Meta-analysis of the relationship between sleep duration and the risk of diabetic retinopathy

doi:10.3969/j.issn.1674-8115.2021.11.015

Abstract

Abstract: Objective

·To explore the relationship between sleep duration and the risk of diabetic retinopathy (DR) by performing a meta-analysis.

Methods

·The databases of Cochrane Library, PubMed, Embase, Web of Science, SinoMed, CNKI, VIP, and WanFang were searched for eligible studies regarding the relationship between sleep duration and the risk of DR up to April 2021. English search terms included "sleep" "sleep duration" "sleep time" "sleeping habit" "quantity of sleep diabetic retinopathy" and "retinal diseases". Chinese search terms included "睡眠" "睡眠时间" and "糖尿病性视网膜病变". The type of literature was observational studies, including cross-sectional studies, case-control studies, and cohort studies. Two researchers independently screened the literature and extracted data. The extracted data included the first author, country, publication time, study type, sample size, mean age, exposure assessment, sleep duration, outcome assessment, adjusted variables. The Newcastle-Qttawa Scale (NOS) was used to evaluate the quality of the included studies and a meta-analysis was performed by using R 4.0.4 software.

Results

·A total of 1 146 documents were retrieved, and 5 met the inclusion criteria, including 5 627 study subjects. Results showed that long sleep duration was positively correlated with the risk of any DR [the combined odds ratio(OR) in the fixed-effect model and random-effect model both were 2.05, 95% confidence interval (CI) 1.37?3.05) ], while short sleep duration was not associated with the risk of any DR (OR in the fixed-effect model and random-effect model were 0.89, 95%CI 0.72?1.10 and 0.98, 95%CI 0.71?1.37, respectively], but it was related to the risk of moderate DR (OR in the fixed-effect model and random-effect model were2.07, 95%CI 1.29?3.33 and 2.06, 95% CI 1.18?3.58, respectively). Short sleep duration was not associated with the risk of vision-threatening diabetic retinopathy (OR in the fixed-effect model and random-effect model both were 0.92, 95%CI 0.58?1.47).

Conclusion

·Sleep duration is significantly associated with the risk of DR, in which too much sleep is a risk factor, while short sleep is to be further determined by research. As a modifiable factor at the individual level, the role of sleep intervention in the management of DR should be further emphasized.

Key words: sleep duration, diabetic retinopathy, meta-analysis

CLC Number:

R587.2

Jie LIU, Xin-min XIE, Xue-mei ZHI, Jing-yi LU. Meta-analysis of the relationship between sleep duration and the risk of diabetic retinopathy[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(11): 1502-1508.

