The Association of Dry Eye Symptom Severity and Comorbid Insomnia in US Veterans.
OBJECTIVE
To investigate the association between dry eye (DE) and insomnia symptom severity.


METHODS
Cross-sectional study of 187 individuals seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding insomnia (insomnia severity index [ISI]) and DE symptoms, including ocular pain, followed by a comprehensive ocular surface examination. Using a two-step cluster analysis based on intensity ratings of ocular pain, the patient population was divided into two groups (high and low ocular pain groups: HOP and LOP). A control group was ascertained at the same time from the same clinic as defined by no symptoms of DE (Dry Eye Questionnaire 5 [DEQ5], <6). The main outcome measure was the frequency of moderate or greater insomnia in the DE groups.


RESULTS
The mean age of the study sample was 63 years, and 93% were male. All insomnia complaints were rated higher in the HOP group compared with the LOP and control groups (P<0.0005). Most (61%) individuals in the HOP group experienced insomnia of at least moderate severity (ISI≥15) compared with the LOP (41%) and control groups (18%) (P<0.0005). Black race (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.0; P=0.02), depression severity (OR, 1.2; 95% CI, 1.1-1.3; P<0.0005), and DE symptom severity (DEQ5; OR, 1.1; 95% CI, 1.01-1.2; P=0.03) were significantly associated with clinical insomnia (ISI≥15) after controlling for potential confounders.


CONCLUSIONS
After adjusting for demographics and medical comorbidities, we show that DE symptom severity is positively associated with insomnia severity.
Research Services (A.G., B.E.S., J.J.P., A.L.M., E.R.F., R.C.L., C.S., D.M.W.), Miami Veterans Administration Medical Center, Miami, FL; Department of Ophthalmology (A.G., W.F.), Bascom Palmer Eye Institute, University of Miami, Miami, FL; Department of Physical Medicine and Rehabilitation (E.R.F.), University of Miami Miller School of Medicine, Miami, FL; Department of Anesthesiology (R.C.L., C.S.), Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL; John P. Hussman Institute for Human Genomics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; John T Macdonald Foundation Department of Human Genetics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; and Department of Neurology (D.M.W.), University of Miami Miller School of Medicine, Miami, FL.
Anat
A
Galor
Benjamin E
BE
Seiden
Jasmine J
JJ
Park
William J
WJ
Feuer
Allison L
AL
McClellan
Elizabeth R
ER
Felix
Roy C
RC
Levitt
Constantine D
CD
Sarantopoulos
Douglas M
DM
Wallace
D015897:Comorbidity; D003430:Cross-Sectional Studies; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans