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Shu Y, Liao N, Fang F, Shi Q, Yan N, Hu Y. The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study. BMC Neurol 2023; 23:137. [PMID: 37004007 PMCID: PMC10064541 DOI: 10.1186/s12883-023-03169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV. METHODS A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse. RESULTS During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence. CONCLUSIONS The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.
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Affiliation(s)
- Yuexin Shu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Nannan Liao
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Fang Fang
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ning Yan
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China.
| | - Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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Cengiz DU, Demir İ, Demirel S, Can Çolak S, Emekçi T, Bayındır T. Investigation of the Relationship Between BPPV with Anxiety, Sleep Quality and Falls. Turk Arch Otorhinolaryngol 2022; 60:199-205. [PMID: 37456598 PMCID: PMC10339271 DOI: 10.4274/tao.2022.2022-8-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/26/2022] [Indexed: 07/18/2023] Open
Abstract
Objective To investigate the effects of dizziness on sleep quality and psychological status in patients with benign paroxysmal positional vertigo (BPPV) and to evaluate its relationship with falls. Methods A Demographic Data Form, a Visual Vertigo Analog Scale, the Falls Efficacy Scale - International (FES-I), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI) were administered in 102 individuals diagnosed with BPPV by videonystagmography test. The same scales were applied to 75 healthy volunteers as the control group, and the two groups were compared. The BPPV group was divided into two groups as posterior canal and lateral canal BPPV. These two groups were compared among themselves and with the control group. Results A statistically significant difference was found between the BPPV and control groups, the lateral canal BPPV and posterior canal BPPV groups, the lateral canal BPPV and control groups, and the posterior canal BPPV and control groups in terms of total scores of the PSQI, the FES-I, and the HADS (p<0.001). In the regression model, the FES-I score was fully explained by the PSQI and HADS scores (p<0.001). Conclusion BPPV significantly affects sleep quality, psychological state, and the risk of fall. The negative effects of BPPV restrict daily living activities, affect the prognosis of the disease, and increase the risk of falling. Considering that psychiatric issues and sleep problems increase the risk of falling in individuals with BPPV, counseling services on this issue would reduce the incidence of falls and related injuries.
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Affiliation(s)
- Deniz Uğur Cengiz
- Department of Audiology, İnönü University Faculty of Health Sciences, Malatya, Turkey
| | - İsmail Demir
- Department of Audiology, İnönü University Faculty of Health Sciences, Malatya, Turkey
| | - Sümeyye Demirel
- Department of Audiology, Bingöl University Faculty of Health Sciences, Bingöl, Turkey
| | - Sanem Can Çolak
- Department of Audiology, İnönü University Faculty of Health Sciences, Malatya, Turkey
| | - Tuğba Emekçi
- Department of Audiology, University of Health Sciences Turkey, Gülhane Faculty of Health Sciences, Ankara, Turkey
| | - Tuba Bayındır
- Department of Otorhinolaryngology, İnönü University, Turgut Özal Medical Center, Malatya, Turkey
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Mutlu B, Topcu MT. Investigation of the Relationship between Vestibular Disorders and Sleep Disturbance. Int Arch Otorhinolaryngol 2022; 26:e688-e696. [PMID: 36405483 PMCID: PMC9668417 DOI: 10.1055/s-0042-1742763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction
Vestibular pathologies cause physical and psychological symptoms, as well as cognitive problems.
Objective
To evaluate the deterioration in sleep quality associated with vestibular pathologies.
Methods
The Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index (PSQI), and the Limits of Stability test (LOS) were applied to the participants.
Results
We included 25 patients with Meniere's disease (MD), 22 patients with benign paroxysmal positional vertigo (BPPV), 21 patients with unilateral peripheral vestibular loss (UPVL), 23 patients with vestibular migraine (VM), and 43 controls. The total PSQI scores of the controls were better than those of the MD (
p
= 0.014), VM (
p
< 0.001), BPPV (
p
= 0.003), and UPVL (
p
= 0.001) groups. The proportion of poor sleepers in the MD (
p
= 0.005), BPPV (
p
= 0.018), and UPVL (
p
< 0.001) groups was significantly higher than that of the controls. The highest total DHI score (45.68 ± 25.76) was found among the MD group, and it was significantly higher than the scores of the BPPV (
p
= 0.007) and control (
p
< 0.001) groups. The highest BDI score was obtained in the VM group, and it was significantly higher than the scores of the BPPV (
p
= 0.046) and control (
p
< 0.001) groups. Moreover, the BDI scores of the MD (
p
= 0.001) and UPVL groups were also significantly worse than the score of the controls (
p
= 0.001).
