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Original Investigation
September 7, 2017

Association Between Eyelid Laxity and Obstructive Sleep Apnea

Author Affiliations
  • 1Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Division of Pulmonary Medicine, Lenox Hill Hospital, New York, New York
  • 3Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Ophthalmol. Published online September 7, 2017. doi:10.1001/jamaophthalmol.2017.3263
Key Points

Question  Is there an association between obstructive sleep apnea and eyelid laxity when using quantitative eyelid measurements?

Findings  This cross-sectional study that included 201 patients from a sleep clinic found no statistically significant association between obstructive sleep apnea severity and markers of eyelid laxity or secondary ocular surface disease. Subset regression analysis revealed several potential confounding variables.

Meaning  There appears to be no association between the presence or severity of obstructive sleep apnea and markers of eyelid laxity or secondary ocular surface disease.


Importance  While much has been reported on the relationship between floppy eyelid syndrome and obstructive sleep apnea (OSA), the diagnostic criteria of floppy eyelid syndrome are often subjective and vague.

Objective  To evaluate the association between OSA and quantitative markers of eyelid laxity or secondary ocular surface disease in a sleep clinic population.

Design, Setting, and Participants  This investigation was a cross-sectional observational study at the Center for Sleep Medicine at Icahn School of Medicine at Mount Sinai. Participants were individuals referred for overnight polysomnography from March 1 to August 30, 2015.

Main Outcomes and Measures  Eyelid laxity and ocular surface disease were assessed on bedside ophthalmologic examination. The presence and severity of OSA were determined from polysomnography results. Initial correlation between OSA and ocular surface and eyelid markers was calculated through bivariate linear regression analysis, and the association between ocular symptoms was obtained through bivariate ordered logistic regression. Analysis was repeated adjusting for known associations between OSA and sex, age, body mass index, and medical comorbidities through multivariable analysis.

Results  In total, 201 individuals (402 eyes) were enrolled in the study. Their mean (SD) age was 53.2 (13.5) years, 43.3% (n = 87) were female, 56.7% (n = 114) were of white race/ethnicity, 26.9% (n = 54) were black/African American, 4.0% (n = 8) were Asian, 8.0% (n = 16) were multiracial or other, and 4.5% (n = 9) were of unknown race/ethnicity, with 21.9% (n = 44) of all individuals self-identifying as Hispanic and 75.1% (n = 151) self-identifying as non-Hispanic. After adjustment, no association was observed between OSA severity and an eyelid laxity score (regression coefficient, 0.85; 95% CI, −0.33 to 0.62; P = .40) or an ocular surface score (regression coefficient, 1.09; 95% CI, −0.32 to 0.29; P = .93). Through subset analysis, male sex was associated with a higher ocular surface score, while older age and diabetes were associated with a higher eyelid laxity score. Only one patient (0.5%) exhibited findings of floppy eyelid syndrome.

Conclusions and Relevance  Among individuals referred for overnight polysomnography, quantitative markers of eyelid laxity were not associated with the presence or severity of OSA. Subset analysis suggests that prior studies may have been limited by confounding variables or the technique of identifying eyelid laxity.