Correlation of ocular surface function with sleep quality, anxiety, and depression in patients with dry eye disease

Table 1 Distribution of sleep quality scores among the patients, n (%)/mean ± SD

Variable	Number	PSQI	Statistic	P value
Total	358 (100)	9.94 ± 2.18
Age (years)			t = -2.34	0.020
< 50	213 (59.50)	9.71 ± 2.03
≥ 50	145 (40.50)	10.27 ± 2.35
Gender			t = -0.28	0.780
Female	243 (67.88)	9.91 ± 2.25
Male	115 (32.12)	9.98 ± 2.02
Degree of education			t = -2.20	0.028
College or higher	77 (21.51)	9.45 ± 2.37
Below college	281 (78.49)	10.07 ± 2.11
Hypertension			t = -1.48	0.140
No	239 (66.76)	9.82 ± 2.18
Yes	119 (33.24)	10.18 ± 2.17
Diabetes			t = -1.72	0.086
No	283 (79.05)	9.83 ± 2.16
Yes	75 (20.95)	10.32 ± 2.20
Duration of illness			t = -1.51	0.133
< 12 months	188 (52.51)	9.77 ± 2.19
≥ 12 months	170 (47.49)	10.12 ± 2.16

PSQI: Pittsburgh Sleep Quality Index.

Table 2 Distribution of anxiety scores among the patients, n (%)/mean ± SD

Variable	Number	SAS	Statistic	P value
Total	358 (100)	47.30 ± 4.90
Age (years)			t = -1.83	0.068
< 50	213 (59.50)	46.91 ± 4.92
≥ 50	145 (40.50)	47.87 ± 4.83
Gender			t = -0.55	0.581
Female	243 (67.88)	47.20 ± 4.89
Male	115 (32.12)	47.50 ± 4.92
Degree of education			t = 0.01	0.996
College or higher	77 (21.51)	47.30 ± 4.80
Below college	281 (78.49)	47.30 ± 4.93
Hypertension			t = -0.98	0.328
No	239 (66.76)	47.12 ± 4.78
Yes	119 (33.24)	47.66 ± 5.13
Diabetes			t = -0.44	0.657
No	283 (79.05)	47.24 ± 4.93
Yes	75 (20.95)	47.52 ± 4.81
Duration of illness			t = -1.99	0.047
< 12 months	188 (52.51)	46.81 ± 5.11
≥ 12 months	170 (47.49)	47.84 ± 4.61

SAS: Self-Rating Anxiety Scale.

Table 3 Distribution of depression scores among the patients, n (%)/mean ± SD

Variable	Number	SDS	Statistic	P value
Total	358 (100)	50.08 ± 5.52
Age (years)			t = -3.10	0.002
< 50	213 (59.50)	49.34 ± 5.51
≥ 50	145 (40.50)	51.16 ± 5.38
Gender			t = -1.71	0.088
Female	243 (67.88)	49.73 ± 5.62
Male	115 (32.12)	50.80 ± 5.25
Degree of education			t = -0.76	0.445
College or higher	77 (21.51)	49.65 ± 5.27
Below college	281 (78.49)	50.19 ± 5.59
Hypertension			t = -1.57	0.117
No	239 (66.76)	49.73 ± 5.14
Yes	119 (33.24)	50.76 ± 6.18
Diabetes			t = -2.26	0.025
No	283 (79.05)	49.74 ± 5.56
Yes	75 (20.95)	51.35 ± 5.23
Duration of illness			t = -3.35	< 0.001
< 12 months	188 (52.51)	49.16 ± 5.17
≥ 12 months	170 (47.49)	51.09 ± 5.73

SDS: Self-Rating Depression Scale.

