睡眠时间与糖尿病性视网膜病变风险关系的meta分析

Meta-analysis of the relationship between sleep duration and the risk of diabetic retinopathy

目的·采用meta分析探讨睡眠时间与糖尿病性视网膜病变(diabetic retinopathy,DR)风险的关系。方法·计算机检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文摘数据库、中国知网、维普数据库和万方数据知识服务平台等数据库,检索时间从建库至2021年4月。英文检索词包括"sleep""sleep duration""sleep time""sleeping habit""quantity of sleep""diabetic retinopathy"和"retinal diseases",中文检索词为"睡眠""睡眠时间""糖尿病性视网膜病变"。收集各数据库中发表的有关睡眠时间与发生DR风险关系的文献,文献类型为观察性研究,包括横断面研究、病例对照研究和队列研究。由2名研究人员独立筛选文献、提取数据和评价纳入文献的质量。提取的数据包括第一作者、研究地区、发表时间、研究类型、样本量、年龄、睡眠时间评估方法、睡眠时间分组、结局指标、校正混杂因素。采用纽卡斯尔-渥太华量表评价纳入文献的质量。使用R 4.0.4软件进行meta分析。结果·共纳入5篇文献,包含研究对象5627例。Meta分析结果表明:长睡眠时间与DR发生的风险呈正相关[固定效应模型和随机效应模型合并效应量比值比(odds ratio,OR)均为2.05,95%置信区间(confidence interval,CI)1.37~3.05],短睡眠时间与DR的发生风险无关(固定效应模型OR=0.89,95%CI 0.72~1.10;随机效应模型OR=0.98,95%CI 0.71~1.37),但与中度DR的发生相关(固定效应模型OR=2.07,95%CI 1.29~3.33;随机效应模型OR=2.06,95%CI 1.18~3.58);短睡眠时间与威胁视力的糖尿病视网膜病变风险无关(固定效应模型和随机效应模型OR均为0.92,95%CI 0.58~1.47)。结论·睡眠时间与DR患病风险存在显著关联。其中,过长的睡眠时间是DR的危险因素,而短睡眠时间则待研究进一步确定。作为个人层面的可改变因素,睡眠干预对于DR管理的作用应当得到进一步重视。

Objective·To explore the relationship between sleep duration and the risk of diabetic retinopathy(DR)by performing a meta-analysis.Methods·The databases of Cochrane Library,Pub Med,Embase,Web of Science,Sino Med,CNKI,VIP,and Wan Fang were searched for eligible studies regarding the relationship between sleep duration and the risk of DR up to April 2021.English search terms included"sleep""sleep duration""sleep time""sleeping habit""quantity of sleep diabetic retinopathy"and"retinal diseases".Chinese search terms included"睡眠""睡眠时间"and"糖尿病性视网膜病变".The type of literature was observational studies,including cross-sectional studies,case-control studies,and cohort studies.Two researchers independently screened the literature and extracted data.The extracted data included the first author,country,publication time,study type,sample size,mean age,exposure assessment,sleep duration,outcome assessment,adjusted variables.The Newcastle-Qttawa Scale(NOS)was used to evaluate the quality of the included studies and a meta-analysis was performed by using R 4.0.4 software.Results·A total of 1146 documents were retrieved,and5 met the inclusion criteria,including 5627 study subjects.Results showed that long sleep duration was positively correlated with the risk of any DR[the combined odds ratio(OR)in the fixed-effect model and random-effect model both were 2.05,95%confidence interval(CI)1.37-3.05)],while short sleep duration was not associated with the risk of any DR(OR in the fixed-effect model and random-effect model were 0.89,95%CI 0.72-1.10 and 0.98,95%CI0.71-1.37,respectively],but it was related to the risk of moderate DR(OR in the fixed-effect model and random-effect model were 2.07,95%CI 1.29-3.33 and 2.06,95%CI 1.18-3.58,respectively).Short sleep duration was not associated with the risk of vision-threatening diabetic retinopathy(OR in the fixedeffect model and random-effect model both were 0.92,95%CI 0.58-1.47).Conclusion·Sleep duration is significantly associated with the risk of DR,in which too much sleep is a risk factor,while short sleep is to be further determined by research.As a modifiable factor at the individual level,the role of sleep intervention in the management of DR should be further emphasized.