Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association between visual impairment and sleep quality: A cross-sectional, comparative study of severity, eye conditions, and risk factors

Eye volume 40, pages 230–237 (2026)Cite this article

Subjects

Abstract

Background/objectives

Visual impairment (VI) is associated with significant disruptions in sleep quality. This study aimed to investigate the association between VI and sleep quality across varying severities of VI and ocular conditions in adults.

Subjects/methods

A cross-sectional, observational, study was conducted among 277 adults with VI and 278 age- and sex-matched controls from two hospitals. Participants underwent comprehensive ocular examinations and completed the Arabic version of the Pittsburgh Sleep Quality Index (PSQI). Sociodemographic and clinical data were collected, and ocular conditions were recorded. Multivariate logistic regression models were used to evaluate the association between VI, its severity, ocular conditions, and poor sleep quality while adjusting for potential confounders.

Results

VI patients had worse sleep quality than controls (mean PSQI: 6.83 ± 3.6 vs. 5.30 ± 3.5; p < 0.001), with 57.8% experiencing poor sleep (PSQI > 5) compared to 36.7% of controls(p < 0.001). In multivariate analysis, patients with VI had significantly higher odds of poor sleep quality compared to controls (OR = 2.0 (95% CI: 1.4–2.8); p < 0.001). Moderate VI (OR = 2.1, 95% CI: 1.4–3.2, p = 0.001) and blindness (OR = 2.9, 95% CI: 1.4–5.9, p = 0.004) were significantly associated with poor sleep quality. Diabetic retinopathy (OR = 2.2, 95% CI: 1.4–3.4; p < 0.001) and combined ocular conditions (OR = 3.6, 95% CI: 1.4–9.3; p = 0.009) were significantly associated with poor sleep quality.

Conclusions

VI is significantly associated with poor sleep quality, particularly in moderate VI and blindness. Diabetic retinopathy and combined ocular conditions were associated with poor sleep quality. Comprehensive management strategies addressing sleep in VI patients are essential for improving their overall well-being.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Prevalence of poor sleep quality by ocular diagnosis and visual impairment severity.

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Panigrahi A, Nageswar Rao G, Kumari Konar A. Vision-Related Quality of Life and Its Sociodemographic Correlates Among Individuals With Visual Impairments. J Vis Impair Blindness. 2021;115:319–28.

    Article  Google Scholar 

  2. World Health Organization (2019) World report on vision. https://www.who.int/publications/i/item/9789241516570. Accessed 13 Feb 2025.

  3. Tamura N, Sasai-Sakuma T, Morita Y, Okawa M, Inoue S, Inoue Y. Prevalence and associated factors of circadian rhythm sleep-wake disorders and insomnia among visually impaired Japanese individuals. BMC Public Health. 2021;21:31.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chen X, Zhu Y, Luo M. The relationship between visual impairment and insomnia among people middle-aged and older in India. Sci Rep. 2024;14:30261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Choi S, Kim G, Pionke JJ. The Sleep Health of Individuals with Visual Impairments: A Scoping Review. Ophthalmic Epidemiol 2025;32:259–77.

  6. Uchiyama M, Lockley SW. Non-24-Hour Sleep-Wake Rhythm Disorder in Sighted and Blind Patients. Sleep Med Clin. 2015;10:495–516.

    Article  PubMed  Google Scholar 

  7. Hartley S, Dauvilliers Y, Quera-Salva M-A. Circadian Rhythm Disturbances in the Blind. Curr Neurol Neurosci Rep. 2018;18:65.

    Article  PubMed  Google Scholar 

  8. Aubin S, Gacon C, Jennum P, Ptito M, Kupers R. Altered sleep-wake patterns in blindness: a combined actigraphy and psychometric study. Sleep Med. 2016;24:100–8.

    Article  CAS  PubMed  Google Scholar 

  9. Xue R, Wan G. Association Between Vision-Related Functional Burden and Sleep Disorders in Adults Aged 20 and Over in the United States. Transl Vis Sci Technol. 2023;12:3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.

    Article  CAS  PubMed  Google Scholar 

  11. Al Maqbali M, Hughes C, Gracey J, Rankin J, Dunwoody L, Hacker E. Validation of the Pittsburgh Sleep Quality Index (PSQI) with Arabic cancer patients. Sleep Biol Rhythms. 2020;18:217–23.

