, as the ATP (Adenosine Tri-Phosphate) accumulated in the brain decreases unstable, the adrenocorticotropic hormone is secreted, causing mental problems such as chronic fatigue, depression, and anxiety, or endocrine dysfunction, immune dysfunction, and cardiovascular problems. It has also been shown to be associated with an increased risk of diabetes and hypertension.6-11) Studies have also reported that these symptoms may affect dry eyes.12) Dry eyes is a multifactorial disease whose main cause is the loss of homeostasis of the tear film. When the homeostasis in the tear film is broken, the tear film becomes unstable, and inflammation and damage to the ocular surface may occur, which may cause evaporation of tears, and abnormalities neurosensory sensation.13) According to several studies of dry eyes, it has a prevalence of about 5 to 30% and has been reported as a serious chronic disease worldwide.14,15) Although problems caused by sleep deprivation to disrupt tear homeostasis can affect dry eyes, there is still insufficient research on the effects of sleep on dry eyes. Therefore, we tried to evaluate the correlation between dry eyes and sleep duration using a large-scale survey of national health and nutritional data in Koreans. In this study, we analyzed the raw data of the 7th National Health and Nutrition Examination Survey 2nd year (2017) and 3rd year (2018) to understand the effects on dry eyes, and to identify the factors that affect them and try to use it as evidence.

    Ⅱ. Methods

    1. Study object

    This study was conducted based on the data of the National Health and Nutrition Examination Survey. The 7th National Health and Nutrition Examination Survey was conducted every three years from 2016 to 2018, in which the data for the 2nd year (2017) and 3rd year (2018) were integrated with a 1:1 weight. In the 2nd year of the 7th, the participants were 8,127, 3,766 male, and 4,361 female. In the 3rd year, the participants were 7,992, 3,640 male and 4,352 female. The total number was 16,119, but 2,506 people over the age of 40 who were diagnosed with eye disease were included. The average age of the subjects was 66.15±11.08 years.

    2. Measurements

    The general characteristics of the subjects were analyzed using gender, age, education, household income, job, work time zone, BMI (Body Mass Index), smoking, and drinking. In the case of education, it was classified into ‘Less than elementary’, ‘Middle school’, ‘High school’, and ‘College graduate or higher’. Household income was divided into quartiles according to the classification presented in the National Health and Nutrition Examination Survey data, and classified into ‘Low’, ‘Low-middle’, ‘High-middle’, and ‘High’. In the case of job, it was classified into ‘Managers & experts’, ‘Office worker’, ‘Service & seller’, ‘Agricultural & fishermen’, ‘Machine operator & assembly worker’, ‘Labor worker’, ‘Inoccupation(housewife, students, etc.)’. In the case of work time zone, it was classified into ‘Day duty’, ‘Evening duty (pm 14:00~24:00)’, ‘Night duty (pm 21:00~next day am 8:00)’, ‘Regular day & night duty rotation’, ‘24 hours duty rotation’, ‘Split duty(more than 2 working hours per day)’, ‘Irregular duty rotation’, ‘Etcetera’. Based on BMI, it was classified into ‘Low weight’ with a BMI of less than 18.5 kg/m2, ‘Normal’ with a BMI of less than 18.5~25.0 kg/m2, and ‘Obesity’ with a BMI of 25.0 kg/m2 or more. As for smoking status, those who smoked 100 or more cigarettes in their lifetime were classified as ‘current smokers’, and those who smoked 100 cigarettes or less in their lifetime or who did not smoke were classified as ‘never smokers’. Drinking was classified as ‘Never’, ‘1 times or less per month’, ‘1 times per month’, ‘2~4 times per month’, ‘2~3 times per week’, ‘4 times or more per week’ according to the number of times of drinking in one year. Dry eyes was classified according to whether it was diagnosed by a doctor. Sleep duration was classified into ‘ shorter than 5 hours’, ‘6, 7, 8 hours’ and ‘longer than 9 hours’ on weekday sleep duration.

    3. Data Analysis

    The analysis was performed using composite samples for the analysis of National Health and Nutrition Examination Survey for the 7th of 2017 and 2018. The sleep duration according to the general characteristics of the subjects and dry eyes were analyzed by t-test and ANOVA. A chi-square test was analyzed to investigate the correlation between dry eyes with sleep duration. Logistic regression analysis was analyzed to analyze the effect of general characteristics on dry eyes. Missing values were excluded from the data analysis results. Statistical analyses were performed using SPSS 18.0 version (SPSS Inc., Chicago, IL, USA) for the data analysis. A p-value lower than 0.050 was regarded as statistically significant in all analyses above.

