The Relation of Intracranial Pressure B-waves to Different Sleep Stages in Patients with Suspected Normal Pressure Hydrocephalus

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 1995 Jan 1

PMID 8748854

Citations 14

Authors

J K Krauss

D W Droste

M Bohus

J P Regel

R Scheremet

D Riemann

W Seeger

Affiliations

Soon will be listed here.

Abstract

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.

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References

Chawla J, Hulme A, Cooper R . Intracranial pressure in patients with dementia and communicating hydrocephalus. J Neurosurg. 1974; 40(3):376-80. DOI: 10.3171/jns.1974.40.3.0376. View

Vanneste J . Three decades of normal pressure hydrocephalus: are we wiser now?. J Neurol Neurosurg Psychiatry. 1994; 57(9):1021-5. PMC: 1073120. DOI: 10.1136/jnnp.57.9.1021. View

Adams R, Fisher C, Hakim S, Ojemann R, SWEET W . SYMPTOMATIC OCCULT HYDROCEPHALUS WITH "NORMAL" CEREBROSPINAL-FLUID PRESSURE. A TREATABLE SYNDROME. N Engl J Med. 1965; 273:117-26. DOI: 10.1056/NEJM196507152730301. View

Droste D, Krauss J, Berger W, Schuler E, Brown M . Rhythmic oscillations with a wavelength of 0.5-2 min in transcranial Doppler recordings. Acta Neurol Scand. 1994; 90(2):99-104. DOI: 10.1111/j.1600-0404.1994.tb02687.x. View

Maira G, Di Rocco C, Rossi G . [Intraventricular pressure in normal pressure hydrocephalus during wakefulness and sleep]. Neurochirurgie. 1974; 20(5):462-7. View

Ogashiwa M, Takeuchi K . [Intracranial pressure changes during sleep in man]. No To Shinkei. 1983; 35(2):123-9. View

Di Rocco C, McLone D, Shimoji T, RAIMONDI A . Continuous intraventricular cerebrospinal fluid pressure recording in hydrocephalic children during wakefulness and sleep. J Neurosurg. 1975; 42(6):683-9. DOI: 10.3171/jns.1975.42.6.0683. View

Madsen P, Schmidt J, Wildschiodtz G, Friberg L, Holm S, Vorstrup S . Cerebral O2 metabolism and cerebral blood flow in humans during deep and rapid-eye-movement sleep. J Appl Physiol (1985). 1991; 70(6):2597-601. DOI: 10.1152/jappl.1991.70.6.2597. View

Hori T, Sugita Y, Koga E, Shirakawa S, Inoue K, Uchida S . Proposed supplements and amendments to 'A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects', the Rechtschaffen & Kales (1968) standard. Psychiatry Clin Neurosci. 2001; 55(3):305-10. DOI: 10.1046/j.1440-1819.2001.00810.x. View

10.

Raftopoulos C, Chaskis C, Delecluse F, Cantraine F, Bidaut L, Brotchi J . Morphological quantitative analysis of intracranial pressure waves in normal pressure hydrocephalus. Neurol Res. 1992; 14(5):389-96. DOI: 10.1080/01616412.1992.11740091. View

11.

Townsend R, Prinz P, Obrist W . Human cerebral blood flow during sleep and waking. J Appl Physiol. 1973; 35(5):620-5. DOI: 10.1152/jappl.1973.35.5.620. View

12.

Hajak G, Klingelhofer J, Matzander G, Sander D, Conrad B, Ruther E . Relationship between cerebral blood flow velocities and cerebral electrical activity in sleep. Sleep. 1994; 17(1):11-9. DOI: 10.1093/sleep/17.1.11. View

13.

Sahuquillo J, Rubio E, Codina A, Molins A, GUITART J, Poca M . Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called "normal pressure hydrocephalus" syndrome. Acta Neurochir (Wien). 1991; 112(1-2):50-61. DOI: 10.1007/BF01402454. View

14.

Brock M . [Clinical signs and therapy of intermittent normotensive hydrocephalus (author's transl)]. Radiologe. 1977; 17(11):460-5. View

15.

Nornes H, Rootwelt K, Sjaastad O . Normal pressure hydrocephalus. Long-term intracranial pressure recording. Eur Neurol. 1973; 9(5):261-74. DOI: 10.1159/000114232. View

16.

Nilsson C, Stahlberg F, Thomsen C, Henriksen O, Herning M, Owman C . Circadian variation in human cerebrospinal fluid production measured by magnetic resonance imaging. Am J Physiol. 1992; 262(1 Pt 2):R20-4. DOI: 10.1152/ajpregu.1992.262.1.R20. View

17.

Pickard J . Adult communicating hydrocephalus. Br J Hosp Med. 1982; 27(1):35, 37-8, 40, passim. View

18.

Symon L, Dorsch N, Stephens R . Pressure waves in so-called low-pressure hydrocephalus. Lancet. 1972; 2(7790):1291-2. DOI: 10.1016/s0140-6736(72)92658-x. View

19.

Droste D, Berger W, Schuler E, Krauss J . Middle cerebral artery blood flow velocity in healthy persons during wakefulness and sleep: a transcranial Doppler study. Sleep. 1993; 16(7):603-9. View

20.

Vanneste J, Augustijn P, Dirven C, Tan W, Goedhart Z . Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review. Neurology. 1992; 42(1):54-9. DOI: 10.1212/wnl.42.1.54. View