İdiyopatik İntrakraniyal Hipertansiyon ve Obstrüktif Uyku Apnesi Arasındaki İlişki: İkisi Arasındaki Tek Aracı Faktör Obezite mi?

Year 2024, Volume: 26 Issue: 2, 122 - 128, 30.08.2024

Şule Deveci , Vasfiye Kabeloğlu

https://doi.org/10.18678/dtfd.1458219

Abstract

Amaç: Bu çalışmanın amacı idiyopatik intrakraniyal hipertansiyon (İİH) ve obstrüktif uyku apnesi (OSA) arasındaki olası karşılıklı ilişkiyi araştırmaktır.
Gereç ve Yöntemler: Bu kesitsel çalışma Ekim 2023 ile Şubat 2024 tarihleri arasında gerçekleştirilmiştir. İİH'li hastalar ve İİH'si olmayan yaş ve cinsiyet uyumlu kontroller çalışmaya dahil edilmiştir. Yaş, cinsiyet, komorbiditeler, sigara içme ve alkol tüketimine ilişkin bilgiler kaydedilmiştir. Vücut kitle indeksi (VKİ) hesaplanmış ve VKİ ≥30 olanlar obez olarak kabul edilmiştir. Tüm katılımcılara Berlin anketi ve STOP-BANG anketi uygulanmıştır. Katılımcılar STOP-BANG anketindeki sekiz sorudan en az üçüne olumlu yanıt verdiğinde veya Berlin anketinde üç kategoriden ikisi olumlu sonuç verdiğinde OUA için yüksek risk belirlenmiştir.
Bulgular: Altmış İİH hastası ve 120 kontrol grubu katılmıştır. Gruplar arasında yaş (p=0.437) ve cinsiyet dağılımı (p=0.716) açısından anlamlı fark yoktu. Obez bireylerin yüzdesi İİH grubunda anlamlı derecede yüksekti (p<0.001). Berlin ve STOP-BANG sonuçları, İİH grubunun kontrol grubuna göre OUA için daha yüksek risk taşıdığını göstermiştir. Çok değişkenli lojistik regresyon analizi, Berlin anketinde yüksek risk sınıflandırması ile bağımsız olarak ilişkili tek faktörün obezite olduğunu ortaya koymuştur. STOP-BANG anketinde ise yüksek yaş, erkek cinsiyet, obezite ve hiperlipidemi bağımsız olarak yüksek risk sınıflandırması ile ilişkili bulunmuştur.
Sonuç: Obezite hem OSA hem de İİH için ortak risk faktörüdür. OSA ve İİH birlikteliği her iki hastalıkta da artmış morbidite ve mortalite oranlarına neden olabilir. Bu nedenle, İİH'li hastaların OSA riski açısından taranmasını öneriyoruz.

Keywords

Psödotümör serebri, uyku apnesi, obstrüktif, vücut kitle indeksi, obezite

The Relationship between Idiopathic Intracranial Hypertension and Obstructive Sleep Apnea: Is Obesity the Only Mediating Factor between the Two?

Abstract

Aim: This study aimed to investigate the possible reciprocal relationship between idiopathic intracranial hypertension (IIH) and obstructive sleep apnea (OSA).
Material and Methods: This cross-sectional study was conducted from October 2023 to February 2024. Patients with IIH and age and gender-matched controls without IIH were included. Information on age, gender, comorbidities, smoking, and alcohol consumption was recorded. Body mass index (BMI) was calculated, and a BMI ≥30 was considered obese. Berlin questionnaire and STOP-BANG questionnaire were administered to all participants. High risk for OSA was determined if participants responded affirmatively to at least three out of the eight questions on the STOP-BANG questionnaire, or if two out of the three categories showed positive results on the Berlin questionnaire.
Results: Sixty patients with IIH and 120 controls participated. There were no significant differences between groups regarding age (p=0.437) and gender distribution (p=0.716). The percentage of obese subjects was significantly higher in the IIH group (p<0.001). The Berlin and STOP-BANG results showed that the IIH group had higher risks for OSA than the control group. Multivariate logistic regression analysis revealed obesity as the only factor independently associated with high-risk classification with the Berlin questionnaire. In the STOP-BANG survey, higher age, male gender, obesity, and hyperlipidemia were independently related to high-risk classification.
Conclusion: Obesity is a common risk factor for both OSA and IIH. The coexistence of OSA and IIH may cause increased morbidity and mortality rates in both diseases. Therefore, we recommend that patients with IIH be screened for OSA risk.

