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Hoppes CW, Erbele ID, Lambert KH, Thapa S, Rich ES, Yuan TT, Brock MS, Reavis KM. Sleep quality of service members and veterans with and without reports of dizziness. J Vestib Res 2025:9574271251338696. [PMID: 40384621 DOI: 10.1177/09574271251338696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
BackgroundMilitary duty may place Service members and Veterans at an increased risk of experiencing dizziness. Individuals with dizziness report poor sleep quality as well as abnormal sleep duration, which is associated with increased risk of falling and worse quality of life. The overall pooled prevalence of poor sleep quality in Service members and Veterans was 69%, but it is not known if Service members and Veterans with self-reported dizziness report poorer sleep quality than their counterparts without dizziness.ObjectiveThe purpose of this research study was to evaluate the sleep quality of Service members and Veterans with and without reports of dizziness.MethodsDescriptive statistics were used to explore the prevalence of self-reported dizziness among Service members and Veterans by demographic characteristics. Descriptive statistics were also used to describe the prevalence of participants' dizziness symptoms and the mean age participants first noticed dizziness. Models (unadjusted and adjusted) were created by regressing sleep disorders and daytime sleepiness on dizziness frequency. Potential confounders were chosen a priori through a theoretical framework. Military status (Service member vs Veteran) was explored as an interaction term. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, with statistical significance determined by the 95% CI.ResultsDizziness was reported by 22.4% of Service members (n = 171 of 763) and 31.7% of Veterans (n = 241 of 761). Service members and Veterans with dizziness were 1.7 times more likely to have a sleep disorder than Service members and Veterans without dizziness.ConclusionsService members and Veterans with dizziness were more likely to have poor sleep quality than those without dizziness. Medical providers should screen for sleep disturbances, evaluate for obstructive sleep apnea, treat chronic insomnia disorder, and consider referral for vestibular rehabilitation in Service members and Veterans presenting with dizziness.
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Affiliation(s)
- Carrie W Hoppes
- Advanced Exposures, Diagnostics, Interventions, and Biosecurity (AEGIS) Program, Joint Base San Antonio-Lackland Air Force Base, TX, USA
| | - Isaac D Erbele
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Karen H Lambert
- Goldbelt-Apex, Defense Health Agency - Hearing Center of Excellence, Joint Base San Antonio-Lackland Air Force Base, TX, USA
| | - Samrita Thapa
- Veterans Affairs Rehabilitation Research & Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University-Portland State University, School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Erica S Rich
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Tony T Yuan
- Advanced Exposures, Diagnostics, Interventions, and Biosecurity (AEGIS) Program, Joint Base San Antonio-Lackland Air Force Base, TX, USA
- Department of Radiology and Bioengineering, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Matthew S Brock
- Department of Sleep Medicine and Neurology, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland Air Force Base, TX, USA
| | - Kelly M Reavis
- Veterans Affairs Rehabilitation Research & Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University-Portland State University, School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Petry A, Leuzzi M, Thibault C, Comtet H, Kilic-Huck U, Bourgin P, Charpiot A, Ruppert E. High prevalence of sleep disorders in Ménière's disease: Interplay between vestibular function and sleep. J Vestib Res 2025:9574271251328339. [PMID: 40096817 DOI: 10.1177/09574271251328339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
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.
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Affiliation(s)
- Arnaud Petry
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, Strasbourg, France
- Department of ENT, University Hospital of Strasbourg, Strasbourg, France
| | - Manuela Leuzzi
- Department of ENT, University Hospital of Strasbourg, Strasbourg, France
| | - Claire Thibault
- Department of ENT, University Hospital of Strasbourg, Strasbourg, France
| | - Henri Comtet
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, Strasbourg, France
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & University of Strasbourg, Strasbourg, France
| | - Ulker Kilic-Huck
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, Strasbourg, France
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & University of Strasbourg, Strasbourg, France
| | - Patrice Bourgin
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, Strasbourg, France
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & University of Strasbourg, Strasbourg, France
| | - Anne Charpiot
- Department of ENT, University Hospital of Strasbourg, Strasbourg, France
| | - Elisabeth Ruppert
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, Strasbourg, France
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & University of Strasbourg, Strasbourg, France
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Kang KT, Lin MT, Nakayama M, Young YH, Hsu WC. Association of vertigo with adult obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med 2025; 126:194-204. [PMID: 39693701 DOI: 10.1016/j.sleep.2024.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 11/27/2024] [Accepted: 12/08/2024] [Indexed: 12/20/2024]
Abstract
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.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology and Sleep Center, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Ming-Tzer Lin
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan
| | | | - Yi-Ho Young
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Ikeda K, Tanaka K, Tajima S, Takakura T, Sugihara M, Ono K. Dizziness and unstable gait in the older adults are associated with vestibular hypofunction, muscle dysfunction and sleep disturbance: impact on prevention of accidental falls. BMC Geriatr 2024; 24:1042. [PMID: 39731063 DOI: 10.1186/s12877-024-05620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 12/09/2024] [Indexed: 12/29/2024] Open
Abstract
BACKGROUND Dizziness and unstable gait with resultant falls are common symptoms among the older adults. Most of studies have focused on statistical analysis regarding single factor related to dizziness and unstable gait. On the other hand, there are very few comprehensive studies using a large number of patients except several review papers. METHODS We retrospectively analyzed a total of 164 aged patients with dizziness and unstable gait. The patients underwent description of the Japanese version of the Dizziness Handicap Inventory (DHI), measurements of vestibular function, handgrip muscle strength, physical performance, height-adjusted appendicular skeletal muscle mass, and vitamin B1 and B12, a full-night polysomnography study, cognition test and visual test. RESULTS Average age was 80.5 ± 6.1 years and ranged from 59 to 91 years. Forty-eight were males and 116 females. Three causative factors, namely vestibular hypofunction, muscle dysfunction and sleep disturbance, were independently and combinedly associated with dizziness and unstable gait in over 93% of the patients. Patients with higher scores defined by these three causative factors had higher scores of DHI. 23% of the patients showed vitamin B1 and/or B12 deficiency, which was highly associated with sarcopenia/frailty. Cognitive and visual impairment were recognized in 4.9% and 5.0%, respectively. CONCLUSION Dizziness and unstable gait were mainly associated with vestibular hypofunction, muscle dysfunction and sleep disturbance. In addition, vitamin B1 and B12 deficiency, and cognitive and visual impairment secondarily contribute to dizziness and unstable gait. Appropriate selection of treatment according to the underlying causes would prevent accidental falls among the older adults.
