Sleep Apnea: Floppy Eyelids May Be Sign | Loyola Medicine
Thursday, June 21, 2018

Floppy Eyelids May Be Sign of Sleep Apnea, Loyola Study Finds

MAYWOOD, IL –  A Loyola Medicine study is providing further evidence that floppy eyelids may be a sign of sleep apnea.
 
In a study published in the journal The Ocular Surface, corresponding author Charles Bouchard, MD, and colleagues reported that 53 percent of sleep apnea patients had upper eyelids that were lax and rubbery. The most severe cases of sleep apnea were associated with the most pronounced cases of floppy eyelids, but this association was not strong enough to be considered statistically significant.
 
Obstructive sleep apnea (OSA) occurs when the upper airway becomes blocked repeatedly, preventing restful sleep. Symptoms include loud snoring, excessive daytime sleepiness and fatigue. OSA affects an estimated 34 percent of men and 17 percent of women, but up to 80 percent those affected have not been diagnosed. A 2010 Harvard Medical School report estimated that moderate-to-severe sleep apnea was associated with $115 billion in healthcare costs, behind only cancer, diabetes and coronary heart disease.
 
Lax, rubbery eyelids are found in people who have one of three related conditions: lax eyelid condition (rubbery lids); lax eyelid syndrome (lax eyelids plus conjunctivitis); and floppy eyelid syndrome (lax eyelid syndrome in obese young men), said Dr. Bouchard, chair of Loyola Medicine's department of ophthalmology.
 
The Loyola study included 35 patients who were evaluated by Loyola sleep specialists for suspicion of sleep apnea. Overnight sleep studies confirmed that 32 of these patients had sleep apnea. Examinations by ophthalmologists found that 17 of the 32 sleep apnea patients (53 percent) also had lax eyelid condition.
 
Among the methods ophthalmologists employed to measure lax eyelids was a measuring instrument developed at Loyola called a laxometer. Researchers hypothesized that this objective measuring technique would provide a more accurate predictor of sleep apnea.
 
It's unclear why sleep apnea is linked to floppy eyelids. One theory suggests the condition is associated with low-grade inflammation that causes degradation of elastin, a protein that allows skin and other tissues to resume their shape after stretching or contracting.
 
"Obstructive sleep apnea is a severely underdiagnosed disease, and without treatment leads to increased morbidity and mortality," researchers concluded. "It is the duty of today's ophthalmologist to be diligent in making the diagnosis of lax eyelid syndrome in the ophthalmology clinic. They are in the unique position to identify patients at risk for obstructive sleep apnea and address this critical public health problem."
 
The study is titled, "Lax eyelid syndrome, obstructive sleep apnea and ocular surface inflammation." In addition to Dr. Bouchard, other co-authors are Mackenzie Sward, MD, Clayton Kirk, MD, Sunita Kumar, MD, Nabila Nasir, MD, and William Adams, PhD.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.