Intracranial hypertension associated with obstructive sleep apnea: A discussion of potential etiologic factors

Obstructive sleep apnea has been shown to increase intracranial pressure, and to be a secondary cause of intracranial hypertension. There are a few theories that attempt to explain this relationship, however there is little data, and even less recognition among physicians that this actually occurs. This paper discusses multiple pieces of data, from anatomical correlates to biochemical information involving neuroexcitotoxicity, as well as hematologic factors and issues surrounding brain edema and blood brain barrier dysfunction. A complex paradigm for how obstructive sleep apnea may lead to increased intracranial pressure is thus proposed. In addition, suggestions are made for how obstructive sleep apnea must as a result be managed differently in the setting of idiopathic intracranial hypertension. (C) 2014 Elsevier Ltd. All rights reserved.