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Affiliation(s)
- Katsuhisa Ikeda
- Department of Otorhinolaryngology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo, 136-0075, Japan.
| | - Kumiko Tanaka
- Department of Otorhinolaryngology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo, 136-0075, Japan
| | - Shori Tajima
- Department of Otorhinolaryngology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo, 136-0075, Japan
| | - Tomokazu Takakura
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo, 136-0075, Japan
| | - Masami Sugihara
- Department of Clinical Laboratory, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3- 3-20, Koto-ku, Tokyo, 136-0075, Japan
| | - Koichi Ono
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3- 20, Koto-ku, Tokyo, 136-0075, Japan
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Milot E, Martin T, Kuldavletova O, Bessot N, Toupet M, Hautefort C, Van Nechel C, Clément G, Quarck G, Denise P. Exploration of sleep quality and rest-activity rhythms characteristics in Bilateral Vestibulopathy patients. Sleep Med 2024; 124:9-15. [PMID: 39241434 DOI: 10.1016/j.sleep.2024.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024]
Abstract
Sleep and circadian timing systems are constantly regulated by both photic and non-photic signals. Connections between the vestibular nuclei and the biological clock raise the question of the effect of peripheral vestibular loss on daily rhythms, such as the sleep-wake cycle and circadian rhythm. To answer this question, we compared the sleep and rest-activity rhythm parameters of 15 patients with bilateral vestibulopathy (BVP) to those of 15 healthy controls. Sleep and rest-activity cycle were recorded by a device coupling actimetry with the heart rate and actigraphy at home over 7 days. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Sleep efficiency and subjective sleep quality were significantly reduced, and sleep fragmentation was increased in BVP patients compared to controls. BVP patients displayed a damped amplitude of the rest-activity rhythm and higher sleep fragmentation, reflected by a higher nocturnal activity compared to controls. These results suggest that both rest-activity and sleep cycles are impaired in BVP patients compared to healthy controls. BVP patients seem to have greater difficulty maintaining good sleep at night compared to controls. BVP pathology appears to affect the sleep-wake cycle and disturb the circadian rhythm synchronization. Nevertheless, these results need further investigation to be confirmed, particularly with larger sample sizes.
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Affiliation(s)
- E Milot
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Univ, France.
| | - T Martin
- Movement - Interactions, Performance, MIP, EA 4334, Faculty of Sciences and Technologies, Le Mans University, Le Mans, France
| | - O Kuldavletova
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Univ, France
| | - N Bessot
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Univ, France
| | - M Toupet
- Centre d'Explorations Fonctionnelles Oto-Neurologiques, Paris, France
| | - C Hautefort
- Université de Paris Cité, INSERM U1141, Paris, France; Department of Head and Neck Surgery, Lariboisière Hospital, Paris, France
| | - C Van Nechel
- Centre d'Explorations Fonctionnelles Oto-Neurologiques, Paris, France
| | - G Clément
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Univ, France
| | - G Quarck
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Univ, France
| | - P Denise
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Univ, France
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Ozses M, Mungan Durankaya S, Guneri EA, Öztura İ, Ecevit MC, Ellidokuz H, Kirkim G. Is the Otolithic Function Affected in Patients with Obstructive Sleep Apnea Syndrome? J Am Acad Audiol 2024; 35:234-240. [PMID: 39694055 DOI: 10.1055/s-0044-1791216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024]
Abstract
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.
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Affiliation(s)
- Merve Ozses
- Department of Otorhinolaryngology, Audiology Programme, Institute of Health Sciences, Dokuz Eylul University, İzmir, Türkiye
| | - Serpil Mungan Durankaya
- Department of Audiometry, Vocational School of Health Services, Dokuz Eylül University, İzmir, Türkiye
| | - Enis A Guneri
- Department of Otorhinolaryngology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - İbrahim Öztura
- Department of Neurology, Clinical Neurophysiology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Mustafa C Ecevit
- Department of Otorhinolaryngology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Hülya Ellidokuz
- Department of Biostatistics and Medical Informatics, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
| | - Günay Kirkim
- Department of Otorhinolaryngology, Audiology, Dokuz Eylul University Hospital, Izmir, Türkiye
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Xu XD, Luo HP, Yu J, Gao N. Prevalence survey and psychometric measurement of vertigo and dizziness in individuals with obstructive sleep apnoea: A cross-sectional study. Clin Otolaryngol 2024; 49:633-639. [PMID: 38818535 DOI: 10.1111/coa.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 04/10/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
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.
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Affiliation(s)
- Xin-Da Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, China
| | - Hui-Ping Luo
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Yu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, China
| | - Na Gao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research (Fudan University), Shanghai, China
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van Leeuwen RB, Schermer TR, Bienfait HP. The relationship between dizziness and sleep: a review of the literature. Front Neurol 2024; 15:1443827. [PMID: 39268076 PMCID: PMC11390376 DOI: 10.3389/fneur.2024.1443827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024] Open
Abstract
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.
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Affiliation(s)
| | - Tjard R Schermer
- Apeldoorn Dizziness Centre, Gelre Hospitals, Apeldoorn, Netherlands
- Department of Primary and Community Care, Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henri P Bienfait
- Department of Neurology, Gelre Hospitals, Apeldoorn, Netherlands
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Garofalo E, Neri G, Perri LM, Lombardo N, Piazzetta G, Antonelli A, Biamonte E, Bosco V, Battaglia C, Pelaia C, Manti F, Pitino A, Tripepi G, Bruni A, Morelli M, Giudice A, Longhini F. Assessment of cephalometric parameters and correlation with the severity of the obstructive sleep apnea syndrome. J Transl Med 2024; 22:377. [PMID: 38649914 PMCID: PMC11036665 DOI: 10.1186/s12967-024-05194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In individuals diagnosed with obstructive sleep apnea syndrome (OSAS), variations in craniofacial structure have been inconsistently documented, showing differing degrees of alteration between obese and nonobese patients. In addition, sleep disturbance has also been shown to induce disequilibrium in this population of patients. This pilot observational study aimed to assess craniofacial values in obese and nonobese subpopulations of patients with OSAS and their correlation and association with the severity of OSAS. We also assessed whether OSAS patients are characterized by an impaired equilibrium in relation to and associated with the severity of OSAS. METHODS We included all consecutive adult patients with OSAS. Through cephalometry, we assessed the upper (UPa-UPp) and lower (LPa-LPp) pharynx diameters, superior anterior facial height (Sor-ANS), anterior facial height (ANS-Me), anterior vertical dimension (Sor-Me), posterior facial height (S-Go) and craniovertebral angle (CVA). Furthermore, we analyzed postural equilibrium through a stabilometric examination. RESULTS Forty consecutive OSAS patients (45% female with a mean age of 56 ± 8.2 years) were included. The subgroup of nonobese patients had a reduced UPa-UPp (p = 0.02). Cephalometric measurements were correlated with the severity of OSAS in nonobese patients, whereas only Sor-ANS was correlated with the severity of OSAS in the obese subpopulation. In the overall population, altered craniofacial values are associated with severe OSAS. Although there are differences in equilibrium between obese and nonobese OSAS patients, the stabilometric measurements were not correlated or associated with OSAS severity. CONCLUSION Altered craniofacial values and compromised equilibrium in OSAS patients are linked to OSAS severity. Therefore, the management of OSAS should be tailored not only to weight management but also to craniofacial and postural rehabilitation to enhance patient outcomes.
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Affiliation(s)
- Eugenio Garofalo
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Giuseppe Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Lucilla Maria Perri
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Nicola Lombardo
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Giovanna Piazzetta
- Department of Otolaryngology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Alessandro Antonelli
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Biamonte
- Department of Anesthesia and Intensive Care, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Caterina Battaglia
- Department of Radiology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Francesco Manti
- Department of Radiology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | | | | | - Andrea Bruni
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy.
| | - Michele Morelli
- Department of Obstetrics and Gynecology, "Annunziata" Hospital, Cosenza, Italy
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
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Skop KM, Bajor L, Sevigny M, Swank C, Tallavajhula S, Nakase-Richardson R, Miles SR. Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury. PM R 2023; 15:1524-1535. [PMID: 37490363 DOI: 10.1002/pmrj.13044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/09/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
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).
