Thinner Subfoveal Choroidal Thicknesses in Children Associated With Daytime Sleepiness

Tired Schoolgirl playing building with geometric shapes
No link shown between subfoveal choroidal thickness and traditional sleep disorders.

Thinner subfoveal choroidal thicknesses (SFCT) were significantly linked with daytime sleepiness, but not sleep disorders affecting overnight sleep, in preschool children, a report published in Eye shows.

The study included 1337 children. SFCT was measured using spectral-domain optical coherence tomography (SD-OCT), and sleep disorders were identified using the Chinese version of Children’s Sleep Habits Questionnaire (CSHQ). The study’s results show that a higher total CSHQ score was associated with a thinner subfoveal choroid (P =.046), and only the daytime sleepiness subscale score was negatively associated with the SFCT (P =.001) when each of 8 CSHQ scores was analyzed by the multivariable model. Those with clinical daytime sleepiness (n=364) had a significantly thinner mean SFCT than other participants (295.47 µm vs. 308.52 μm, P =.007). 

The report concludes that,, due to the study results, the potential relationship between childhood sleep disorders and ocular development needs further research. However, they explain that childhood daytime sleepiness can be a sleep disorder in itself that is often overlooked.

“Some diseases may result in daytime sleepiness, such as obstructive sleep apnea syndrome, periodic limb movement, restless leg syndrome, narcolepsy, Kleine–Levin syndrome, and so on,” the study explains. “…Our study provides evidence that daytime sleepiness may be related with changes in ocular choroidal structure in children.”

The study also notes that the association between participants with daytime sleepiness and SFCT, which was 13.05 μm thinner than in children who do not experience it, should be explored further.

“This magnitude of difference in SFCT is clinically significant compared with previous studies, which found that some diopter toward myopia was associated with a decrease of 10 μm in central foveal choroidal thickness and child exposure to second-hand smoking was associated with a decrease of 8.3 μm in central foveal choroidal thickness,” the study explains.

Study limitations include possible recall bias in the CSHQ questionnaire, and the exclusion of participants who either refused to participate or who had issues with their ocular examinations.


Shen S, Li X, Li R, et al.. Association of sleep disorders with subfoveal choroidal thickness in preschool children. Eye (Lond). Published online March 11, 2021. doi:10.1038/s41433-021-01489-y.