Purpose of Review: Idiopathic normal-pressure hydrocephalus (iNPH) is characterized clinically by ventriculomegaly, abnormal gait, falls, incontinence, and cognitive decline. This article reviews recent advances in the pathophysiology of iNPH concerning sleep-disordered breathing (SDB) and glymphatic circulation during deep sleep. Recent Findings: The authors found iNPH frequently associated with obstructive sleep apnea (OSA). A critical factor in iNPH is intracranial venous hypertension delaying drainage of cerebrospinal fluid (CSF) into the cerebral venous sinuses. CSF-venous blood circulates in the jugular veins and finally drains into the heart. During SDB, repeated reflex attempts to breathe induce strong respiratory efforts against a closed glottis thereby increasing the negative intrathoracic pressure. This causes atrial distortion and decreases venous return to the heart resulting in retrograde intracranial venous hypertension. Additionally, repeated awakenings from OSA impede sleep-associated circulation of interstitial CSF into the glymphatic circulation contributing to hydrocephalus. Summary: Sleep has become a critical element in the cognitive changes of aging including iNPH.

Original languageEnglish (US)
Article number39
JournalCurrent Neurology and Neuroscience Reports
Issue number7
StatePublished - Jul 1 2019


  • Cerebral venous circulation
  • Glymphatic system
  • Normal-pressure hydrocephalus
  • Obstructive sleep apnea
  • Sleep-disordered breathing
  • Vascular risk factors

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


Dive into the research topics of 'Sleep-Disordered Breathing and Idiopathic Normal-Pressure Hydrocephalus: Recent Pathophysiological Advances'. Together they form a unique fingerprint.

Cite this