Conclusion
The present study showed thatpatients with vestibular symptoms have physical and functional complaints, as well as increased psychosocial stress and decreased sleep quality. Evaluating multiple parameters of quality of life may contribute to a better understanding of vestibular physiology and symptoms, and may help establish a more effective therapeutic approach.
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Affiliation(s)
- Basak Mutlu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Merve Torun Topcu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
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Relationship between benign paroxysmal positional vertigo (BPPV) and sleep quality. Heliyon 2022; 8:e08717. [PMID: 35059515 PMCID: PMC8760439 DOI: 10.1016/j.heliyon.2022.e08717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/13/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo precipitated mainly by changes in head position for example during sleep. The relationship between sleep quality and BPPV has not been studied sufficiently. We decided to compare sleep quality between posterior canal BPPV patients and controls. Methods A total of 120 patients with posterior canal BPPV and 120 controls without BPPV were included. Demographic data as well as body mass index (BMI), cigarette smoking and medical history of the subjects were documented. The sleep quality of the participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Results Mean scores in subjective sleep quality (0.48 vs. 0.19; P = 0.002), sleep disturbances (2.97 vs. 1.85; P = 0.007), use of sleep medications (0.6 vs. 0.25; P = 0.001), and daytime dysfunction (0.76 vs. 0.47; P = 0.07) were significantly higher in the BPPV group than in control group. Poor sleep quality (i.e., total PSQI score >5) was found in 42 patients in the BPPV group (35%) and in 16 controls (13.3%); P < 0.001. Poor sleep quality was significantly more common in those whose vertigo attacks had been started more than 12 months earlier (19 of 33 cases, 57.6%) than the patients whose symptoms had started in the past 12 months (23 of 87 cases, 26.4%); P = 0.001. Conclusion Patients with posterior canal BPPV have poorer sleep quality when compared to controls without this condition, especially in women and those with disease duration longer than 12 months. These finding suggest that close attention should be paid to sleep quality of patients with BPPV.
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Byun H, Chung JH, Jeong JH, Ryu J, Lee SH. Incidence of peripheral vestibular disorders in individuals with obstructive sleep apnea. J Vestib Res 2021; 32:155-162. [PMID: 34250919 DOI: 10.3233/ves-210012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnea(OSA) could influence peripheral vestibular function adversely via intermittent hypoxia and its consequences. OBJECTIVE This study aimed to evaluate the risk of peripheral vestibular disorders in OSA using a nationwide population-based retrospective cohort study. METHODS The National Health Insurance Service-National Sample Cohort represents the entire Korean population from 2002 to 2015. OSA was defined as individuals who had used medical services twice or more under a diagnosis of OSA(G47.33 in ICD-10). A comparison cohort consisted of socio-demographically matched non-OSA subjects in a ratio of 1:4. The incidences of benign paroxysmal positional vertigo(BPPV), Meniere's disease, and vestibular neuritis were evaluated in each cohort. RESULTS A total of 2,082 individuals with OSA and 8,328 matched non-OSA subjects were identified. The incidence rates(IRs) of peripheral vertigo in OSA and non-OSA were 149.86 and 23.88 per 10,000 persons, respectively (Ratio of IR, IRR = 6.28, 95%CI 4.89 to 8.08). In multivariable analysis, the risk of peripheral vertigo was significantly higher in OSA(adjusted HR = 6.64, 95%CI 5.20 to 8.47), old age(adjusted HR = 1.03, 95%CI 1.02 to 1.04), female sex(adjusted HR = 1.92, 95%CI 1.48 to 2.50), and comorbidities(adjusted HR = 1.09, 95%CI 1.003 to 1.19). The IRRs of each vestibular disorder in the two groups were 7.32(95%CI 4.80 to 11.33) for BPPV, 3.61(95%CI 2.24 to 5.81) for Meniere's disease, and 9.51(95%CI 3.97 to 25.11) for vestibular neuritis. CONCLUSIONS Subjects diagnosed with OSA had a higher incidence of peripheral vestibular disorders than those without OSA, according to national administrative claims data. It is recommended to take peripheral vertigo into account when counseling OSA.