Figures/Tables 6

TrendMD

References 34

1	Arden GB, Sivaprasad S. The pathogenesis of early retinal changes of diabetic retinopathy[J]. Doc Ophthalmol, 2012, 124(1): 15-26.
2	Li YZ, Teng D, Shi XG, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: m997.
3	钟学礼(执笔. 全国14省市30万人口中糖尿病调查报告[J]. 中华内科杂志, 1981, 20(11): 678-683.
4	Liew G, Michaelides M, Bunce C. A comparison of the causes of blindness certifications in England and Wales in working age adults (16–64 years), 1999–2000 with 2009–2010[J]. BMJ Open, 2014, 4(2): e004015.
5	Xu TL, Wang BS, Liu H, et al. Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019[J]. Lancet Public Heal, 2020, 5(12): e682-e691.
6	Jampol LM, Glassman AR, Sun J. Evaluation and care of patients with diabetic retinopathy[J]. N Engl J Med, 2020, 382(17): 1629-1637.
7	Association AD. 11. microvascular complications and foot care: standards of medical care in diabetes—2021[J]. Dia Care, 2021, 44(): S151-S167.
8	Shan ZL, Ma HF, Xie ML, et al. Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies[J]. Dia Care, 2015, 38(3): 529-537.
9	Meng LL, Liu Y, Geng RN, et al. Association of diabetic vascular complications with poor sleep complaints[J]. Diabetol Metab Syndr, 2016, 8: 80.
10	Jee D, Keum N, Kang S, et al. Sleep and diabetic retinopathy[J]. Acta Ophthalmol, 2017, 95(1): 41-47.
11	Chew M, Tan NYQ, Lamoureux E, et al. The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy[J]. Diabetes Res Clin Pract, 2020, 159: 107967.
12	Raman R, Gupta A, Venkatesh K, et al. Abnormal sleep patterns in subjects with type Ⅱ diabetes mellitus and its effect on diabetic microangiopathies: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 20)[J]. Acta Diabetol, 2012, 49(4): 255-261.
13	Tan NYQ, Chew M, Tham YC, et al. Associations between sleep duration, sleep quality and diabetic retinopathy[J]. PLoS One, 2018, 13(5): e0196399.
14	Wang X, Bi Y, Zhang Q, et al. Obstructive sleep apnoea and the risk of type 2 diabetes: a meta-analysis of prospective cohort studies[J]. Respirology, 2013, 18(1): 140-146.
15	Williams CJ, Hu FB, Patel SR, et al. Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes[J]. Diabetes Care, 2007, 30(5): 1233-1240.
16	Zizi F, Jean-Louis G, Brown CD, et al. Sleep duration and the risk of diabetes mellitus: epidemiologic evidence and pathophysiologic insights[J]. Curr Diab Rep, 2010, 10(1): 43-47.
17	Linsenmeier RA. Effects of light and darkness on oxygen distribution and consumption in the cat retina[J]. J Gen Physiol, 1986, 88(4): 521-542.
18	Ramsey DJ, Arden GB. Hypoxia and dark adaptation in diabetic retinopathy: interactions, consequences, and therapy[J]. Curr Diab Rep, 2015, 15(12): 118.
19	Patel SR, Malhotra A, Gottlieb DJ, et al. Correlates of long sleep duration[J]. Sleep, 2006, 29(7): 881-889.
20	Krueger PM, Friedman EM. Sleep duration in the United States: a cross-sectional population-based study[J]. Am J Epidemiol, 2009, 169(9): 1052-1063.
21	Whitaker KM, Lutsey PL, Ogilvie RP, et al. Associations between polysomnography and actigraphy-based sleep indices and glycemic control among those with and without type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis[J]. Sleep, 2018, 41(11). DOI:10.1093/sleep/zsy172.
22	Buxton OM, Pavlova M, Reid EW, et al. Sleep restriction for 1 week reduces insulin sensitivity in healthy men[J]. Diabetes, 2010, 59(9): 2126-2133.
23	Buxton OM, Cain SW, O'Connor SP, et al. Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption[J]. Sci Transl Med, 2012, 4(129): 129ra43.
24	Bakour C, Schwartz S, O'Rourke K, et al. Sleep duration trajectories and systemic inflammation in young adults: results from the national longitudinal study of adolescent to adult health (add health)[J]. Sleep, 2017, 40(11). DOI:10.1093/sleep/zsx156.
25	Mullington JM, Simpson NS, Meier-Ewert HK, et al. Sleep loss and inflammation[J]. Best Pract Res Clin Endocrinol Metab, 2010, 24(5): 775-784.
26	Joussen AM, Poulaki V, Le ML, et al. A central role for inflammation in the pathogenesis of diabetic retinopathy[J]. FASEB J, 2004, 18(12): 1450-1452.
27	Faraut B, Boudjeltia KZ, Vanhamme L, et al. Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery[J]. Sleep Med Rev, 2012, 16(2): 137-149.
28	Bain AR, Weil BR, Diehl KJ, et al. Insufficient sleep is associated with impaired nitric oxide-mediated endothelium-dependent vasodilation[J]. Atherosclerosis, 2017, 265: 41-46.
29	Stockelman KA, Bain AR, Dow CA, et al. Regular aerobic exercise counteracts endothelial vasomotor dysfunction associated with insufficient sleep[J]. Am J Physiol Heart Circ Physiol, 2021, 320(3): H1080-H1088.
30	Hikichi T, Tateda N, Miura T. Alteration of melatonin secretion in patients with type 2 diabetes and proliferative diabetic retinopathy[J]. Clin Ophthalmol, 2011, 5: 655-660.
31	Nedeltcheva AV, Kilkus JM, Imperial J, et al. Insufficient sleep undermines dietary efforts to reduce adiposity[J]. Ann Intern Med, 2010, 153(7): 435-441.
32	Ida S, Kaneko R, Imataka K, et al. Are diabetes-related factors associated with the social roles of elderly patients with diabetes?[J]. J Diabetes Complications, 2021, 35(1): 107759.
33	Öztürk ZA, Yesil Y, Kuyumcu ME, et al. Association of depression and sleep quality with complications of type 2 diabetes in geriatric patients[J]. Aging Clin Exp Res, 2015, 27(4): 533-538.
34	Leong WB, Jadhakhan F, Taheri S, et al. Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta-analysis[J]. Diabet Med, 2016, 33(2): 158-168.