    Ⅲ. Results

    1. General characteristics according to sleep duration

    The average sleep duration of study subjects was 7.03±1.35 hours. As a result of analyzing the general characteristics according to sleep duration, it was shown that most 7 hours were higher. By gender, 7 hours of sleep duration appeared higher in both males and females, and there was no statistically significant difference. In all age groups, 7 hours of sleep duration was found to be high, and there was a statistically significant difference (p<0.001). It was shown that the ratio of sleep duration of shorter than 5 hours was high in the age of 60s. In education, 7 hours of sleep duration was higher in all subjects, and there was a statistically significant difference (p<0.001). The household income was highest in 7 hours of sleep duration. In the high-income group, 5 hours of sleep duration was higher than in other groups. In job, labor worker had the highest rate on shorter than 5 hours of sleep duration, and the job with the highest rate on longer than 9 hours of sleep duration was Agricultural & Fishermen. In the work time zone, shorter than 6 hours of sleep duration was higher than that longer than 8 hours of sleep duration. The BMI was found to be higher in those who were low weight and obesity for shorter than 6 hours of sleep duration. In the smoker group, shorter than 7 hours of sleep duration was higher, and 7 hours of sleep duration was the lowest in drinking was 4 times or more per week. However, there was no significant difference in BMI, smoking and drinking (Table 1).

    2. General characteristics by with and without dry eyes

    As a result of analyzing the general characteristics of the study subjects according to dry eyes, showed significant differences in all variables except for work time zone. As for gender, females had more dry eyes than males, and their age was more than 50s (p<0.001). In education, high school graduates often had dry eyes (p<0.001). In household income, High-middle had more dry eyes (p<0.001). It was found that dry eyes was many jobs in the order of inoccupation, service & seller, managers & experts, labor worker, machine operator & assembly worker, office worker, and agricultural & fishermen. In the work time zone, the day duty had more dry eyes, but there was no significant difference. In BMI, dry eye showed in the order of normal, obesity and low weight. Dry eyes was many in those who did not smoke or not drinking (p<0.001). As the drinking increases, they are likely to have dry eyes (Table 2).

    3. Association of sleep duration with dry eyes

    Table 3 shown the association between dry eyes and sleep duration (p<0.001). In the dry eyes group, shorter than 6 hours of sleep duration was higher than in the non-dry eyes group. Shorter than 5 hours of sleep duration increased the risk of having dry eyes, compared to 7 hours of sleep duration (OR 1.93 [95% CI: 1.38-2.71]).

    4. Effect of general characteristics on dry eyes

    In order to confirm the factors affecting the dry eyes of the study subjects, using the simultaneous input method using gender, age, education, household income, job, work time zone, BMI, smoking, drinking as independent variables, logistic regression analysis was performed. Dry eye increased 0.40 [95% CI: 0.32-0.49] in women than men. As the age increased, the odds ratio increased, and it was the highest at 20.79 [95% CI: 5.02-86.09] in older than 70 year. The higher education appeared the higher the odds ratio, and 2.23 [95% CI: 1.17-4.27] in more than college. When regular day & night duty rotation, dry eye increased 0.32 [95% CI: 0.15-0.67] compared to day duty. The odds ratio increased obesity compared to low weight (OR 1.89 [95% CI: 1.11-3.19]). The risk of dry eye was increased in smokers compared to non-smokers (OR 0.65 [95% CI: 0.34-0.95]). Drinking was more than 4 times a week increased the risk by 2.43 [95% CI: 1.42-4.16] compared to not drinking. There were no significant differences in other variables (Table 4).