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Affiliation(s)
- Karen M Skop
- Physical Medicine and Rehabilitation Services, Department of Physical Therapy, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, School of Physical Therapy, Tampa, Florida, USA
| | - Laura Bajor
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Harvard South Shore Psychiatry Training Program, Brockton, Massachusetts, USA
| | - Mitch Sevigny
- Research Department, Craig Hospital, Englewood, Colorado, USA
| | - Chad Swank
- Baylor Scott & White Research Institute for Rehabilitation, Dallas, Texas, USA
- Baylor Scott White Research Institute, Dallas, Texas, USA
| | - Sudha Tallavajhula
- University of Texas McGovern Medical School, Houston, Texas, USA
- TIRR Memorial Hermann Neurological Sleep Disorders Center, Houston, Texas, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences and Defense and Veterans' Brain Injury Center, James A. Haley Veterans' Hospital, Tampa, Florida, USA
- Morsani College of Medicine, Pulmonary and Sleep Medicine Division, University of South Florida, Tampa, Florida, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Micarelli A, Viziano A, Arena M, Misici I, Di Benedetto A, Carbini V, Micarelli B, Alessandrini M. Changes in sleep performance and chronotype behaviour after vestibular rehabilitation in unilateral vestibular hypofunction. J Laryngol Otol 2023; 137:1349-1358. [PMID: 36524555 DOI: 10.1017/s0022215122002602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- A Micarelli
- Unit of Neuroscience, Rehabilitation and Sensory Organs, Uniter Onlus, Rome, Italy
| | - A Viziano
- Department of Clinical Sciences and Translational Medicine, ENT Unit, University of Rome Tor Vergata, Italy
| | - M Arena
- Unit of Neuroscience, Rehabilitation and Sensory Organs, Uniter Onlus, Rome, Italy
| | - I Misici
- Unit of Neuroscience, Rehabilitation and Sensory Organs, Uniter Onlus, Rome, Italy
| | - A Di Benedetto
- Unit of Neuroscience, Rehabilitation and Sensory Organs, Uniter Onlus, Rome, Italy
- Occupational Therapy Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - V Carbini
- Unit of Neuroscience, Rehabilitation and Sensory Organs, Uniter Onlus, Rome, Italy
| | - B Micarelli
- Unit of Neuroscience, Rehabilitation and Sensory Organs, Uniter Onlus, Rome, Italy
| | - M Alessandrini
- Department of Clinical Sciences and Translational Medicine, ENT Unit, University of Rome Tor Vergata, Italy
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12
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Shimizu M, Kasai T, Naito R, Sato A, Ishiwata S, Yatsu S, Shitara J, Matsumoto H, Murata A, Kato T, Suda S, Hiki M, Kuwabara M, Murase T, Nakamura T, Daida H. Overnight changes in uric acid, xanthine oxidoreductase and oxidative stress levels and their relationships with sleep-disordered breathing in patients with coronary artery disease. Hypertens Res 2023; 46:2293-2301. [PMID: 37258622 DOI: 10.1038/s41440-023-01331-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
Serum uric acid (UA) level is associated with the high cumulative incidence or prevalence of coronary artery disease (CAD), and hyperuricemia is considered as an independent risk marker for CAD. Sleep-disordered breathing (SDB) is also associated with an increased risk of CAD. Several studies have shown that SDB is associated with hyperuricemia, but the mechanisms are unclear. We measured serum levels of UA and xanthine oxidoreductase (XOR) activity and urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), all of which were assessed at 6 p.m. and the following 6 a.m. in males with CAD. In addition, nocturnal pulse oximetry was performed for the night. Overall 32 eligible patients with CAD were enrolled. Serum UA levels significantly increased overnight. (5.32 ± 0.98 mg/dl to 5.46 ± 1.02 mg/dl, p < 0.001) Moreover, XOR activity and urinary 8-OHdG levels significantly increased from 6 p.m. to 6 a.m. Furthermore, 3% Oxygen desaturation index (ODI) was correlated with the overnight changes in XOR activity (r = 0.36, P = 0.047) and urinary 8-OHdG levels (r = 0.41, P = 0.02). In addition, 3%ODI was independently correlated with the changes in XOR activity (correlation coefficient, 0.36; P = 0.047) and 8-OHdG (partial correlation coefficient, 0.63; P = 0.004) in multivariable analyses. SDB severity was associated with the overnight changes in XOR activity and urinary 8-OHdG, suggesting that SDB may be associated with oxidative stress via UA production. This trial is registered at University Hospital Medical Information Network (UMIN), number: UMIN000021624.
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Affiliation(s)
- Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihiro Sato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masanari Kuwabara
- Intensive Care Unit and Department of Cardiology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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13
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Cengiz DU, Büyüklü AF. Evaluation of vestibular functions in patients with obstructive sleep apnea syndrome. Acta Otolaryngol 2023; 143:772-778. [PMID: 37902611 DOI: 10.1080/00016489.2023.2269255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023]
Abstract
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.
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Affiliation(s)
| | - Adnan Fuat Büyüklü
- Department of Otorhinolaryngology, Başkent University Faculty of Medicine, Ankara, Turkey
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14
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The use of vestibular evoked myogenic potentials (VEMP) in the diagnosis of otolithic dysfunction of patients with obstructive sleep apnea: a survey of awareness and recognition of otorhinolaryngology medical staffs. Eur Arch Otorhinolaryngol 2023; 280:1603-1610. [PMID: 36030467 DOI: 10.1007/s00405-022-07616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess awareness and recognition of vestibular function tests in otorhinolaryngology medical staffs, especially the vestibular evoked myogenic potentials (VEMP) testing in patients with obstructive sleep apnea (OSA). METHODS A survey was delivered via either email or a social media app. The medical staffs of the Chinese Medical Association of Otolaryngology Head and Neck Surgery from various branches were enrolled. Study data were collected and managed with an online data collection tool. RESULTS A total of 1781 emails and 623 social media messages were sent to 2404 otorhinolaryngology medical staffs. One hundred and fifty-seven of them participated in the survey, including 24 via emails and 133 via the social media app. Regarding the knowledge of VEMP, only 59 (37.6%) of them agreed that OSA could be related to vertigo/dizziness/imbalance and 28 (17.8%) believed that OSA could result in VEMP abnormalities and would factor this in diagnosing the impairment of the vestibular function of OSA patients. A total of 7.6% of the respondents had never heard of the VEMP tests. Responses regarding the minimum age at which VEMP are possible ranged from younger than 6 months to greater than 18 years of age. Beliefs regarding the utility and reliability of VEMP varied, with 'unsure' being the most frequent response. In addition, only 17.8% of otolaryngologists indicated some access to the VEMP test. CONCLUSIONS Knowledge and beliefs about the role of VEMP in diagnosing otolithic organ dysfunction caused by OSA in otorhinolaryngology vary widely. It is important for otorhinolaryngology medical staffs to learn the latest literatures and updated knowledge through continuing education.
