Highlights
- •Multiple vascular risk factors (VRFs) often occur in idiopathic normal-pressure hydrocephalus (iNPH).
- •Obstructive sleep apnea (OSA) is an independent vascular risk factor rarely reported in iNPH.
- •Sleep was studied in a prospective cohort of 31 consecutive patients with iNPH from a single memory clinic.
- •Nocturnal polysomnogram confirmed OSA in 90·3% (28/31) patients with iNPH; all had undiagnosed sleep abnormalities and excessive daytime sleepiness.
- •Larger confirmatory studies are needed but it appears reasonable to obtain a sleep history in patients suspected of iNPH.
Abstract
Background
Idiopathic normal-pressure hydrocephalus (iNPH) is defined by ventriculomegaly, cognitive
decline, urinary incontinence and gait problems. Vascular risk factors (VRF) are associated
with iNPH but obstructive sleep apnea (OSA) —a well-known independent VRF— is seldom
mentioned.
Methods
We investigated the presence of sleep-disordered breathing in a prospective cohort
of 31 consecutive unselected patients with iNPH using sleep questionnaires and nocturnal
polysomnography (PSG).
Results
We found OSA in 90·3% (28/31) patients with iNPH; all had undiagnosed sleep abnormalities
(snoring, awakenings, nocturia) and excessive daytime sleepiness (Epworth scale = 11·4 ± 6·4;
normal <8). Nocturnal PSG showed moderate-to-severe OSA in 25 patients (80·6%) with
mean apnea-hypopnea index (AHI) 31·6 ± 23·6/h; mean respiratory distress index (RDI)
34·5/h; and, mean SaO2 desaturation at nadir, 82·2 ± 7·5%. The observed OSA prevalence is statistically
significant: 90·3%, 95%CI 74·3–97·5; p = 0·000007. Other VRF included overweight body-mass index (BMI >25- < 30 kg/m2) in 59%, hyperhomocysteinemia 57%, hypertension 43%, hyperlipidemia 39%, diabetes
32%, smoking 21%, coronary disease 18%, and previous stroke 10%.
Conclusion
Abnormal sleep breathing is frequently associated with iNPH. Validation in larger
series is required but we suggest including sleep evaluation in patients suspected
of iNPH.
Keywords
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Article info
Publication history
Published online: October 03, 2018
Accepted:
October 2,
2018
Received in revised form:
September 30,
2018
Received:
July 16,
2018
Identification
Copyright
© 2018 Published by Elsevier B.V.
