IRCCS Mondino Foundation, National Neurological Institute, Pavia, Italy.
Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
Eur J Neurol. 2024 Dec;31(12):e16448. doi: 10.1111/ene.16448. Epub 2024 Aug 29.
The pathogenesis of idiopathic normal pressure hydrocephalus (iNPH) remains controversial. Limited studies have indicated a high prevalence of obstructive sleep apnoea (OSA) amongst iNPH patients. The aim was to investigate the clinical correlates of OSA in iNPH patients.
In this cross-sectional observational study, consecutive iNPH patients were prospectively enrolled. Evaluations included the iNPH Rating Scale, the Movement Disorder Society Unified Parkinson's Disease Rating Scale part III, the time and number of steps to walk 10 m, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, a complete neuropsychological evaluation, 3-T brain MRI, full-night video-polysomnography, tap test and cerebrospinal fluid (CSF) neurodegeneration biomarkers.
Fifty-one patients were screened, of whom 38 met the inclusion criteria. Amongst the recruited patients, 19/38 (50%) exhibited OSA, with 12/19 (63.2%) presenting moderate to severe disorder. OSA+ iNPH patients required more time (p = 0.02) and more steps (p = 0.04) to complete the 10-m walking test, had lower scores on the gait subitem of the iNPH Rating Scale (p = 0.04) and demonstrated poorer performance on specific neuropsychological tests (Rey Auditory Verbal Learning Test immediate recall, p = 0.03, and Rey-Osterrieth Complex Figure, p = 0.01). Additionally, OSA+ iNPH patients had higher levels of total tau (p = 0.02) and phospho-tau (p = 0.03) in their CSF but no statistically significant differences in beta-amyloid (1-42) levels compared to OSA- iNPH patients.
Obstructive sleep apnoea is highly prevalent in iNPH patients, particularly at moderate to severe levels. OSA is associated with worse motor and cognitive performance in iNPH. The CSF neurodegeneration biomarker profile observed in OSA+ iNPH patients may reflect OSA-induced impairment of cerebral fluid dynamics.
特发性正常压力脑积水（iNPH）的发病机制仍存在争议。有限的研究表明，iNPH 患者中阻塞性睡眠呼吸暂停（OSA）的患病率较高。本研究旨在探讨 iNPH 患者 OSA 的临床相关性。
在这项横断面观察性研究中，连续纳入了 iNPH 患者。评估包括 iNPH 评分量表、运动障碍协会统一帕金森病评定量表第三部分、行走 10 米所需的时间和步数、Epworth 嗜睡量表、匹兹堡睡眠质量指数、全面的神经心理学评估、3T 脑 MRI、整夜视频多导睡眠图、 tapp 测试和脑脊液（CSF）神经退行性生物标志物。
共筛选了 51 例患者，其中 38 例符合纳入标准。在招募的患者中，19/38（50%）存在 OSA，其中 12/19（63.2%）为中重度障碍。OSA+iNPH 患者完成 10 米行走测试所需的时间（p=0.02）和步数（p=0.04）更多，iNPH 评分量表步态亚项评分较低（p=0.04），且特定神经心理学测试表现较差（ Rey 听觉言语学习测试即时回忆，p=0.03， Rey-Osterrieth 复杂图形，p=0.01）。此外，OSA+iNPH 患者脑脊液中总 tau（p=0.02）和磷酸化 tau（p=0.03）水平较高，但与 OSA-iNPH 患者相比，β-淀粉样蛋白（1-42）水平无统计学差异。
阻塞性睡眠呼吸暂停在 iNPH 患者中非常普遍，尤其是中重度水平。OSA 与 iNPH 患者的运动和认知功能更差相关。在 OSA+iNPH 患者中观察到的 CSF 神经退行性生物标志物谱可能反映了 OSA 引起的脑液动力学受损。
