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

Fluids and Barriers of the CNS

Research

Poul Jennum¹  Jens E. Wilhjelm²  Morten Andresen³  Casper Schwartz Riedel⁴  Isabel Martinez-Tejada⁵  Marianne Juhler⁶ 

[1] Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark;Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark;Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen East, 2100, Copenhagen, Denmark;Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen East, 2100, Copenhagen, Denmark;Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark;Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen East, 2100, Copenhagen, Denmark;Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark;Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen East, 2100, Copenhagen, Denmark;Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;

关键词: Obstructive sleep apnea;    Sleep-disordered breathing;    CPAP;    ICP;    Slow waves;    Hydrocephalus;   

DOI  :  10.1186/s12987-023-00469-6

 received in 2023-02-27, accepted in 2023-09-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundRepetitive 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.MethodsWe 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.ResultsAll 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.ConclusionThe 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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