Advertisement

Acta Neurochirurgica

, Volume 136, Issue 3–4, pp 195–203 | Cite as

The relation of intracranial pressure B-waves to different sleep stages in patients with suspected normal pressure hydrocephalus

  • J. K. Krauss
  • D. W. Droste
  • M. Bohus
  • J. P. Regel
  • R. Scheremet
  • D. Riemann
  • W. Seeger
Clinical Articles

Summary

The interpretation of data from continuous monitoring of intra-cranial 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 technicai 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.

Keywords

B-waves intracranial pressure normal pressure hydrocephalus sleep 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. A treatable syndrome. N Engl J Med 273: 117–126PubMedGoogle Scholar
  2. 2.
    Auer LM, Sayama I (1983) Intracranial pressure oscillations (B-waves) caused by oscillations in cerebrovascular volume. Acta Neurochir (Wien) 68: 93–100Google Scholar
  3. 3.
    Belloni G, Di Rocco C, Focacci C, Galli G, Maira G, Rossi GF (1976) Surgical indications in normotensive hydrocephalus. A retrospective analysis of the relations of some diagnostic findings to the results of surgical treatment. Acta Neurochir (Wien) 33: 1–21Google Scholar
  4. 4.
    Black PMcL, Ojemann RG, Tzouras A (1985) CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg 32: 632–651PubMedGoogle Scholar
  5. 5.
    Boergesen SE, Gjerris F, Soerensen SC (1979) Intracranial pressure and conductance to outflow of cerebrospinal fluid in normal-pressure hydrocephalus. J Neurosurg 50: 489–493PubMedGoogle Scholar
  6. 6.
    Brock M (1977) Klinik und Therapie des intermittierend normotensiven Hydrocephalus. Radiologe 17: 460–465PubMedGoogle Scholar
  7. 7.
    Cardoso ER, Piatek D, Del Bigio MR, Stambrook M, Sutherland JB (1989) Quantification of abnormal intracranial pressure waves and isotope cisternography for diagnosis of occult communicating hydrocephalus. Surg Neurol 31: 20–27PubMedGoogle Scholar
  8. 8.
    Chawla JC, Hulme A, Cooper R (1974) Intracranial pressure in patients with dementia and communicating hydrocephalus. J Neurosurg 40: 376–380PubMedGoogle Scholar
  9. 9.
    Cooper R, Hulme A (1966) Intracranial pressure and related phenomena during sleep. J Neurol Neurosurg Psychiatry 29: 564–570Google Scholar
  10. 10.
    Di Rocco C, McLone DG, Shimoji T, Raimondi AJ (1975) Continuous intraventricular cerebrospinal fluid pressure recording in hydrocephalie children during wakefulness and sleep. J Neurosurg 42: 683–689PubMedGoogle Scholar
  11. 11.
    Droste DW, Berger W, Schuler E, Krauss JK (1993) Middle cerebral artery blood flow velocity in healthy persons during wakefulness and sleep: a transcranial Doppler study. Sleep 16: 603–609PubMedGoogle Scholar
  12. 12.
    Droste DW, Krauss JK (1993) Simultaneous recording of cerebrospinal fluid pressure and middle cerebral artery blood flow velocity in patients with suspected symptomatic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 56: 75–79PubMedGoogle Scholar
  13. 13.
    Droste DW, Krauss JK, Berger W, Schuler E, Brown MM (1994) Rhythmic oscillations with a wavelength of 0.5–2 min in transcranial Doppler recordings. Acta Neurol Scand 90: 99–104PubMedGoogle Scholar
  14. 14.
    Franzini C (1992) Brain metabolism and blood flow during sleep. J Sleep Res 1: 3–16Google Scholar
  15. 15.
    Furuse M, Kuchiwaki H, Nakaya T, Toyama K, Teraoka M, Hasuo M, Ikeyama A, Kageyama N (1980) Relationship between rapid ICP variation, respiratory pattern and wakefulness in neurological patients. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwalt GH, Brock M (eds) Intracranial pressure IV. Springer, Berlin Heidelberg New York, pp 584–587Google Scholar
