Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK.
J Neurol. 2022 Apr;269(4):1945-1956. doi: 10.1007/s00415-021-10700-9. Epub 2021 Aug 22.
Obesity is a risk factor for idiopathic intracranial hypertension (IIH) and obstructive sleep apnoea (OSA). We aimed to determine the prevalence of OSA in IIH and evaluate the diagnostic performance of OSA screening tools in IIH. Additionally, we evaluated the relationship between weight loss, OSA and IIH over 12 months.
A sub-study of a multi-centre, randomised controlled parallel group trial comparing the impact of bariatric surgery vs. community weight management intervention (CWI) on IIH-related outcomes over 12 months (IIH:WT). OSA was assessed using home-based polygraphy (ApneaLink Air, ResMed) at baseline and 12 months. OSA was defined as an apnoea-hypopnoea index (AHI) ≥ 15 or ≥ 5 with excessive daytime sleepiness (Epworth Sleepiness Scale ≥11 ).
Of the 66 women in the IIH: WT trial, 46 were included in the OSA sub-study. OSA prevalence was 47% (n = 19). The STOP-BANG had the highest sensitivity (84%) compared to the Epworth Sleepiness Scale (69%) and Berlin (68%) to detect OSA. Bariatric surgery resulted in greater reductions in AHI vs. CWI (median [95%CI] AHI reduction of - 2.8 [ - 11.9, 0.7], p = 0.017). Over 12 months there was a positive association between changes in papilloedema and AHI (r = 0.543, p = 0.045), despite adjustment for changes in the body mass index (R = 0.522, p = 0.017).
OSA is common in IIH and the STOP-BANG questionnaire was the most sensitive screening tool. Bariatric surgery improved OSA in patients with IIH. The improvement in AHI was associated with improvement in papilloedema independent of weight loss. Whether OSA treatment has beneficial impact on papilloedema warrants further evaluation.
IIH: WT is registered as ISRCTN40152829 and on ClinicalTrials.gov as NCT02124486 (28/04/2014).
肥胖是特发性颅内高压（IIH）和阻塞性睡眠呼吸暂停（OSA）的危险因素。本研究旨在确定 IIH 中 OSA 的患病率，并评估 OSA 筛查工具在 IIH 中的诊断性能。此外，我们还评估了在 12 个月内体重减轻、OSA 和 IIH 之间的关系。
一项多中心、随机对照平行组试验的子研究，比较了减肥手术与社区体重管理干预（CWI）对 12 个月内 IIH 相关结局的影响（IIH：WT）。基线和 12 个月时使用家庭多导睡眠图（ApneaLink Air，ResMed）评估 OSA。OSA 定义为呼吸暂停低通气指数（AHI）≥15 或≥5 且白天嗜睡过度（Epworth 嗜睡量表≥11）。
在 IIH：WT 试验的 66 名女性中，有 46 名纳入了 OSA 子研究。OSA 的患病率为 47%（n=19）。与 Epworth 嗜睡量表（69%）和柏林（68%）相比，STOP-BANG 对 OSA 的检测具有更高的敏感性（84%）。与 CWI 相比，减肥手术导致 AHI 降低更大（中位数[95%CI]AHI 降低-2.8[-11.9，0.7]，p=0.017）。尽管调整了体重指数的变化，但在 12 个月内，视乳头水肿的变化与 AHI 呈正相关（r=0.543，p=0.045）。
OSA 在 IIH 中很常见，STOP-BANG 问卷是最敏感的筛查工具。减肥手术改善了 IIH 患者的 OSA。AHI 的改善与视乳头水肿的改善独立相关，与体重减轻无关。OSA 治疗是否对视乳头水肿有有益影响还需要进一步评估。
IIH：WT 作为 ISRCTN40152829 注册，并在 ClinicalTrials.gov 上注册为 NCT02124486（2014 年 4 月 28 日）。
