Krauss J K, Droste D W, Bohus M, Regel J P, Scheremet R, Riemann D, Seeger W
Department of Neurosurgery, Albert-Ludwigs-Universität, Freiburg, Federal Republic of Germany.
Acta Neurochir (Wien). 1995;136(3-4):195-203. doi: 10.1007/BF01410626.
The interpretation of data from continuous monitoring of intracranial pressure (ICP) in patients with suspected normal pressure hydrocephalus (NPH) is the subject of controversy. Despite the fact that overnight ICP monitoring is widely used for the diagnosis of NPH, normative criteria are poorly defined. The present study demonstrates that there is a relationship between the relative frequency, the absolute amplitude, the wavelength and the morphology of B-waves and different sleep stages. Intraventricular intracranial pressure was recorded continuously overnight in 16 patients with suspected normal pressure hydrocephalus. Simultaneous polysomnography was performed to investigate the relation of spontaneous ICP oscillations to different sleep stages. A correlative analysis was done with the data of 13 patients. Three patients were excluded, one who was awake throughout the night and two in whom polysomnography was incomplete due to technical reasons. The mean resting cerebrospinal fluid (CSF) pressure was 12.87 cm CSF. B-waves were observed in the ICP recordings of all patients. They were present for a mean of 72% of the total recording time. The relative frequency of B-waves was higher during REM sleep and sleep stage 2 as compared to wakefulness (87.8% and 83.2% vs. 56. p < 0.05). The absolute amplitude was higher during REM sleep than in wakefulness (9.56 vs. 3.44 cm CSF, p < 0.05). Wavelengths were longer in REM sleep than in wakefulness and stages 1 and 2 (62.4 vs. 42, 40.7 and 44.8 sec, p < 0.05). The morphology of B-waves was also related to different sleep stages. Ramp-type B-waves were associated with REM sleep in six patients, however, were also present in sleep stage 2 in three of them. Knowledge of the relation of spontaneous ICP oscillations to different sleep stages may help to establish physiological foundations and alterations. Furthermore, polysomnography may be useful to avoid erroneous interpretation of ICP recordings due to sleep stage related variability.
对疑似正常压力脑积水（NPH）患者进行颅内压（ICP）连续监测数据的解读存在争议。尽管夜间ICP监测广泛用于NPH的诊断，但正常标准定义不明确。本研究表明，B波的相对频率、绝对振幅、波长和形态与不同睡眠阶段之间存在关联。对16例疑似正常压力脑积水患者进行了夜间连续的脑室内颅内压记录。同时进行多导睡眠图检查以研究自发性ICP振荡与不同睡眠阶段的关系。对13例患者的数据进行了相关性分析。排除了3例患者，1例整夜清醒，2例因技术原因多导睡眠图检查不完整。平均静息脑脊液（CSF）压力为12.87 cm CSF。所有患者的ICP记录中均观察到B波。它们平均占总记录时间的72%。与清醒状态相比，快速眼动（REM）睡眠和睡眠2期B波的相对频率更高（87.8%和83.2%对56，p<0.05）。REM睡眠期间的绝对振幅高于清醒状态（9.56对3.44 cm CSF，p<0.05）。REM睡眠中的波长比清醒状态以及睡眠1期和2期更长（62.4对42、40.7和44.8秒，p<0.05）。B波的形态也与不同睡眠阶段有关。6例患者的斜坡型B波与REM睡眠相关，然而，其中3例在睡眠2期也出现了斜坡型B波。了解自发性ICP振荡与不同睡眠阶段的关系可能有助于建立生理基础和变化情况。此外，多导睡眠图检查可能有助于避免因睡眠阶段相关变异性而对ICP记录进行错误解读。