  16. 16.
    Graff-Radford NR, Godersky JC, Jones MP (1989) Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly. Neurology 39: 1601–1604PubMedGoogle Scholar
  17. 17.
    Gücer G, Viernstein L (1979) Intracranial pressure in the normal monkey while awake and asleep. J Neurosurg 51: 206–210PubMedGoogle Scholar
  18. 18.
    Hajak G, Klingelhöfer J, Schulz-Varszegi M, Matzander G, Saunder D, Conrad B, Rüther E (1994) Relationship between cerebral blood flow velocities and cerebral electrical activity in sleep. Sleep 17: 11–19PubMedGoogle Scholar
  19. 19.
    Hamer J, Kühner A (1979) Mean intracranial resting pressure, episodic pressure fluctuations, and intracranial volume/pressure response in patients with subarachnoid hemorrhage. In: Beks JWF, Bosch DA, Brock M (eds) Intracranial pressure III. Springer, Berlin Heidelberg New York, pp 157–161Google Scholar
  20. 20.
    Heiss WD, Pawlik G, Herholz K, Wagner R, Wienhard K (1985) Regional cerebral glucose metabolism in man during wakefulness, sleep, and dreaming. Brain Res 327: 362–366PubMedGoogle Scholar
  21. 21.
    Krauss JK, Droste DW (1994) Predictability of intracranial pressure oscillations in patients with suspected normal pressure hydrocephalus by transcranial Doppler ultrasound. Neurol Res 16: 398–402PubMedGoogle Scholar
  22. 22.
    Kuchiwaki H, Kageyama N, Hirai N, Takada S, Inao S, Terashima M, Sugiura M (1984) A biological rhythm in a patient with normal pressure hydrocephalus — comparative studies in pre- and postoperative patients by a polygraphy. No To Shinkei 36: 911–916 (Jpn)PubMedGoogle Scholar
  23. 23.
    Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand [Suppl] 149: 1–193Google Scholar
  24. 24.
    Madsen PL, Schmidt JF, Wildschiodtz G, Friberg L, Holm S, Vorstrup S, Lassen NA (1991) Cerebral O2 metabolism and cerebral blood flow in humans during deep and rapid-eye-movement sleep. J Appl Physiol 70: 2597–2601PubMedGoogle Scholar
  25. 25.
    Maira G, Di Rocco C, Rossi GF (1974) Pression intraventriculaire dans l'hydrocephalie à pression “normale” pendant la veille et le sommeil. Neurochirurgie 20: 462–467PubMedGoogle Scholar
  26. 26.
    Maquet P, Dive D, Salmon E, Sadzot B, Franco G, Poirrier R, von Frenckell R, Frank G (1990) Cerebral glucose utilization during sleep-wake cycle in man determined by positron emission tomography and 18F 2-Fluoro-2-deoxy-D-glucose method. Brain Res 513: 136–143PubMedGoogle Scholar
  27. 27.
    Martin G (1978) Lundberg's B-waves as a feature of normal intracranial pressure. Surg Neurol 9: 347–348PubMedGoogle Scholar
  28. 28.
    Mautner-Huppert D, Haberl RL, Dirnagl U, Villringer A, Schmiedek P, Einhäupl K (1989) B-waves in healthy persons. Neurol Res 11: 194–196PubMedGoogle Scholar
  29. 29.
    Miles LE, Dement WC (1980) Sleep and aging. Sleep 3: 119–121Google Scholar
  30. 30.
    Moszyniski K, Darwaj B, Kozniewska H, Czochra T, Smyk K, Lewelt W (1980) The results of ICP and EEG monitoring of sleep in cases of patients with supratentorial brain tumors. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwalt GH, Brock M (eds) Intracranial pressure IV. Springer, Berlin Heidelberg New York, pp 579–583Google Scholar
  31. 31.
    Munari C, Calbucci F (1976) Organisation du sommeil et variations de la pression intracranienne chez les malades ayant une hydrocéphalie a pression normale. Rev EEG Neurophysiol 6: 497–501Google Scholar
  32. 32.
    Newell DW, Aaslid R, Stooss R, Reulen HJ (1992) The relationship of blood flow velocity fluctuations to intracranial pressure B-waves. J Neurosurg 76: 415–421PubMedGoogle Scholar
  33. 33.
