Increased Risk of Central Serous Chorioretinopathy among Patients with Nonorganic Sleep Disturbance

Abstract

Purpose. Patients with central serous chorioretinopathy (CSC) typically present with acute visual impairment and metamorphopsia. The disease previously has been associated with psychological stress. Population-based cohort studies on the risk of CSC among patients with nonorganic sleep disturbance (NOSD) are limited. An early sign of psychiatric disorder was probably sleep disturbance. Furthermore, psychological stress may be caused by sleep disturbance. We investigated the relationship between NOSD and the incidence of CSC. Design. Longitudinal cohort study. Participants. We used the Longitudinal Health Insurance Database and collected the data of 53,743 NOSD patients without CSC between 2000 and 2005 as the study group. Four-fold controls were selected randomly from those without neither sleep disturbance nor a CSC history with frequency matching of age, sex, and index-year. Methods. The difference in sex, age group, comorbidities, and steroid use between the two groups was analyzed by the χ2 test. Cox-proportional hazard regression was utilized to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for comparison of the two groups. Kaplan–Meier analysis was applied to measure the cumulative incidence of CSC. Furthermore, the log-rank test was used to test the incidence difference between the two groups. Main Outcome Measures. The incidence rate of CSC in the following years until 2011 was detected. Results. During a mean follow-up of 7.36 ± 2.88 years, NOSD patients had a higher incidence of CSC than the controls (3.10 vs. 1.86 per 10,000 person-years; adjusted HR, 1.65; 95% CI, 1.34–2.02). Men had a higher risk of CSC than women. Sensitivity analyses stratified by sex, age group, or comorbidity condition showed consistently that NOSD patients had a higher risk of CSC than their controls. Dose-response showed that higher NOSD severity had even higher CSC risk. Conclusions. NOSD is an independent indicator for the increased risk of subsequent CSC development.

Exploring the Biopsychosocial Pathways Shared by Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC): A Literature Overview

“…With regards to the role of choroidal thickness in both diseases, further studies are warranted to explore the pathophysiology of choroidal thinning and its potential usefulness as a biomarker of systemic vascular dysfunction. Alongside these observations, it has been shown that in OSA-affected subjects, prolonged stimulation by high catecholamine levels might provoke focal retinal pigment epithelium (RPE) cell dysfunction, resulting in a breakdown of the outer blood-retinal barrier, followed by diffusion of fluids, promoting CSC [ 16 , 44 , 45 ].…”

Sharing the Same Perspective. Mental Disorders and Central Serous Chorioretinopathy: A Systematic Review of Evidence from 2010 to 2020

“…In contrast, two other studies from the same group reported no difference in anxiety scores between very small samples of CSC patients at onset and HC [17,18], these studies has an important risk of bias: patients with chronic pharmacological therapy [17] or vasoactive therapy [18] were excluded from the sample. In fact, high evidence levels from longitudinal cohort studies correlate exposure to sleeping pills [16] and anti-anxiety drug [31] with a higher risk of CSC. Both studies [16,31] were performed based on the TNHIR database.…”

“…[ We found four studies using data from the Taiwan National Health Insurance Research (TNHIR) database [11,16,29,31]. Tien et al (2020) made a longitudinal retrospective cohort study to investigate the association between non-organic sleep disturbance (NOSD) and CSC.…”

“…Male patients with a history of steroid usage within 1 year before CSC development were at higher risk to develop CSC than women and non-steroid usage. The subgroup using sleeping pills had a higher risk of CSC compared to subjects not using drugs for insomnia [16]. Tsai et al (2013) evaluated risk factors for CSC unrelated to corticosteroid use with a retrospective cohort study.…”

Central Serous Chorioretinopathy and Personality Characteristics: A Systematic Review of Scientific Evidence over the Last 10 Years (2010 to 2020)

“…An important line of research about CSC is currently focused on differences between patients with an acute disorder and those who develop a chronic disorder [ 22 , 23 , 24 ]. Emerging evidence highlights that patients with non-organic sleep disorders have a higher incidence of CSC than controls, independent of any other comorbidity [ 25 ]. Personality disorders and insomnia show a mutual influence within a circular model in which insomnia is related to maladaptive personality traits and, on the other hand, personality disorders promote the onset of insomnia [ 26 ].…”