No Relationship Between Eyelid Laxity and Obstructive Sleep Apnea
By Lynda Seminara
Selected By: Neil M. Bressler, MD, and Deputy Editors
JAMA Ophthalmology, October 2017
Although studies have indicated a correlation between floppy eyelid syndrome and obstructive sleep apnea (OSA), the diagnostic criteria for eyelid laxity often are vague and subjective. Fox et al. employed quantitative markers to assess eyelid laxity and found no correlation between OSA and floppy eyelid syndrome.
For this cross-sectional observation study, the researchers evaluated 201 patients (402 eyes; mean age, 53 years), all of whom underwent overnight polysomnography at a sleep center in the United States. Eyelid laxity and ocular surface disease were evaluated through detailed bedside ophthalmologic examination, and severity scores for these markers were assigned to each eye. Bedside exams entailed measuring eyelid laxity (including horizontal eyelid distraction, upper eyelid traction, and presence of eyelash ptosis), determining ocular surface disease (including palpebral conjunctival reaction), and performing other objective assessments.
The presence and severity of OSA were established from polysomnographic findings. The initial correlation between OSA and ocular surface and eyelid markers was calculated from bivariate linear regression analysis. Associations between ocular symptoms were obtained through bivariate ordered logistic regression. Adjustments were made for known associations between OSA and sex, age, body mass index, and concomitant medical conditions.
After adjustments, no association was observed between OSA severity and eyelid laxity score or ocular surface score. Subset analyses showed a correlation between male gender and higher ocular surface score. Older age and the presence of diabetes were linked to greater eyelid laxity. Only 1 patient exhibited classic signs of floppy eyelid syndrome.
The authors concluded that, according to their method for measuring eyelid laxity, no significant relationship exists between OSA presence or severity and markers of laxity or ocular surface disease. Findings of their subset analysis suggest that earlier studies may have been hampered by confounding variables or the techniques used to determine eyelid laxity.
The original article can be found here.