    Ⅳ. Discursion and Conclusions

    In this study, the correlation between sleep duration and dry eyes in adults over 40 years old was investigated using data from the 7th National Health and Nutrition Examination Survey. As a result of studying the sleep duration according to general characteristics, it was the highest in 7 hours. The results of this study showed that the average sleep duration was 7.03±1.35 hours, which was less than the OECD average of 8 hours and 22 minutes.16) The proper sleep duration is the amount of time you can get up in the morning and not feel tired and sleepy during the day when you wake up. It has been reported that a sleep duration longer or shorter than the appropriate sleep duration is associated with chronic diseases.17) In gender, there was no significant difference between males and females, and the ratio of sleep duration of shorter than 5 hours was high in the age of 60s. The higher the household income, sleep duration of shorter than 5 hours was the highest. All job had more sleep duration of 7 hours. In the work time zone, sleep duration of shorter than 5 hours was higher in night duty, and 24 hour duty rotation but 7 hours was the highest in other work time zones. As for BMI, sleep duration of shorter than 5 hours was higher in obesity. In the case of drinking, drinking more than 4 times a week showed a high rate sleep duration of shorter than 5 hours. Alcohol causes temporary sleep, but it causes sleep disturbance due to a decrease in NRAM (Non-rapid eye movement) sleep towards the latter part of sleep. Repeated alcohol thereby continues the sleep disorder caused by the tolerance of alcohol.18) In addition, there may also experience dry eyes due to drinking. As alcohol increases the tear film osmotic pressure, the tear film break time becomes shorter.19) As a result of the study of dry eyes according to general characteristics, dry eyes occurred more frequently in women, and the age group was mainly in their 50s. Results similar to previous studies that dry eyes increased with increasing age were showed.20,21) The higher the education, the more dry eyes, and the higher the household income were dry eyes. Although there is no exact mechanism for education and dry eyes, a previous study by Farrand et al.22) showed that dry eyes was more common among those with a college or higher education. It is also related to higher education and income, so it is thought that the higher the education level, the higher the income, the more dry eyes. Most of the job was in occupation, and sleep duration was mostly day duty. The BMI was found in the order of normal, obesity, and low weight. It was found that non-smokers and non-drinkers had more dry eyes. Sleep duration and dry eyes have been shown to be associated. The odds ratio increased in shorter than 5 hours compared to 7 hours (OR 1.93 [95% CI: 1.38-2.71]).

    Dry eyes was 0.40 [95% CI: 0.32-0.49] in women, and 20.79 [95% CI: 5.02-86.09] in older than 70 year. This is the same result as in previous studies that dry eyes is related to sex hormones and occurs more in women than men. In addition, the odds ratio was 1.89 [95% CI: 1.11-3.19] in obesity, and drinking was 2.43 [95% CI: 1.42-4.16] in more than 4 times a week. In a previous study by Lee et al.23), the prevalence of dry eyes was high in subjects with short sleep duration. An analysis, using the 2010-2012 Korea National Health and Nutrition Examination Survey data, showed that the subjects were different from this study, the number of subjects was large, and the results of the study were similar to those of this study. Sleep plays an important role in maintaining body homeostasis among the causes of tear film breakage in dry eyes.24) When homeostasis in the body is disrupted by sleep, homeostasis in the tear film is also broken, which can lead to dry eyes. Dry eyes is not only an inconvenience to the eyes, but can also cause visual acuity impairment.25) There are several limitations to this study. First, The design of this study is cross-sectional, and the causal direction cannot be evaluated. The sleep duration could be an influencing factor for dry eyes, but the opposite may be true. It should also be considered that there may be residual confounding factors (refractive surgery, wearing contact lenses, and medications to be taken, etc.) and there may be missing factors that affect dry eyes. The prospective studies are needed to figure out association between sleep duration and dry eyes. Second, dry eyes used the experience diagnosed by ophthalmology using a self-reported survey. Because we do not test for dry eyes, some people may have more symptoms, which may reduce accuracy and affect relevance.26) However, dry eyes is a chronic disease and once diagnosed, the diagnosis remains valid.27) Third, sleep could not reflect that it affects not only sleep duration, but also sleep quality. Nevertheless, the correlation between sleep duration and dry eyes according to general characteristics was analyzed with the latest data, and the representativeness of the study subjects was secured using the data from the Korea National Health and Nutrition Examination Survey. Through this study, it was confirmed that the association between sleep duration and dry eyes. It is thought that proper sleep duration should prevent dry eyes.

