Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a substudy of the Idiopathic Intracranial Hypertension Weight randomised controlled trial (IIH:WT)

Andreas Yiangou, James Mitchell, Matthew Nicholls, Yu Jeat Chong, Vivek Vijay, Benjamin Wakerley, Gareth Lavery, Abd Tahrani, Susan Mollan, Alex Sinclair

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Abstract

Objective
Obesity is a risk factor for idiopathic intracranial hypertension (IIH) and obstructive sleep apnoea (OSA). We aimed to determine the prevalence of OSA in IIH and evaluate the diagnostic performance of OSA screening tools in IIH. Additionally, we evaluated the relationship between weight loss, OSA and IIH over 12 months.

Methods
A sub-study of a multi-centre, randomised controlled parallel group trial comparing the impact of bariatric surgery vs. community weight management intervention (CWI) on IIH-related outcomes over 12 months (IIH:WT). OSA was assessed using home-based polygraphy (ApneaLink Air, ResMed) at baseline and 12 months. OSA was defined as an apnoea–hypopnoea index (AHI) ≥ 15 or ≥ 5 with excessive daytime sleepiness (Epworth Sleepiness Scale ≥11 ).

Results
Of the 66 women in the IIH: WT trial, 46 were included in the OSA sub-study. OSA prevalence was 47% (n = 19). The STOP-BANG had the highest sensitivity (84%) compared to the Epworth Sleepiness Scale (69%) and Berlin (68%) to detect OSA. Bariatric surgery resulted in greater reductions in AHI vs. CWI (median [95%CI] AHI reduction of  – 2.8 [ – 11.9, 0.7], p = 0.017). Over 12 months there was a positive association between changes in papilloedema and AHI (r = 0.543, p = 0.045), despite adjustment for changes in the body mass index (R2 = 0.522, p = 0.017).

Conclusion
OSA is common in IIH and the STOP-BANG questionnaire was the most sensitive screening tool. Bariatric surgery improved OSA in patients with IIH. The improvement in AHI was associated with improvement in papilloedema independent of weight loss. Whether OSA treatment has beneficial impact on papilloedema warrants further evaluation.

Trial registration number
IIH: WT is registered as ISRCTN40152829 and on ClinicalTrials.gov as NCT02124486 (28/04/2014).
Original languageEnglish
Number of pages13
JournalJournal of Neurology
Early online date22 Aug 2021
DOIs
Publication statusE-pub ahead of print - 22 Aug 2021

Bibliographical note

Funding Information:
Nicholls, Chong, Vijay, Lavery have no conflicts of interest to declare that are relevant to the content of this article. Yiangou reports receiving speaker fees from Teva, UK outside the submitted work. Mitchell reports receiving grants from the National Institute of Health Research during the conduct of the study and grants from the UK Ministry of Defence outside the submitted work. Wakerley reports receiving consultancy fees from Invex Therapeutics outside the submitted work. Lavery reports receiving funding through a Wellcome Trust Senior Fellowship during the conduct of the study. Mollan reports receiving personal fees from Allergan, Chiesi Farmaceutici, Heidelberg Engineering, Invex Therapeutics, Neurodiem, Novartis, Roche, Santen Pharmaceutical, Scope Ophthalmics and Santhera Pharmaceuticals outside the submitted work. Tahrani reports grants, personal fees, and travel support from Sanofi, grants, personal fees and educational events grants from Novo Nordisk, travel support from Merck Sharp and Dohme, personal fees and travel support from Boehringer Ingelheim, personal fees from Lilly, AstraZeneca, Bristol-Myers Squibb, and Janssen, equipment and travel support from ResMed, equipment from Philips Resporinics, Impeto Medical, and ANSAR Medical Technologies, grants and non-financial support from Napp, and equipment and support staff from BHR Pharmaceuticals Ltd. Tahrani is currently an employee of Novo Nordisk. This work was performed before Tahrani becoming a Novo Nordisk employee and Novo Nordisk had no role in this study. Sinclair reports receiving personal fees (salary and stock options) from Invex therapeutics, during the conduct of the study but outside the submitted work; and receiving grants from the Medical Research Council of the United Kingdom and funding through a Sir Jules Thorn Award for Biomedical Science during the conduct of the study.

Funding Information:
The National Institute for Health Research (NIHR-CS-011-028) funded the trial to which the participants were recruited. Additional funding for trial was funded by the Medical Research Council, UK (MR/K015184/1). Lavery is supported by a Wellcome Trust Senior Fellowship (104612/Z/14/Z). Tahrani was funded by an NIHR Clinician Scientist Award for part of the duration of the study (NIHR-CS-2013-13-029). The sleep apnoea diagnostics were funded by NIHR-CS-2013-13-029. Sinclair is funded by a Sir Jules Thorn Award for Biomedical Science. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK department of Health and Social Care.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Bariatric surgery
  • Idiopathic intracranial hypertension
  • Obstructive sleep apnoea
  • Papilloedema
  • Screening

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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