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

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.

Keywords

cervical - ocular - VEMP - obstructive sleep apnea

Previous Presentation

This study was presented as a preliminary study at the 15th Turkish Rhinology Congress, 7th National Otology Neurootology Congress, and 3rd National Head and Neck Surgery Congress, April 4–7, 2019.

Publikationsverlauf

Eingereicht: 23. Juli 2023

Angenommen: 26. April 2024

Artikel online veröffentlicht:
18. Dezember 2024

• References

• 1 Benjafield AV, Ayas NT, Eastwood PR. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019; 7 (08) 687-698
• 2 Senaratna CV, Perret JL, Lodge CJ. et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017; 34: 70-81
• 3 Lazarini PR, Camargo ACK. Idiopathic sudden sensorineural hearing loss: etiopathogenic aspects. Rev Bras Otorrinolaringol (Engl Ed) 2006; 72 (04) 554-561
• 4 Xie H, Zhang YQ, Pan XL. et al. Decreased calcium-activated potassium channels by hypoxia causes abnormal firing in the spontaneous firing medial vestibular nuclei neurons. Eur Arch Otorhinolaryngol 2015; 272 (10) 2703-2711
• 5 Drummond SP, Brown GG. The effects of total sleep deprivation on cerebral responses to cognitive performance. Neuropsychopharmacology 2001; 25 (5, Suppl): S68-S73
• 6 Quarck G, Ventre J, Etard O, Denise P. Total sleep deprivation can increase vestibulo-ocular responses. J Sleep Res 2006; 15 (04) 369-375
• 7 Gallina S, Dispenza F, Kulamarva G, Riggio F, Speciale R. Obstructive sleep apnoea syndrome (OSAS): effects on the vestibular system. Acta Otorhinolaryngol Ital 2010; 30 (06) 281-284
• 8 Deniz M, Çiftçi Z, Ersözlü T, Gültekin E, Alp R. The evaluation of auditory system in obstructive sleep apnea syndrome (OSAS) patients. Am J Otolaryngol 2016; 37 (04) 299-303
• 9 Kouzo HS, Talaat MAM, Bahgat AY, Zamel HAM, Eldeeb MK. Postoperative audiovestibular assessment of obstructive sleep apnea patients. Egypt J Otolaryngol 2020; 36 (01) 56
• 10 Luo HP, Yu J, Xu XD. et al. Characteristic manifestation of ocular and cervical vestibular evoked myogenic potentials findings in severe obstructive sleep apnea patients. Acta Otolaryngol 2021; 141 (08) 754-761
• 11 Mutlu M, Bayır Ö, Yüceege MB. et al. Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2015; 272 (11) 3137-3141
• 12 Ulusoy B, Gül O, Elsürer Ç. et al. The relationship between the findings of vestibular evoked myogenic potentials and severity of obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2020; 277 (01) 37-46
• 13 Xu XD, Chen BJ, Sun AR. et al. Uneven effects of sleep apnea on semicircular canals and otolithic organs. Front Neurol 2022; 13: 819721
• 14 Erbek HS. Vestibüler uyarılmış kas potansiyelleri (VEMP). In: Ardıç FN. ed. Vertigo. 2nd ed.. us akademi; 2018: 179-190
• 15 Gao T, Zhang Q, Hou J. et al. Vestibular-evoked myogenic potentials in patients with severe obstructive sleep apnea. J Int Med Res 2020; 48 (03) 300060520909717
• 16 Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 1989; 41 (06) 304-311
• 17 Powell LE, Myers AM. The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 1995; 50A (01) M28-M34
• 18 Babakurban ST, İnan S, Hızal E, Büyüklü F, Bozbaş Ş, Özlüoğlu NL. The relationship between dizziness and obstructive sleep apnea syndrome: is reduction in dizziness complaint with CPAP treatment possible?. The Turkish Journal of ENT 2016; 24 (02) 47-51
• 19 Besnard S, Tighilet B, Chabbert C. et al. The balance of sleep: role of the vestibular sensory system. Sleep Med Rev 2018; 42: 220-228
• 20 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
• 21 Berry RB, Budhiraja R, Gottlieb DJ. et al; American Academy of Sleep Medicine, Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med 2012; 8 (05) 597-619
• 22 Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 1998; 53 (04) M287-M294
• 23 Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg 2018; 126 (05) 1763-1768
• 24 Rosengren SM, Colebatch JG. The contributions of vestibular evoked myogenic potentials and acoustic vestibular stimulation to our understanding of the vestibular system. Front Neurol 2018; 9: 481
• 25 Harun A, Oh ES, Bigelow RT, Studenski S, Agrawal Y. Vestibular impairment in dementia. Otol Neurotol 2016; 37 (08) 1137-1142
• 26 de Natale ER, Ginatempo F, Laccu I. et al. Vestibular evoked myogenic potentials are abnormal in idiopathic REM sleep behavior disorder. Front Neurol 2018; 9: 911
• 27 Kayabasi S, Iriz A, Cayonu M. et al. Vestibular functions were found to be impaired in patients with moderate-to-severe obstructive sleep apnea. Laryngoscope 2015; 125 (05) 1244-1248
• 28 Güven H, Bayır O, Aytaç E, Özdek A, Comoğlu SS, Korkmaz H. Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis. Neurol Sci 2014; 35 (02) 221-226
• 29 Itoh A, Kim YS, Yoshioka K. et al. Clinical study of vestibular-evoked myogenic potentials and auditory brainstem responses in patients with brainstem lesions. Acta Otolaryngol Suppl 2001; 545 (545) 116-119
• 30 Lin BY, Young YH. Effect of short-duration sleep deprivation on the vestibulo-ocular reflex system evaluated by ocular vestibular-evoked myogenic potential test. Acta Otolaryngol 2014; 134 (07) 698-703
• 31 Gomez S, Patel M, Berg S, Magnusson M, Johansson R, Fransson PA. Effects of proprioceptive vibratory stimulation on body movement at 24 and 36h of sleep deprivation. Clin Neurophysiol 2008; 119 (03) 617-625
• 32 Micarelli A, Liguori C, Viziano A, Izzi F, Placidi F, Alessandrini M. Integrating postural and vestibular dimensions to depict impairment in moderate-to-severe obstructive sleep apnea syndrome patients. J Sleep Res 2017; 26 (04) 487-494
• 33 Alessandrini M, Liguori C, Viziano A. et al. Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study. Sleep Breath 2019; 23 (02) 665-672
• 34 Soyalıç H, İnönü Köseoğlu H, Avcu M, Koçak C, Inanir A, Tuna E. Evaluation of postural stability and fall risk in patients with obstructive sleep apnea syndrome. KBB-Forum 2017; 16 (03) 83-88
• 35 Ertekin Ö, Özakbaş S, Idiman E, Algun ZC. The effects of low and severe disability on walking abilities and quality of life in multiple sclerosis patients: 6 month follow-up study. Arch Neuropsychiatry 2013; 50 (01) 23-29
• 36 Alghwiri AA, Alghadir AH, Al-Momani MO, Whitney SL. The activities-specific balance confidence scale and Berg balance scale: reliability and validity in Arabic-speaking vestibular patients. J Vestib Res 2016; 25 (5–6): 253-259