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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
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: 117–126
Auer LM, Sayama I (1983) Intracranial pressure oscillations (B-waves) caused by oscillations in cerebrovascular volume. Acta Neurochir (Wien) 68: 93–100
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: 1–21
Black PMcL, Ojemann RG, Tzouras A (1985) CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg 32: 632–651
Boergesen SE, Gjerris F, Soerensen SC (1979) Intracranial pressure and conductance to outflow of cerebrospinal fluid in normal-pressure hydrocephalus. J Neurosurg 50: 489–493
Brock M (1977) Klinik und Therapie des intermittierend normotensiven Hydrocephalus. Radiologe 17: 460–465
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: 20–27
Chawla JC, Hulme A, Cooper R (1974) Intracranial pressure in patients with dementia and communicating hydrocephalus. J Neurosurg 40: 376–380
Cooper R, Hulme A (1966) Intracranial pressure and related phenomena during sleep. J Neurol Neurosurg Psychiatry 29: 564–570
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: 683–689
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: 603–609
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: 75–79
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: 99–104
Franzini C (1992) Brain metabolism and blood flow during sleep. J Sleep Res 1: 3–16
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 584–587
Graff-Radford NR, Godersky JC, Jones MP (1989) Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly. Neurology 39: 1601–1604
Gücer G, Viernstein L (1979) Intracranial pressure in the normal monkey while awake and asleep. J Neurosurg 51: 206–210
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: 11–19
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 157–161
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: 362–366
Krauss JK, Droste DW (1994) Predictability of intracranial pressure oscillations in patients with suspected normal pressure hydrocephalus by transcranial Doppler ultrasound. Neurol Res 16: 398–402
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)
Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand [Suppl] 149: 1–193
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: 2597–2601
Maira G, Di Rocco C, Rossi GF (1974) Pression intraventriculaire dans l'hydrocephalie à pression “normale” pendant la veille et le sommeil. Neurochirurgie 20: 462–467
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: 136–143
Martin G (1978) Lundberg's B-waves as a feature of normal intracranial pressure. Surg Neurol 9: 347–348
Mautner-Huppert D, Haberl RL, Dirnagl U, Villringer A, Schmiedek P, Einhäupl K (1989) B-waves in healthy persons. Neurol Res 11: 194–196
Miles LE, Dement WC (1980) Sleep and aging. Sleep 3: 119–121
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 579–583
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: 497–501
Newell DW, Aaslid R, Stooss R, Reulen HJ (1992) The relationship of blood flow velocity fluctuations to intracranial pressure B-waves. J Neurosurg 76: 415–421
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–R24
Nornes H, Rootwelt K, Sjaastad O (1973) Normal pressure hydrocephalus. Long-term intracranial pressure recording. Eur Neurol 9: 261–274
Ogashiwa M, Takeuchi K (1983) Intracranial pressure changes during sleep in man. No To Shinkei 35: 123–129
Pickard JD (1982) Adult communicating hydrocephalus. Br J Hosp Med 27: 35–44
Pierre-Kahn A, Gabersek V, Hirsch JF (1976) Intracranial pressure and rapid eye movement sleep in hydrocephalus. Childs Brain 2: 156–166
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: 389–396
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: 397–405
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, Washington
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: 50–61
Sakai F, Meyer JS, Karacan I, Derman S, Yamamoto M (1980) Normal human sleep: regional cerebral hemodynamics. Ann Neurol 7: 471–478
Symon L, Dorsch NWC, Stephens RJ (1972) Pressure waves in so-called low pressure hydrocephalus. Lancet 2: 1291–1292
Symon L, Dorsch NWC (1975) Use of long-term intracranial pressure measurement to assess hydrocephalic patients prior to shunt surgery. J Neurosurg 42: 258–273
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: 285–315
Townsend RE, Prinz PN, Obrist WD (1973) Human cerebral blood flow during sleep and waking. J Appl Physiol 35: 620–625
Vanneste JAL (1994) Three decades of normal pressure hydrocephalus: are we wiser now? J Neurol Neurosurg Psychiatry 57: 1021–1025
Vanneste JAL, Augustijn P, Dirven C, Tan WF, Goedhart ZD (1992) Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? Neurology 42: 54–59
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: 383–391
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Krauss, J.K., Droste, D.W., Bohus, M. et al. The relation of intracranial pressure B-waves to different sleep stages in patients with suspected normal pressure hydrocephalus. Acta neurochir 136, 195–203 (1995). https://doi.org/10.1007/BF01410626
Issue Date:
DOI: https://doi.org/10.1007/BF01410626