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15
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Levin O, Vints WAJ, Ziv G, Katkutė G, Kušleikienė S, Valatkevičienė K, Sheoran S, Drozdova-Statkevičienė M, Gleiznienė R, Pääsuke M, Dudonienė V, Himmelreich U, Česnaitienė VJ, Masiulis N. Neurometabolic correlates of posturography in normal aging and older adults with mild cognitive impairment: Evidence from a 1H-MRS study. Neuroimage Clin 2023; 37:103304. [PMID: 36580713 PMCID: PMC9827054 DOI: 10.1016/j.nicl.2022.103304] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/03/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) holds promise for revealing and understanding neurodegenerative processes associated with cognitive and functional impairments in aging. In the present study, we examined the neurometabolic correlates of balance performance in 42 cognitively intact older adults (healthy controls - HC) and 26 older individuals that were diagnosed with mild cognitive impairment (MCI). Neurometabolite ratios of total N-acetyl aspartate (tNAA), glutamate-glutamine complex (Glx), total choline (tCho) and myo-inositol (mIns) relative to total creatine (tCr) were assessed using single voxel 1H-MRS in four different brain regions. Regions of interest were the left hippocampus (HPC), dorsal posterior cingulate cortex (dPCC), left sensorimotor cortex (SM1), and right dorsolateral prefrontal cortex (dlPFC). Center-of-pressure velocity (Vcop) and dual task effect (DTE) were used as measures of balance performance. Results indicated no significant group differences in neurometabolite ratios and balance performance measures. However, our observations revealed that higher tCho/tCr and mIns/tCr in hippocampus and dPCC were generic predictors of worse balance performance, suggesting that neuroinflammatory processes in these regions might be a driving factor for impaired balance performance in aging. Further, we found that higher tNAA/tCr and mIns/tCr and lower Glx/tCr in left SM1 were predictors of better balance performance in MCI but not in HC. The latter observation hints at the possibility that individuals with MCI may upregulate balance control through recruitment of sensorimotor pathways.
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Affiliation(s)
- Oron Levin
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium
| | - Wouter A J Vints
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University P.O. Box 616, 6200 MD Maastricht, the Netherlands; Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, The Netherlands.
| | - Gal Ziv
- The Academic College at Wingate, Netanya 4290200, Israel
| | - Gintarė Katkutė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Simona Kušleikienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Kristina Valatkevičienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Samrat Sheoran
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | | | - Rymantė Gleiznienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mati Pääsuke
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Estonia
| | - Vilma Dudonienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Uwe Himmelreich
- Biomedical MRI Unit, Department of Imaging and Pathology, Group Biomedical Sciences, KU Leuven, Leuven 3000, Belgium
| | - Vida J Česnaitienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Nerijus Masiulis
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Science, Vilnius University, Vilnius, Lithuania
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16
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Micarelli A, Viziano A, Carbini V, Misici I, Guzzo F, Micarelli B, Alessandrini M. Effects of vestibular rehabilitation on body composition and daily-living physical activity in chronic unilateral vestibular hypofunction. J Vestib Res 2022; 33:71-83. [PMID: 36463467 DOI: 10.3233/ves-220019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Unilateral vestibular hypofunction (UVH) may lead to modifications on metabolism and body composition. Vestibular rehabilitation (VR) demonstrated its effectiveness in ameliorating balance function and several other daily-living aspects. OBJECTIVES The aim of this study was to evaluate metabolic composition, by means of bioelectrical impedance analysis (BIA) and daily activity, with the use of a wrist-worn movement tracker, in UVH participants before and after VR, and to compare data with a healthy control group (CG) of adults. METHODS 46 UVH and 60 CG participants underwent otoneurological testing, self-report and performance questionnaires, BIA, and wore a device tracking daily movement and energy expenditure for one full day; this was performed before and after VR. RESULTS UVH participants demonstrated a significant (p = 0.008) increase in muscle mass after VR, and, when compared to CG, no differences were present with respect to visceral fat and muscle mass. UVH adults reported a significant increase in energy expenditure spent in movement (p = 0.008) and during the day (p = 0.009), daily number of strides (p = 0.009) and calories spent in sweeping (p = 0.009) and stairing (p = 0.008). CONCLUSIONS Results from this study show that VR provided an improvement of metabolic function and body composition of people with UVH, possibly by contrasting structural modifications in neural pathways stemming from the vestibular nuclei and connected to autonomous function.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), UNITER Onlus, Rome, Italy
| | - Andrea Viziano
- University of Rome Tor Vergata - Department of Clinical Sciences and Translational Medicine - Italy
| | - Valentina Carbini
- ITER Center for Balance and Rehabilitation Research (ICBRR), UNITER Onlus, Rome, Italy
| | - Ilaria Misici
- ITER Center for Balance and Rehabilitation Research (ICBRR), UNITER Onlus, Rome, Italy
| | - Federico Guzzo
- ITER Center for Balance and Rehabilitation Research (ICBRR), UNITER Onlus, Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), UNITER Onlus, Rome, Italy
| | - Marco Alessandrini
- University of Rome Tor Vergata - Department of Clinical Sciences and Translational Medicine - Italy
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17
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Stevens D, Barr C, Bassett K, Oh A, Lord SR, Crotty M, Bickley K, Mukherjee S, Vakulin A. Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years. Sleep Med 2022; 100:448-453. [PMID: 36252413 DOI: 10.1016/j.sleep.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- David Stevens
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Centre for Nutritional and Gastrointestinal Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chris Barr
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Bassett
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Aaron Oh
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, and Faculty of Medicine, University of New South Wales, Sydney, N.S.W, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Rehabilitation Unit, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sutapa Mukherjee
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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18
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Fox MG, Cohen HS, Sangi-Haghpeykar H, Takashima M. Relationship Between Obstructive Sleep Apnea and Balance on Computerized Dynamic Posturography. Cureus 2022; 14:e30973. [DOI: 10.7759/cureus.30973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
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Cheung ICW, Thorne PR, Hussain S, Neeff M, Sommer JU. The relationship between obstructive sleep apnea with hearing and balance: A scoping review. Sleep Med 2022; 95:55-75. [PMID: 35567880 DOI: 10.1016/j.sleep.2022.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Irene C W Cheung
- Audiology, School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, 1023, New Zealand; Eisdell Moore Centre for Hearing and Balance Research, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, 1023, New Zealand.
