Sleep disturbances in young subjects with visual dysfunction

doi:10.1016/j.ophtha.2003.05.014

Ophthalmology

Volume 111, Issue 2, February 2004, Pages 297-302

Presented at: American Academy of Ophthalmology Annual Meeting, October, 2002; Orlando.

https://doi.org/10.1016/j.ophtha.2003.05.014 Get rights and content

Abstract

Purpose

To determine whether the type of ophthalmic disease is predictive of sleep and wakefulness disturbances in young subjects with visual dysfunction.

Design

Prospective cohort study.

Participants and controls

Twenty-five subjects (ages 12–20) were recruited from the Missouri School for the Blind. Twelve controls with normal sight were recruited from a residential school.

Methods

Daily activity was monitored for 14 days using wrist actigraphy. Sleep and wakefulness measures were derived from actigraphy records by automated analysis. Visually impaired subjects were prospectively stratified by presence or absence of optic nerve disease.

Main outcome measures

Daytime napping and regularity of awakening time (wake-up time instability).

Results

Subjects with optic nerve disease napped in the daytime significantly more than other visually impaired children or normal sighted controls: 28.1±4.0 minutes per day (mean ± standard error) versus 11.9±2.4 minutes per day in equally visually impaired subjects with intact optic nerve function versus 6.2±2.2 minutes per day in subjects with normal sight (P<0.0001). These subjects also showed significantly more variable awakening times than the other groups. Logistic regression revealed that subjects with optic nerve disease are 9.1 times more likely to demonstrate daily napping of more than 20 minutes per day than equally blind subjects without optic nerve disease (95% confidence interval [CI] = 1.4–58.7, P = 0.02). Blind subjects with optic nerve disease are 21.3 times more likely than children with normal sight to nap more than 20 minutes on average per day (95% CI = 1.2–378, P = 0.04).

Conclusions

Optic nerve disease is predictive of increased daytime napping in young visually impaired subjects, suggesting that the nature and presence of ophthalmic disease affect the probability of concomitant sleep timing disorders.

Section snippets

Materials and methods

Twenty-five visually impaired children and young adults (ages 12–20) were recruited from the Missouri School for the Blind, a residential school. Twelve subjects with normal sight were recruited from the Thomas Jefferson boarding school. The students were prospectively placed into 3 groups based on established visual diagnosis, confirmed through a complete eye examination: (1) optic nerve disease (n = 11), (2) visual impairment without evidence of optic nerve disease (n = 14), and (3) normal

Results

Full 14-day datasets were obtained on 37 subjects. One dataset from a visually impaired subject was lost due to a lost activity watch. Demographic information for the 11 visually impaired subjects with optic nerve disease, 14 visually impaired subjects with intact optic nerves, and 12 subjects with normal sight is shown in Table 1. All 3 groups were similar in age. No subjects were excluded based on a screen for depression, medication use, or illness. Thirty-six of the 37 subjects in the study

Discussion

Previous studies have suggested that visually impaired subjects are at risk for both self-reported1 and objectively measured sleep disorders.18 These sleep disorders are thought to arise, at least in part, from inability of the circadian clock to entrain correctly to external light and dark signals in visually impaired individuals.19 In the present field study of children and young adults with visual impairment, we confirmed that a subset of visually impaired subjects had abnormally high levels

Acknowledgements

The authors thank Karen Steger-May, MA, and Mae Gordon, PhD, of the Washington University Division of Biostatistics for statistical advice. They especially thank the Missouri School for the Blind and the Thomas Jefferson School for assisting in subject recruitment.

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^☆

Manuscript no. 220703.

Dr Wee was supported by the Doris Duke Foundation, New York, New York. Dr Van Gelder was supported by career development awards from Research to Prevent Blindness, Inc. (New York, New York); the Becker/Association of University Professors of Ophthalmology/Research to Prevent Blindness Physician–Scientist Award; the Culpepper Physician–Scientist Award; the National Alliance for Schizophrenia and Affective Disorders; and the National Institutes of Health (K08EY00403).

View full text

Original articleSleep disturbances in young subjects with visual dysfunction☆

Abstract

Purpose

Design

Participants and controls

Methods

Main outcome measures

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Am J Ophthalmol

Lancet

Brain Res

Surv Ophthalmol

Brain Res

Biol Psychiatry

Sleep disorders in children with blindness

Ann Neurol

Sleep and activity rhythms are related to circadian phase in the blind

Sleep

Prevalence of sleep/wake disorders in persons with blindness

Clin Sci (Lond)

Blind people often sleep poorly; research shines light on therapy

JAMA

Circadian rhythms in man

Science

Light suppresses melatonin secretion in humans

Science

Circadian photoreception in the retinally degenerate mouse (rd/rd)

J Comp Physiol [A]

Non-visual ocular photoreception

Ophthalmic Genet

Phototransduction by retinal ganglion cells that set the circadian clock

Science

The role of actigraphy in the study of sleep and circadian rhythms

Sleep

Original article
Sleep disturbances in young subjects with visual dysfunction☆