• No Relationship Between Eyelid Laxity and Obstructive Sleep Apnea

    By Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, October 2017

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    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.