Sleep, Diabetic Retinopathy and Melatonin

Prior treatment

• illicit drug use
• night shift work or travel beyond 2 time zones in the month before enrollment

Other illness

• end stage renal disease requiring renal replacement therapy
• history of stroke or transient ischemic attacks
• history of dementia or memory impairment
• uncontrolled congestive heart failure or recent hospitalization for cardiac condition (6 months)
• chronic obstructive pulmonary disease requiring oxygen
• severe chronic liver disease such as cirrhosis
• ongoing treatment for major medical problems such as cancer
• history of severe hypoglycemia defined as hypoglycemic episodes requiring assistance from others within the past six months.
• uncontrolled hypertension (blood pressure ≥ 160/100 mmHg),
• uncontrolled diabetes (A1C ≥ 11%),
• clinically significant epiretinal membranes, clinically significant lens opacities, or cystoid macular edema, iris neovascularization, iris atrophy, or an asymmetrically shaped pupil, nuclear sclerotic, posterior subcapsular, or cortical lens opacities greater than 2+, a history of pan-retinal photocoagulation.

Lab values

• abnormal liver function (AST or ALT\>3x upper limits of normal
• hemoglobin \<11.5 g/dL in women and \<13.5 g/dL in men.

Other

• use of melatonin
• antidepressants or antipsychotics
• Significant depressive symptoms
• untreated severe OSA (AHI≥ 30 events/hour),
• abnormal TSH
• use of sedatives and hypnotics.

• Type 2 diabetes (clinically diagnosed, taking anti-diabetes medications or history of elevated A1C≥6.5%)
• 40-65 years of age
• Diabetic retinopathy of at least moderate degree