Sleep Deprivation Increases Risk of Epiretinal Membrane

Prospective longitudinal studies are warranted to validate the potential causal influence of sleep duration on ERM development and to elucidate the underlying biological mechanisms.  Photo: Diana Shechtman, OD. Click image to enlarge. Various ocular conditions such as anomalous posterior vitreous detachment, cataract surgery, retinal tears, retinal vascular disease and ocular inflammatory disease may result in epiretinal membrane (ERM) formation. Despite these associations, the specific relationship between sleep deprivation and the prevalence of ERM has not been studied. This has left a gap in understanding the potential ocular effects of insufficient sleep.Researchers in South Korea used a large-scale national survey to investigate this association. Their findings indicated that sleep deprivation was significantly associated with a 1.25-fold increase in the prevalence of ERM, especially among non–high-risk alcohol consumers and those with diabetes.“This suggests that weekday sleep deprivation, defined as an average of less than six hours of sleep per night, may be a modifiable risk factor for ERM,” the study authors wrote in their paper for Retina.Data from 2018 to 2020 were used for machine learning training and internal validation, and data from 2017 were used for external validation. Participants were divided into ERM and non-ERM groups, and their sociodemographic, lifestyle and clinical characteristics were assessed. Machine learning-based logistic regression was used to model the association between sleep deprivation and ERM, adjusting for confounders. The study included data from 15,240 participants, with an ERM prevalence of 9.6%.Sleep deprivation was significantly associated with increased ERM risk (odds ratio; OR: 1.25), particularly among non–high-risk alcohol consumers (OR: 1.22) and individuals with diabetes mellitus (OR: 1.26). Sleep deprivation was the fourth most influential predictor (5.3%), after age, cataract surgery, and dyslipidemia.“Insufficient sleep can exacerbate inflammatory milieu by inducing chronic low-grade systemic inflammation, impairing immune regulation, disrupting vascular homeostasis and reducing glymphatic clearance,” the research team suggested. “These systemic disturbances may further weaken the clearance functions of macrophage-like hyalocytes in perivascular spaces, leading to the accumulation of inflammatory mediators and growth factors at the vitreoretinal interface.”The researchers noted that their study’s cross-sectional design prevented them from establishing causality. Despite achieving statistical significance, uncontrolled confounding factors may have influenced the observed associations. Given the relatively few participants affected by ERM, residual confounding may have persisted even after adjusting for known associated variables. Also, the average weekly sleep duration was assessed through self-reported surveys, which may have introduced recall bias, and weekend sleep duration was not included in the analysis. Finally, they pointed out that they could not analyze the impact of uveitis and retinal tears— known risk factors for secondary ERM—because of the data constraints in this study.Click here for the journal source. Kim JW, Kim M, Lee CS, et al. Sleep deprivation and epiretinal membrane risk machine learning findings from a nation-wide survey. Retina. 2026;46(6):1057-64.  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.