# Eyelid ptosis and dermatochalasis in obese patients with obstructive sleep apnoea: A large-scale propensity score-matched analysis

## TL;DR

Obese patients with obstructive sleep apnoea have nearly double the risk of eyelid ptosis and dermatochalasis compared to controls.

## Contribution

Large-scale analysis using propensity score matching reveals a novel association between OSA and eyelid disorders beyond floppy eyelid syndrome.

## Key findings

- OSA patients had a 1.95-fold increased risk of eyelid complications compared to controls.
- Ptosis occurred in 1.51% of OSA patients versus 0.67% of controls.
- Dermatochalasis occurred in 1.33% of OSA patients versus 0.70% of controls.

## Abstract

While obstructive sleep apnoea (OSA) has been associated with various ocular manifestations, the relationship between OSA and eyelid disorders beyond floppy eyelid syndrome remains poorly characterised. This study investigated the association between OSA and eyelid ptosis and dermatochalasis in obese patients.

A retrospective propensity score-matched cohort study was conducted using the TriNetX Research Network database (2015–2024). Obese patients with OSA confirmed by CPAP initiation (n = 315,223) were matched 1:1 with obese controls without OSA (n = 315,223) based on demographics and comorbidities. Primary outcomes included eyelid ptosis and dermatochalasis occurring after OSA diagnosis, analysed both as a composite outcome and as separate individual outcomes. Statistical analysis included risk ratios, odds ratios, number needed to harm (NNH), and time-to-event analysis with 95% confidence intervals.

Eyelid complications occurred in 7600 OSA patients (2.41%) versus 3890 controls (1.23%). OSA patients demonstrated significantly increased risk (risk ratio 1.95, 95% CI 1.88–2.03; odds ratio 1.98, 95% CI 1.90–2.06; NNH 119 patients, 95% CI 110–130; p < 0.0001). When analysed separately, ptosis occurred in 4760 OSA patients (1.51%) versus 2,112 controls (0.67%) with risk ratio 2.25 (95% CI 2.14–2.37, p < 0.0001). Dermatochalasis occurred in 4192 OSA patients (1.33%) versus 2207 controls (0.70%) with risk ratio 1.90 (95% CI 1.81–2.01, p < 0.0001).

OSA is independently associated with a nearly two-fold increased risk of eyelid ptosis and dermatochalasis in obese patients, beyond the known association with floppy eyelid syndrome. These findings support enhanced ophthalmologic surveillance in OSA patients and highlight the importance of recognising ocular manifestations in sleep disorder populations.