Journal of Neurology

, Volume 260, Issue 7, pp 1748–1751 | Cite as

Obstructive sleep apnea in idiopathic intracranial hypertension: comparison with matched population data

  • Matthew J. Thurtell
  • Lynn Marie Trotti
  • Edward O. Bixler
  • David B. Rye
  • Donald L. Bliwise
  • Nancy J. Newman
  • Valérie Biousse
  • Beau B. Bruce
Original Communication


Patients with idiopathic intracranial hypertension (IIH) frequently have coexisting obstructive sleep apnea (OSA). We aimed to determine if the prevalence and severity of OSA is greater in patients with IIH than would be expected, given their other risk factors for OSA. We included 24 patients (20 women, four men) with newly-diagnosed IIH who had undergone overnight polysomnography. We calculated the expected apnea-hypopnea index (AHI) for each patient, based on their age, sex, race, body mass index (BMI), and menopausal status, using a model derived from 1,741 randomly-sampled members of the general population who had undergone overnight polysomnography. We compared the AHI values obtained from polysomnography with those predicted by the model using a paired t test. Our study had 80 % power to detect a 10-unit change in mean AHI at α = 0.05. Eight patients (33.3 %; six women, two men) had OSA by polysomnography. AHIs from polysomnography were not significantly different from those predicted by the model (mean difference 3.5, 95 % CI: −3.0−9.9, p = 0.28). We conclude that the prevalence and severity of OSA in IIH patients is no greater than would be expected for their age, sex, race, BMI, and menopausal status. It remains unclear whether the presence or treatment of OSA influences the clinical course of IIH.


Idiopathic intracranial hypertension Papilledema Obstructive sleep apnea Intracranial pressure 



NIH/NEI core grant P30-EY06360 (Department of Ophthalmology); Research to Prevent Blindness Lew R. Wasserman Merit Award (NJN); Department of Ophthalmology grant (MJT, BBB) from Research to Prevent Blindness Inc, New York, NY. In addition, Dr. Bruce receives research support from the NIH/NEI (K23-EY019341).

Conflicts of interest

Dr. Thurtell reports no conflicts of interest. Dr. Trotti reports no conflicts of interest. Dr. Bixler reports no conflicts of interest. Dr. Rye reports no conflicts of interest. Dr. Bliwise reports no conflicts of interest. Dr. Newman reports no conflicts of interest. Dr. Biousse reports no conflicts of interest. Dr. Bruce reports no conflicts of interest.


  1. 1.
    Friedman DI, Jacobson DM (2002) Diagnostic criteria for idiopathic intracranial hypertension. Neurology 59(10):1492–1495PubMedCrossRefGoogle Scholar
  2. 2.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235PubMedCrossRefGoogle Scholar
  3. 3.
    Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A (1998) Effects of age on sleep apnea in men: i. prevalence and severity. Am J Respir Crit Care Med 157(1):144–148PubMedCrossRefGoogle Scholar
  4. 4.
    Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A (2001) Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 163(3):608–613PubMedCrossRefGoogle Scholar
  5. 5.
    Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM (2002) Predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study. Arch Intern Med 162(8):893–900PubMedCrossRefGoogle Scholar
  6. 6.
    Marcus DM, Lynn J, Miller JJ, Chaudhary O, Thomas D, Chaudhary B (2001) Sleep disorders: a risk factor for pseudotumor cerebri? J Neuroophthalmol 21(2):121–123PubMedCrossRefGoogle Scholar
  7. 7.
    Lee AG, Golnik K, Kardon R, Wall M, Eggenberger E, Yedavally S (2002) Sleep apnea and intracranial hypertension in men. Ophthalmology 109(3):482–485PubMedCrossRefGoogle Scholar
  8. 8.
    Thurtell MJ, Bruce BB, Rye DB, Newman NJ, Biousse V (2011) The Berlin questionnaire screens for obstructive sleep apnea in idiopathic intracranial hypertension. J Neuroophthalmol 31(4):316–319PubMedCrossRefGoogle Scholar
  9. 9.
    Jennum P, Borgesen SE (1989) Intracranial pressure and obstructive sleep apnea. Chest 95(2):279–283PubMedCrossRefGoogle Scholar
  10. 10.
    Sugita Y, Iijima S, Teshima Y, Shimizu T, Nishimura N, Tsutsumi T, Hayashi H, Kaneda H, Hishikawa Y (1985) Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome. Electroencephalogr Clin Neurophysiol 60(3):214–219PubMedCrossRefGoogle Scholar
  11. 11.
    Purvin VA, Kawasaki A, Yee RD (2000) Papilledema and obstructive sleep apnea syndrome. Arch Ophthalmol 118(12):1626–1630PubMedCrossRefGoogle Scholar
  12. 12.
    Wall M, Purvin V (2009) Idiopathic intracranial hypertension in men and the relationship to sleep apnea. Neurology 72(4):300–301PubMedCrossRefGoogle Scholar
  13. 13.
    Iber C, Ancoli-Israel S, Chesson AL, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  14. 14.
    Stein JD, Kim DS, Mundy KM, Talwar N, Nan B, Chervin RD, Musch DC (2011) The association between glaucomatous and other causes of optic neuropathy and sleep apnea. Am J Ophthalmol 152(6):989–998PubMedCrossRefGoogle Scholar
  15. 15.
    Peter L, Jacob M, Krolak-Salmon P, Petitjean T, Bastuji H, Grange JD, Vighetto A (2007) Prevalence of papilloedema in patients with sleep apnoea syndrome: a prospective study. J Sleep Res 16(3):313–318PubMedCrossRefGoogle Scholar
  16. 16.
    Fraser JA, Bruce BB, Rucker J, Fraser LA, Atkins EJ, Newman NJ, Biousse V (2010) Risk factors for idiopathic intracranial hypertension in men: a case-control study. J Neurol Sci 290(1–2):86–89PubMedCrossRefGoogle Scholar
  17. 17.
    Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O’Connor GT, Rapoport DM, Redline S, Resnick HE, Robbins JA, Shahar E, Unruh ML, Samet JM (2009) Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 6:e1000132PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Matthew J. Thurtell
    • 1
    • 6
    • 7
    • 8
    • 9
  • Lynn Marie Trotti
    • 2
  • Edward O. Bixler
    • 10
  • David B. Rye
    • 2
  • Donald L. Bliwise
    • 2
  • Nancy J. Newman
    • 1
    • 2
    • 3
  • Valérie Biousse
    • 1
    • 2
  • Beau B. Bruce
    • 1
    • 2
    • 4
    • 5
  1. 1.Department of OphthalmologyEmory UniversityAtlantaUSA
  2. 2.Department of NeurologyEmory UniversityAtlantaUSA
  3. 3.Department of Neurological SurgeryEmory UniversityAtlantaUSA
  4. 4.Rollins School of Public HealthEmory UniversityAtlantaUSA
  5. 5.Laney Graduate SchoolEmory UniversityAtlantaUSA
  6. 6.Department of Ophthalmology and Visual SciencesUniversity of IowaIowa CityUSA
  7. 7.Department of NeurologyUniversity of IowaIowa CityUSA
  8. 8.Neurology ServiceVeterans Affairs Medical CenterIowa CityUSA
  9. 9.Center for the Prevention and Treatment of Visual LossVeterans Affairs Medical CenterIowa CityUSA
  10. 10.Department of PsychiatryPennsylvania State University College of MedicineHersheyUSA

Personalised recommendations