    Article  Google Scholar 

  12. Ghemrawi R, Kerek R, Kayed K, Aldulaymi R, Ramadan A, Khair M. Association between visual impairment and sleep duration in college students: A study conducted in UAE and Lebanon. J Am Coll Health. 2023;71:228–34.

    Article  PubMed  Google Scholar 

  13. von Gall C. The Effects of Light and the Circadian System on Rhythmic Brain Function. Int J Mol Sci. 2022;23:2778.

    Article  Google Scholar 

  14. Skene DJ, Arendt J. Circadian rhythm sleep disorders in the blind and their treatment with melatonin. Sleep Med. 2007;8:651–5.

    Article  PubMed  Google Scholar 

  15. Nastasi JA. The strategies used by adults with visual impairment. Br J Occup Ther. 2024;87:213–20.

    Article  PubMed  Google Scholar 

  16. Arns M, Kooij JJS, Coogan AN. Review: Identification and Management of Circadian Rhythm Sleep Disorders as a Transdiagnostic Feature in Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry. 2021;60:1085–95.

    Article  PubMed  Google Scholar 

  17. Ramos AR, Wallace DM, Williams NJ, Spence DW, Pandi-Perumal SR, Zizi F, et al. Association between visual impairment and sleep duration: analysis of the 2009 National Health Interview Survey (NHIS). BMC Ophthalmol. 2014;14:1–5.

    Article  Google Scholar 

  18. Barbosa DG, Andrade RD, Santos MdeO, Silva RCD, Beltrame TS, Gomes Felden ÉP. Assessment of sleep in subjects with visual impairment: Comparison using subjective and objective methods. Chronobiol Int. 2017;34:895–902.

    Article  PubMed  Google Scholar 

  19. Um YH, Kim T-W, Jeong J-H, Hong S-C, Seo H-J, Han K-D Association Between Diabetic Retinopathy and Insomnia Risk: A Nationwide Population-Based Study. Front Endocrinol. https://doi.org/10.3389/fendo.2022.939251 (2022).

  20. Tan NYQ, Chew M, Tham Y-C, Nguyen QD, Yasuda M, Cheng C-Y, et al. Associations between sleep duration, sleep quality and diabetic retinopathy. PLoS ONE. 2018;13:e0196399.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Altaf QA, Dodson P, Ali A, Raymond NT, Wharton H, Fellows H, et al. Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study. Am J Respir Crit Care Med. 2017;196:892–900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Chang AC, Fox TP, Wang S, Wu AY. Relationship Between Obstructive Sleep Apnea And The Presence And Severity Of Diabetic Retinopathy. RETINA. 2018;38:2197.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ayaki M, Shiba D, Negishi K, Tsubota K. Depressed visual field and mood are associated with sleep disorder in glaucoma patients. Sci Rep. 2016;6:25699.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Agorastos A, Skevas C, Matthaei M, Otte C, Klemm M, Richard G, et al. Depression, Anxiety, and Disturbed Sleep in Glaucoma. JNP. 2013;25:205–13.

    Article  Google Scholar 

  25. Stoner AM, Patnaik JL, Ertel MK, Capitena-Young CE, SooHoo JR, Pantcheva MB, et al. Subjective and Objective Measurement of Sleep Quality and Activity in Glaucoma. J Glaucoma. 2023;32:265–71.

    Article  PubMed  Google Scholar 

  26. Jimura H, Yoshikawa T, Obayashi K, Miyata K, Saeki K, Ogata N. Post-Illumination Pupil Response and Sleep Quality in Patients With Glaucoma: The LIGHT Study. Invest Ophthalmol Vis Sci. 2023;64:34.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bec L, Herber R, Bailly S, Van Ngo TH, Tamisier R, Pépin J-L, et al. Sleep quality in glaucoma patients. Sci Rep. 2024;14:25593.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Sia JT, Lee EPX, Cheung CMG, Fenwick EK, Laude A, Ho KC, et al. Associations between age-related macular degeneration and sleep dysfunction: A systematic review. Clin Exp Ophthalmol. 2022;50:1025–37.

    Article  PubMed  Google Scholar 

  29. Etindele Sosso FA, Kreidlmayer M, Pearson D, Bendaoud I. Towards A Socioeconomic Model of Sleep Health among the Canadian Population: A Systematic Review of the Relationship between Age, Income, Employment, Education, Social Class, Socioeconomic Status and Sleep Disparities. Eur J Investig Health, Psychol Educ. 2022;12:1143–67.

