自发性颅内高压男性有视力损失风险

迄今最大型的自发性颅内高压研究发现，男性发生视力损失的风险为女性的两倍；研究结果线上登载于10月15日的神经学期刊。
　　
　　主要研究者、Emory大学的Beau Bruce医师在新闻稿中表示，虽然男性比较少发生颅内高压，但是相较于女性，男性发生严重视力损失的频率增加，这相当值得关注。
　　
　　他指出，我们的发现认为，有此状况的男性应该更仔细监控他们的视力，且于出现视力损失现象时积极治疗。
　　
　　该研究也发现，男性比较可能发生睡眠呼吸中止；Bruce医师表示，需要更多前溯研究来评估睡眠呼吸中止对于治疗颅内高压的影响，而医师应将受此影响的男性和女性病患都纳入睡眠研究。
　　
　　爱荷华大学的Michael Wall医师和印第安那大学医学中心的Valerie Purvin医师在编辑评论中写道，希望大家记住的是，符合Dandy氏标准的男性应广被评估引起颅内高压的原因，包括阻塞性睡眠呼吸中止(OSA)。
　　
　　他们认为，更紧密监控这些病患的视力功能且更积极治疗他们是谨慎的做法，这包括确认并积极治疗睡眠呼吸中止。
　　
　　研究者研究了Emory大学、密西西比大学、伟恩州立大学共721名病患的医疗纪录，研究者收集人口统计学、联合因素与视力功能等的现况并追踪。
　　
　　研究中，男性平均年纪大于女性(37岁vs. 28岁; P=.02)，在最初的神经-眼科评估中，相较于女性，男性比较不会将头痛报告为最初症状，且后续也较少指出有头痛(79% vs. 89%; P=.01)。
　　
　　【颅内高压病患之间的症状比较】

症状	男性、 66 人(%)	女性、 655 人(%)	P
睡眠呼吸中止	24	4	<.001
头痛	55	75	<.001
视力困扰	35	20	.005

　　Bruce医师等人表示，男性在现况与追踪时的视力及视野都显著较差；相较于女性，男性至少单眼严重视力损失相对风险为2.1倍 (95% CI, 1.4 – 3.3; P=.002)，双眼为2.1倍(95% CI, 1.1 – 3.7; P=.03)。
　　
　　研究者报告指出，逻辑回归支持性别是严重视力损失的独立风险因素。
　　
　　Wall医师和Purvin医师写道，Bruce医师等人报告指出24%男性的睡眠研究符合阻塞性睡眠呼吸中止的标准，但是我们不知道其他的76%有多少人是多频道睡眠检查阴性，因此，睡眠呼吸中止的实际发生率是被低估的；这很重要，因为睡眠呼吸中止和颅内高压之间的关系是相当复杂的。
　　
　　作者结论表示，校正年纪、睡眠呼吸中止诊断、头痛是颅内高压的最初征兆等因素之后，男性依旧是严重视力损失的独立风险因素。
　　
　　编辑指出，虽然他们的结论有统计清楚支持，但睡眠呼吸中止很可能未被诊断。藉由收集前溯资料，或许可以发现，造成视力不佳结果的原因可能是睡眠呼吸中止，而非男性。
　　
　　但是编辑也指出，若不论机转，颅内高压男性应该要有更好的视力结果。
　　
　　本研究接受防盲研究与国家健康研究中心的支持。研究者宣称没有相关资金的往来。
 

 

Men With Idiopathic Intracranial Hypertension at Risk for Vision Loss

By Allison Gandey
Medscape Medical News

Men are twice as likely as women to develop severe vision loss, the largest study to date looking at idiopathic intracranial hypertension has found. Results are published online October 15 in Neurology.

"While intracranial hypertension occurs less often in men, their increased frequency of severe vision loss compared with women is a major concern," lead investigator Beau Bruce, MD, from Emory University, in Atlanta, Georgia, said in a news release.

"Our findings suggest that men with this condition should have more careful monitoring of their eyesight and likely should be treated more aggressively when they do have evidence of vision loss," he added.

The study also found men were more likely to have sleep apnea. Dr. Bruce says that more prospective studies are needed to evaluate the role of sleep apnea in the treatment of patients with intracranial hypertension, but that clinicians should consider referring affected patients — both men and women — for sleep studies.

While intracranial hypertension occurs less often in men, their increased frequency of severe vision loss is a major concern.

 

"The take-home message is that men who meet the Dandy criteria should be extensively evaluated for causes of intracranial hypertension, including obstructive sleep apnea," Michael Wall, MD, from the University of Iowa, in Iowa City, and Valerie Purvin, MD, from Indiana University Medical Center, in Indianapolis, write in an accompanying editorial.

They suggest that it is prudent to follow visual function more closely in these patients and be more aggressive in treating them. This includes identifying and vigorously treating sleep apnea when present.

Investigators studied medical records for 721 consecutive patients from Emory University, the University of Mississippi, and Wayne State University. Researchers collected demographics, associated factors, and visual function at presentation and follow-up.

Men were on average older than the women in the study (37 years vs 28; P?=?.02). Men were less likely to report headache as a first symptom and continued to report fewer headaches than women at initial neuro-ophthalmologic assessment (79% vs 89%; P?=?.01)

Symptom Comparison Between Patients With Intracranial Hypertension

Symptom	Men, n=66 (%)	Women, n=655 (%)	P
Sleep apnea	24	4	<.001
Headache	55	75	<.001
Visual disturbances	35	20	.005

 

 

Dr. Bruce and his team demonstrate that visual acuity and fields at presentation and last follow-up were significantly worse among men. The relative risk of severe visual loss for men compared with women was 2.1 (95% CI, 1.4 – 3.3; P?=?.002) for at least 1 eye and 2.1 (95% CI, 1.1 – 3.7; P?=?.03) for both eyes.

The researchers report that logistic regression supported sex as an independent risk factor for severe visual loss.

"Bruce et al report that 24% of the men had sleep studies that met criteria for obstructive sleep apnea," Drs. Wall and Purvin write. "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 sleep apnea and intracranial hypertension."

The authors conclude that male sex remains an independent risk factor for severe visual loss in at least 1 eye when adjusted for age, diagnosis of sleep apnea, and headache as first sign of intracranial hypertension.

"While their conclusions are clearly supported statistically," the editorialists note, "sleep apnea was likely underdiagnosed. With prospective data collection, we might find that the reason for the poor visual outcome is sleep apnea rather than being male."

But regardless of the mechanism, the editorialists point out, better visual outcomes should be observed in men with intracranial hypertension.

The study was supported by a grant from Research to Prevent Blindness and the National Institutes of Health. The researchers have disclosed no relevant financial relationships.

Neurology. Published online October 15, 2008. Abstract Abstract