Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study

High prevalence of sleep disorders in Ménière's disease: Interplay between vestibular function and sleep

BackgroundIn Ménière's disease (MD), impaired sleep worsens the quality of life and triggers episodes, perpetuating a vicious cycle. The intricate connection between vestibular function and sleep regulation is poorly understood.ObjectiveWe aimed to investigate this link by studying sleep in confirmed MD patients.MethodsIn a single-center observational study, 26 consecutive patients with MD were enrolled. Sleep characterization included thorough symptom inquiry, questionnaires (PSQI, ESS, PFS, STOP-Bang, and AAO-HNS), and respiratory polygraphy (RP) or polysomnography (PSG).ResultsDespite 42% of patients reporting overall sleep satisfaction, further inquiry revealed 76% experiencing sleep disturbances per PSQI. STOP-Bang indicated 56% with a moderate-to-severe risk of OSAS. OSAS defined by apnea hypopnea index (AHI) ≥ 5/h was present in 75%. OSAS severity was categorized as mild (5/h ≤ AHI < 15/h, 33%), moderate (15/h ≤ AHI < 30/h, 21%), and severe (AHI ≥ 30/h, 21%). In patients with AAO-HNS score >3, migraines and insomnia were more prevalent. Patients with moderate-to-severe OSAS had poorer hearing. All recently diagnosed patients with moderate-to-severe OSAS had undergone more than one medical treatment compared to others (32%).ConclusionsThe high prevalence of sleep disorders in MD patients underscores the need for thorough screening, even without spontaneous complaints. Instrumental sleep exploration via RP or PSG is essential, as OSAS treatment could aid vestibular function.

Association of vertigo with adult obstructive sleep apnea: A systematic review and meta-analysis

BACKGROUND

Several studies have demonstrated a relationship between vertigo and obstructive sleep apnea (OSA) in adults. This review examined the association between vertigo and OSA and investigated the effects of OSA treatment on vestibular function.

METHODS

Searches were conducted in PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases. Two authors independently searched the databases up to November 2023. Meta-analysis of caloric test, cervical vestibular evoked myogenic potential (cVEMP), and ocular vestibular evoked myogenic potential (oVEMP), between adults with and without OSA was done.

RESULTS

Overall, 28 studies were identified, and most of which focused on vestibular dysfunction in the OSA group. Compared with controls, adults with OSA had an increased risk of abnormal caloric test results (odds ratio [OR] = 4.8), absence of cVEMP (OR = 7.9), absence of oVEMP (OR = 6.2), decreased n1p2 amplitude (standardized mean difference [SMD] = -0.78), decreased p1n1 amplitude (SMD = -0.92), decreased p1n1 interval (SMD = -2.37) in cVEMP testing and prolonged n1 latency (SMD = 0.81) and decreased p1n1 amplitude (SMD = -0.51) in oVEMP testing. Three population-based studies implied a high risk of vertigo in adult OSA, although not statistically significant (OR = 2.53, 95 % confidence interval = 0.97 to 6.61). According to 3 studies, OSA is relatively prevalent among patients with vertigo. Another 3 studies regarding OSA treatment on vestibular functions revealed inconsistent findings.

CONCLUSION

Adults with OSA exhibit abnormalities in caloric, cVEMP, and oVEMP test results, indicating impairments in the semicircular canal, saccule, and utricle.

Is the Otolithic Function Affected in Patients with Obstructive Sleep Apnea Syndrome?

BACKGROUND

 While cardiovascular and neurological diseases induced by obstructive sleep apnea syndrome (OSAS) hypoxia are well established, the association between neuro-otological diseases and OSAS is not entirely understood. Vestibular and audiological tests have been used to evaluate the degeneration of neurons in the brainstem caused by recurrent hypoxia.

PURPOSE

 Evaluation of the vestibular-evoked myogenic potential (VEMP) test findings applied to detect the possible influence on the vestibular reflex arc due to hypoxia in patients diagnosed with OSAS using Activity-Specific Balance Confidence (ABC) and Berg Balance Scale (BBS) scales determination of scores.

RESEARCH DESIGN

 This was a cross-sectional study.

STUDY SAMPLE

 Participants aged 18 to 60 who underwent polysomnography due to snoring/sleep apnea were divided into an OSAS, and a control group of subjects were also included. Each group consisted of 20 participants.

DATA COLLECTION AND ANALYSIS

 All participants were evaluated with cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests. The groups were compared regarding variables such as the rate of oVEMP and cVEMP waves obtained, the interval between the waves, and the latency and amplitude. Also, BBS and ABC scales were applied to all participants.

