特发性正常压力脑积水和阻塞性睡眠呼吸暂停常相关：一项前瞻性队列研究。
Idiopathic normal-pressure hydrocephalus and obstructive sleep apnea are frequently associated: A prospective cohort study.
机构信息
Department of Neurology, Methodist Neurological Institute and Houston Methodist Hospital Research Institute for Academic Medicine, Houston, TX, USA; Department of Neurology, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Department of Neurology, Methodist Neurological Institute and Houston Methodist Hospital Research Institute for Academic Medicine, Houston, TX, USA; Sleep Laboratory Houston Methodist Hospital, Houston, TX, USA.
出版信息
J Neurol Sci. 2018 Dec 15;395:164-168. doi: 10.1016/j.jns.2018.10.005. Epub 2018 Oct 3.
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 SaO 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/m) 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.
背景
特发性正常压力脑积水（iNPH）的定义为脑室扩大、认知功能下降、尿失禁和步态问题。血管危险因素（VRF）与 iNPH 相关，但阻塞性睡眠呼吸暂停（OSA）——一种众所周知的独立 VRF——很少被提及。
方法
我们使用睡眠问卷和夜间多导睡眠图（PSG）对 31 例连续未经选择的 iNPH 患者进行前瞻性队列研究，以调查睡眠呼吸障碍的存在。
结果
我们发现 90.3%（28/31）的 iNPH 患者存在 OSA；所有患者均有未诊断的睡眠异常（打鼾、觉醒、夜尿）和日间过度嗜睡（Epworth 量表=11.4±6.4；正常<8）。夜间 PSG 显示 25 例（80.6%）患者存在中重度 OSA，平均呼吸暂停低通气指数（AHI）为 31.6±23.6/h；平均呼吸窘迫指数（RDI）为 34.5/h；平均 SaO2 最低时为 82.2±7.5%。观察到的 OSA 患病率具有统计学意义：90.3%，95%CI 74.3-97.5；p=0.000007。其他 VRF 包括超重体重指数（BMI>25-<30 kg/m）59%、高同型半胱氨酸血症 57%、高血压 43%、高血脂 39%、糖尿病 32%、吸烟 21%、冠心病 18%和既往卒中 10%。
结论
异常睡眠呼吸常与 iNPH 相关。需要在更大的系列中进行验证，但我们建议在怀疑患有 iNPH 的患者中进行睡眠评估。
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