Association of ocular symptom burden with sleep quality and psychological distress in patients with primary glaucoma: A cross-sectional study.

Sleep problems and psychological distress are frequently reported by patients with primary glaucoma, yet the contribution of day‑to‑day ocular symptom burden has not been quantified with standard sleep and mental‑health metrics. We performed a single‑center cross‑sectional study of consecutive adults with primary glaucoma. Patients completed the study questionnaire, chart data provided visual acuity, visual field index, intraocular pressure. Ocular symptom burden (OSB) was derived from 20 bilateral ocular‑symptom items. Sleep quality was summarized by the Pittsburgh Sleep Quality Index (PSQI) constructed from S1 to S9 (global score 0-21; poor sleep PSQI > 5). Psychological distress was assessed with Kessler-10 psychological distress scale (K10) (10-50). Vision and visual‑field severities were recomputed as textbook‑concordant vision grade (1-5) and modified Glaucoma Symptom Scale grade from visual field index (1-5). Associations were tested with Spearman correlation (Benjamini-Hochberg false discovery rate), and multivariable linear/logistic regression (heteroskedasticity-consistent 3robust standard errors) adjusting for age, sex, glaucoma subtype, disease course, vision grade and visual‑field grade. We analyzed 208 patients (mean age 59.3 ± 15.0 years; 52.9% female; primary open-angle glaucoma 55.3%, primary angle-closure glaucoma 44.7%). Mean OSB severity was 34.9 ± 17.4 (0-80). PSQI global score averaged 5.81 ± 2.64; 51.9% met PSQI > 5 (108/208; 95% confidence interval (CI) 45.2%-58.6%), with sleep efficiency 90.6 ± 11.0%. K10 averaged 15.2 ± 4.9; 16.3% had mild‑to‑severe distress (≥20). OSB correlated with PSQI (OSB count r = 0.16, P = .022; OSB severity r = 0.14, P = .038) and more strongly with K10 (r = 0.23, P = .0007). The ocular‑surface/irritation symptom and pain domain correlated with PSQI (r = 0.16, P = .019), whereas visual‑function/glare domains did not (P > .20). In adjusted models, standardized OSB severity had a positive point estimate for PSOI (β = 0.31, 95% CI -0.04 to 0.66; P = .080) and was not independently associated with poor sleep (PSQI > 5; OR = 1.22, 95% CI 0.92-1.62; P = .165). Standardized OSB severity was also not independently associated with K10 total (β = 0.56, 95% CI -0.12 to 1.24; P = .109) or distress (K10 ≥ 20; OR = 1.03, 95% CI 0.72-1.48; P = .868). In this cross‑sectional study, OSB showed small bivariate correlations with sleep quality and psychological distress. However, covariate-adjusted associations were imprecise and not statistically significant. Given that approximately half of participants screened positive for poor sleep, brief screening for sleep quality and psychological distress may be considered in glaucoma care.