Idiopathic intracranial hypertension in men and the relationship to sleep apnea

Abstract

In this issue of Neurology ®, Bruce et al.1 use a retrospective chart review to study men who meet the modified Dandy criteria for idiopathic intracranial hypertension (IIH). This is the largest study to date of IIH in men and confirms the earlier suggestion that men with IIH are at greater risk for severe visual outcome than women.2 The study, however, raises as many questions as it answers. By design, retrospective studies tend to underestimate symptoms, signs, and disease associations, even in the best of hands. Bruce et al. report that 24% (16) of the men had sleep studies that met criteria for obstructive sleep apnea (OSA), but we do not know how many of the remaining 76% had negative polysomnography. Thus, the actual incidence of sleep apnea was likely underestimated. This is important because of the complex relationship between OSA and IIH. A previous study3 reported four men with OSA and papilledema. Nocturnal monitoring, performed in one patient, showed repeated episodes of marked intracranial pressure elevation …