Abstract
Purpose :
OSA is a significant risk factor for biomechanical anterior segment and neurovascular posterior segment eye disease. Lax eyelid condition (LEC), diagnosed by abnormal elasticity of the eyelid, is associated with OSA. 5.9 million U.S. adults are diagnosed with OSA, costing healthcare $65-$165 B. 23.5 million people with undiagnosed OSA have an annual cost of $150 B. Strategies to identify biomarkers to uncover this overlooked disease with widespread ocular comorbidities, in addition to body mass index (BMI), family history, and snoring is an important public health issue and the aim of our study.
Methods :
150 patients with LEC were identified in the Loyola ophthalmology service from 12-2020 to 8-2023. The STOP-BANG questionnaire was completed for each patient and a home polysomnography (PSM) was obtained. Demographic information, BMI, and family history of OSA and/or snoring were documented.
Results :
150 patients with LEC had a home PSM testing. 37.3% of the patients were males and 62.7% females. Most (84.7%) patients with LEC were 51 to 80 years old. 62.7% of patients were Caucasian, 16% were Hispanic, 12% were African American, 4% were Asian, and 5.3% other. 44% of the 150 patients had a BMI >30, 32.7% had a BMI=30-25, 22% had a BMI=25-18.5, and 0.07% had a BMI <18.5. A family history of snoring was present in 99.93% of patients, with most patients (43%) having a father who snored. 117 of the patients with LEC (78%) had OSA of which 16.2% was severe, 32.5% was moderate, and 48.7% was mild. 48/117 (41%) patients with OSA had a BMI<30, of which 61% had mild, 31.1% had moderate, and 8.2% had severe OSA. 69/117 (59%) with BMI ≥30, 38% had mild, 36% had moderate, and 27% had severe OSA. We correlated OSA severity with the STOP-BANG score. Patients without OSA (AHI <5) had a mean score of 3.42, patients with mild OSA (AHI 5-15) had a score of 3.31, moderate OSA (AHI 15-30) had a score of 4.05, and patients with severe OSA (AHI >30) had a score of 4.95.
Conclusions :
LEC is an important risk factor for OSA, predicting OSA in 78% of patients. 41% of patients with OSA determined from home PSM had a BMI <30, suggesting that BMI should not be used as the sole risk factor for OSA. The public health and ocular disease impact of undiagnosed OSA must be addressed. Clinical training to diagnose LEC may offer a practical and effective strategy to identify patients at risk for OSA.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.