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Jeffrey Adam Schwartz, Timothy Fox, Aimee Chang, Fatemeh Parvin-Nejad, Steven Feinsilver, Albert Ya-Po Wu; Lack of Association between Obstructive Sleep Apnea and Floppy Eyelid Syndrome. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
While previous studies have supported an association between Floppy Eyelid Syndrome (FES) and Obstructive Sleep Apnea (OSA), the validity of this relationship remains uncertain due to insufficient sample sizes, unreliable data measurement, and inconsistent and subjective outcome classification. We performed the largest-to-date prospective observational clinical study evaluating the potential role of OSA in eyelid laxity spectrum disorders, of which FES is a subset.
We enrolled 201 adult patients that visited the Mount Sinai Sleep Center for overnight polysomnography from 3/1/15-8/31/15. Subjects underwent bedside evaluation at the sleep center, including an ocular history, visual acuity assessment, and an eyelid and ocular surface exam. At time of evaluation, examiners were blinded to patient medical history and OSA status. Patients were characterized as having no, mild, moderate, or severe OSA by a sleep specialist on the basis of their polysomnography results. Review of patient records provided information on systemic disease. Three surrogate measurements were designed to assess patient FES status (Table 2): eyelid laxity score (0-24), ocular surface score (0-16), and eye symptom score (0-3). Correlation between OSA and ocular surface and eyelid score was obtained through multivariate linear regression analysis and association with positive history of FES ocular symptoms was obtained through multivariate ordered logistic regression. Analysis was adjusted for known associations between OSA and gender, age, BMI, and systemic disease.
After adjustment, no statistically significant association was observed between OSA severity and changes in eyelid laxity score of 0.15 (95% CI -0.33 to + 0.62), ocular surface score of 0.014 (95% CI -0.32 to + 0.29), and an odds ratio of positive history of FES symptoms of 0.92 (95% CI -0.69 to + 1.22).
Findings suggest a lack of an association between OSA and eyelid laxity. Correlation between patient demographics with OSA and FES status suggests that smaller studies may have been limited by confounding variables.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Table 1: Summary of Patient Demographics and Comorbidities by Obstructive Sleep Apnea Status
Table 2: Outcome Measurements by Obstructive Sleep Apnea Status
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