title: Sleep and diabetic retinopathy.
abstract: OBJECTIVE
  To investigate the association between sleep duration and diabetic retinopathy (DR).
  
  
  METHODS
  A population-based cross-sectional study using a nation-wide, systemically stratified, multistage, clustered sampling method included a total of 1670 subjects aged ≥40 years with diabetes who participated in the Korean National Health and Nutrition Examination Survey during 2008-2012. All participants performed standardized interviews, including self-reported sleep duration, and comprehensive ophthalmic examinations. Seven standard retinal fundus photographs were obtained from both eyes after pupil dilatation. Diabetic retinopathy (DR) was graded and classified as any DR and vision-threatening DR. Participants were stratified into men and women.
  
  
  RESULTS
  The mean sleep duration was 6.71 hr/day. In men, adjusted OR of any DR was 1.88 [95% confidence interval (OR), 1.01-3.59] in those with ≤5 hr sleep, and 2.19 (95% CI, 1.01-4.89) in those with ≥9 hr sleep, compared to in subjects with 6-8 hr sleep, after adjusting for potential confounders including age, body mass index (BMI), diabetes duration, fasting glucose level, haemoglobin A1c levels and hypertension. In women, however, no significant association between sleep duration and DR was found. The vision-threatening DR was not significantly associated with sleep duration in either men or women.
  
  
  CONCLUSIONS
  Short and long sleep was associated with high prevalence of DR in men. Sleep deprivation may be involved in the pathogenesis of DR development.
authors.affiliation: Department of Ophthalmology and Visual Science, St. Vincents' Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.|Department of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Donghyun
authors.initials: D
authors.lastname: Jee
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Nana
authors.initials: N
authors.lastname: Keum
authors.affiliation: Department of Ophthalmology and Visual Science, St. Daejon's Hosptial, College of Medicine, Catholic University of Korea, Seoul, Korea.
authors.forename: Seungbum
authors.initials: S
authors.lastname: Kang
authors.affiliation: Department of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Arroyo
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000209:etiology / Q000503:physiopathology*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Korea; diabetic retinopathy; sleep duration; vision-threatening diabetic retinopathy