Prevalence and utility of overnight pulse oximetry as a screening tool for obstructive sleep apnoea in newly diagnosed idiopathic intracranial hypertension

Abstract

Background Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP). Obstructive sleep apnoea (OSA) has been shown to cause episodic rises in ICP and is frequently reported in patients with IIH. The aim of this study is to identify the prevalence of OSA in a cohort of IIH patients. Methods We conducted a retrospective case notes review as part of a service evaluation of newly diagnosed IIH patients who were all referred for OSA screening with overnight pulse oximetry. The 3% oxygen desaturation index (3% ODI) was used to evaluate the presence and severity of OSA. The clinical outcomes of patients who received continuous positive airway pressure (CPAP) therapy as treatment for OSA were reviewed. Results In our cohort of newly diagnosed IIH patients, the yield of overnight pulse oximetry as a screening tool was 48.6% for OSA and 15.3% for moderate to severe OSA. We found that age ( p = 0.0008), BMI ( p < 0.0001), vitamin B 12 ( p = 0.0183), and a higher Epworth Sleep Score ( p = 0.0269) correlated with more severe OSA. Eleven (10%) patients had CPAP therapy and those with good adherence alongside weight loss or medical therapy found improvements in symptoms of raised ICP. Conclusion We report the largest series of consecutive IIH patients screened for OSA using overnight pulse oximetry. The high rate of OSA highlights a potential role for the recognition and management of OSA in the IIH patient cohort. Further studies on the potential contribution of OSA as a cause of raised ICP in the IIH cohort is warranted.

Neuro-ophthalmic features of patients with spontaneous cerebrospinal fluid leaks

“…However, additional studies are warranted to further evaluate their long-term role in preventing recurrent CSF leaks. OSA episodically increases the ICP and is a common comorbidity in patients with IIH [ 27 ] . One of the patients refused CPAP treatment, which reinforces the importance of education in OSA management.…”

Obstructive sleep apnea-hypopnea syndrome complicated with idiopathic intracranial hypertension: a case report

“…Special attention should be paid to IIH, which can be life-threatening. Overnight pulse oximetry can be used as a screening tool for OSAHS patients (12). Currently, there is still a lack of awareness and knowledge regarding sleep apnea, and patients with OSAHS (including those associated with stroke) are often not diagnosed or treated promptly.…”

Guidelines of the International Headache Society for Controlled Clinical Trials in Idiopathic Intracranial Hypertension

“…In the clinical setting, the most sensitive screening tool to identify OSA risk in IIH was the STOP-BANG questionnaire. Treating OSA in patients with IIH may improve papilledema (107,108). Polysomnography is required to confirm OSA. Presence of OSA may influence the visual and ICP endpoints. Patients with this diagnosis can be included, if their symptoms are actively managed and may need to be accounted for at statistical analysis. Where a person has untreated or unstable OSA it should be considered an exclusion to entry to the study.…”

“…In the clinical setting, the most sensitive screening tool to identify OSA risk in IIH was the STOP-BANG questionnaire. Treating OSA in patients with IIH may improve papilledema (107,108). Polysomnography is required to confirm OSA.…”