Sleep outcomes associated with dry eye disease: a systematic review and meta-analysis

Objective: To summarize and quantitatively evaluate sleep outcomes of dry eye disease (DED) patients. Design: A systematic review and meta-analysis. Participants: DED patients were individuals with dry eye symptoms or primary Sjogren's syndrome (pSS). Controls were healthy, non-pSS, or non-DED patients. Methods: A systematic search of MEDLINE, EMBASE, PsycINFO, and grey literature was conducted. Studies were screened using Covidence software. Outcomes included sleep quality, duration, day time sleepiness, prevalence/incidence/severity of sleep disorders, and sleep disturbances. Meta-analysis was conducted using STATA 13.0. The weighted mean difference(WMD) was calculated as the effect size for continuous scale outcomes. Random-effects models were developed based on the presence of heterogeneity. Results: Seventeen full-text articles (16370 subjects) and 2 conference abstracts(571 763 subjects) were included. Compared to controls, DED patients score higher on the Pittsburgh Sleep Quality Index (WMD = 1.69, 95% CI: 0.82,2.56; I-2 = 88.8%, p < 0.001) and Epworth Sleepiness Scale (WMD = 2.26, 95% CI: 0.96, 3.56; I-2 = 82.4%, p < 0.001). Additionally, DED patients spend less time a sleep(WMD = -0.59 hours, 95% CI: -0.94, -0.24; I-2 = 85.1%, p < 0.001), experience more sleep disturbances, and may have increased prevalence, incidence, severity of sleep disorders. Conclusion: DED patients may have poorer sleep quality, greater day time sleepiness, less sleep, more sleep disturbances, increased prevalence, incidence, and severity of sleep disorders compared to non-DED patients. Further research is needed to identify potential causes of these outcomes given the paucity and heterogeneity of included studies. It may be worth while to consider sleep in the clinical management of DED.