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Affiliation(s)
- Hayoung Byun
- Departments of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jae Ho Chung
- Departments of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Department of HY-KIST Bio-convergence, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jin Hyeok Jeong
- Departments of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jiin Ryu
- Biostatistical Consulting and Research Laboratory, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Departments of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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王 玥, 张 东, 雷 敏, 曾 培, 蔡 成. [Study on the relationship between benign paroxysmal positional vertigo and sleep disturbance]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:62-65. [PMID: 33540977 PMCID: PMC10128540 DOI: 10.13201/j.issn.2096-7993.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 06/12/2023]
Abstract
Objective:To explore the relationship between benign paroxysmal positional vertigo (BPPV) and sleep disorders through the analysis of subjective and objective sleep conditions. Methods:Forty-five patients with BPPV and fifty controls who met the inclusion and exclusion criteria were selected for Pittsburgh sleep quality index (PSQI) questionnaire survey and polysomnography (PSG) check, and SPSS 23.0 was used to compare and analyze the results. Results:Compared with the control group, patients with BPPV had changes in sleep structure, high apnea hypopnea index (AHI) and significantly decreased subjective sleep quality (P<0.05), and there were significant differences in the PQSI scores of patients with BPPV before and after treatment (P<0.05).Binary logistic regression analysis of BPPV and AHI showed that for every 1 increase in AHI index, the probability of BPPV increased by 1.8 times (OR=2.80, 95%CI=2.25-3.66).After grouping AHI and performing regression analysis, it was found that the risk of BPPV in patients with AHI≥5 was 3.94 times that of patients with AHI <5(OR=3.94,95%CI=1.63-9.48). Conclusion:Patients with BPPV have decreased sleep quality and altered sleep structure, and in this study, AHI is found to be a risk indicator for BPPV.
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Affiliation(s)
- 玥 王
- 厦门大学附属第一医院耳鼻咽喉头颈外科(福建厦门,361003)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - 东东 张
- 厦门大学医学院School of Medicine, Xiamen University
| | - 敏 雷
- 厦门大学医学院School of Medicine, Xiamen University
| | - 培基 曾
- 厦门大学附属第一医院耳鼻咽喉头颈外科(福建厦门,361003)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - 成福 蔡
- 厦门大学附属中山医院耳鼻咽喉科Department of Otolaryngology, Zhongshan Hospital Affiliated to Xiamen University
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7
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Fu CY, Zhang ZZ, Chen J, Jaiswal SK, Yan FL. Unhealthy Lifestyle Is an Important Risk Factor of Idiopathic BPPV. Front Neurol 2020; 11:950. [PMID: 33178091 PMCID: PMC7593564 DOI: 10.3389/fneur.2020.00950] [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] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is a self-limiting and recurrent disease but the cost is considerable. The number of patients with BPPV increased significantly under the quarantine policy in Hangzhou. The unhealthy lifestyle risk factors of BPPV have not yet been investigated. Thus, the objective is to analyze whether an unhealthy lifestyle is a risk factor of BPPV. Methods: One hundred and sixty three patients with idiopathic BPPV aged 22-87 years (BPPV group), and 89 aged 23-92 years sex-matched control subjects (non-BPPV group) were enrolled in this study. All BPPV patients received a definitive diagnosis which excluded secondary BPPV. Non-BPPV cases excluded BPPV, sudden deafness, Meniere's disease, ear or craniofacial surgery, vestibular neuritis, and head trauma history. We obtained a blood lipids profile, serum uric acid, total bilirubin, and related diagnostic information through the electronic medical record system. To get the time of physical activities and recumbent positions, we asked the patient or their family from February 2020 to June 2020, and the rest of the patient's information was acquired by phone or WeChat. Data Analyses: The t-test or chi-squared test, univariate, and multiple logistic regression analyses were performed for the two groups. For each factor, odds ratios were calculated with 95% confidence intervals (CIs). Moreover, test equality of two or more receiver operating characteristic (ROC) analyses were applied to the physical activities, and recumbent position time; area under curve (AUC) measures were calculated with 95% CIs and compared with each other. Results: The BPPV group had unhealthy lifestyles such as poor physical activities, prolonged recumbent position time, and low rate of calcium or VD supplementation in univariate logistic regression analyses (P < 0.05). Poor physical activities and prolonged recumbent position time were independently associated with BPPV in multiple logistic regression models (OR = 18.92, 95% CI: 6.34-56.43, p = 0.00 and OR = 1.15, 95% CI: 1.01-1.33, p < 0.04). In the comparison of ROC curves of recumbent position time and physical activities in identifying BPPV, AUCs were 0.68 (0.61-0.74), and 0.68 (0.63-0.73), respectively. Conclusion: We conclude that poor physical activities and prolonged recumbent position time may be independent risk factors for BPPV patients, but hypertension, hyperuricemia, hyperlipidemia, hemoglobin, diabetes, serum bilirubin, CHD, and CI, may not be.
