Symptoms Underestimate the Presence of Obstructive Sleep Apnea in Patients with Spontaneous Cerebrospinal Fluid Leaks of the Temporal Bone

Abstract

Objective: To determine the severity of symptoms and degree of obstructive sleep apnea (OSA) in patients with spontaneous cerebrospinal fluid (sCSF) leaks of the temporal bone given the known association between sCSF leaks and OSA. Study Design: Retrospective case review. Setting: Ambulatory clinics in tertiary referral centers. Patients: Polysomnogram testing in 34 consecutive patients who had been diagnosed with sCSF leaks of the temporal bone was examined. Diagnosis of sCSF leak was defined as biochemically confirmed CSF from middle ear fluid with no other obvious source. Intervention: Diagnostic. Main Outcomes Measure(s): Patient characteristics (age, sex, body mass index, Epworth Sleepiness Scale score, presence of hypoxia, overnight change in blood pressure, and apnea hypopnea index [AHI]) were recorded. Diagnosis of OSA was defined as mild when AHI ≥5 and <15/h, moderate when AHI ≥15 and <30/h, and severe when AHI ≥30/h.Results: Of the 34 patients, 28 (82%) had a confirmed diagnosis of OSA. There was a male predisposition in those with OSA, and 17 of 28 (61%) were male. A majority were overweight, and the mean body mass index was 30.1 (SD, 4.8; range, kg/m 2 . The mean severity of OSA was moderate, and the mean AHI was 28.7 (SD, 21.9; range,). Of the 28 patients, 13 with OSA (46%) had Epworth Sleepiness Scale scores higher than 8, suggesting that many were asymptomatic for excessive daytime sleepiness at the time of presentation. Conclusion: OSA is highly prevalent among patients with sCSF leaks of the temporal bone. Patients with sCSF leaks irrespective of symptoms of OSA should undergo formal polysomnogram testing.

Meningitis Risk and Role of Prophylactic Antibiotics in Spontaneous Lateral Skull Base CSF Leaks

“…[1][2][3][4][5][6][7] There are significantly increased odds of obesity and OSA among patients with sCSF leak compared to control patient populations, and both OSA and obesity have been correlated with diffuse skull base thinning-a factor which may underlie the development of sCSF leak. [8][9][10][11][12][13] In a proportion of cases, a breach in the associated temporal lobe dura will lead to CSF leak and/or encephalocele development. Lateral skull base sCSF leaks often present with nonspecific symptoms that can obfuscate diagnostic decision making, including hearing loss, aural fullness, tinnitus, otalgia, vertigo/dizziness, and headache.…”