Prevalence of Floppy Eyelid Syndrome in Obstructive Sleep Apnea–Hypopnea Syndrome

ObjectivesTo determine the prevalence of floppy eyelid syndrome (FES) in obstructive sleep apnea–hypopnea syndrome (OSAHS) and to develop a method to measure eyelid laxity.DesignMasked cross-sectional (prevalence) study examining patients referred to the Mayo Sleep Disorders Center.Participants and/or ControlsFifty-nine subjects were examined before undergoing polysomnography. Forty-four subjects had OSAHS, and 15 did not have it.TestingSubjects underwent slit-lamp examination and eyelid laxity measurements, followed by polysomnography.Main Outcome MeasuresPresence of FES as defined by subjectively easy eyelid eversion, tarsal papillary conjunctivitis, and lash ptosis; force required to displace the upper lid 5 mm, as measured by a strain gauge device; number of apnea or hypopnea episodes per hour (apnea–hypopnea index [AHI]); presence of OSAHS, as defined by an AHI of ≥5; and abnormalities on electrocardiography.ResultsOne patient with OSAHS was found to have FES, yielding a prevalence of 2.3% (95% confidence interval [CI]: 0.1%–12.0%). One patient was referred to the Sleep Disorders Center due to a diagnosis of FES; if this patient were included, the prevalence would be 4.5% (95% CI: 0.5%–15.1%). Subjectively easy lid eversion was more common in OSAHS patients than in non-OSAHS patients. When adjusted for age and body mass index, there was a trend for association between subjectively easy lid eversion and OSAHS, but this did not reach statistical significance. Subjectively easy lid eversion was associated with AHI. Force required to displace the upper lid 5 mm was lower in lids with subjectively easy eversion, but was not associated with OSAHS or AHI. Intraclass correlation among 3 strain gauge measurements was good for both right (82%) and left (83%) lids. There were no statistically significant differences in frequency of electrocardiographic abnormalities among the various groups.ConclusionsThe prevalence of FES among OSAHS patients is low. Patients with subjectively easy upper lid eversion are at risk for OSAHS. By recognizing the potential for OSAHS in these patients, the ophthalmologist may play an important role in initiating their evaluation and treatment.