The relationship between sleep disorders and photosensitive retina ganglion cells in glaucoma patients

Purpose: To assess the effects of circadian rhythm disturbance on nighttime sleep quality and daytime sleepiness after progressive photosensitive retinal ganglion cell damage in glaucoma patients. Methods: The study included 37 patients with primary open-angle glaucoma who applied to the glaucoma unit of Yozgat Bozok University Ophthalmology Department between August 2020 and February 2021, and 34 patients with no diagnosis or suspicion of glaucoma. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were administered to all patients by the same experienced person. Exclusion questionnaires (Beck Anxiety, Beck Depression, Berlin, and Stop-Bang) were administered to the individuals participating in the study for diseases such as anxiety, depression, and obstructive sleep apnea that may cause sleep disturbance. RNFL, GCC, FLV and GLV values of individuals diagnosed with primary open-angle glaucoma and healthy individuals were measured by optical coherence tomography. Perimetry was performed in all patients and the mean deviation value was obtained. The relationship between glaucomatous damage detected in glaucoma patients and their nighttime sleep quality and daytime sleepiness was evaluated by questionnaires. Results: There was no difference between the groups participating in the study in terms of age, gender and education levels. As the numerical value of the mean deviation values increased in the primary open-angle glaucoma group, there was a statistically significant increase in the individuals' PSQI sleep quality, sleep latency, sleep duration, sleep efficiency and daytime functions (p<0.05). The decrease in mean RNFL, superior RNFL and inferior RNFL values and the increase in total ESS and PSQI values in the primary open-angle glaucoma group were statistically significant (p<0.05). In addition, the decrease in superior RNFL and inferior RNFL values and the increase in sleep quality, sleep latency, sleep duration and sleep efficiency values, which are sub-components of PSQI, were statistically significant (p<0.05). The decrease in GCC values and the increase in ESS, PSQI total, sleep quality, sleep latency, sleep duration and sleep efficiency values were statistically significant in the primary open-angle glaucoma group (p<0.05). In the control group, there was no statistically significant difference between MD, RNFL, GCC, FLV, GLV values and ESS, PSQI, PSQI subcomponents. Conclusion: Glaucoma can cause progressive loss of photosensitive retinal ganglion cells (ipRGC). The progressive loss of photosensitive retinal ganglion cells may cause the circadian rhythm to be out of sync due to decreased light transmission. As the amount of glaucomatous damage increases, there is a decrease in sleep quality and an increase in daytime sleepiness in patients with primary open-angle glaucoma. Giving various prophylactic treatments in addition to medical treatment in glaucoma patients will prevent deterioration in their quality of life. Keywords: Primary open-angle glaucoma, photosensitivity retinal ganglion cells, sleep disorders, Epworth Sleepiness Scale, Pittsburg Sleep Quality Index