Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea

Association between sleep duration and hearing threshold shifts of adults in the United States: National Health and Nutrition Examination Survey, 2015-2016

BACKGROUND

Obstructive sleep apnea (OSA) is linked to hearing loss (HL). Another sleep characteristics, sleep duration might also be associated with HL, but prior evidence is limited. This study is aimed to investigate the association between sleep duration and hearing level in the adult US population.

METHODS

In total, a sample of 2777 individuals aged 20-69 years from the 2015-2016 National Health and Nutrition Examination Survey cycle (NHANES, 2015-2016) were investigated in this study. Self-reported sleep duration data was classified into the short-sleep (< 7 h), normal-sleep (7-9 h), and long-sleep (> 9 h) group. Multivariable linear regression models between sleep duration and hearing threshold shifts were estimated. Interactions between sleep duration and age, gender, race, OSA were also considered, and the study population was stratified by age, gender, race, and OSA to analyze the potential disparities among adults in different subgroups.

RESULTS

Long-sleep duration was positively associated with speech- and high-frequency pure-tone average (PTA) thresholds with statistical significance (β = 1.31, 95%CI: 0.10, 2.53, P = 0.0347, and β = 2.71, 95%CI: 0.69, 4.74, P = 0.0087, respectively). When stratified by age, short sleep duration was positively associated with low-, and speech-frequency PTAs (P = 0.0140 and 0.0225, respectively) for adults aged 40-59 years, and long-sleep duration was positively associated with low-, and speech-frequency PTAs (P = 0.0495 and 0.0142, respectively) for adults aged 60-69 years with statistical significance. There was statistically significant interaction between OSA and sleep duration on speech-frequency PTA, but no significant interaction between either gender or race with sleep duration on hearing thresholds among US adults.

CONCLUSION

Short/long sleep durations are associated with worse hearing level comparing to sleep 7-9 h in the American adults. Nonoptimal sleep duration may be a potential risk factor for HL.

Associations of sleep characteristics in late midlife with late-life hearing loss in the Atherosclerosis Risk in Communities-Sleep Heart Health Study (ARIC-SHHS)

OBJECTIVES

This study investigated associations of late midlife sleep characteristics with late-life hearing, which adds to the existing cross-sectional evidence and is novel in examining polysomnographic sleep measures and central auditory processing.

METHODS

A subset of Atherosclerosis Risk in Communities Study participants underwent sleep assessment in the Sleep Heart Health Study in 1996-1998 and hearing assessment in 2016-2017. Peripheral hearing thresholds (0.5-4kHz) assessed by pure-tone audiometry were averaged to calculate speech-frequency pure-tone average in better-hearing ear (higher pure-tone average=worse hearing). Central auditory processing was measured by the Quick Speech-in-Noise Test (lower score=worse performance). Sleep was measured using polysomnography (time spent in stage 1, stage 2, stage 3/4, rapid eye movement sleep; sleep-disordered breathing [apnea-hypopnea index ≥5]) and self-report (habitual sleep duration; excessive daytime sleepiness [Epworth Sleepiness Scale 10]). Linear regression models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors.

RESULTS

Among 719 Atherosclerosis Risk in Communities-Sleep Heart Health Study participants (61 ± 5years, 54% female, 100% White), worse speech-frequency pure-tone average was found with sleep-disordered breathing (2.51dB, 95% confidence interval: 0.27, 4.75) and excessive daytime sleepiness (3.35 dB, 95% confidence interval: 0.81, 5.90). Every additional hour of sleep when sleeping >8 hours was associated with worse Quick Speech-in-Noise score (1.61 points, 95% confidence interval: 0.03, 3.19). Every 10-minute increase in rapid eye movement sleep was associated with 0.14-point better Quick Speech-in-Noise score (95% confidence interval: 0.02, 0.25).

CONCLUSIONS

Sleep abnormalities might be risk factors for late-life hearing loss. Future longitudinal studies are needed to confirm these novel findings and clarify the mechanisms.

Evaluation of auditory system in obstructive sleep apnea patients

OBJECTIVES

Obstructive sleep apnea (OSA) has been associated with auditory dysfunction both to the cochlear and higher auditory pathways. However, available literatures presented conflicting results. We aimed to study the impact of OSA severity and their polysomnography parameters on hearing function.

MATERIALS AND METHODS

A total of 44 patients were included after evaluation for sleep disorders and were divided into four groups in accordance with apnea-hypopnea index (AHI). Pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) were compared in commensurate with the severity of AHI. Polysomnography oximetry parameters of oxygen desaturation index, mean SPO2, minimum SPO2 and percent SPO2 < 90% were correlated with their respective PTA, DPOAE and ABR results.

RESULTS

There was no significant change in the PTA, DPOAE and ABR results in connection with AHI severity. However, we found significant correlations between mean SPO2 and percent SPO2 < 90% with ABR wave I, III and V absolute latencies. Minimum SPO2 was also significantly correlated with wave III peak latency changes.

CONCLUSIONS

Mean SPO2, percent SPO2 < 90% and minimum SPO2 could be key prognostic indicators of central auditory dysfunction in OSA patients. These parameters should be explored further as indicators of OSA severity rather than utilizing AHI alone. The hypoxic burden derived could be a better predictor of auditory function abnormalities rather than one derived from AHI.

Association of Obstructive Sleep Apnea-Hypopnea Syndrome with hearing loss: A systematic review and meta-analysis

Objective

This study seeks to investigate the relationship between Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) and hearing impairment by meta-analysis.

Methods

Cochrane Library, PubMed, Embase, Web of Science and other databases are searched from their establishment to July 1st, 2022. Literature on the relationship between OSAHS and hearing loss is collected, and two researchers independently perform screening, data extraction and quality evaluation on the included literature. Meta-analysis is performed using RevMan 5.4.1 software. According to the heterogeneity between studies, a random-effects model or fixed-effects model is used for meta-analysis.

