特发性颅内压增高与阻塞性睡眠呼吸暂停一例分析

目的 通过报道及文献复习探讨特发性颅内压增高(IIH)与阻塞性睡眠呼吸暂停(OSA)之间的关系.方法 报道1例中年男性颅内压增高患者,经MRI、血管造影排除颅内病变,确诊为IIH;患者有嗜睡、肥胖等症状,进行多导睡眠图(PSG)证实合并有重度OSA,在单纯使用降颅压治疗不能获得持续有效控制高颅压症状后,改用针对OSA给予控制体重和持续正压通气等综合治疗观察临床疗效.结果 经过3个月治疗,患者体质量指数由35.7降至31.4,呼吸暂停低通气指数由72.6降至10.1,血氧饱和度从67%上升到82%,头痛、视乳突水肿等高颅压症状得到持续改善.结论 睡眠呼吸暂停是IIH的风险因素之一,尤其是肥胖男性患者;对有睡眠症状的患者进行PSG监测有助于寻找IIH中容易被忽视的重要因素即OSA;采取积极措施治疗OSA能持续有效地缓解IIH患者高颅压症状.

Idiopathic intracranial hypertension with obstructive sleep apnea: a case report

Objective To report a case of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) combined with idiopathic intracranial hypertension (IIH) and review the relationship between the IIH and OSA. Methods A case of increased intracranial pressure in a middle-aged male patient who was diagnosed as IIH after the MRI and angiography ruled out intracranial lesions was reported. This patient presented with drowsiness, obesity and other symptoms. An overnight polysomnography (PSG) confirmed severe OSA. The simple use of intracranial pressure lowering therapy could not achieve sustained effective control of symptoms of high intracranial pressure. The clinical effects of comprehensive treatment for the OSA including CPAP and weight loss were observed. Results After 3 months treatment, the body mass index of this patient dropped from 35.7 to 31.4, apnea hypopnea index dropped from 72.6 to 10. 1, and the minimum SaO2 increased from 67% to 82%. And the symptoms of high intracranial pressure including headache and papillaedema were continuously improved. Conclusion Sleep apnea is a risk factor for IIH, especially for obese male patients. PSG monitoring could help us to find the important but easily overlooked factor of OSA. Taking active measures to treat OSA can effectively relieve the high intracranial pressure symptoms in patients with IIH.