| | - Peter R Thorne
- Audiology, School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, 1023, New Zealand; Eisdell Moore Centre for Hearing and Balance Research, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, 1023, New Zealand
| | - Syed Hussain
- Respiratory Department, Auckland City Hospital, Auckland District Health Board, Auckland, 1023, New Zealand
| | - Michel Neeff
- ENT- Otorhinolaryngology (ORL), Auckland City Hospital, Auckland District Health Board, Auckland, 1023, New Zealand
| | - J Ulrich Sommer
- ENT Department, Universität Witten/Herdecke, Witten, 58455, Germany
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20
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Fernandes M, Chiaravalloti A, Manfredi N, Placidi F, Nuccetelli M, Izzi F, Camedda R, Bernardini S, Schillaci O, Mercuri NB, Liguori C. Nocturnal Hypoxia and Sleep Fragmentation May Drive Neurodegenerative Processes: The Compared Effects of Obstructive Sleep Apnea Syndrome and Periodic Limb Movement Disorder on Alzheimer’s Disease Biomarkers. J Alzheimers Dis 2022; 88:127-139. [DOI: 10.3233/jad-215734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Sleep disorders may cause dysregulation of cerebral glucose metabolism and synaptic functions, as well as alterations in cerebrospinal fluid (CSF) biomarker levels. Objective: This study aimed at measuring sleep, CSF Alzheimer’s disease (AD) biomarkers, and cerebral glucose consumption in patients with obstructive sleep apnea syndrome (OSAS) and patients with periodic limb movement disorder (PLMD), compared to controls. Methods: OSAS and PLMD patients underwent 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET), polysomnographic monitoring, and lumbar puncture to quantify CSF levels of amyloid-β42 (Aβ42), total tau, and phosphorylated tau. All patients were compared to controls, who were not affected by sleep or neurodegenerative disorders. Results: Twenty OSAS patients, 12 PLMD patients, and 15 controls were included. Sleep quality and sleep structure were altered in both OSAS and PLMD patients when compared to controls. OSAS and PLMD patients showed lower CSF Aβ42 levels than controls. OSAS patients showed a significant increase in glucose uptake in a wide cluster of temporal-frontal areas and cerebellum, as well as a reduced glucose consumption in temporal-parietal regions compared to controls. PLMD patients showed increased brain glucose consumption in the left parahippocampal gyrus and left caudate than controls. Conclusion: Sleep dysregulation and nocturnal hypoxia present in OSAS patients, more than sleep fragmentation in PLMD patients, were associated with the alteration in CSF and 18F-FDG PET AD biomarkers, namely reduction of CSF Aβ42 levels and cerebral glucose metabolism dysregulation mainly in temporal areas, thus highlighting the possible role of sleep disorders in driving neurodegenerative processes typical of AD pathology.
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Affiliation(s)
- Mariana Fernandes
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome “Tor Vergata”, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Natalia Manfredi
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome “Tor Vergata”, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome “Tor Vergata”, Rome, Italy
- Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
| | - Marzia Nuccetelli
- Department of Clinical Biochemistry and Molecular Biology, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesca Izzi
- Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
| | - Riccardo Camedda
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Sergio Bernardini
- Department of Clinical Biochemistry and Molecular Biology, University of Rome “Tor Vergata”, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
- IRCSS Santa Lucia Foundation, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome “Tor Vergata”, Rome, Italy
- Neurology Unit, University Hospital of Rome “Tor Vergata”, Rome, Italy
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21
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Micarelli A, Viziano A, Alessandrini M. Video Head Impulse Test Changes Related to Obstructive Sleep Apnea: In Reply to the Work of Xin-Da Xu et al. Front Neurol 2022; 13:889187. [PMID: 35572935 PMCID: PMC9100950 DOI: 10.3389/fneur.2022.889187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alessandro Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- *Correspondence: Alessandro Micarelli
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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22
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Onset and resolution failure of recurrent benign paroxysmal positional vertigo: the role of cervical range of motion. Eur Arch Otorhinolaryngol 2022; 279:2183-2192. [DOI: 10.1007/s00405-021-07226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
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23
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Pace A, Milani A, Rossetti V, Iannella G, Maniaci A, Cocuzza S, Alunni Fegatelli D, Vestri A, Magliulo G. Evaluation of Vestibular Function in Patients Affected by Obstructive Sleep Apnea Performing Functional Head Impulse Test (fHIT). Nat Sci Sleep 2022; 14:475-482. [PMID: 35321358 PMCID: PMC8937310 DOI: 10.2147/nss.s346241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/18/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Obstructive sleep apnoea (OSA) is a common disease with significantly related complications. Since a connection between the vestibular nucleus and sleep regulator pathways has been demonstrated, vestibular evaluation in OSA patients was partially studied and none used functional head impulse test (fHIT) for this purpose. This paper aimed at evaluating the vestibular function in patients affected by OSA using fHIT, selecting patients who did not present any other related to cardiovascular, neurological, or metabolic diseases. PATIENTS AND METHODS Patients enrolled had a diagnosis of OSA by polysomnography type III and were cataloged according to American Association of Sleep Medicine criteria. Each patient underwent fHIT. Statistical significance was set at 0.05. RESULTS A total of 85 patients were enrolled in the study of which 50 had a diagnosis of OSA and were included in the case group, while 35 belonged to the control group. In 88.6% of subjects of the case group was evidenced a vestibular impairment with a substantial difference between the two study groups (p<0.05). CONCLUSION The results show that the incidence of vestibular lesions in patients with obstructive sleep apnoea is underestimated and that fHIT can identify these lesions early.
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Affiliation(s)
- Annalisa Pace
- Organi di Senso Department, Sapienza University, Rome, Italy.,Scienze Chirurgiche Department, Sapienza University, Rome, Italy
| | | | | | - Giannicola Iannella
- Organi di Senso Department, Sapienza University, Rome, Italy.,Scienze Chirurgiche Department, Sapienza University, Rome, Italy.,Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Antonino Maniaci
- Otorinolaringoiatria Department, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Otorinolaringoiatria Department, University of Catania, Catania, Italy
| | | | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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24
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Influence of Sleep Dysfunction on Concussion Assessment Outcomes Among Adolescent Athletes After Concussion and Healthy Controls. Clin J Sport Med 2021; 31:481-487. [PMID: 32941365 DOI: 10.1097/jsm.0000000000000860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/14/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sleep dysfunction (SD) is associated with a high symptom burden and lower neurocognitive performance after concussion and on baseline testing without injury. However, few studies have compared concussed athletes and controls with and without SD on clinical outcomes. OBJECTIVE To evaluate differences in clinical outcomes among both concussed athletes and matched controls with and without SD. DESIGN Retrospective cross-sectional study. PARTICIPANTS Participants aged 12 to 20 years were recruited from a concussion clinic (n = 50 patients) and research registry/flyers (n = 50 healthy age-/sex-matched controls). Participants were categorized by self-reported SD into one of 4 groups: sport-related concussion (SRC) + SD, SRC only, SD only, and controls. MAIN OUTCOME MEASURES Post-Concussion Symptom Scale (PCSS), Vestibular/Oculomotor Screening (VOMS), and neurocognitive testing (Immediate Postconcussion Assessment Cognitive Test). RESULTS Compared with the SRC only group, the SRC + SD group performed worse on all neurocognitive domains, had a higher total symptom score, and endorsed more symptoms on most VOMS items. In addition, the SRC + SD group was at an increased likelihood of having at least 1 abnormal VOMS item compared with SRC only group. The SRC only group had neurocognitive test scores and symptom reports statistically similar to the SD only group. CONCLUSION Sleep dysfunction after concussion is related to worse neurocognitive performance and higher concussion symptom reporting. This study extended findings to suggest vestibular symptomology is worse among athletes with SD after injury compared to injured athletes without SD. Similar performances on concussion assessments for the SRC only and SD only groups suggest SD may appear similar to clinical presentation of concussion, even at baseline in the absence of SRC.