    CAS  PubMed  Google Scholar 

  30. Gulati I, Kilian C, Buckley C, Mulia N, Probst C Socioeconomic disparities in healthcare access and implications for all-cause mortality among US adults: a 2000-2019 record linkage study. Am J Epidemiol. 2025;194:432–40.

  31. Kim H, Park J, Kim JB. A Case of Circadian Rhythm Sleep-Wake Disorder in Partial Blindness. J Sleep Med. 2018;15:31–34.

    Article  Google Scholar 

  32. Kessel L, Siganos G, Jørgensen T, Larsen M. Sleep Disturbances Are Related to Decreased Transmission of Blue Light to the Retina Caused by Lens Yellowing. Sleep. 2011;34:1215–9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gubin DG, Malishevskaya N, Astakhov YS, Astakhov SY, Cornelissen G, Kuznetsov VA, et al. Progressive retinal ganglion cell loss in primary open-angle glaucoma is associated with temperature circadian rhythm phase delay and compromised sleep. Chronobiol Int. 2019;36:564–77.

    Article  CAS  PubMed  Google Scholar 

  34. Zizi F, Jean-Louis G, Magai C, Greenidge KC, Wolintz AH, Heath-Phillip O. Sleep Complaints and Visual Impairment Among Older Americans: A Community-Based Study. J Gerontol Ser A. 2002;57:M691–4.

    Article  Google Scholar 

  35. Adhikari S, van Nispen RMA, Poudel M, van Rens F, Elsman EBM, van der Werf YD, et al. Sleep Patterns in Children With Blindness: A Comparison With Normally Sighted Peers. Invest Ophthalmol Vis Sci. 2023;64:46.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hayton J, Marshall J, Dimitriou D. Lights Out: Examining Sleep in Children with Vision Impairment. Brain Sci. 2021;11:421.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Khan SA, Heussler H, McGuire T, Dakin C, Pache D, Norris R, et al. Therapeutic options in the management of sleep disorders in visually impaired children: a systematic review. Clin Ther. 2011;33:168–81.

    Article  PubMed  Google Scholar 

  38. Leger D, Prevot E, Philip P, Yence C, Labaye N, Paillard M, et al. Sleep disorders in children with blindness. Ann Neurol. 1999;46:648–51.

    Article  CAS  PubMed  Google Scholar 

  39. Dietrich SK, Francis-Jimenez CM, Knibbs MD, Umali IL, Truglio-Londrigan M. Effectiveness of sleep education programs to improve sleep hygiene and/or sleep quality in college students: a systematic review. JBI Evid Synth. 2016;14:108.

    Google Scholar 

  40. Asplund R, Lindblad BE. Sleep and sleepiness 1 and 9 months after cataract surgery. Arch Gerontol Geriatr. 2004;38:69–75.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the deanship of research, Jordan University of Science and Technology, Grant No: [20210196]. The sponsor was not involved in any stage of this work.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan

    Hisham M. Jammal

  2. Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan

    Yousef Khader

  3. Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan

    Khader Almhdawi

  4. Department of Ophthalmology, Faculty of Medicine, Yarmouk University, Irbid, Jordan

    Rami Al- Omari

  5. Department of Ophthalmology, School of Medicine, The University of Jordan, Amman, Jordan

    Muawyah Al Bdour

Authors
  1. Hisham M. Jammal
    View author publications

    Search author on:PubMed Google Scholar

  2. Yousef Khader
    View author publications

    Search author on:PubMed Google Scholar

  3. Khader Almhdawi
    View author publications

    Search author on:PubMed Google Scholar

  4. Rami Al- Omari
    View author publications

    Search author on:PubMed Google Scholar

  5. Muawyah Al Bdour
    View author publications

    Search author on:PubMed Google Scholar

Contributions

HJ led the conceptualisation, methodology, formal analysis, investigation, writing - original draft, supervision, and funding acquisition. YK was involved in conceptualisation, methodology, formal analysis, writing - review & editing. KA was involved in conceptualisation, resources, writing - review & editing. RA was involved in conceptualisation, writing - review & editing. MA was involved in conceptualisation, methodology, investigation, writing - review & editing. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Hisham M. Jammal.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jammal, H.M., Khader, Y., Almhdawi, K. et al. Association between visual impairment and sleep quality: A cross-sectional, comparative study of severity, eye conditions, and risk factors. Eye 40, 230–237 (2026). https://doi.org/10.1038/s41433-025-04150-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41433-025-04150-0

Search

Advanced search

Quick links