Pressure wave with apnoea evaluated by sleep level in patient with ventricular dilàtion

Kuchiwaki, Hiroji; Takada, Susumu; Ishiguri, Hitoshi; Kageyama, Naoki; Terashima, Minoru; Furuse, Masahiro; Sugiura, Mitsuo

doi:10.1080/01616412.1988.11739824

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…2 and Additional file 1 : Table S2, patients with iNPH had the highest number of sleep apnea-associated transient ICP elevations among the four groups of patients. Transient increases in ICP caused by sleep apnea, as shown here and previously [ 4 , 5 , 31 ], could be involved in the progression of chronic hydrocephalus, particularly in patients with iNPH, and require further investigation. It is also worth considering whether transient ICP elevations generated by sleep apnea could play a role in the well-known association between sleep apnea, stroke, and cardiovascular disease [ 32 ].…”

Section: Discussionsupporting

confidence: 52%

Transient intracranial pressure elevations (B waves) are associated with sleep apnea

Riedel,

Martinez-Tejada,

Andresen

et al. 2023

Fluids Barriers CNS

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Background Repetitive transient intracranial pressure waveform elevations up to 50 mmHg (ICP B-waves) are often used to define pathological conditions and determine indications for ICP-reducing treatment. We recently showed that nocturnal transient ICP elevations are present in patients without structural brain lesions or hydrocephalus in whom they are associated with sleep apnea. However, whether this signifies a general association between ICP macropatterns and sleep apnea remains unknown. Methods We included 34 patients with hydrocephalus, or idiopathic intracranial hypertension (IIH), who were referred to the Neurosurgical Department, Copenhagen, Denmark, from 2017 to 2021. Every patient underwent diagnostic overnight ICP monitoring for clinical indications, with simultaneous polysomnography (PSG) sleep studies. All transient ICP elevations were objectively quantified in all patients. Three patients were monitored with continuous positive airway pressure (CPAP) treatment for an additional night. Results All patients had transient ICP elevations associated with sleep apnea. The mean temporal delay from sleep apnea to transient ICP elevations for all patients was 3.6 s (SEM 0.2 s). Ramp-type transient ICP elevations with a large increase in ICP were associated with rapid eye movement (REM) sleep and sinusoidal-type elevations with non-REM (NREM) sleep. In three patients treated with CPAP, the treatment reduced the number of transient ICP elevations with a mean of 37%. CPAP treatment resulted in insignificant changes in the average ICP in two patients but elevated the average ICP during sleep in one patient by 5.6 mmHg. Conclusion The findings suggest that sleep apnea causes a significant proportion of transient ICP elevations, such as B-waves, and sleep apnea should be considered in ICP evaluation. Treatment of sleep apnea with CPAP can reduce the occurrence of transient ICP elevations. More research is needed on the impact of slow oscillating mechanisms on transient ICP elevations during high ICP and REM sleep.

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Section: Discussionsupporting

confidence: 52%

Transient intracranial pressure elevations (B waves) are associated with sleep apnea

Riedel,

Martinez-Tejada,

Andresen

et al. 2023

Fluids Barriers CNS

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“…Markedly increased intracranial pressure has been associated with the apnoeas of sleep disordered breathing21 22 and patients with severe sleep disordered breathing may have increased intracranial pressure during daytime that increases further during sleep 21. It is well known from overnight intracranial pressure recordings in patients with AHS that B-waves are a frequent manifestation and related both to different sleep stages,23 apnoea episodes, and rhythmic alterations of cerebral blood flow 24.…”

Section: Discussionmentioning

confidence: 99%

Effects of transient and persistent cerebrospinal fluid drainage on sleep disordered breathing in patients with idiopathic adult hydrocephalus syndrome