RESULTS

 The cVEMP (50%) and oVEMP (45%) response rates and amplitudes were significantly lower in the OSAS group. No significant difference was found between the groups when comparing other VEMP parameters. However, a statistically significant decrease was observed in the ABC and BBS scores in the OSAS group.

CONCLUSION

 The identification of VEMP alterations in the OSAS group is a clear indication that the vestibular reflex pathways may be adversely affected by hypoxia. Personal rehabilitation programs can be created by evaluating activities of daily living with the ABC and static and dynamic balances with BBS in patients with OSAS.

Prevalence survey and psychometric measurement of vertigo and dizziness in individuals with obstructive sleep apnoea: A cross-sectional study

INTRODUCTION

This study aimed to evaluate the prevalence and psychometric properties of vertigo and dizziness in an obstructive sleep apnoea (OSA) population.

METHODS

Five hundred and twelve OSA patients and 53 controls were enroled. All eligible subjects were asked to complete the basic information questionnaire, the Chinese version of Vestibular Disorders Activities of Daily Living (VADL-C), the Dizziness Handicap Inventory (DHI) and the Activities-Specific Balance Confidence (ABC) scale.

RESULTS

Among 512 enroled OSA patients, a 22.46% (115) prevalence of vertigo and dizziness was found. The scores of the VADL-C, DHI and ABC of the study group were significantly worse (p < .001) than those of the control group, while the abnormal rates of the three scales in the study group were higher than those of the control group. In the study group, the results of the VADL-C were correlated with those of the DHI (r = .55, p < .001) and inversely correlated with those of the ABC (r = -.50, p < .001), and the results of the DHI were inversely correlated with those of the ABC (r = -.60, p < .001).

CONCLUSIONS

A high prevalence of vertigo and dizziness in the OSA population was detected. Psychometric results showed that vertigo and dizziness in OSA patients led to changes in activities of daily living, increased frequency of somatic symptoms, and reduced balance confidence. In the diagnosis and treatment of OSA patients, the occurrence of vertigo and dizziness is worth clinicians' attention.

The relationship between dizziness and sleep: a review of the literature

Background

The relation between vestibular disorders and (quality of) sleep is underexplored scientifically and the complex interactions between vestibular and sleep disorders are far from being well understood. Some studies have been conducted on the association between patients with vestibular disorders and (the occurrence of) sleep disorders, other studies have been published on the prevalence of dizziness complaints in patients with sleep disorders. The quality of sleep in patients with vestibular disorders generally receives little attention in clinical practice.

Objective

To establish what is currently known about the mutual relationship between dizziness and sleep, and to assess whether or not there is evidence of causality with regard to this relationship.

Methods

After systematically searching four literature database up until 1 April 2024, selected studies were summarized and evaluated through a (critical) review.

Results

Ultimately, 42 studies were selected and evaluated. Patients with dizziness in general and patients with a specific vestibular disorder like Benign Paroxysmal Positional Vertigo, Vestibular Migraine, Meniere's disease, and vestibular hypofunction were significantly more likely to have sleep disorders than control groups. A causal relationship is not supported due to the nature of the studies. In patients with obstructive sleep apnea syndrome there were significantly more vestibular complaints, and more disorders in the vestibular system were identified.

Conclusion

Dizziness complaints often co-exist with a sleep disorder. To what extent this sleep disorder influences dizziness is not clear. Paying attention to the quality of sleep in patients with a vestibular disorder seems to be important. In patients with OSAS, consideration should be given to vestibular complaints and dysfunction.

Risk of Obstructive Sleep Apnea, Chronic Dizziness, and Sleep Duration

BACKGROUND

Although it is recommended that obstructive sleep apnea (OSA) be screened for using a validated self-report questionnaire in patients experiencing dizziness, there is still a lack of research on the relationship between high risk of OSA and chronic dizziness.

OBJECTIVES

The study aimed to examine the relationship between the high risk of OSA and chronic dizziness and investigate how this relationship is affected by sleep duration.

METHODS

This cross-sectional study used data from the 8th Korea National Health and Nutrition Examination Survey (2019-2021). Adults aged 40 years or older were included and divided into two groups using the STOP-Bang Questionnaire (SBQ): a high-risk group for OSA or not. Complex samples logistic regression analyses were performed to examine the odds ratios of chronic dizziness based on the national population estimates.

RESULTS

Our findings showed that individuals in the high-risk group for OSA were significantly more likely to experience chronic dizziness. Specifically, among subgroups based on sleep duration, the high-risk group for OSA with a short sleep duration of ≤5 hours demonstrated the highest odds of chronic dizziness, showing a significantly 2.48-fold increased likelihood compared to the non-high risk for OSA with a sleep duration of 5-9 hours.

