Floppy eyelid syndrome in Obstructive Sleep Apnea: Diagnosis and Post- CPAP changes

Obstructive sleep apnea (OSA) describes a sleep disorder where pharyngeal collapse leads to complete or partial airway obstruction resulting in apnea or hypopnea. It occurs due to changes in connective tissue and increased neck thickness. Floppy eye syndrome (FES) is a condition associated to OSA in which the upper lids evert with upward traction or spontaneously during sleep and histology reveals similar connective tissue weakness. The aim of this study is to identify FES in OSA patients and to understand the effect of Continuous Positive Airway Pressure (CPAP) on FES. The present work is a prospective study with 2 evaluations in time between September 2018 and June 2019 in Leiria Hospital. In a sample of 47 subjects, newly diagnosed patients with OSA were submitted to an ophthalmologic evaluation for the presence of FES. Patients with OSA and FES were submitted to an ophthalmological re-evaluation 6 months after starting CPAP. Statistical significance was set to p FES was present in 34% (n=16) of OSA patients. Mean Apnea Hypopnea Index (AHI) in supine was significantly higher in FES (p=0.041) and the presence of FES could be predicted by a higher AHI in supine (p=0.034; OR=0.48). Patients who had severe OSA (n=19) were more associated with FES (p=0.023). Six months after CPAP, the majority of the “non-reversable FES group” had severe OSA (n=4) and there was a significant association between higher Mallampati classification and “non-reversable” FES (rs=0.764, p=0.046). AHI in supine predicts the presence of FES and is associated with severe OSA and higher Mallampati score.