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Associations between sleep patterns and diabetic retinopathy: insights from cross-sectional and longitudinal evidence

Eye volume 39, pages 3314–3323 (2025)Cite this article

Subjects

Abstract

Objectives

To investigates the associations between various sleep patterns and DR prevalence and incidence.

Methods

We conducted a multi-stage analysis combining cross-sectional and longitudinal data from UK Biobank (UKB) and Shanghai Cohort of Diabetic Eye Disease (SCODE), alongside two-sample Mendelian randomisation (MR) using genome-wide association study (GWAS) summary statistics. Sleep traits included daytime napping, sleep duration, chronotype, snoring, insomnia, dozing and sleep apnoea. Associations with DR prevalence and incidence were evaluated using logistic and Cox regression models, adjusting for key covariates. Daytime sleepiness was further assessed using the Epworth Sleepiness Scale (ESS). MR analysis employed inverse variance weighting and sensitivity tests to assess causality, heterogeneity, and pleiotropy.

Results

UKB cross-sectional data showed that frequent daytime napping was associated with higher DR prevalence (Usually vs. Never/rarely, adjusted odds ratio [OR] = 1.847, P < 0.001), while SCODE data linked more frequent napping (P = 0.013), longer daytime sleep duration (P = 0.023), and higher Epworth Sleepiness Scale scores (P = 0.046) to higher DR prevalence. Longitudinal analysis found that frequent daytime napping (Usually vs. Never/rarely, hazard ratio [HR] = 2.317, P < 0.001) was associated with DR incidence. Mendelian randomisation analysis suggested a possible link between daytime napping and DR (IVW OR = 1.46, P = 0.04), though this did not withstand multiple testing correction.

Conclusions

Excessive daytime sleepiness may be associated with an increased risk of DR.

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Fig. 1: Study Design and Mendelian Randomisation Framework.

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Data availability

This study utilised data from the UK Biobank (UKB), the Shanghai Cohort for Diabetic Eye Disease (SCODE), and publicly available genome-wide association studies (GWAS). Access to the UK Biobank data is available to bona fide researchers through application via access@ukbiobank.ac.uk and subject to the UKB’s institutional access procedures. Data from the SCODE study are not publicly available but can be obtained from the corresponding author (YM) upon reasonable request and under a formal data use agreement. The SCODE dataset can only be shared for non-commercial academic purposes, and data sharing must comply with relevant Chinese laws and regulations. Summary statistics from GWAS used in this study are publicly accessible and their sources are detailed in the Supplementary Materials.

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Funding

This work was supported by the National Key Research and Development Program of China (2021YFC2702100), the Key Disciplinary Projects of the 3-year Action Plan to Strengthen the Construction of the Public Health System in Shanghai (GWVI-11.1-30), the Science and Technology Commission of Shanghai Municipality (23ZR1481000), the Shanghai Municipal Health Commission (2022YQ051), Shanghai Engineering Research Centre of Precise Diagnosis and Treatment of Eye Diseases (19DZ2250100), and Shanghai “Rising Stars of Medical Talent” Youth Development Program.

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  1. These authors contributed equally: Xixuan Zhao, Senlin Lin.

Authors and Affiliations

  1. Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Xixuan Zhao, Haidong Zou & Yingyan Ma

  2. Shanghai Eye Diseases Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China

    Xixuan Zhao, Senlin Lin, Lina Lu, Yi Xu, Haidong Zou & Yingyan Ma

  3. Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China

    Xixuan Zhao, Senlin Lin, Lina Lu, Yi Xu, Haidong Zou & Yingyan Ma

  4. Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China

    Xixuan Zhao, Senlin Lin, Lina Lu, Yi Xu, Haidong Zou & Yingyan Ma

  5. National Clinical Research Center for Eye Diseases, Shanghai, China

    Xixuan Zhao, Senlin Lin, Lina Lu, Yi Xu, Haidong Zou & Yingyan Ma

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Contributions

Conceptualisation, XZ, SL, LL, YX, HZ and YM; Methodology, SL, LL, YX, HZ and YM; Formal Analysis, XZ, SL, and YM; Investigation, SL, LL, YX, HZ and YM; Resources, SL, LL, YX, HZ and YM; Data Curation, SL, LL, YX, HZ and YM; Writing – Original Draft, XZ, SL, and YM; Writing – Review & Editing, all authors; Visualisation, LL, YX, HZ and YM; Supervision, SL, LL, YX, HZ and YM; Project Administration, SL, LL, YX, HZ and YM; Funding Acquisition, HZ.

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Correspondence to Haidong Zou or Yingyan Ma.

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Zhao, X., Lin, S., Lu, L. et al. Associations between sleep patterns and diabetic retinopathy: insights from cross-sectional and longitudinal evidence. Eye 39, 3314–3323 (2025). https://doi.org/10.1038/s41433-025-04066-9

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