    Figure

    Table

    General characteristics according to sleep duration N (%)

    General characteristics by with and without dry eyes N (%) or M±SD

    Association of sleep duration with dry eyes

    Logistic regression analysis by the variables to dry eyes

    Reference

    1. Carskadon MA, Dement WC: Cumulative effects of sleep restriction on daytime sleepiness. Psychophysiology 18(2), 107-113, 1981.
    2. Schwab RJ: Disturbances of sleep in the intensive care unit. Crit Care Clin. 10(4), 681-694, 1994.
    3. Marquis DF, Wykle M: Nursing standard-ofpractice protocol: Sleep disturbances in elderly patients: Alterations in the sleep-wake cycle call for immediate assessment and intervention. A NICHE Project protocol. Geriatric Nursing 16(5), 238-243, 1995.
    4. Hong SH, Kim SY: Effects of sleep promoting program on sleep and immune response in elderly. J Korean Adult Nur. 21(2), 167-178, 2009.
    5. Shin EY: Relationships between health status, physical activity level, health related quality of life and sleep duration in the elderly. Korean J Intern Med. 42(3), 53-65, 2016.
    6. Southwell MT, Wistow G: Sleep in hospitals at night: Are patients’ needs being met? J Adv Nurs. 21(6), 1101-1109, 1995.
    7. Nasermoaddeli A, Sekine M et al.: Job strain and sleep quality in Japanese civil servants with special reference to sense of coherence. J Occup Health 44(5), 337-342, 2002.
    8. Spiegel K, Leproult R et al.: Impact of sleep debt on metabolic and endocrine function. Lancet 354(9188), 1435-1439, 1999.
    9. Rogers NL, Szuba MP et al.: Neuroimmunologic aspects of sleep and sleep loss. Semin Clin Neuropsychiatry 6(4), 295-307, 2001.
    10. Koren D, Dumin M et al.: Role of sleep quality in the metabolic syndrome. Diabetes Metab Syndr Obes. 9, 281-310, 2016.
    11. Luca A, Luca M et al.: Sleep disorders and depression: Brief review of the literature, case report, and nonpharmacologic interventions for depression. Clin Interv Aging 8, 1033-1039, 2013.
    12. Hwang H: The pathogenesis of dry eye disease and trends in treatment. J Korean Med Assoc. 59(9), 713-718, 2016.
    13. Research in dry eye: Report of the Research Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 5(2), 179-193, 2007.
    14. The epidemiology of dry eye disease: Report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 5(2), 93-107, 2007.
    15. Schaumberg DA, Sullivan DA et al.: Epidemiology of dry eye syndrome. Adv Exp Med Biol. 506(Pt B), 989-998, 2002.
    16. OECD: Society at a Glance 2009: OECD Social Indicators. 2009, Available at https://www.oecd-ilibrary.org. Accessed December 13 2021. https://www.oecd-ilibrary.org/social-issuesmigration-health/society-at-a-glance-2009_soc_glance-2008-en
    17. Kim YH, Lee JH: Relevance of periodontal disease according to presence of cognitive stress, sleeping hours, and subjective oral-health status of adults. J Korean Health Ser Manag. 11(4), 169-178, 2017.
    18. Gillin JC, Smith TL et al.: Increased pressure for rapid eye movement sleep at time of hospital admission predicts relapse in nondepressed patients with primary alcoholism at 3-month follow-up. Arch Gen Psychiatry 51(3), 189-197, 1994.
    19. Magno MS, Daniel T et al.: The relationship between alcohol consumption and dry eye. Ocul Surf. 21, 87-95, 2021.
    20. Vehof J, Kozareva D et al.: Prevalence and risk factors of dry eye disease in a British female cohort. Br J Ophthalmol. 98(12), 1712-1717, 2014.
    21. Nowak MS, Smigielski J: The prevalence and risk factors for dry eye disease among older adults in the city of lodz, Poland. Open J Ophthalmol. 6(1), 1-5, 2016.
    22. Farrand KF, Fridman M et al.: Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. Am J Ophthalmol. 182, 90-98, 2017.
    23. Lee W, Lim SS et al.: The association between sleep duration and dry eye syndrome among Korean adults. Sleep Med. 16(11), 1327-1331, 2015.
    24. Banks S, Dinges DF: Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 3(5), 519-528, 2007.
    25. Craig JP, Nichols KK et al.: TFOS DEWS II definition and classification report. Ocul Surf. 15(3), 276-283, 2017.
    26. Park SI: Statistical analysis techniques for veterinary data. J Korean Soc Vet Clin. 109-113, 2009.
    27. Fujihara T, Nagano T et al.: Establishment of a rabbit short-term dry eye model. J Ocul pharmacol Ther. 11(4), 503-508, 1995.
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