Kristensen

Malm

Rabben

1998

Journal of Neurology, Neurosurgery & Psychiatry

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Objectives-To examine sleep disordered breathing including obstructive sleep apnoea in patients with idiopathic adult hydrocephalus syndrome (IAHS) and to study the eVects of CSF drainage and shunting procedure on sleep disordered breathing. Methods-In 17 patients with IAHS polysomnographic investigations were performed before and after lumbar CSF drainage and after shunt operation. Results-Baseline investigations documented a high prevalence of sleep related obstructive respiratory events (respiratory disturbance index >10 in 65% of the patients) and impaired sleep structure. There was no correlation between respiratory disturbance index and CSF pressure. Minimum oxygen saturation was highly correlated with cognitive function. Neither lumbar CSF drainage nor shunting alleviated the respiratory disturbance index. REM and delta sleep increased initially after shunting but there was no sustained eVect on sleep quality. Conclusions-Sleep disordered breathing is a prevalent finding in patients with IAHS. The shortcoming of CSF drainage to improve sleep disordered breathing either transiently or permanently implies that sleep disordered breathing is a coexistent condition, or an irreversible consequence of the hydrocephalus, with a potential of causing additional dysfunction in IAHS. (J Neurol Neurosurg Psychiatry 1998;65:497-501)

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“…Patients with iNPH often suffer from severe sleep apnea, [11][12][13] which is also linked to cerebral microbleeds and brain ischemias. 35,36 It is possible that the transient increases in intracranial pressure caused by sleep apnea, as shown here and previously, 4,5,32 could damage the brain's periventricular tissue and capillaries, leading to decreased compliance and the progression of chronic hydrocephalus, particularly in patients with iNPH. Furthermore, pressure peaks resulting from sleep apnea and the retrograde ow of venous blood through incompetent jugular valves 33,34 may enlarge the ventricles through transient venous hypertension hindering CSF absorption, particularly in the presence of brain atrophy.…”

Section: Idiopathic Normal Pressure Hydrocephalus and Sleep Apneamentioning

confidence: 77%

Transient intracranial pressure elevations are associated with sleep apnea

Riedel

Martinez-Tejada

Andresen

et al. 2023

Preprint

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Background Repetitive transient intracranial pressure waveform elevations up to 50 mmHg (ICP B-waves) are often used to define pathological conditions and determine intracranial pressure-reducing treatment indications. We recently showed that nocturnal transient ICP elevations are present in patients without structural brain lesions or hydrocephalus in whom they are associated with sleep apnea. However, whether this signifies a general association between intracranial pressure patterns and sleep apnea is still unknown. Methods We included 34 patients with hydrocephalus, or idiopathic intracranial hypertension (IIH), referred to the Neurosurgical Department, Copenhagen, Denmark, from 2017 to 2021. Every patient underwent a diagnostic overnight intracranial pressure monitoring on clinical indications with simultaneous polysomnography (PSG) sleep studies. All transient ICP elevations were objectively quantified for all patients. Three patients were monitored with continuous positive airway pressure (CPAP) treatment for an additional night. Results All patients had transient intracranial pressure elevations associated with sleep apnea. The mean temporal delay from sleep apnea to transient intracranial pressure elevations for all patients was 3.6 seconds (SEM 0.2 seconds). High amplitude ramp-type transient intracranial pressure elevations were associated with rapid eye movement (REM) sleep and sinusoidal-type elevations with non-REM (NREM) sleep. CPAP treatment reduced the number of transient intracranial pressure elevations in all three patients (mean 37%). CPAP treatment elevated the mean intracranial pressure during sleep in two patients by 1.2 and 5.6 mmHg, respectively, and reduced the mean intracranial pressure in one patient with a ventriculoperitoneal shunt by 1.0 mmHg. Conclusion The findings suggest that sleep apnea causes a significant proportion of transient intracranial pressure elevations, and sleep apnea should be considered in intracranial pressure evaluation. Continuous positive airway pressure (CPAP) treatment can reduce their occurrence. However, CPAP may concurrently elevate the mean intracranial pressure. More research is needed on the impact of slow oscillating mechanisms on transient intracranial pressure elevations during high intracranial pressure and REM sleep.

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Pressure wave with apnoea evaluated by sleep level in patient with ventricular dilàtion

Cited by 9 publications

References 24 publications

Transient intracranial pressure elevations (B waves) are associated with sleep apnea

Transient intracranial pressure elevations (B waves) are associated with sleep apnea

Effects of transient and persistent cerebrospinal fluid drainage on sleep disordered breathing in patients with idiopathic adult hydrocephalus syndrome

Transient intracranial pressure elevations are associated with sleep apnea

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