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

Oct 16, 2025Eye (London, England)

Links between sleep habits and diabetic eye disease from short- and long-term studies

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Abstract

Frequent daytime napping is associated with a 1.847 times higher prevalence of diabetic retinopathy (DR).

Higher prevalence of DR was observed in individuals who usually nap during the day compared to those who rarely or never nap.
Longitudinal data indicated that frequent daytime napping is linked to a 2.317 times higher risk of developing DR.
Analysis from the Shanghai Cohort of Diabetic Eye Disease found significant associations between more frequent napping, longer daytime sleep duration, and higher scores on the Epworth Sleepiness Scale with increased DR prevalence.
Mendelian randomisation analysis suggested a potential link between daytime napping and DR, with an odds ratio of 1.46, although this finding did not survive correction for multiple testing.

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

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