Obstructive sleep apnea associated with surgical ptosis failure
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Key takeaways:
- Patients with OSA had a significantly higher rate of surgical failure vs. those without OSA.
- Patients with OSA also were at greater risk for revision, with most attributed to unsatisfactory eyelid height.
Obstructive sleep apnea appears to increase the risk for ptosis repair failure and revision surgery, according to a study in Ophthalmic Plastic and Reconstructive Surgery.
“[Obstructive sleep apnea (OSA)] affects the tissues of the eyelid resulting in laxity and [floppy eyelid syndrome (FES)],” Aravindh Nirmalan, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “We hypothesized that patients with OSA may be more likely to require revision surgery after ptosis repair failure from insufficient eyelid elevation or contour abnormalities.”
In a retrospective cohort study of 577 adults (mean age, 67.9 years; 28.8% with OSA) who underwent ptosis repair by levator advancement or Müller muscle-conjunctiva resection (MMCR) between 2018 and 2021, researchers measured outcomes at 1 to 3 months of follow-up to determine how OSA affects ptosis repair.
Most patients (67.1%) underwent levator advancement and 32.9% underwent MMCR. Bilateral correction was performed on 60.1% of patients and unilateral correction on 39.9%.
According to results, patients with OSA had a higher frequency of diabetes vs. those without OSA (23.5% vs. 11.4%; P < .001), as well as a higher frequency of FES (3.7% vs. 0.5%; P = .004).
Patients with OSA also had a significantly higher rate of surgical failure (20.5% vs. 13.1%; P = .02) and greater risk for revision (OR = 1.7), with 72.6% of revisions attributed to unsatisfactory eyelid height and 21.1% attributed to eyelid asymmetry.
“OSA appears to be a significant and independent risk factor for ptosis surgical failure requiring revision,” Nirmalan and colleagues wrote. “Surgeons may consider screening for OSA or specific counseling for these patients prior to surgery. Future studies may investigate the exact mechanism of OSA contributing to ptosis repair failure.”
Perspective
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Ptosis may be a result of age-related change to levator muscle-aponeurosis complex and is known as involutional or aponeurotic ptosis. Recent studies show an association between involutional ptosis and obesity, hyperlipidemia and type 2 diabetes. Similarly, studies have demonstrated an association between not only obesity and OSA, but also between OSA and FES.
This study conducted by Nirmalan and colleagues found that patients with OSA were more likely to experience ptosis repair failure and require a revision of the surgical procedure than patients without OSA.
As optometrists, we often see patients present with chief complaint of ptosis and request surgical repair. Once a neurological cause of ptosis is ruled out, it may be beneficial for us to screen our patients for OSA prior to referring for ptosis repair. This will help set realistic expectations and improve patient satisfaction.
One drawback of this study is that it does not tell us if there is any statistically significant difference in the rate of ptosis repair failure between OSA patients who are undergoing treatment with CPAP or BiPAP vs. those who are not. Future studies may be beneficial to determine whether treatment for OSA has a positive impact on ptosis repair failure rate. This would mean that we as optometrists would not only screen patients for OSA before referring for ptosis repair but also recommend initiation of treatment for OSA supported by evidence-based research.
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