    Nilsson C, Stahlberg F, Thomsen C, Henriksen O, Herning M, Owman C (1992) Circadian variation in human cerebrospinal fluid production measured by magnetic resonance imaging. Am J Physiol 262 (Regulatory Integrative Comp Physiol 31): R20–R24PubMedGoogle Scholar
  34. 34.
    Nornes H, Rootwelt K, Sjaastad O (1973) Normal pressure hydrocephalus. Long-term intracranial pressure recording. Eur Neurol 9: 261–274PubMedGoogle Scholar
  35. 35.
    Ogashiwa M, Takeuchi K (1983) Intracranial pressure changes during sleep in man. No To Shinkei 35: 123–129PubMedGoogle Scholar
  36. 36.
    Pickard JD (1982) Adult communicating hydrocephalus. Br J Hosp Med 27: 35–44PubMedGoogle Scholar
  37. 37.
    Pierre-Kahn A, Gabersek V, Hirsch JF (1976) Intracranial pressure and rapid eye movement sleep in hydrocephalus. Childs Brain 2: 156–166PubMedGoogle Scholar
  38. 38.
    Raftopoulos C, Chaskis C, Delecluse F, Cantraine F, Bidaut L, Brotchi J (1992) Morphological quantitative analysis of intracranial pressure waves in normal pressure hydrocephalus. Neurol Res 14: 389–396PubMedGoogle Scholar
  39. 39.
    Raftopoulos C, Deleval J, Chaskis C, Leonard A, Cantraine F, Desmyttere F, Clarysse S, Brotchi J (1994) Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery 35: 397–405PubMedGoogle Scholar
  40. 40.
    Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Public Health Service, U.S. Government Printing Office, WashingtonGoogle Scholar
  41. 41.
    Sahuquillo J, Rubio E, Codina A, Molins A, Giutart JM, Poca MA, Chasampi A (1991) Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called “normal pressure hydrocephalus” syndrome. Acta Neurochir (Wien) 112: 50–61Google Scholar
  42. 42.
    Sakai F, Meyer JS, Karacan I, Derman S, Yamamoto M (1980) Normal human sleep: regional cerebral hemodynamics. Ann Neurol 7: 471–478PubMedGoogle Scholar
  43. 43.
    Symon L, Dorsch NWC, Stephens RJ (1972) Pressure waves in so-called low pressure hydrocephalus. Lancet 2: 1291–1292PubMedGoogle Scholar
  44. 44.
    Symon L, Dorsch NWC (1975) Use of long-term intracranial pressure measurement to assess hydrocephalic patients prior to shunt surgery. J Neurosurg 42: 258–273PubMedGoogle Scholar
  45. 45.
    Symon L, Hinzpeter T (1977) The enigma of normal pressure hydrocephalus: tests to select patients for surgery and to predict shunt function. Clin Neurosurg 24: 285–315PubMedGoogle Scholar
  46. 46.
    Townsend RE, Prinz PN, Obrist WD (1973) Human cerebral blood flow during sleep and waking. J Appl Physiol 35: 620–625PubMedGoogle Scholar
  47. 47.
    Vanneste JAL (1994) Three decades of normal pressure hydrocephalus: are we wiser now? J Neurol Neurosurg Psychiatry 57: 1021–1025PubMedGoogle Scholar
  48. 48.
    Vanneste JAL, Augustijn P, Dirven C, Tan WF, Goedhart ZD (1992) Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? Neurology 42: 54–59PubMedGoogle Scholar
  49. 49.
    Yokota A, Matsuoka S, Ishikawa T, Kohshi K, Kajiwara H (1989) Overnight recordings of intracranial pressure and electroencephalography in neurosurgical patients. Part II: changes in intracranial pressure during sleep. Sangyo Ika Daigaku Zasshi 11: 383–391PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • J. K. Krauss
    • 1
  • D. W. Droste
    • 2
    • 4
  • M. Bohus
    • 3
  • J. P. Regel
    • 1
  • R. Scheremet
    • 1
  • D. Riemann
    • 3
  • W. Seeger
    • 1
  1. 1.Department of NeurosurgeryAlbert-Ludwigs-UniversitätFreiburg
  2. 2.Department of NeurologyAlbert-Ludwigs-UniversitätFreiburg
  3. 3.Department of PsychiatryAlbert-Ludwigs-UniversitätFreiburg
  4. 4.Department of NeurologyMedizinische Universität zu LübeckLübeckGermany

Personalised recommendations