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25
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Micarelli A, Viziano A, Pistillo R, Granito I, Micarelli B, Alessandrini M. Sleep Performance and Chronotype Behavior in Unilateral Vestibular Hypofunction. Laryngoscope 2021; 131:2341-2347. [PMID: 34191310 DOI: 10.1002/lary.29719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate sleep behavior and its relation to otoneurological parameters in a group of patients with chronic unilateral vestibular hypofunction (UVH) without self-reported sleep disturbances when compared with healthy subjects serving as a control group (CG). METHODS Fifty-one patients affected by UVH underwent a retrospective clinical and instrumental otoneurological examination, a 1-week actigraphy sleep analysis, and a series of self-report and performance measures (SRM/PM). A CG of 60 gender- and age-matched healthy subjects was also enrolled. A between-group analysis of variance was performed for each variable, while correlation analysis was performed in UVH patients between otoneurological, SRM/PM, and actigraphy measure scores. RESULTS When compared with CG subjects, UVH patients were found to be spending less time sleeping and taking more time to go from being fully awake to asleep, based on actigraphy-based sleep analysis. Also, SRM/PM depicted UVH patients to have poor sleep quality and to be more prone to an evening-type behavior. Correlations were found between vestibular-related functionality indexes and subjective sleep quality, as well as between longer disease duration and reduced sleep time. CONCLUSION For the first time, a multiparametric sleep analysis was performed on a large population-based sample of chronic UVH patients. While a different pattern in sleep behavior was found, the cause is still unclear. Further research is needed to expand the extent of knowledge about sleep disruption in vestibular disorders. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2021.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rossella Pistillo
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Ivan Granito
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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26
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Nishino LK, Rocha GD, Souza TSAD, Ribeiro FDAQ, Cóser PL. Protocol for static posturography with dynamic tests in individuals without vestibular complaints using the Horus system. Codas 2021; 33:e20190270. [PMID: 34161438 DOI: 10.1590/2317-1782/20202019270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/15/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To propose a protocol for investigating the body balance and determining reference values in different age groups and gender, using the methodology of static posturography with dynamic tests, in low-cost Brazilian equipment for diagnosing balance. METHODS The objectives of this study aimed to propose a protocol for investigating the body balance and determining reference values in different age groups and gender, using the methodology of static posturography with dynamic tests, in new low-cost Brazilian equipment for diagnosing balance. Method: 297 healthy volunteers, between 20 and 89 years old, without vestibular complaints, were divided into six groups according to age group and gender. Stability limits and seven sensory conditions named from C1 to C7 were evaluated. The work was carried out using Horus equipment, manufactured in Brazil. RESULTS The reference values of the stability limit for females and males were obtained according to the ages: from 20 to 59 (≥ 12,594 mm2 and ≥ 19,221 mm2); from 60 to 69 (≥ 7,031 mm2 and ≥ 12,161 mm2); from 70 to 89 (≥ 6,340 mm2 and ≥ 8,794 mm2). For sensory integration tests under conditions C1 to C7, as age increased, the values of the Confidence Ellipse (CE) area also increased. Reference percentile values were established for Residual Functional Balance (RFB) and Sensory Analysis (SA). CONCLUSION A protocol was established to investigate body balance via static posturography as well as reference values for normal individuals were determined, according to the different gender and age groups.
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Affiliation(s)
- Lucia Kazuko Nishino
- Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo - São Paulo (SP), Brasil
| | - Guilherme Dias Rocha
- Centro de Audiologia e Pesquisa em Equilíbrio - CAPE - Rio de Janeiro (RJ), Brasil
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27
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Micarelli A, Viziano A, Micarelli B, Giulia DF, Alessandrini M. Usefulness of postural sway spectral analysis in the diagnostic route and clinical integration of cervicogenic and vestibular sources of dizziness: A cross-sectional preliminary study. J Vestib Res 2021; 31:353-364. [PMID: 33843709 DOI: 10.3233/ves-190729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin. OBJECTIVE To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients -93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) -with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON). METHODS All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires. RESULTS UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients. CONCLUSIONS PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Di Fulvio Giulia
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
| | - Marco Alessandrini
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
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28
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Stevens D, Jackson B, Carberry J, McLoughlin J, Barr C, Mukherjee S, Oh A, McEvoy RD, Crotty M, Vakulin A. The Impact of Obstructive Sleep Apnea on Balance, Gait, and Falls Risk: A Narrative Review of the Literature. J Gerontol A Biol Sci Med Sci 2021; 75:2450-2460. [PMID: 32039438 DOI: 10.1093/gerona/glaa014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Indexed: 12/24/2022] Open
Abstract
Falls-related hospitalization and injury rates are steadily increasing globally due to a growth in the aging population, and the associated health problems that increase risk of falls. One such associated health problem is sleep disturbances and disorders. Recent cohort studies have shown that subjectively reported poor quality sleep is associated with an increased risk of falls. Obstructive sleep apnea (OSA) is a common sleep disorder characterized by the repetitive reductions, or cessation, of airflow. Some studies have shown that OSA impairs posture/balance and gait with nocturnal hypoxemia the likely main cause. Emerging evidence suggests that treating OSA by continuous positive airway pressure (CPAP) can improve gait, but no studies to date have examined the effect of CPAP on posture/balance. The overall control of balance relies on a complex interaction between several physiological functions including vestibular, muscle, visual, and cognitive functions. We postulate that OSA impacts balance by affecting these different systems to various degrees, with the nocturnal hypoxic burden likely playing an important role. Importantly, these impairments in balance/posture and possible falls risk may be alleviated by OSA treatment. Larger mechanistic studies are needed to properly elucidate how OSA affects falls risk and future large-scale randomized control trials are needed to determine the effectiveness of OSA treatment in reducing the risk of falls.
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Affiliation(s)
- David Stevens
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Brianna Jackson
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Jayne Carberry
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - James McLoughlin
- College of Nursing and Health Science, Flinders University, South Australia, Australia
| | - Chris Barr
- College of Nursing and Health Science, Flinders University, South Australia, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia.,Sleep Health Service, Sleep and Respiratory Services, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - Aaron Oh
- Sleep Health Service, Sleep and Respiratory Services, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged, and Extended Aged Care, College of Medicine and Public Health, Flinders University, South Australia, Australia.,4th Generation Rehabilitation Clinic, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia.,Neurosleep CRE, Woolcock Institute of Medical Research, New South Wales, Australia
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29
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Viziano A, Micarelli A, Carlino P, Granito I, Alessandrini M. Bridging the gap between temporomandibular disorders, static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes. J Electromyogr Kinesiol 2020; 54:102455. [PMID: 32795906 DOI: 10.1016/j.jelekin.2020.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/22/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022] Open
Abstract
Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.