Table 4 Distribution of ocular surface functions among the patients, n (%)/mean ± SD

Variable	Number	OSDI	TBUT	FL	SIT
Total	358 (100)	32.66 ± 6.79	4.69 ± 1.18	2.77 ± 0.52	4.84 ± 1.20
Age (years)
< 50	213 (59.50)	31.73 ± 6.29b	4.81 ± 1.23a	2.74 ± 0.53	4.92 ± 1.22
≥ 50	145 (40.50)	34.04 ± 7.27	4.52 ± 1.09	2.81 ± 0.49	4.71 ± 1.16
Gender
Female	243 (67.88)	32.69 ± 6.64	4.75 ± 1.22	2.77 ± 0.53	4.84 ± 1.18
Male	115 (32.12)	32.61 ± 7.13	4.57 ± 1.11	2.77 ± 0.50	4.82 ± 1.25
Degree of education
College or higher	77 (21.51)	32.23 ± 6.90	4.91 ± 1.09	2.72 ± 0.53	4.81 ± 1.24
Below college	281 (78.49)	32.78 ± 6.77	4.63 ± 1.20	2.78 ± 0.51	4.84 ± 1.19
Hypertension
No	239 (66.76)	32.20 ± 6.78	4.65 ± 1.17	2.73 ± 0.52	4.82 ± 1.24
Yes	119 (33.24)	33.60 ± 6.75	4.77 ± 1.22	2.83 ± 0.50	4.87 ± 1.12
Diabetes
No	283 (79.05)	32.51 ± 6.67	4.76 ± 1.18*	2.72 ± 0.51b	4.88 ± 1.22
Yes	75 (20.95)	33.24 ± 7.24	4.42 ± 1.17	2.97 ± 0.48	4.68 ± 1.10
Duration of illness
< 12 months	188 (52.51)	32.41 ± 6.65	4.76 ± 1.11	2.69 ± 0.52b	5.05 ± 1.21b
≥ 12 months	170 (47.49)	32.95 ± 6.95	4.61 ± 1.26	2.86 ± 0.50	4.60 ± 1.15

^aP < 0.05.

^bP < 0.01.

OSDI: Ocular surface disease index; TBUT: Tear film break-up time; FL: Fluorescein Staining Score; SIT: Schirmer I test.

Table 5 Correlation among the ocular surface status indicators, sleep quality, anxiety, and depression

Variable		PSQI	SAS	SDS	OSDI	TBUT	FL	SIT
PSQI	r	1	0.1574	0.207	0.245	-0.177	0.206	-0.116
	P value		0.003	< 0.001	< 0.001	< 0.001	< 0.001	0.028
SAS	r	0.1574	1	0.162	0.183	-0.208	0.218	-0.167
	P value	0.003		0.002	< 0.001	< 0.001	< 0.001	0.001
SDS	r	0.207	0.162	1	0.200	-0.162	0.284	-0.234
	P value	< 0.001	0.002		< 0.001	0.002	< 0.001	< 0.001
OSDI	r	0.245	0.183	0.200	1	-0.111	0.213	-0.245
	P value	< 0.001	< 0.001	< 0.001		0.037	< 0.001	< 0.001
TBUT	r	-0.177	-0.208	-0.162	-0.111	1	-0.254	0.195
	P value	< 0.001	< 0.001	0.002	0.037		< 0.001	< 0.001
FL	r	0.206	0.218	0.284	0.213	-0.254	1	-0.280
	P value	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001		< 0.001
SIT	r	-0.116	-0.167	-0.234	-0.245	0.195	-0.280
	P value	0.028	0.001	< 0.001	< 0.001	< 0.001	< 0.001

PSQI: Pittsburgh Sleep Quality Index; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; OSDI: Ocular surface disease index; TBUT: Tear film break-up time; FL: Fluorescein staining score; SIT: Schirmer I test.

Table 6 Multiple linear regression analysis

Variables	β	SE	t	P value	β (95%CI)	VIF
Intercept	10.60	4.27	2.48	0.014	10.60 (2.23-18.97)
Age (years)
< 50					Reference1
≥ 50	1.55	0.71	2.19	0.029	1.55 (0.16-2.93)	1.040
PSQI	0.58	0.16	3.59	< 0.001	0.58 (0.26-0.90)	1.070
SAS	0.17	0.07	2.40	0.017	0.17 (0.03-0.31)	1.048
SDS	0.15	0.06	2.36	0.019	0.15 (0.03-0.28)	1.082
R2	0.112
F value	F(4, 353) = 11.094, P < 0.001
Durbin-Watson value	2.007

¹Reference group.

PSQI: Pittsburgh Sleep Quality Index; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; CI: Confidence interval; VIF: Variance inflation factor.