Obstructive sleep apnea in patients undergoing endoscopic surgical repair of cerebrospinal fluid rhinorrhea.

OBJECTIVES/HYPOTHESIS: To examine the relationship between cerebrospinal fluid (CSF) rhinorrhea and obstructive sleep apnea (OSA).

STUDY DESIGN: Retrospective chart review of patients who underwent surgical repair of encephaloceles and/or CSF rhinorrhea at a tertiary medical center over a 12-year period.

METHODS: Pertinent demographic, clinical, and surgical data including age, sex, and medical and surgical history were obtained. Patients were classified by etiology of CSF leak into a spontaneous leak group and a nonspontaneous leak group, which included patients with documented trauma, malignancy, or known iatrogenic injury.

RESULTS: We retrospectively identified 126 patients who underwent repair of encephalocele or CSF rhinorrhea. Of these, 70 (55.5%) were found to have a spontaneous etiology, whereas 56 (44.4%) had a nonspontaneous cause. Patients with spontaneous CSF rhinorrhea were more likely than their nonspontaneous counterparts to have a diagnosis of OSA (30.0% vs. 14.3%, P = .0294) and radiographic evidence of an empty sella on magnetic resonance imaging MRI (55.4% vs. 24.3%, P = .0027). Overall, patients in the spontaneous CSF rhinorrhea group were more likely to be female compared to the nonspontaneous group (84.3% vs. 41.1% female, P = .0001).

CONCLUSIONS: Our study shows that patients with spontaneous CSF rhinorrhea are significantly more likely to have a diagnosis of OSA compared to those with nonspontaneous causes of CSF leaks, or to the general population (incidence of 1%-5% in various population studies). Given the known association between OSA and intracranial hypertension (ICH), it may be prudent to screen all patients with spontaneous CSF rhinorrhea for symptoms of OSA as well as for ICH, and vice versa.

LEVEL OF EVIDENCE: 4