Association between obstructive sleep apnea and persistent postural-perceptual dizziness

Article type: Research Article

Authors: Bery, Anand K.^a | Azzi, Jayson Lee^b | Le, Andre^c | Spitale, Naomi S.^{d; e} | Leech, Judith^e | Lelli, Daniel A.^a | Tse, Darren^{c; *}

Affiliations: [a] Department of Medicine, Division of Neurology, University of Ottawa, Ottowa, ON, Canada | [b] Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, MB,Canada | [c] Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ottowa, ON, Canada | [d] Royal Ottawa Mental Health Centre, Ottawa, ON, Canada | [e] Department of Medicine, Division of Respirology, University of Ottawa, Ottowa, ON, Canada

Correspondence: [*] Corresponding author: Darren Tse, Department of Otolaryngology – Head & Neck Surgery, The Ottawa Hospital, 268-737 Parkdale Ave, Civic Hospital Campus, Ottawa, Ontario, K1Y 4M9, Canada. Tel.: +1 613 798 5555 /Ext: 13360; Fax: +1 613 667 2899; E-mail: dtse@toh.ca.

Abstract: BACKGROUND:Obstructive sleep apnea (OSA) has been linked to vestibular dysfunction, but no prior studies have investigated the relationship between Persistent Postural-Perceptual Dizziness (PPPD), a common cause of chronic dizziness, and OSA. OBJECTIVE AND METHODS:We determined the frequency of OSA in an uncontrolled group of PPPD patients from a tertiary dizziness clinic based on polysomnogram (PSG). We then assessed the sensitivity and specificity of common OSA questionnaires in this population. RESULTS:Twenty-five patients with PPPD underwent PSG (mean age 47, 60% female, mean BMI 29.5). A majority, or 56%, of patients were diagnosed with OSA, and in most, the OSA was severe. OSA patients were older (56 years versus 40 years, p = 0.0006) and had higher BMI (32 versus 26, p = 0.0078), but there was no clear gender bias (56% versus 64% female, p = 1.00). The mean sensitivity and specificity of the STOP BANG questionnaire for detecting OSA was 86% and 55%, respectively. Sensitivity and specificity of the Berlin Questionnaire was 79% and 45%, respectively. CONCLUSIONS:The prevalence of OSA was much higher in our small PPPD group than in the general population. Screening questionnaires appear to demonstrate good sensitivity to detect PPPD patients at risk of OSA in this small study. Future studies should confirm these findings and determine whether treatment of OSA improves symptoms in PPPD.

Keywords: Dizziness, PPPD, sleep apnea, neuro-otology, sleep medicine

DOI: 10.3233/VES-201508

Journal: Journal of Vestibular Research, vol. 31, no. 5, pp. 401-406, 2021