Obstructive Sleep Apnea in Patients Undergoing Endoscopic Surgical Repair of Cerebrospinal Fluid Rhinorrhea

Objective: 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 CSF rhinorrhea at a tertiary medical center over a 6-year period.

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

Results: Eighty-two patients who underwent repair of CSF rhinorrhea were identified. Of these, 50 (61%) were found to have a spontaneous etiology, while 32 (39%) had a nonspontaneous cause. Patients with spontaneous CSF rhinorrhea were more likely than their nonspontaneous counterparts to have a diagnosis of OSA (34% versus 12.5%, respectively; P = 0.0251) and were also more likely to be older (mean age, 51 versus 40 years, respectively). Overall, patients with CSF rhinorrhea were more likely to be female (68%), and this was further magnified in the spontaneous group compared with the nonspontaneous group (82% versus 46% female, respectively; P = 0.0004).

Conclusions: Our study shows that patients with spontaneous CSF rhinorrhea are significantly more likely to have a diagnosis of OSA compared with 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.