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  • Oculoplastics/Orbit

    Review of: Prevalence of obstructive sleep apnea with floppy eyelid syndrome: A systematic review and meta-analysis

    Bulloch G, Seth I, Alphonse S, et al. Ophthalmic Plastic and Reconstructive Surgery, in press 2022

    A systematic review and meta-analysis were conducted to investigate the prevalence of obstructive sleep apnea (OSA) among patients with floppy eyelid syndrome (FES).

    Study design

    Twelve studies (511 patients) published between January 1997 and January 2022 were included. The quality of the included studies was assessed using the Joanna Briggs Institute checklist for prevalence studies, and the publication bias was assessed with the Begg's test.


    The prevalence of OSA in patients with FES was found to be 57%, a rate dramatically higher than the 2%–5% rate of OSA in the general population. Male patients with FES were far more likely to have OSA than female patients. The most common systemic comorbidities were obesity, hypertension, and diabetes mellitus.


    One limitation of this meta-analysis was considerable selection bias. The majority of study designs were cohort studies, so a lack of control groups prevented odds ratios and tests of significance from being undertaken. There was also heterogeneity in the diagnosis of both OSA and FES.

    Clinical significance

    Untreated OSA is considered a major cause of ocular and systemic morbidity and mortality. Therefore, screening for OSA should be considered for every patient with FES. The high OSA prevalence rate noted needs further acknowledgment by the ophthalmic community.

    Financial Disclosures: Dr. Nikisha Richards discloses no financial relationships.