DISCUSSION

The SBQ can be beneficial when other causes do not explain chronic dizziness, helping to rule in the possibility of OSA. Educating individuals suspected of having OSA or who have been diagnosed with OSA about the importance of adequate sleep duration may help reduce the risk of chronic dizziness.

Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury

BACKGROUND

Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often involves comorbid vestibular impairment. Sleep apnea is another comorbidity that may exacerbate, and/or be exacerbated by, vestibular dysfunction.

OBJECTIVE

To examine the relationship between sleep apnea and vestibular symptoms in V/SM diagnosed with TBI of any severity.

DESIGN

Multicenter cohort study; cross-sectional sample.

SETTING

In-patient TBI rehabilitation units within five Veterans Affairs (VA) Polytrauma Rehabilitation Centers.

PARTICIPANTS

V/SM with a diagnosis of TBI (N = 630) enrolled in the VA TBI Model Systems study.

INTERVENTION

Not applicable.

METHODS

A multivariable regression model was used to evaluate the association between sleep apnea and vestibular symptom severity while controlling for relevant covariates, for example, posttraumatic stress disorder (PTSD).

MAIN OUTCOME MEASURES

Lifetime history of sleep apnea was determined via best source reporting. Vestibular disturbances were measured with the 3-item Vestibular subscale of the Neurobehavioral Symptom Inventory (NSI).

RESULTS

One third (30.6%) of the sample had a self-reported sleep apnea diagnosis. Initial analysis showed that participants who had sleep apnea had more severe vestibular symptoms (M = 3.84, SD = 2.86) than those without sleep apnea (M = 2.88, SD = 2.67, p < .001). However, when the data was analyzed via a multiple regression model, sleep apnea no longer reached the threshold of significance as a factor associated with vestibular symptoms. PTSD severity was shown to be significantly associated with vestibular symptoms within this sample (p < .001).

CONCLUSION

Analysis of these data revealed a relationship between sleep apnea and vestibular symptoms in V/SM with TBI. The significance of this relationship was affected when PTSD symptoms were factored into a multivariable regression model. However, given that the mechanisms and directionality of these relationships are not yet well understood, we assert that in terms of clinical relevance, providers should emphasize screening for each of the three studied comorbidities (sleep apnea, vestibular symptoms, and PTSD).

Changes in sleep performance and chronotype behaviour after vestibular rehabilitation in unilateral vestibular hypofunction

OBJECTIVE

This study aimed to investigate changes in sleep parameters and self-perceived sleep quality in unilateral vestibular hypofunction participants after vestibular rehabilitation.

METHOD

Forty-six unilateral vestibular hypofunction participants (before and after vestibular rehabilitation) along with a control group of 60 healthy patients underwent otoneurological examination, a one-week actigraphy sleep analysis and a series of self-report and performance measures.

RESULTS

After vestibular rehabilitation, unilateral vestibular hypofunction participants showed a significant score decrease in the Pittsburgh Sleep Quality Index, a self-rated reliable questionnaire depicting sleep quality during the last month, as well as a reduction in sleep onset latency and an increase in total sleep time, indicating an objective improvement in sleep quality as measured by actigraphy analysis. However, after vestibular rehabilitation, unilateral vestibular hypofunction participants still showed statistically significant differences with respect to the control group in both self-rated and objective measurements of sleep quality.

CONCLUSION

Vestibular rehabilitation may impact on sleep performance and chronotype behaviour, possibly by opposing long-term structural changes along neural pathways entangled in sleep activity because of the deafferentation of the vestibular nuclei.

Evaluation of vestibular functions in patients with obstructive sleep apnea syndrome

BACKGROUND

To determine the anatomical proximity of the vestibular nuclei to the respiratory nuclei and the effect of susceptibility of the posterior labyrinth to a hypoxic state on the vestibular system.

OBJECTIVE

It was aimed to evaluate the possible effects of periodic hypoxia on vestibular reflexes and proprioceptive perception in patients with obstructive sleep apnea syndrome (OSAS).

MATERIAL AND METHODS

The study was conducted with 40 patients diagnosed with moderate and severe OSAS and 21 healthy individuals. All individuals were evaluated with Dizziness Handicap Inventory, ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), video head impulse test (vHIT), videonystagmography (VNG) and sportKAT 3000.

RESULTS

In the vHIT, a statistically significant difference was found between the groups in terms of anterior and posterior semicircular canal vestibulo-ocular reflex gains (p < .05). A negative correlation was found between the lateral gain asymmetry and RALP gain asymmetry and the awake blood oxygen level in the OSAS groups. There was a statistically significant difference between the groups in terms of wave response rates cVEMP 100 dB nHL and oVEMP 100-110 dB nHL (p < .05).

