Sleep quality, perceived stress, and dry eye disease among university students in Ghana: A cross-sectional study of individual and joint associations
- 1Discipline of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- 2School of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- 3College of Optometry, University of Houston, Houston, Texas, United States of America
Abstract
Purpose: Dry Eye Disease (DED) is highly prevalent among university students and may be influenced by modifiable factors such as psychological stress and sleep disturbance. The primary objective of this study was to investigate the associations of sleep disturbance and perceived stress with DED, while the secondary objective was to evaluate their potential interaction. Methods: This analytical cross-sectional study included a random sample of university students aged 18–34 years. Perceived stress was assessed using the Perceived Stress Scale, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index. DED was diagnosed according to TFOS DEWS II criteria using the Ocular Surface Disease Index, tear break-up time, corneal staining, and Schirmer testing. Robust Poisson regression models were used to estimate relative risks (RRs) for DED associated with sleep disturbance and stress. Interaction effects were assessed on both additive and multiplicative scales. Results: The prevalence of DED was 77.9%. Sleep disturbance was present in 75.9% of participants, while 21.3% reported high perceived stress. In univariate analyses, both sleep disturbance and stress were significantly associated with DED prevalence (sleep disturbance: χ²(1, 403) = 14.57, p < 0.0001; stress: χ²(1, 403) = 4.20, p = 0.040). After adjustment for sex and the alternate exposure, poor sleep quality (adjusted RR = 1.11, 95% CI: 1.05–1.18; p = 0.001) and high perceived stress (adjusted RR = 1.06, 95% CI: 1.01–1.11; p = 0.015) remained independently associated with increased DED risk. Participants with both poor sleep quality and high stress exhibited the highest DED risk (RR = 1.18, 95% CI: 1.10–1.27; p < 0.0001), although no significant interaction. Conclusion: Sleep disturbance and perceived stress were independently associated with an increased risk of DED in this student population. However, there was no evidence that stress modified the association between sleep disturbance and DED.
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BibTeX
@article{ayobi2026sleep,
title = {{Sleep quality, perceived stress, and dry eye disease among university students in Ghana: A cross-sectional study of individual and joint associations}},
author = {Benedict Ayobi and Gwendolyn Otwiwa Attram and Bright Vandyke Okyere and Belinda Aba Osrah and John Kwesi Assan and Samuel Abokyi},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361053},
url = {https://doi.org/10.1371/journal.pone.0361053},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sleep quality, perceived stress, and dry eye disease among university students in Ghana: A cross-sectional study of individual and joint associations
AU - Benedict Ayobi
AU - Gwendolyn Otwiwa Attram
AU - Bright Vandyke Okyere
AU - Belinda Aba Osrah
AU - John Kwesi Assan
AU - Samuel Abokyi
PY - 2026
DA - 2026/10/27
JO - PLOS One
DO - 10.1371/journal.pone.0361053
UR - https://doi.org/10.1371/journal.pone.0361053
AB - Purpose: Dry Eye Disease (DED) is highly prevalent among university students and may be influenced by modifiable factors such as psychological stress and sleep disturbance. The primary objective of this study was to investigate the associations of sleep disturbance and perceived stress with DED, while the secondary objective was to evaluate their potential interaction. Methods: This analytical cross-sectional study included a random sample of university students aged 18–34 years. Perceived stress was assessed using the Perceived Stress Scale, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index. DED was diagnosed according to TFOS DEWS II criteria using the Ocular Surface Disease Index, tear break-up time, corneal staining, and Schirmer testing. Robust Poisson regression models were used to estimate relative risks (RRs) for DED associated with sleep disturbance and stress. Interaction effects were assessed on both additive and multiplicative scales. Results: The prevalence of DED was 77.9%. Sleep disturbance was present in 75.9% of participants, while 21.3% reported high perceived stress. In univariate analyses, both sleep disturbance and stress were significantly associated with DED prevalence (sleep disturbance: χ²(1, 403) = 14.57, p < 0.0001; stress: χ²(1, 403) = 4.20, p = 0.040). After adjustment for sex and the alternate exposure, poor sleep quality (adjusted RR = 1.11, 95% CI: 1.05–1.18; p = 0.001) and high perceived stress (adjusted RR = 1.06, 95% CI: 1.01–1.11; p = 0.015) remained independently associated with increased DED risk. Participants with both poor sleep quality and high stress exhibited the highest DED risk (RR = 1.18, 95% CI: 1.10–1.27; p < 0.0001), although no significant interaction. Conclusion: Sleep disturbance and perceived stress were independently associated with an increased risk of DED in this student population. However, there was no evidence that stress modified the association between sleep disturbance and DED.
SN - 1932-6203
ER -