Results

A total of 10 articles are included, with 7,867 subjects, 1,832 in the OSAHS group and 6,035 in the control group. The meta-analysis shows that the incidence of hearing impairment in the OSAHS group is higher than in the control group (OR = 1.38; 95% CI 1.18–1.62, Z = 4.09, P < 0.001), and the average hearing threshold of OSAHS patients is higher than that of the control group (MD = 5.89; 95% CI 1.87–9.91, Z = 2.87, P = 0.004). After stratifying the included studies according to hearing frequency, the meta-analysis shows that the OSAHS group has a higher threshold of 0.25, and the response amplitudes at frequencies 2, 4, 6, and 8 kHz are all higher than those of the control group.

Conclusion

Compared with the control group, the OSAHS group has a higher incidence of hearing loss, mainly high-frequency hearing loss. Thus, OSAHS is closely associated with and a risk factor for hearing loss.

Influence of obstructive sleep apnea on auditory event-related potentials

PURPOSE

To evaluate the influence of obstructive sleep apnea (OSA) on the P300 response of auditory event-related potentials (ERPs) and to correlate the electrophysiological findings with OSA severity.

METHODS

Patients with no OSA and mild, moderate, and severe OSA according to polysomnography (PSG) with normal hearing and no comorbidities were studied. Individuals with a body mass index (BMI) ≥ 40 kg/m², hypertension, diabetes, dyslipidemia, the use of chronic medications, and a risk of hearing loss were excluded. All patients underwent full PSG and auditory ERP measurement using the oddball paradigm with tone burst and speech stimuli. For P300 analysis (latencies and amplitudes), normal multiple linear regression models were adjusted with the groups (No OSA, Mild OSA, Moderate OSA, Severe OSA), age, BMI, and Epworth score as explanatory variables.

RESULTS

We studied 54 individuals (47 males) aged 35 ± 8 years with a BMI of 28.4 ± 4.3 kg/m². Patients were divided according to the apnea-hypopnea index (AHI) derived from PSG into no OSA (n = 14), mild (n = 16), moderate (n = 12), and severe OSA (n = 12) groups. Patients with severe OSA presented prolonged P300 latencies with tone burst stimuli compared to patients with no OSA and those with mild and moderate OSA.

CONCLUSION

Severe OSA is associated with impairment of the P300 response of auditory ERPs, suggesting a decrease in the processing speed of acoustic information that may be mediated by the level of somnolence.

Auditory Function of Patients with Obstructive Sleep Apnea Syndrome: A Study

Objective

Obstructive sleep apnea syndrome (OSAS) is a respiratory syndrome that manifests during sleep. For the auditory system to be able to function normally, the inner ear and cochlear nerve require healthy oxygen support. The purpose of this study was to assess the hearing function of patients with OSAS and to reveal the relationship between polysomnographic parameters and hearing test results.

Materials and Methods

The study was performed with 35 patients diagnosed with moderate or severe OSAS using polysomnography and a control group consisting of 30 individuals. The snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference and gender (STOP-Bang) questionnaire was used to establish the control group. Detailed otoscopic examinations were administered to all subjects by the same otolaryngologist, followed by a tympanogram, pure-tone audiometry (PTA) and transient evoked otoacoustic emissions (TEOAE) tests.

Results

We determined mild sensorineural hearing loss in patients with OSAS. When the different frequencies were evaluated separately, hearing threshold values in the patients with OSAS were significantly higher compared to the control group at 500, 1000, 2000, 4000, and 8000 Hz in both ears. TEOAE test reproducibility values in both ears were significantly lower in the study group compared to the control group.

Conclusion

The hearing system is affected to varying degrees in patients with OSAS. If hearing loss is detected in patients presenting at otolaryngology clinics due to snoring, then assessing these subjects in terms of risk of OSAS is important to reduce mortality and morbidity that may develop at later stages in association with OSAS.

Severe obstructive sleep apnea is associated with cochlear function impairment

PURPOSE

The purpose of this study is to investigate the association between obstructive sleep apnea (OSA) with middle ear acoustic transference and cochlear function.

METHODS

Male individuals with and without mild, moderate, and severe OSA according to standard criteria of full polysomnography and no co-morbidities were studied. Subjects with BMI ≥40 kg/m², present or past treatment for OSA, with heart failure, diabetes, hypertension, dyslipidemia, stroke, use of chronic medications, and previous history of risk for hearing loss were excluded. All subjects were submitted to full polysomnography, evaluation of wideband acoustic immittance by energy of absorbance (EA), and distortion product otoacoustic emissions (DPOAE).

RESULTS

We studied 38 subjects (age 35.8 ± 7.2 years, BMI 28.8 ± 3.8 kg/m²) divided into no OSA (n = 10, age 33.6 ± 6.4 years, BMI 26.9 ± 4.1 kg/m²), mild (n = 11, age 32.8 ± 2.9 years, BMI 28.5 ± 3.5 kg/m²), moderate (n = 8, age 34.1 ± 6.8 years, BMI 29.6 ± 3.3 kg/m²), and severe OSA (n = 9, age 41.2 ± 9.2 years, BMI 30.5 ± 3.8 kg/m²). EA was similar between groups. In contrast, patients with severe OSA presented significantly lower DPOAE amplitudes when compared to the control, mild, and moderate OSA groups (p ≤ 0.03, for all comparisons).

CONCLUSIONS

Acoustic transference function of middle ear is similar in adults with and without OSA. Severe OSA is independently associated with cochlear function impairment in patients with no significant co-morbidities.