Keywords

Pseudotumor cerebri, sleep apnea, obstructive, body mass index, obesity

References

• Elsaid N, Ahmed O, Belal T, Razek A, Azab A. Pathogenesis and evaluation of the effects of idiopathic intracranial hypertension on the optic nerves. Neuroophthalmology. 2020;44(5):281-9.
• Akçakaya NH, Akçakaya MO, Sencer A, Yapıcı Z. Idiopathic intracranial hypertension: diagnosis and therapeutic approach. Turk J Neurol. 2017;23(2):43-50.
• Wakerley BR, Mollan SP, Sinclair AJ. Idiopathic intracranial hypertension: Update on diagnosis and management. Clin Med (Lond). 2020;20(4):384-8.
• Yiangou A, Mitchell JL, Nicholls M, Chong YJ, Vijay V, Wakerley BR, et al. Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a sub-study of the idiopathic intracranial hypertension weight randomised controlled trial (IIH: WT). J Neurol. 2022;269(4):1945-56.
• Adderley NJ, Subramanian A, Nirantharakumar K, Yiangou A, Gokhale KM, Mollan SP, et al. Association between idiopathic intracranial hypertension and risk of cardiovascular diseases in women in the United Kingdom. JAMA Neurol. 2019;76(9):1088-98.
• Jensen RH, Radojicic A, Yri H. The diagnosis and management of idiopathic intracranial hypertension and the associated headache. Ther Adv Neurol Disord. 2016;9(4):317-26.
• Maurer JT. Early diagnosis of sleep related breathing disorders. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2008;7:Doc03.
• Adderley NJ, Subramanian A, Toulis K, Gokhale K, Taverner T, Hanif W, et al. Obstructive sleep apnea, a risk factor for cardiovascular and microvascular disease in patients with type 2 diabetes: Findings from a population-based cohort study. Diabetes Care. 2020;43(8):1868-77.
• Purvin VA, Kawasaki A, Yee RD. Papilledema and obstructive sleep apnea syndrome. Arch Ophthalmol. 2000;118(12):1626-30.
• Marcus DM, Lynn J, Miller JJ, Chaudhary O, Thomas D, Chaudhary B. Sleep disorders: a risk factor for pseudotumor cerebri? J Neuroophthalmol. 2001;21(2):121-3.
• Lee AG, Golnik K, Kardon R, Wall M, Eggenberger E, Yedavally S. Sleep apnea and intracranial hypertension in men. Ophthalmology. 2002;109(3):482-5.
• Fraser CL, Bliwise DL, Newman NJ, Lamirel C, Collop NA, Rye DB, et al. A prospective photographic study of the ocular fundus in obstructive sleep apnea. J Neuroophthalmol. 2013;33(3):241-6.
• Elsaid N, Mosa AAH, Saied A. Screening for obstructive sleep apnea in a sample of Egyptian idiopathic intracranial hypertension female patients using the Berlin questionnaire. Mansoura Med J. 2023;52(1):15-19.
• Mollan SP, Mitchell JL, Ottridge RS, Aguiar M, Yiangou A, Alimajstorovic Z, et al. Effectiveness of bariatric surgery vs community weight management intervention for the treatment of idiopathic intracranial hypertension: a randomized clinical trial. JAMA Neurol. 2021;78(6):678-86.
• Thurtell MJ, Trotti LM, Bixler EO, Rye DB, Bliwise DL, Newman NJ, et al. Obstructive sleep apnea in idiopathic intracranial hypertension: comparison with matched population data. J Neurol. 2013;260(7):1748-51.
• Thurtell MJ, Bruce BB, Rye DB, Newman NJ, Biousse V. The Berlin questionnaire screens for obstructive sleep apnea in idiopathic intracranial hypertension. J Neuroophthalmol. 2011;31(4):316-9.
• Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631-8.
• Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81(13):1159-65.
• Fraser JA, Bruce BB, Rucker J, Fraser LA, Atkins EJ, Newman NJ, et al. Risk factors for idiopathic intracranial hypertension in men: a case-control study. J Neurol Sci. 2010;290(1-2):86-9.
• Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485-91.
• Karakoc O, Akcam T, Genc H, Yetkin S, Piskin B, Gerek M. Use of the Berlin questionnaire to screen at-risk patients for obstructive sleep apnea. B-ENT. 2014;10(1):21-5.
• Ulukavak Çiftçi T, Çiftçi B; Turkish Thoracic Society Sleep Breathing Disorders Study Group. Turkish Thoracic Society obstructive sleep apnea syndrome diagnosis and treatment consensus report. Turk Thorac J. 2012;13(Suppl 1):1-66. Turkish.
• Ziemska-Gorczyca M, Woźniak, M, Dżaman K. Otoneurological symptoms in idiopathic intracranial hypertension. Pol Otorhino Rev. 2023;12(1):35-41.
• Stein JD, Kim DS, Mundy KM, Talwar N, Nan B, Chervin RD, et al. The association between glaucomatous and other causes of optic neuropathy and sleep apnea. Am J Ophthalmol. 2011;152(6):989-98.e3.
• Kabanovski A, Chan A, Shapiro C, Margolin E. Obstructive sleep apnea in men with idiopathic intracranial hypertension: a prospective case-control study. J Neuroophthalmol. 2023;43(4):531-4.
• Ajjeya MT, Sudhakar P. Role of obstructive sleep apnea in idiopathic intracranial hypertension. Neurology; 2023;100(17 Suppl 2):P10-4.004.
• Youssef M, Sundaram ANE, Veitch M, Aziz A, Gurges P, Bingeliene A, et al. Obstructive sleep apnea in those with idiopathic intracranial hypertension undergoing diagnostic in-laboratory polysomnography. Sleep Med. 2024;114:279-89.
• Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81.
• Aguiar M, Frew E, Mollan SP, Mitchell JL, Ottridge RS, Alimajstorovic Z, et al. The health economic evaluation of bariatric surgery versus a community weight management intervention analysis from the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT). Life (Basel). 2021;11(5):409.
• Elliot L, Frew E, Mollan SP, Mitchell JL, Yiangou A, Alimajstorovic Z, et al. Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single-payer healthcare system. Surg Obes Relat Dis. 2021;17(7):1310-6.
• Sugita Y, Iijima S, Teshima Y, Shimizu T, Nishimura N, Tsutsumi T, et al. Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome. Electroencephalogr Clin Neurophysiol. 1985;60(3):214-9.
• Baronio D, Martinez D, Fiori CZ, Bambini-Junior V, Forgiarini LF, Pase da Rosa D, et al. Altered aquaporins in the brains of mice submitted to intermittent hypoxia model of sleep apnea. Respir Physiol Neurobiol. 2013;185(2):217-21.
• Fung SJ, Xi MC, Zhang JH, Sampogna S, Yamuy J, Morales FR, et al. Apnea promotes glutamate-induced excitotoxicity in hippocampal neurons. Brain Res. 2007;1179:42-50.
• Lim DC, Pack AI. Obstructive sleep apnea and cognitive impairment: addressing the blood-brain barrier. Sleep Med Rev. 2014;18(1):35-48.
• Shiba T, Maeno T, Saishin Y, Hori Y, Takahashi M. Nocturnal intermittent serious hypoxia and reoxygenation in proliferative diabetic retinopathy cases. Am J Ophthalmol. 2010;149(6):959-63.
• Mojon DS, Hedges TR 3rd, Ehrenberg B, Karam EZ, Goldblum D, Abou-Chebl A, et al. Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy. Arch Ophthalmol. 2002;120(5):601-5.