Extraocular Manifestations of Obstructive Sleep Apnea as a Potential Screening Tool for Perioperative Complications: A Case Control Study.

Background: Obstructive sleep apnea presents with a variety of potential intra- and post-operative complications; thus, adequate screening is needed to properly manage them. The gold standard for diagnosing OSA is polysomnography; however, due to access and practicality, alternative tools such as the STOP-BANG score are utilized. Another avenue to be investigated is the association between floppy eye syndrome (FES) and OSA. The aim of this study is to use STOP-BANG and FES to predict perioperative risk of complications arising from obstructive sleep apnea.

Methods: Prospective case-control study with 160 clinic participants was used in this study. Patients with known formal OSA diagnosis were excluded from the study. OSA was classified as a STOP-BANG score ≥ 3. FES was classified as grading ≥ 2. We took photographs while vertically and horizontally retracting the patient's eyes. Two blinded ophthalmologists and two blinded anesthesiologists used a graded scale to classify eyelid laxity.

Results: A total of 32.5% of patients were in the experimental OSA group and 67.5% were in the control group. FES prevalence among the OSA group was 15% and 2% among control. Ophthalmologist reviewers showed a greater incidence of FES in the OSA group compared to control (p < 0.05), while anesthesiologist reviewers did not. Ophthalmologists and anesthesiologists exhibited significant specificity (93% and 98%, respectively) and positive predictive value (88% and 86%, respectively).

Conclusions: Using FES to determine probability of OSA, as determined by the STOP-BANG questionnaire, may have utility in the perioperative setting due to its high rule-in value as shown by high specificity and positive pressure ventilation (PPV).