Overnight Dynamics of Ventricular Cerebrospinal Fluid Amyloid-Beta, Lactate and Hypocretin in Patients With Hydrocephalus: A Pilot Study

This pilot observational study evaluated whether frequent overnight sampling of ventricular cerebrospinal fluid could clarify how sleep, hypocretin and lactate relate to amyloid-β42 dynamics in adults with hydrocephalus. Seven participants underwent hourly ventricular cerebrospinal fluid sampling from early evening to late morning during inpatient monitoring, combined with full polysomnography. Concentrations of amyloid-β42, hypocretin, lactate, melatonin and electrolytes were measured and normalised to each individual's mean. Relationships with sleep stage and circadian patterns were examined using correlation analysis and cosinor modelling. Sleep was markedly disrupted, with obstructive sleep apnea common and analysable sleep data available for six participants. Non-rapid eye movement sleep peaked at approximately 4 AM Amyloid-β42 rose in the evening, plateaued during peak non-rapid eye movement sleep and increased sharply after 8 AM Hypocretin and lactate were positively correlated and each preceded and correlated with amyloid-β42 surges. Melatonin peaked near 6 AM and was associated with non-rapid eye movement sleep. Intracranial pressure displayed a strong circadian rhythm, peaking during non-rapid eye movement sleep, whereas hypocretin and amyloid-β42 exhibited only modest rhythmicity. These findings demonstrate that overnight ventricular cerebrospinal fluid sampling is feasible in adults with hydrocephalus. Preliminary evidence suggests that processes linked to wakefulness, rather than sleep or intrinsic circadian timing, may be the primary drivers of overnight amyloid-β42 variation. Hypocretin pathways may represent potential therapeutic targets in Alzheimer's disease, but conclusions are limited by abnormal sleep architecture and underlying neurological disease. Validation in larger and more representative populations is warranted.