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Affiliation(s)
- Andrea Viziano
- University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.
| | - Alessandro Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy; Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Pasquale Carlino
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Ivan Granito
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy
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30
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Micarelli A, Cormano A, Caccamo D, Alessandrini M. Olfactory-Related Quality of Life in Multiple Chemical Sensitivity: A Genetic-Acquired Factors Model. Int J Mol Sci 2019; 21:ijms21010156. [PMID: 31881664 PMCID: PMC6981591 DOI: 10.3390/ijms21010156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/21/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022] Open
Abstract
Genetic polymorphisms as well as environmental exposures to chemical compounds, iatrogenic, psychological, and physical trauma may play a pathophysiological role in multiple chemical sensitivity (MCS) olfactory complaints, given that xenobiotic metabolism is influenced by sequence variations in genes of metabolizing enzymes. Thus, the aim of the present study was to depict-by means of multiple regression analysis-how different genetic conditions, grouped according to their function as well as clinical background and environmental exposure may interfere with those olfactory complaints referred by MCS patients. Therefore, MCS patients after gene polymorphism sequencing, the olfactory-related quality of life score-calculated by means of the Questionnaire of Olfactory Disorder in forty-six MCS patients-have been found to significantly rely on the phase I and II enzymes score and exposure to previous compounds and surgical treatments. The present work-implementing for the first time a genetic-acquired factors model on a regression analysis-further reinforces those theories, positing MCS as a complex, multifactorial, disease in which the genetic risk related to phase I and II enzymes involved in xenobiotic detoxification, olfactory, and neurodegenerative diseases play a necessary, but probably not sufficient role, along the pathophysiological route of the disease.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, EURAC Research, I-39100 Bolzano, Italy
- ITER Center for Balance and Rehabilitation Research (ICBRR), 02032 Rome, Italy
- Correspondence:
| | | | - Daniela Caccamo
- Department of Biomedical Sciences, Dental Sciences and Morpho-functional Imaging, Polyclinic Hospital University, 98124 Messina, Italy;
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
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31
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Alessandrini M, Viziano A, Roselli L, Micarelli A. Surgical treatment of otosclerosis leading to changes in postural control and quality of life. Laryngoscope 2019; 130:2448-2454. [PMID: 31804726 DOI: 10.1002/lary.28438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Lucrezia Roselli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy.,Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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32
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Micarelli A, Viziano A, Lanzillotta A, Giorgino FM, Pisano C, Ruvolo G, Alessandrini M. Postural control abnormalities related to sleep deprivation in patients with Marfan Syndrome. J Vestib Res 2019; 29:261-269. [PMID: 31707379 DOI: 10.3233/ves-190684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy
| | - Alessia Lanzillotta
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy
| | - Federica Maria Giorgino
- Department of Experimental Medicine, Respiratory Unit, 'Tor Vergata' University, Rome, Italy
| | - Calogera Pisano
- Department of Surgery Sciences, Cardiac Surgery Unit, 'Tor Vergata' University, Rome, Italy
| | - Giovanni Ruvolo
- Department of Surgery Sciences, Cardiac Surgery Unit, 'Tor Vergata' University, Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy
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Micarelli A, Viziano A, Augimeri I, Micarelli B, Capoccia D, Alessandrini M. Diagnostic route of cervicogenic dizziness: usefulness of posturography, objective and subjective testing implementation and their correlation. Disabil Rehabil 2019; 43:1730-1737. [PMID: 31656108 DOI: 10.1080/09638288.2019.1680747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects. MATERIALS AND METHODS Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale. RESULTS Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures - highlighting significant complaints of subjective feeling of dizziness - were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients. CONCLUSIONS The implementation of posturography - including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements.Implications for rehabilitationUncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation.Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations.Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up.
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Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ivan Augimeri
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | | | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Kim JY, Ko I, Cho BJ, Kim DK. Association of Obstructive Sleep Apnea With the Risk of Ménière's Disease and Sudden Sensorineural Hearing Loss: A Study Using Data From the Korean National Health Insurance Service. J Clin Sleep Med 2019; 15:1293-1301. [PMID: 31538600 PMCID: PMC6760412 DOI: 10.5664/jcsm.7922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Several studies have reported an association between obstructive sleep apnea (OSA) and neuro-otologic diseases, such as Ménière's disease or sudden sensorineural hearing loss (SSNHL). However, the exact relationship between OSA and those diseases has not been fully evaluated. Therefore, the aim of this study was to investigate the prospective link between OSA and Ménière's disease or SSNHL. METHODS We used a nationwide cohort sample of data for 2002-2013 representing approximately 1 million patients. The OSA group (n = 942) included patients diagnosed between 2004 and 2006; the comparison group was selected using propensity score matching (n = 3,768). We investigated Ménière's disease and SSNHL events over a 9-year follow-up period. Survival analysis, log-rank test, and Cox proportional hazards regression models were used to calculate incidence, survival rate, and hazard ratios for each group. RESULTS In the OSA group, the incidences of Ménière's disease and SSNHL were 7,854.4 and 7,876.3 person-years, respectively. Cox proportional hazards analysis revealed no overall association between patients with OSA and the risk of subsequent Ménière's disease or SSNHL. In a subgroup analysis, female and middle-aged patients with OSA were independently associated with a two-fold higher incidence of subsequent Ménière's disease, compared to those without OSA. However, we could not find any significant association between patients with OSA and SSNHL even in the subgroup analysis. CONCLUSIONS Our findings suggest that female or middle-aged patients with OSA are associated with an increased incidence of Ménière's disease. However, there was no association between OSA and SSNHL. CITATION Kim J-Y, Ko I, Cho B-J, Kim D-K. Association of obstructive sleep apnea with the risk of Ménière's disease and sudden sensorineural hearing loss: a study using data from the Korean National Health Insurance Service. J Clin Sleep Med. 2019;15(9):1293-1301.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Bum-Joo Cho
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Dong-Kyu Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
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Micarelli A, Viziano A, Augimeri I, Micarelli B, Alessandrini M. Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents. J Mot Behav 2019; 52:418-426. [PMID: 31328659 DOI: 10.1080/00222895.2019.1643284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant (p < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.
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Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ivan Augimeri
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display. Arch Gerontol Geriatr 2019; 83:246-256. [DOI: 10.1016/j.archger.2019.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
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Micarelli A, Viziano A, Panella M, Micarelli E, Alessandrini M. Power spectra prognostic aspects of impulsive eye movement traces in superior vestibular neuritis. Med Biol Eng Comput 2019; 57:1617-1627. [DOI: 10.1007/s11517-019-01982-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/08/2019] [Indexed: 12/01/2022]
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Micarelli A, Viziano A, Lanzillotta A, Ruscello B, D'Ottavio S, Alessandrini M. Visual dependency and postural control on swing performance in golf players. Eur J Sport Sci 2019; 19:922-930. [PMID: 30774005 DOI: 10.1080/17461391.2019.1571635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Individuals have to reweight the respective contribution of the different sources of sensorial information for regulating posture and balance, especially during fine task execution. Given the evidences indicating strategy during swing performance as associated with prioritization of task-relevant visuospatial information for skill execution, the aim of the present work is to assess differences in visual dependency (VD) and postural control in a population of expert (EXP) and non-expert (NEXP) golfers when compared with healthy subjects (HC) and to discover possible relationships between these outcomes and swing performance. Thus, 15 golfers (EXP = 7; NEXP = 8) and 32 matched HC underwent otoneurological testing including video Head Impulse Test, posturography and Rod and Disk Test (RDT). Golf players also underwent a swing session procedure, which performance was measured by means of the Flightscope X2 Doppler-radar launch monitor system. EXP subjects demonstrated significant (p < 0.05) lower values in i) counter-clockwise (CCW) and clockwise (CW) dynamic conditions when compared with both NEXP and HC subjects RDT outcome measures and ii) surface and length posturography values as compared with HC subjects. When treating golf players outcomes as 'a continuum', CCW and CW scores were found to positively correlate with both lateral distance and horizontal launch angle and to negatively correlate with spin rpm. In conclusion, the present study suggests that the high-level of visual-independency demonstrated by EXP subjects may be functionally related in expert golfers to an effective motor strategy preferentially not referring to an inappropriate reliance on visual input.
