TY - JOUR
T1 - Sleep-Disordered Breathing and Idiopathic Normal-Pressure Hydrocephalus
T2 - Recent Pathophysiological Advances
AU - Roman, Gustavo C.
AU - Jackson, Robert E.
AU - Fung, Steve H.
AU - Zhang, Y. Jonathan
AU - Verma, Aparajitha
N1 - Funding Information:
Acknowledgments Dr. Gustavo Roman’s research is supported by The Jack S. Blanton Presidential Distinguished Chair, the Fondren Fund, and the Wareing Family Fund at Houston Methodist Hospital. We acknowledge the collaboration of Matthew G. Landry, medical artist, at Houston Methodist Hospital Research Institute.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Purpose of Review: Idiopathic normal-pressure hydrocephalus (iNPH) is characterized clinically by ventriculomegaly, abnormal gait, falls, incontinence, and cognitive decline. This article reviews recent advances in the pathophysiology of iNPH concerning sleep-disordered breathing (SDB) and glymphatic circulation during deep sleep. Recent Findings: The authors found iNPH frequently associated with obstructive sleep apnea (OSA). A critical factor in iNPH is intracranial venous hypertension delaying drainage of cerebrospinal fluid (CSF) into the cerebral venous sinuses. CSF-venous blood circulates in the jugular veins and finally drains into the heart. During SDB, repeated reflex attempts to breathe induce strong respiratory efforts against a closed glottis thereby increasing the negative intrathoracic pressure. This causes atrial distortion and decreases venous return to the heart resulting in retrograde intracranial venous hypertension. Additionally, repeated awakenings from OSA impede sleep-associated circulation of interstitial CSF into the glymphatic circulation contributing to hydrocephalus. Summary: Sleep has become a critical element in the cognitive changes of aging including iNPH.
AB - Purpose of Review: Idiopathic normal-pressure hydrocephalus (iNPH) is characterized clinically by ventriculomegaly, abnormal gait, falls, incontinence, and cognitive decline. This article reviews recent advances in the pathophysiology of iNPH concerning sleep-disordered breathing (SDB) and glymphatic circulation during deep sleep. Recent Findings: The authors found iNPH frequently associated with obstructive sleep apnea (OSA). A critical factor in iNPH is intracranial venous hypertension delaying drainage of cerebrospinal fluid (CSF) into the cerebral venous sinuses. CSF-venous blood circulates in the jugular veins and finally drains into the heart. During SDB, repeated reflex attempts to breathe induce strong respiratory efforts against a closed glottis thereby increasing the negative intrathoracic pressure. This causes atrial distortion and decreases venous return to the heart resulting in retrograde intracranial venous hypertension. Additionally, repeated awakenings from OSA impede sleep-associated circulation of interstitial CSF into the glymphatic circulation contributing to hydrocephalus. Summary: Sleep has become a critical element in the cognitive changes of aging including iNPH.
KW - Cerebral venous circulation
KW - Glymphatic system
KW - Normal-pressure hydrocephalus
KW - Obstructive sleep apnea
KW - Sleep-disordered breathing
KW - Vascular risk factors
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U2 - 10.1007/s11910-019-0952-9
DO - 10.1007/s11910-019-0952-9
M3 - Review article
C2 - 31144048
AN - SCOPUS:85066465518
SN - 1528-4042
VL - 19
JO - Current Neurology and Neuroscience Reports
JF - Current Neurology and Neuroscience Reports
IS - 7
M1 - 39
ER -