Prevalence of dry eye disease and its association with sleep quality and depression: A hospital-based survey in Thai population
Issued Date
2025-06-18
Resource Type
eISSN
20446055
Scopus ID
2-s2.0-105008538847
Journal Title
BMJ Open
Volume
15
Issue
6
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMJ Open Vol.15 No.6 (2025)
Suggested Citation
Jongkhajornpong P., Lekhanont K., Anothaisintawee T., Rattanasiri S., McKay G., Attia J., Thakkinstian A. Prevalence of dry eye disease and its association with sleep quality and depression: A hospital-based survey in Thai population. BMJ Open Vol.15 No.6 (2025). doi:10.1136/bmjopen-2024-094046 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/111003
Title
Prevalence of dry eye disease and its association with sleep quality and depression: A hospital-based survey in Thai population
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives To estimate the prevalence of dry eye disease (DED) and explore its association with depression and poor sleep quality. Design A cross-sectional study. Setting The study was conducted at the ophthalmology outpatient clinic of a tertiary university hospital in Thailand, from September 2022 to April 2023. Participants A total of 1321 patients aged 18 years or older, without any history of orbital disease, active superficial or intraocular infection/inflammation, eyelid pathology, or prior intraocular or eyelid surgery within the past 6 months, were enrolled in the study. Interventions All patients underwent dry eye examination, including the Ocular Surface Disease Index questionnaire, tear break-up time and ocular surface staining. Physical activity was measured using the Global Physical Activity Questionnaire, which was expressed as total Metabolic Equivalent of Task-minutes per week. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), Composite Scale of Morningness (CSM) and STOP-Bang. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9). Primary and secondary outcome measures Prevalence of DED and association pathways involving depression, sleep quality and DED. Results The mean age of the participants was 58.3±14.0 years, with a female predominance of 73.7%. Of the 1321 patients, 668 were diagnosed with DED, resulting in a hospital-based prevalence of 50.6% (95% CI: 47.8%, 53.3%). After adjusting for age, sex and underlying disease, PSQI, PHQ-9, STOP-Bang and CSM scores remained significantly associated with DED with adjusted ORs of 2.48 (95% CI: 1.96, 3.14; p<0.001), 1.65 (95% CI: 1.05, 2.61; p=0.031), 1.81 (95% CI: 1.05, 3.14; p=0.033) and 1.32 (95% CI: 1.04, 1.68; p=0.023), respectively. The effects of depression on DED were mediated indirectly via poor sleep quality (OR=1.32; 95% CI: 1.18, 1.49; p<0.001) and directly via other mechanisms (OR=1.66; 95% CI: 1.06, 2.58; p=0.021). Conclusions DED is notably common among Thai patients. Depression and poor sleep quality are significantly associated with DED. Poor sleep quality may mediate the relationship between depression and DED.