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Affiliation(s)
- Alessandro Micarelli
- a Department of Clinical Sciences and Translational Medicine , University of Rome "Tor Vergata" , Rome , Italy.,b ITER Center for Balance and Rehabilitation Research (ICBRR) , Rome , Italy
| | - Andrea Viziano
- a Department of Clinical Sciences and Translational Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Alessia Lanzillotta
- a Department of Clinical Sciences and Translational Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Bruno Ruscello
- c School of Sport and Exercise Science , University of Rome "Tor Vergata" , Rome , Italy
| | - Stefano D'Ottavio
- a Department of Clinical Sciences and Translational Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Marco Alessandrini
- a Department of Clinical Sciences and Translational Medicine , University of Rome "Tor Vergata" , Rome , Italy
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Reply to Micarelli et al. Commentary on The Balance of Sleep: Role of the Vestibular Sensory System. Sleep Med Rev 2019; 44:87-88. [PMID: 30598424 DOI: 10.1016/j.smrv.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
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40
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Alessandrini M, Viziano A, Micarelli A. New trends in otoneurological dysfunctions in OSA patients concerning "The balance of sleep: Role of the vestibular sensory system". Sleep Med Rev 2018; 44:85-86. [PMID: 30594470 DOI: 10.1016/j.smrv.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Marco Alessandrini
- University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy
| | - Andrea Viziano
- University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy
| | - Alessandro Micarelli
- University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy; ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy.
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Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study. Sleep Breath 2018; 23:665-672. [PMID: 30456739 DOI: 10.1007/s11325-018-1754-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess whether vestibulo-ocular reflex (VOR) gain, posturography parameters and related clinical outcomes can improve in OSA patients after 12 months of CPAP treatment, taking into consideration that a certain degree of vestibular dysfunction has been identified in these subjects. METHODS Vestibular, postural, clinical, and polygraphic parameters were assessed in 32 OSA patients before and after beneficial CPAP treatment by means of video head impulse test (vHIT), static posturography (SP), Dizziness Handicap Inventory (DHI), Epworth Sleepiness Scale (ESS), and Apnea-Hypopnea Index (AHI), respectively, and were compared by means of a "within-subject" ANOVA model and Spearman's rank correlation. RESULTS After the 12-month period of treatment, OSA patients demonstrated a significant reduction in AHI values, in both opened and closed eyes conditions of surface and length as well as in power spectra recorded in low, middle, and high frequency interval. Although a significant improvement was also recorded among DHI and ESS scores, VOR gain increase did not survive to post-hoc corrections. Finally, positive correlations between the differences between pre- and post-treatment AHI, ESS, and PS values were found. CONCLUSIONS The present work highlighted that postural instability and dizziness-related conditions due to OSA may improve after 12 months of CPAP treatment. Although VOR gain did not demonstrate significant improvement, this study might open future perspectives directed to assessing VOR gain changes after longer periods of CPAP treatment.
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Micarelli A, Viziano A, Bruno E, Micarelli E, Augimeri I, Alessandrini M. Gradient impact of cognitive decline in unilateral vestibular hypofunction after rehabilitation: preliminary findings. Eur Arch Otorhinolaryngol 2018; 275:2457-2465. [DOI: 10.1007/s00405-018-5109-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
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43
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Viziano A, Micarelli A, Augimeri I, Micarelli D, Alessandrini M. Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial. Clin Rehabil 2018; 33:24-33. [PMID: 30012022 DOI: 10.1177/0269215518788598] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To investigate the long-term effects of adding virtual reality-based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction. DESIGN: Follow-up otoneurological examination in two randomized groups following a previous one-month trial. SETTING: Tertiary rehabilitation center. SUBJECTS: A total of 47 patients with unilateral vestibular hypofunction, one group ( n = 24) undergoing conventional vestibular rehabilitation and the other one ( n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month. INTERVENTIONS: One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure. MAIN MEASURES: Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores. RESULTS: Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation-only group ( P < 0.001). Accordingly, some classical posturography scores such as surface with eyes open and length with eyes closed and low-frequency power spectra were significantly different between groups, with the virtual reality group showing improvement ( P < 0.001). Self-report measures were significantly better in both groups compared to pretreatment, with significant improvement in the mixed-method group as compared to conventional rehabilitation alone: Dizziness Handicap Inventory mean total score was 24.34 (2.8) versus 35.73 (5.88) with a P-value <0.001. CONCLUSION: Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes.
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Affiliation(s)
- Andrea Viziano
- 1 Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Alessandro Micarelli
- 1 Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata," Rome, Italy.,2 Department of Systems Medicine, Neuroscience Unit, University of Rome "Tor Vergata," Rome, Italy
| | | | | | - Marco Alessandrini
- 1 Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata," Rome, Italy
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Degree of Functional Impairment Associated With Vestibular Hypofunction Among Older Adults With Cognitive Decline. Otol Neurotol 2018; 39:e392-e400. [DOI: 10.1097/mao.0000000000001746] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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45
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Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial. Int J Rehabil Res 2018; 40:325-332. [PMID: 28723718 DOI: 10.1097/mrr.0000000000000244] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes.
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Zhang J, Song Y, Ji Y, Song Y, Cai S, Yu Y, Liu S, Zhang W. Correlation between coronary artery disease and obstructive sleep apnea syndrome and analysis of risk factors. Exp Ther Med 2018; 15:4771-4776. [PMID: 29805494 PMCID: PMC5958735 DOI: 10.3892/etm.2018.6070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/09/2018] [Indexed: 12/20/2022] Open
Abstract
The correlation between coronary artery disease (CAD) and obstructive sleep apnea syndrome (OSAS) was investigated to analyze its risk factors. A total of 84 patients with suspected CAD due to chest tightness and pain or nocturnal angina, were selected. They were admitted and received coronary angiography in The Affiliated Hospital of Medical College Qingdao University from March, 2016 to June, 2017. The vital signs were monitored, and the sleep monitoring was performed before and after coronary angiography. Before angiography, the fasting blood was drawn for blood biochemical detection, followed by routine electrocardiogram and echocardiographic examination. In addition, the body mass index was calculated and whether patients suffered from hypertension and diabetes mellitus was observed. The patients were divided into the control group (patients with a negative coronary angiography) and the CAD group (patients with a positive coronary angiography). There were 34 cases in the control group, including 21 cases of OSAS (61.76%), and 50 in the CAD group, including 40 cases of OSAS (80.00%). Statistical analysis revealed that there were statistically significant differences in the apnea hypopnea index (AHI), lowest oxygen saturation, degree of coronary stenosis (Gensini score) and triglyceride level between the two groups (P<0.05). There were no statistically significant differences in the cholesterol level and prevalence rates of hypertension and diabetes mellitus between the two groups. Logistic regression analysis revealed that smoking and AHI >20 were the risk factors of CAD (OR=7.036 and 5.377). Thus, CAD is closely correlated with OSAS and AHI >20 is one of the risk factors of CAD.
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Affiliation(s)
- Jidong Zhang
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Yu Song
- Department of Orthodontics, Qingdao Stomatological Hospital, Qingdao, Shandong 266001, P.R. China
| | - Yang Ji
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Yiying Song
- Department of Invasive Technology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Shanglang Cai
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Yanling Yu
- Department of Orthodontics, Qingdao Stomatological Hospital, Qingdao, Shandong 266001, P.R. China
| | - Song Liu
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Wenzhong Zhang
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
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