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Affiliation(s)
- Chang-Yong Fu
- School of Medicine, Southeast University, Nanjing, China.,Neurology Department, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Zhen-Zhong Zhang
- Neurology Department, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jin Chen
- School of Medicine, Southeast University, Nanjing, China
| | | | - Fu-Ling Yan
- Department of Neurology, Zhongda Hospital, Southeast University, Nanjing, China
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Bashir K, Elsotohy HH, Elmoheen A. Do Night Shifts Increase the Risk of Benign Paroxysmal Positional Vertigo Among Doctors and Nurses? J Multidiscip Healthc 2020; 13:963-966. [PMID: 32982272 PMCID: PMC7509318 DOI: 10.2147/jmdh.s256055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022] Open
Abstract
Background Night shift work is one of the significant and most frequent reasons for circadian rhythm disruptions, resulting in the alteration of biological functions and sleep. These factors can affect the psychological and physical well-being and also negatively impact an individual’s performance at work. Sleep disturbance has been associated with increased risk of several medical conditions such as benign paroxysmal positional vertigo (BPPV), hypertension, diabetes, high cholesterol, chronic obstructive pulmonary disease, and others. Objective To determine whether the night shift increases the risk of BPPV by reviewing a 7-year retrospective data. Methods The cross-sectional research study was conducted at the emergency department of a tertiary care teaching hospital in Qatar. A total of 69 doctors and nurses who suffered from vertigo in a period of seven years were consented and considered for the study. We excluded 12 patients with vertigo due to causes rather than BPPV. Fifty-seven patients who were diagnosed with BPPV based on examination using the Dix–Hallpike bedside test. They were treated by particle repositioning maneuvers in the emergency department. Results Approximately, 93% (n = 53) of participants had posterior canal BPPV and 7% (n = 4) had lateral canal BPPV (n = 5) between 2013 and 2019. Anterior canal BPPV was not reported. Chi-square test showed that night shift was associated with a high prevalence of first BPPV episode (P ≥0.001) with less likelihood of diabetes and hypertension (P ≥0.001). Conclusion Retrospective data review indicates a possible association between night shifts and BPPV development in doctors and nurses.
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Affiliation(s)
- Khalid Bashir
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation Doha, Qatar
| | - Hamdy Hamed Elsotohy
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation Doha, Qatar
| | - Amr Elmoheen
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation Doha, Qatar
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Chen J, Zhang S, Cui K, Liu C. Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol 2020; 268:4117-4127. [DOI: 10.1007/s00415-020-10175-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
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10
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Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y, Han L, Ma X, Xia R, Yu L. Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP112-NP134. [PMID: 32776833 DOI: 10.1177/0145561320943362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. RESULTS Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. CONCLUSION These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.
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Affiliation(s)
- Shichang Li
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Zijing Wang
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yan Liu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Jie Cao
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Hongwei Zheng
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lin Han
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Ruiming Xia
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
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