CONCLUSION AND SIGNIFICANCE

It was concluded that vestibular reflexes and proprioceptive perception were affected due to periodic/chronic hypoxia in patients with moderate and severe OSAS.

Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years

OBJECTIVES

Falls in older people can lead to serious injury and significant societal health and financial burden. Obstructive sleep apnoea (OSA) is associated with impaired gait/balance and may increase fall risk, yet few studies examined whether treating OSA reduces fall risk. This study examined the effect of continuous positive airway pressure (CPAP) on fall risk markers in people over 65yrs diagnosed with OSA.

DESIGN

Single arm intervention study.

SETTING

University and tertiary care CPAP clinic.

PARTICIPANTS

Individuals over 65 years diagnosed with OSA and recommended CPAP.

INTERVENTION

3-6 months CPAP therapy.

MEASUREMENTS

28 participants had a physiological profile assessment (PPA) at baseline and following 3-6 months of CPAP. The PPA examines visual contrast sensitivity, lower limb proprioception, knee extension strength, reaction time and postural sway to generate a fall risk score (FRS). t-tests were used to determine difference between pre- and post-treatment FRS. Regression was used to examine the associations between CPAP use and daytime sleepiness with FRS.

RESULTS

CPAP significantly reduced the FRS ([Mean ± SD] 0.59 ± 1.0 vs 0.04 ± 1.1, p = 0.016), contrast sensitivity and lower limb proprioception (P < 0.05). Increased CPAP use was associated with improvement in FRS in unadjusted analysis (β = -0.213, 95%CI -0.371 to -0.056, p = 0.01). Reduction in Epworth sleepiness score was associated with a reduction in FRS in unadjusted (p = 0.023) and adjusted analysis (adjusted for AHI p = 0.027 or O2Nadir p = 0.015).

CONCLUSIONS

CPAP may reduce fall risk in people over 65yrs, possibly related to better CPAP adherence and reduced daytime sleepiness. Future controlled trials and mechanistic studies are needed to elucidate how CPAP may reduce fall risk.

The relationship between obstructive sleep apnea with hearing and balance: A scoping review

BACKGROUND

Obstructive sleep apnea (OSA) has been linked to multiple co-morbidities, and some research points to a potential relationship between OSA and hearing and balance dysfunction, and the benefits of continuous positive airway pressure (CPAP) treatment.

OBJECTIVE

The present study was undertaken as a scoping review of research on OSA and its impact on hearing and balance function in adults and children and whether the treatment of CPAP would affect hearing and balance function.

METHOD

Online databases were used to identify 45 papers published that used hearing and balance assessments concerning OSA and CPAP therapy as a primary outcome. The secondary outcome was the subjective perception through validated questionnaires.

RESULTS

Whilst the data on the effect of OSA on middle ear function remains inconclusive, most papers demonstrate an increase in hearing thresholds, an absence of otoacoustic emissions (OAE) and delayed auditory brainstem response (ABR) in adults with OSA. Nystagmus and abnormal vestibular evoked myogenic potentials (VEMPs) were observed in the small number of papers. The positive pressure from CPAP significantly and transiently increases middle ear pressure, however, its effects on other auditory regions and the vestibular system remains inconclusive. Research on hearing and balance function in children with OSA is limited.

CONCLUSIONS

Narrow assessments of hearing and balance are not sufficient to understand the nature of hearing and balance function in OSA patients and the effect of CPAP therapy. More comprehensive assessments are necessary to observe peripheral and central changes in the auditory and vestibular pathways.

Surgical treatment of otosclerosis leading to changes in postural control and quality of life

OBJECTIVE

Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated.

METHODS

Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters.

RESULTS

A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires.

CONCLUSION

The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:2448-2454, 2020.

Postural control abnormalities related to sleep deprivation in patients with Marfan Syndrome

BACKGROUND

Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance.

OBJECTIVE

To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent.

METHODS

Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC).

RESULTS

DHI and ESS scores were increased in MFS patients (p < 0,01). vHIT scores showed no between-group effect. Classical (surface and length) and frequency-domain posturographic parameters were significantly increased in MFS with respect to HC (p < 0,01). A positive correlation was found between ESS scores and posturographic parameters in MFS patients.

CONCLUSIONS

An impaired postural control, related to the extent of sleep deprivation, was found in MFS patients. Such results could advocate for screening and treating sleep deprivation and balance dysfunctions in MFS patients.