Indian Journal of Sleep Medicine

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VOLUME 15 , ISSUE 4 ( October-December, 2020 ) > List of Articles


Obstructive Sleep Apnea and Floppy Eyelid Syndrome: An Eye Opener

Nileena NKM, Nagarajan Ramakrishnan, Mary I Charles, Hema Deenadayalan, Lakshmi Ranganathan

Keywords : Floppy eyelid, Obstructive sleep apnea, Snoring

Citation Information : NKM N, Ramakrishnan N, Charles MI, Deenadayalan H, Ranganathan L. Obstructive Sleep Apnea and Floppy Eyelid Syndrome: An Eye Opener. Indian Sleep Med 2020; 15 (4):69-72.

DOI: 10.5005/jp-journals-10069-0062

License: CC BY-NC 4.0

Published Online: 23-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Aim and objective: Obstructive sleep apnea (OSA) is a common yet underdiagnosed sleep disorder associated with partial or complete obstruction of upper airway during sleep. Floppy eyelid syndrome (FES) is another frequently overlooked diagnosis associated with lax upper eyelids, a soft and foldable tarsus, and a chronic papillary conjunctivitis of the upper palpebral conjunctiva. There has been growing literature to support the association between the two, and this study explores the same and also the clinical implications. Materials and methods: Retrospective study from 2015 to 2018 at a freestanding sleep clinic, India. Patients who were diagnosed with FES at an ophthalmic care hospital, and referred for evaluation of suspected OSA based on symptoms of snoring and daytime hypersomnolence were included in the study. Subjects underwent clinical evaluation and polysomnography, if required. Results: All the referrals were males and the mean age was 49.8 ± 13.4. Of 51 patients, 13 (25.4%) were not willing to undergo sleep study as they were unwilling to accept the possible association of OSA and FES and/or could not afford additional testing. Thirty-six of the 38 patients with FES were diagnosed of OSA (94.8%) and 20 of 38 had severe OSA (55.5%). Of the 38 patients diagnosed with OSA, only one patient accepted continuous positive airway pressure (CPAP) therapy. Conclusions: Ophthalmologists were able to effectively screen patients for OSA with simple screening questions about snoring and daytime hypersomnolence. The association between OSA and FES was significant but a large proportion of patients were not ready to undergo sleep study or commence treatment despite being diagnosed and explained the consequences of untreated severe OSA.

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