Prevalence of Obstructive Sleep Apnea (OSA) in Spontaneous Cerebrospinal Fluid (CSF) Leaks: A Prospective Cohort Study

Rabbani, Cyrus C.; Saltagi, Mohamad Z.; Manchanda, Shalini; Yates, Charles W.; Nelson, Rick F.

doi:10.1097/mao.0000000000001805

Cited by 31 publications

(42 citation statements)

References 32 publications

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“…Since the extracranial zygoma thickness is unaffected in sCSF‐L patients, 3 sCSF‐L likely occur due to an intracranial process that causes isolated skull thinning independent of obesity 3 . Researchers hypothesize obesity‐related factors, such as idiopathic intracranial hypertension (IIH) and OSA, play a role in the intracranial process that results in the development of sCSF‐L 3,4,20–22 (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

et al. 2020

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Objectives To determine the safety and effectiveness of the middle cranial fossa (MCF) approach in repairing spontaneous cerebrospinal fluid (sCSF) leaks. Study Design Retrospective cohort study. Methods Patient with sCSF leaks repaired by MCF approach between January 1, 2014 and August 31, 2019 were included. Demographic information, clinical and surgical findings, and postoperative outcomes were recorded. Results The cohort (n = 45) included 24 tegmen repairs by multilayer reconstruction using hydroxyapatite cement and 21 cases of multilayer repair without hydroxyapatite cement. Ten MCF repairs were performed on patients ≥65 years old. Twenty (53%) ears had multiple tegmen defects (range, 1–9 tegmen defects) and 78% of patients had ≥1 encephaloceles. All sCSF leaks were resolved with one surgical intervention. There were no major intracranial complications. Transient expressive aphasia occurred in 2 patients. Medical complications occurred in four patients. There were no short‐term postoperative CSF leaks with bone cement reconstruction and two postoperative leaks without bone cement. One resolved with lumbar drain (LD) and the other resolved without treatment. The average (SD) length of stay (LOS) with bone cement was shorter than in patients without bone cement (2.54 [0.83] days vs. 3.52 [1.99] days, P < .05). There have been no long‐term CSF leak recurrences with an average (SD) follow‐up of 13.5 (12.9) months (range 0.25–46 months). Conclusions MCF approach for sCSF repairs demonstrate efficacious outcomes, particularly with tegmen reconstruction using hydroxyapatite cement. The approach exhibited no serious adverse events and few complications requiring intervention. Therefore, MCF is a safe and effective approach to resolve sCSF leaks. Level of Evidence 3 Laryngoscope, 131:624–632, 2021

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Section: Discussionmentioning

confidence: 99%

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

et al. 2020

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“…16,22 A recent prospective study found that the prevalence of OSA among patients with sCSF-L is 83%. 17 We investigated a cohort of patients who were obese, yet did not have sCSF-L, and discovered that patients with moderate to severe OSA have thinning of the squamous portion of the temporal bone and skull base compared with non-OSA patients, a relationship independent of age, BMI, sex, and multiple comorbidities. We also found that patients with sCSF-L had nearly 20% thinner calvaria than those without OSA, similar to previous studies showing a mean 22% thinning of the skull in patients with sCSF-L. 15 We used the thickness of the squamous temporal bone as a surrogate for global calvarial thickness because it is not feasible to measure the entire calvarium.…”

Section: Discussionmentioning

confidence: 99%

“…15 This suggests an intracranial process leads to skull thinning and the development of sCSF-L. 15 Elevated intracranial pressure (ICP) on a constant or transient basis has been postulated to lead to skull thinning over time. 10,11,13 Elevated ICP has been documented in some (approximately 36%) but not all patients with sCSF-L. 10 In addition, OSA is associated with transient spikes in ICP during apnea episodes 16 and the prevalence of OSA is 83% in patients with sCSF-L. 17 Our study aimed to determine if OSA is independently associated with skull thinning by investigating the radiologic skull base and calvaria findings in non-sCSF-L patients with and without OSA based on formal PSG testing. To our knowledge, no studies have established a connection between OSA and skull thinning.…”

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Association of Obstructive Sleep Apnea With Calvarial and Skull Base Thinning

Rabbani

Saltagi

et al. 2018

JAMA Otolaryngol Head Neck Surg

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“…sCSF-L has been associated with thinning of the calvarium with no changes to extracranial bones and is linked with obesity and OSA. 63,64 In particular, the incidence of OSA in sCSF-L patients was reported to be 83.3% and patients with OSA have been shown to have a thinner mean calvaria. 63,64 This suggests that there might be an indirect link between OSA and chronic untreated IIH.…”

Section: Osa and Iihmentioning

confidence: 99%

<p>Neuro-Ophthalmological Manifestations of Obstructive Sleep Apnea: Current Perspectives</p>

Farahvash

Micieli

2020

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Obstructive sleep apnea (OSA) is a disease of obstructed airways during sleep that significantly impacts the quality of life and increases the risk of various systemic diseases. OSA has been studied as a risk factor for a number of neuro-ophthalmic conditions and a strong relationship has been established with non-arteritic anterior ischemic optic neuropathy (NAION). The incidence of glaucoma and stroke have also been significantly associated with OSA and are conditions that may also be seen by neuro-ophthalmologists. Patients with NAION have a significantly higher incidence of OSA and OSA diagnosis significantly increases the risk for NAION development. Non-compliance with continuous positive airway pressure (CPAP) in OSA patients has also been found to be a risk factor for fellow-eye involvement and there is increasing evidence to suggest that every patient with NAION should be formally evaluated with polysomnography. The relationship between OSA and idiopathic intracranial hypertension (IIH) has also been studied, but the relationship between these two conditions is less clear. There is insufficient evidence to recommend routine eye examinations in OSA patients for papilledema and conducting a sleep study for a newly diagnosed IIH patient should be left to the discretion of the clinician based on other symptoms and risk factors of OSA.

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Prevalence of Obstructive Sleep Apnea (OSA) in Spontaneous Cerebrospinal Fluid (CSF) Leaks: A Prospective Cohort Study

Abstract: OSA is highly prevalent among patients with sCSF leaks. All patients with sCSF leaks should undergo formal PSG testing. Future studies are needed to determine the role of OSA in the development of sCSF leaks.

Cited by 31 publications

References 32 publications

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

Association of Obstructive Sleep Apnea With Calvarial and Skull Base Thinning

<p>Neuro-Ophthalmological Manifestations of Obstructive Sleep Apnea: Current Perspectives</p>

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