{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:52:31Z","timestamp":1793393551655,"version":"4.5.0"},"reference-count":39,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004704","name":"The National Research Council of Thailand","doi-asserted-by":"crossref","award":["N42A640323"],"award-info":[{"award-number":["N42A640323"]}],"id":[{"id":"10.13039\/501100004704","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,6,4]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the prevalence of dry eye disease (DED) and explore its association with depression and poor sleep quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted at the ophthalmology outpatient clinic of a tertiary university hospital in Thailand, from September 2022 to April 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 1321 patients aged 18 years or older, without any history of orbital disease, active superficial or intraocular infection\/inflammation, eyelid pathology, or prior intraocular or eyelid surgery within the past 6\u2009months, were enrolled in the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>All patients underwent dry eye examination, including the Ocular Surface Disease Index questionnaire, tear break-up time and ocular surface staining. Physical activity was measured using the Global Physical Activity Questionnaire, which was expressed as total Metabolic Equivalent of Task-minutes per week. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), Composite Scale of Morningness (CSM) and STOP-Bang. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Prevalence of DED and association pathways involving depression, sleep quality and DED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of the participants was 58.3\u00b114.0 years, with a female predominance of 73.7%. Of the 1321 patients, 668 were diagnosed with DED, resulting in a hospital-based prevalence of 50.6% (95% CI: 47.8%, 53.3%). After adjusting for age, sex and underlying disease, PSQI, PHQ-9, STOP-Bang and CSM scores remained significantly associated with DED with adjusted ORs of 2.48 (95% CI: 1.96, 3.14; p&lt;0.001), 1.65 (95% CI: 1.05, 2.61; p=0.031), 1.81 (95% CI: 1.05, 3.14; p=0.033) and 1.32 (95% CI: 1.04, 1.68; p=0.023), respectively. The effects of depression on DED were mediated indirectly via poor sleep quality (OR=1.32; 95%\u2009CI: 1.18, 1.49; p&lt;0.001) and directly via other mechanisms (OR=1.66; 95%\u2009CI: 1.06, 2.58; p=0.021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DED is notably common among Thai patients. Depression and poor sleep quality are significantly associated with DED. Poor sleep quality may mediate the relationship between depression and DED.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094046","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:31:38Z","timestamp":1750224698000},"page":"e094046","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence of dry eye disease and its association with sleep quality and depression: a hospital-based survey in Thai population"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8203-2353","authenticated-orcid":false,"given":"Passara","family":"Jongkhajornpong","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 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