Effects of Insufficient Sleep on Myopia in Children: A Systematic Review and Meta-Analysis

Xixuan Zhao,1– 4 Yining He,5 Juzhao Zhang,1– 3 Senlin Lin,1– 3 Haidong Zou,1– 4 Yingyan Ma1– 4 1Shanghai Eye Diseases Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China; 3Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, People’s Republic of China; 4Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 5Biostatistics Office of Clinical Research Unit, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Yingyan Ma; Haidong Zou, Email mYy_29@163.com; zouhaidong@sjtu.edu.cnAbstract: Myopia is increasingly prevalent in children. Its association with insufficient sleep has been studied, yielding inconsistent findings. This review aims to assess the association of insufficient sleep with myopia and myopia-related refractive parameters in children. A total of 657 articles were identified, of which 40 were included in the systematic review and 33 were included in the meta-analysis. Results showed that insufficient sleep was significantly associated with an increased prevalence of myopia (odds ratio [OR] = 1.59; 95% confidence interval [CI] = 1.31, 1.95; I2 = 99%), and an increased prevalence of high myopia (OR = 3.36; 95% CI = 1.26, 9.00; I2 = 96%). Shorter sleep duration was significantly linked to faster changes in axial length (AL) (β = 0.05; 95% CI = 0.02, 0.08; I2 = 0%). However, correlation between insufficient sleep and the incidence of myopia, spherical equivalent refraction, corneal curvature radius (CR) and AL/CR were insignificant. Moreover, the effect of insufficient sleep on premyopia and astigmatism was not well-studied. The results of this study suggest that insufficient sleep may be an important risk factor for the development of myopia in school-aged children. Therefore, in addition to ensuring sufficient outdoor activities and reducing near work, it is necessary to inform children and parents about the importance of adequate sleep to mitigate the risk of myopia.Keywords: insufficient sleep, myopia, children, axial length, refractive parameters