Review Article

Is Floppy Eyelid Syndrome More Prevalent in Obstructive Sleep Apnea Syndrome Patients?

Table 1

Characteristics of the studies included in meta-analysis.

StudyMean age (years), non-OSAS/OSASSex (F/M)OSAS diagnosisFES diagnosisFES in OSASFES in non-OSASStatistically significantStudy quality score

Mojon et al., 1999 [9]Non-OSAS: 48.7 ± 13.7;
mild: 51.1 ± 9.2;
moderate: 56.0 ± 11.1; severe: 53.6 ± 8.1
Non-OSAS: 6/22;
mild: 0/9;
moderate: 2/10;
severe: 4/19
PSG. Hypopnea was defined as a 30% reduction in airflow accompanied by a 4% oxygen desaturation or a 50% reduction in airflow accompanied by a 3% oxygen desaturation or arousal.
Non-OSAS: RDI < 10; mild: 10 ≤ RDI < 20; moderate: 20 ≤ RDI < 40; severe: AHI ≥ 40
Not presentedMild: 2/9;
moderate: 2/12;
severe: 9/23;
overall: 13/44
1/28Yes3

Karger et al., 2006 [18]Non-OSAS: 43.2 ± 11.82;
OSAS: 62.7 ± 15.02
Non-OSAS: 7/8;
OSAS: 16/28
PSG. Obstructive apnea was defined as cessation of airflow despite respiratory effort for at least 10 s. Hypopnea was defined as at least a 30% drop in airflow for at least 10 s despite respiratory effort and at least a 4% drop in oxyhemoglobin saturationSubjectively easy eversion, papillary conjunctivitis, and lash ptosis 1/440/15No4

Kadyan et al., 2010 [2]Non-OSAS: 55.3 ± 10.7;
OSAS: 55.75 ± 10.97
Non-OSAS: 9/17;
OSAS: 14/75
Oximetry. ODI: events of 4% oxygen desaturation rate per hour. Non-OSAS: ODI < 5; mild: 5 ≤ ODI < 15; moderate: 15 ≤ ODI < 30; severe: ODI > 30 Subjectively easy eversion, papillary conjunctivitis, and symptoms of ocular irritation 28/891/26Yes5

Chambe et al., 2012 [31]Non-OSAS: 45.6 ± 1.9;
mild: 53.8 ± 1.9;
moderate: 56.8 ± 2.0;
severe: 59.2 ± 1.4
Non-OSAS: 19/19;
mild: 21/22;
moderate: 7/19;
severe: 4/19
PSG. Hypopnea was defined as a 30% reduction in airflow accompanied by a 4% oxygen desaturation or a 50% reduction in airflow accompanied by a 3% oxygen desaturation or arousal. Non-OSAS: AHI ≤ 5; mild: 5 < AHI ≤ 15; moderate: 15 < AHI ≤ 30; severe: 30 < AHIEyelid hyperlaxity and papillary conjunctivitis23/896/38Yes5

Acar et al., 2013 [32]Non-OSAS: 46.7 ± 9;
mild: 43.9 ± 11.5;
moderate: 49.9 ± 9.3;
severe: 48.1 ± 10.5
Non-OSAS: 16/10;
mild: 17/43;
moderate: 28/44;
severe: 22/100
PSG. Hypopnea was defined as a 30% reduction in airflow accompanied by a 4% oxygen desaturation or a 50% reduction in airflow accompanied by a 3% oxygen desaturation or arousal. Non-OSAS: AHI < 5; mild: 5 ≤ AHI < 15; moderate: 15 ≤ AHI ≤ 30; severe: 30 < AHISubjectively easy eversion and tarsal conjunctivaMild: 25/60;
moderate: 48/72;
severe: 91/122;
overall: 164/254
6/26Yes4

Muniesa Royo et al., 2013 [33]Non-OSAS: 48.6 ± 11.15;
OSAS: 55.1 ± 9.41
Non-OSAS: 7/18;
OSAS: 21/67
PSG or cardiorespiratory sleep study. Obstructive apnea was defined as an absence of airflow for at least 10 s and hypopnea was defined as a clear (50%) airflow reduction for at least 10 s, with a drop in oxygen saturation of at least 4% or an arousal. Non-OSAS: AHI < 10; mild: 10 ≤ AHI < 20; moderate: 20 ≤ AHI ≤ 30; severe: AHI > 30Subjectively easy eversion and papillary conjunctivitisMild: 1/9;
moderate: 2/24;
severe: 11/56;
overall: 14/89
2/25No5

OSAS: obstructive sleep apnea/hypopnea syndrome; PSG: polysomnography; RDI: respiratory disturbance index; AHI: apneas or hypopneas index; ODI: oxygen desaturation index; BMI: body mass index.