Floppy eyelids: sleeping patterns of spouses as indicators of laterality
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ORIGINAL ARTICLE
Floppy eyelids: sleeping patterns of spouses as indicators of laterality Ran Stein1,2 · John P. Fezza3 · Andrew R. Harrison4 · Guy G. Massry5 · Robert M. Schwarcz6 · Morris E. Hartstein1,2 Received: 13 July 2020 / Accepted: 3 October 2020 © Japanese Society of Sleep Research 2020
Abstract Floppy eyelids are usually asymmetrical, and more severe on the side the patient sleeps on. This has been related to the mechanical basis of this entity’s pathophysiology. Patients who exhibit floppy eyelid syndrome (FES) tend to suffer from obstructive sleep apnea and other sleeping disorder such as snoring; therefore, their spouses are likely to be found sleeping facing away from them. In this study, we aim to assess this correlation between FES laterality and the spouse’s sleeping side. 185 patients with floppy eyelid were assessed. Upper lids were pulled cephalad towards the orbital rim to assess which side everted and was more floppy. Based on the upper lid distraction test, a prediction was made to which side of the bed the spouse slept on. 185 patients with floppy eyelid syndrome were assessed, 160 male patients and 25 females, at an average age of 68. All 25 female patients, and 117 of the male patients, had spouses that slept in the same bed. Their side of sleep was predicted correctly in 87% of cases. The physician extrapolated the spouse slept on the opposite side facing away from the snoring spouse and was correct in 91% of cases. There is a high correlation between FES laterality and the patient’s spouse’s sleeping side. These data strengthen the mechanical etiology, and can also be used to confirm the worse-affected side in FES patients. Keywords Floppy eyelid syndrome · Sleep apnea
Introduction Floppy eyelid syndrome (FES) is a condition characterized by excess upper eyelid laxity, papillary conjunctivitis, and was initially described in obese, middle-aged men [1]. Since its description by Culbertson and Osler in 1981, this entity’s association with sleep disturbances and specifically, obstructive sleep apnea (OSA) has been described in a number of studies [2–4]. * Ran Stein [email protected] 1
Ophthalmic Plastic and Reconstructive Surgery, Shamir Medical Center, Zerifin, Israel
2
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
3
Center for Sight, Sarasota, FL, USA
4
University of Minnesota, Minneapolis, MN, USA
5
Ophthalmic Plastic and Reconstructive Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
6
Department of Ophthalmology/Division of Oculoplastic Surgery, NYU Langone Health, NYU School of Medicine, New York, NY, USA
Frequent episodes of waking up, gasping for air, wheezing and snoring have been recognized both by FES patients and by their spouses [2, 5], as they interfere with both partners’ sleep. Most FES patients have a preferred side on which they sleep and this [1, 3] corresponds to the more affected side of the eyelid condition. This in turn would determine the direction of their snoring. A person who shares a bed with a FES partne
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