Idiopathic normal-pressure hydrocephalus and obstructive sleep apnea are frequently associated: A prospective cohort study

Román, Gustavo C.; Verma, Aparajitha K.; Zhang, Y. Jonathan; Fung, Steve H.

doi:10.1016/j.jns.2018.10.005

Cited by 32 publications

(22 citation statements)

References 36 publications

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“… 39 , 71 Nevertheless, iNPH pathogenesis remains unclear. Very recently, Román et al 72 found a strong correlation between obstructive sleep apnea and NPH.…”

Section: Idiopathic Normal-pressure Hydrocephalus (Inph)mentioning

confidence: 96%

Normal-pressure hydrocephalus: A critical review

Oliveira

Nitrini

Román

2019

Dement. neuropsychol.

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ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords “normal-pressure hydrocephalus” / “idiopathic normal-pressure hydrocephalus” / “secondary normal-pressure hydrocephalus” / “NPH” / “ventriculoperitoneal shunt”. The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

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“… 39 , 71 Nevertheless, iNPH pathogenesis remains unclear. Very recently, Román et al 72 found a strong correlation between obstructive sleep apnea and NPH.…”

Section: Idiopathic Normal-pressure Hydrocephalus (Inph)mentioning

confidence: 96%

Normal-pressure hydrocephalus: A critical review

Oliveira

Nitrini

Román

2019

Dement. neuropsychol.

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“…This is due in part to the fact that both iNPH and OSA are largely under-diagnosed clinical conditions. However, with routine use of sleep questionnaires and polysomnography, we were able to demonstrate that SDB and iNPH are commonly associated, ranging in frequency from 65 to 90% [ 18 ••]. The latter observation serves as the basis for the present update.…”

Section: Introductionmentioning

confidence: 78%

“…The pathophysiological interactions between respiration and CSF circulation have been solidly established since then [ 66 ]. However, those earlier observations were essentially forgotten until we rediscovered the interaction by the systematic assessment of sleep in all patients evaluated at our Memory Disorders and Dementia Clinic [ 18 ••]. Recent and future discoveries of sleep physiology relevant to cognitive disorders of aging should continue to increase our understanding of iNPH perhaps opening new venues for treatment and prevention.…”

Section: Discussionmentioning

confidence: 99%

“…The statistically significant association of OSA with NPH is relatively novel [ 18 •• ] but the physiopathological vascular and metabolic mechanisms have been amply supported in the literature [ 66 – 71 , 74 – 80 ]. For instance, pulmonary hypertension is a well-known effect of OSA [ 82 ] and positive end-expiratory pressure (PEEP) [ 83 – 85 ] can increase central venous pressure, decreasing outflow and elevating intracranial CSF pressure.…”

Section: Introductionmentioning

confidence: 99%

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Sleep-Disordered Breathing and Idiopathic Normal-Pressure Hydrocephalus: Recent Pathophysiological Advances

Román

Jackson

Fung

et al. 2019

Curr Neurol Neurosci Rep

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Purpose of Review Idiopathic normal-pressure hydrocephalus (iNPH) is characterized clinically by ventriculomegaly, abnormal gait, falls, incontinence, and cognitive decline. This article reviews recent advances in the pathophysiology of iNPH concerning sleep-disordered breathing (SDB) and glymphatic circulation during deep sleep. Recent Findings The authors found iNPH frequently associated with obstructive sleep apnea (OSA). A critical factor in iNPH is intracranial venous hypertension delaying drainage of cerebrospinal fluid (CSF) into the cerebral venous sinuses. CSF-venous blood circulates in the jugular veins and finally drains into the heart. During SDB, repeated reflex attempts to breathe induce strong respiratory efforts against a closed glottis thereby increasing the negative intrathoracic pressure. This causes atrial distortion and decreases venous return to the heart resulting in retrograde intracranial venous hypertension. Additionally, repeated awakenings from OSA impede sleep-associated circulation of interstitial CSF into the glymphatic circulation contributing to hydrocephalus. Summary Sleep has become a critical element in the cognitive changes of aging including iNPH.

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“…[8][9][10] Recently, obstructive sleep apnea has also been associated with iNPH. 11 In addition, other neurodegenerative diseases, such as Alzheimer's disease (AD), PSP, and Parkinson's disease, have been diagnosed in patients with iNPH (see later).…”

Section: Associated Medical Conditionsmentioning

confidence: 99%

Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

et al. 2020

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A BS TRACT: Idiopathic normal pressure hydrocephalus is considered common but remains underinvestigated. There are no uniformly accepted diagnostic criteria and therapeutic guidelines. We summarize the accumulated evidence regarding the definition, pathophysiology, diagnosis, and treatment of idiopathic normal pressure hydrocephalus, highlighting the many gaps and controversies, including diagnostic challenges, the frequent association with neurodegeneration and vascular disease, and the many unknowns regarding patient selection and outcome predictors. A roadmap to fill these gaps and solve the controversies around this condition is also proposed. More evidence is required with respect to diagnostic criteria, the value of ancillary testing, prospective population-based studies and novel trial designs. Furthermore, a need exists to develop new advanced options in shunt technology.

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Idiopathic normal-pressure hydrocephalus and obstructive sleep apnea are frequently associated: A prospective cohort study

Cited by 32 publications

References 36 publications

Normal-pressure hydrocephalus: A critical review

Normal-pressure hydrocephalus: A critical review

Sleep-Disordered Breathing and Idiopathic Normal-Pressure Hydrocephalus: Recent Pathophysiological Advances

Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

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