Study	Country	Sample size	Mean age/ year	Exposure assessment	Sleep duration /h	Outcome	Outcome assessment	Adjusted variable	NOS score
Meng^［9］， 2016	China	1 220	57.78±10.41（DR present） 55.75±11.72（DR absent）	Self-report	Short （<6 ） Long （>9）	Any DR	Indirect ophthalmoscopy Retinal photographs	Gender， age， duration of diabetes， smoking history， BMI， SBP， HbA1c and dyslipidemia	7
Jee^［10］， 2017	Korean	1 670	60.3	Self-report	Short （≤5） Long （≥9）	Any DR VTDR	Retinal photographs	Gender， age， BMI， diabetes duration， fasting glucose level， HbA1c and hypertension	7
Chew^［11］， 2020	Singapore	92	57.6±8.3	Self-report	Short （<5 ）	Moderate DR VTDR	Retinal photographs	Age， gender， duration of diabetes	7
Raman^［12］，2012	India	1 414	M： 56.9±10.5	Self-report	Short （<5）	Any DR	Retinal photographs	Not mentioned	6
Raman^［12］，2012	India	1 414	F： 56.4±8.9	Self-report	Long （>9）	Any DR	Retinal photographs	Not mentioned	6
Tan^［13］， 2018	Malay India	1 231（Malaysian， 395；Indian， 836）	64.4±9.0	Self-report	Short （<6） Long （≥8）	Moderate DR VTDR	Retinal photographs	Age， gender， ethnicity， education， antihypertensive medication， current smoking， respiratory disorders， mood-related complaints， obesity， systolic and diastolic blood pressure， HbA1c， total cholesterol， low-density lipoprotein cholesterol， duration of diabetes， insulin use	9

Study	Country	Sample size	Mean age/ year	Exposure assessment	Sleep duration /h	Outcome	Outcome assessment	Adjusted variable	NOS score
Meng^［9］， 2016	China	1 220	57.78±10.41（DR present） 55.75±11.72（DR absent）	Self-report	Short （<6 ） Long （>9）	Any DR	Indirect ophthalmoscopy Retinal photographs	Gender， age， duration of diabetes， smoking history， BMI， SBP， HbA1c and dyslipidemia	7
Jee^［10］， 2017	Korean	1 670	60.3	Self-report	Short （≤5） Long （≥9）	Any DR VTDR	Retinal photographs	Gender， age， BMI， diabetes duration， fasting glucose level， HbA1c and hypertension	7
Chew^［11］， 2020	Singapore	92	57.6±8.3	Self-report	Short （<5 ）	Moderate DR VTDR	Retinal photographs	Age， gender， duration of diabetes	7
Raman^［12］，2012	India	1 414	M： 56.9±10.5	Self-report	Short （<5）	Any DR	Retinal photographs	Not mentioned	6
Raman^［12］，2012	India	1 414	F： 56.4±8.9	Self-report	Long （>9）	Any DR	Retinal photographs	Not mentioned	6
Tan^［13］， 2018	Malay India	1 231（Malaysian， 395；Indian， 836）	64.4±9.0	Self-report	Short （<6） Long （≥8）	Moderate DR VTDR	Retinal photographs	Age， gender， ethnicity， education， antihypertensive medication， current smoking， respiratory disorders， mood-related complaints， obesity， systolic and diastolic blood pressure， HbA1c， total cholesterol， low-density lipoprotein cholesterol， duration of diabetes， insulin use	9

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[4]	PAN Sheng-ke, LI Hui, WEI Yan-yan, YAO Pei-fen, LI Hua-fang. Placebo effect in primary insomnia: a meta-analysis [J]. , 2020, 40(4): 505-.
[5]	HUANG Yan, ZHANG Xian-gao, LIN Heng, CHENG Shu-ying. Meta-analysis of effect and safety of repetitive transcranial magnetic stimulation on patients with schizophrenia [J]. , 2020, 40(1): 81-.
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[7]	YU Qi1, 2, LIU Meng-xue3, YANG Jie3, LIU Kun1, 2, XU Xun1, 2. Automated analysis of microaneurysm lesions in standard seven-field color fundus photography [J]. , 2019, 39(6): 598-.
[8]	WANG Ye-wei, CHEN Yan, FANG Xin-yu, ZHANG Yi, CAI Jun, SONG Li-sheng, ZHANG Chen. Association of serum olanzapine concentration and cytochrome P450 1A2 gene polymorphisms: a meta-analysis [J]. , 2019, 39(10): 1167-.
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