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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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Shigeno K, Ogita H, Funabiki K. Variants of benign paroxysmal positional vertigo in relation to head position during sleep. J Vestib Res 2021; 32:39-47. [PMID: 34633334 DOI: 10.3233/ves-180616] [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 Patients with posterior- and lateral-(canal)-benign paroxysmal positional vertigo (BPPV)-canalolithiasis sleep in the affected-ear-down head position. Posterior-BPPV-canalolithiasis typically affects the right than left ear; sleeping in the right-ear-down head position may be causal. OBJECTIVE To investigate the relationship between habitual head position during sleep and the onset of BPPV variants. METHODS Among 1,170 cases of BPPV variants with unknown etiology, the affected ears, habitual head positions during sleep based on interviews, and relationships among them were investigated. RESULTS Posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-geotropic affected the right ear significantly more often. Significantly more patients with posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-apogeotropic habitually slept in the right-ear-down head position. Patients with posterior- and lateral-BPPV-canalolithiasis and light cupula were more likely to sleep habitually in the affected-ear-down position than in the healthy-ear-down head position; no relationship was observed in patients with posterior- and lateral-BPPV-cupulolithiasis. In patients with posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-geotropic, the proportion of right-affected ears in those sleeping habitually in the right-ear-down head position was significantly greater than that for the left-affected ear. CONCLUSIONS A habitual affected-ear-down head position during sleep may contribute to BPPV-canalolithiasis and light cupula onset, but not BPPV-cupulolithiasis onset. However, habitual sleeping in the right-ear-down head position cannot explain the predominance of right-affected ears.
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Affiliation(s)
- Kohichiro Shigeno
- Shigeno Otolaryngology Vertigo-Hearing Impairment Clinic, Nagasaki City, Japan
| | - Hideaki Ogita
- Department of Otolaryngology, Shiga General Hospital, Moriyama City, Japan
| | - Kazuo Funabiki
- Institute for Biomedical Research and Innovation, Kobe City, Japan
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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: 22] [Impact Index Per Article: 5.5] [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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Abstract
The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere's disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.
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Affiliation(s)
- Sertac Yetiser
- Department of Otolaryngology-Head and Neck Surgery, Anadolu Medical Center, Gebze, Kocaeli, Turkey
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Davcheva-Chakar M, Kopacheva-Barsova G, Nikolovski N. Simultaneous Presentation of Benign Paroxysmal Positional Vertigo and Meniere's Disease - Case Report. Open Access Maced J Med Sci 2019; 7:3626-3629. [PMID: 32010389 PMCID: PMC6986504 DOI: 10.3889/oamjms.2019.600] [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: 09/20/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities, which develops spontaneously in most of the cases, but it can be secondary as a result of different conditions such as head injuries, viral neurolabyrinthitis, Meniere's disease and vertebrobasilar ischemia. The aim of presenting this case is to point out to the need of taking a precise clinical history and performing Dix-Hallpike manoeuvre in all patients who complain about vertigo regardless of the previously diagnosed primary disease of the inner ear. CASE PRESENTATION A 63-year-old female patient presented with the classical triad of symptoms for Meniere's disease (fluctuating sensorineural hearing loss in the right ear, tinnitus and fullness in the same ear and rotary vertigo), two years later complained of brief episodes of vertigo linked to changes in head position relative to gravity. Dix-Hallpike manoeuvre showed a classical response in the head-hanging right position. Benign paroxysmal positional vertigo (BPPV) in the same ear was diagnosed in this patient. After treatment with Epley's canal repositioning manoeuvre for a few days, the symptoms of positional vertigo resolved. CONCLUSION The authors recommend complete audiological and otoneurological evaluation in all patients with vertigo for timely recognition/diagnosis of any inner ear associated pathology.
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Affiliation(s)
- Marina Davcheva-Chakar
- University Clinic of Ear, Nose and Throat, University Campus “St. Mother Theresa”, Skopje, Republic of Macedonia
| | - Gabriela Kopacheva-Barsova
- University Clinic of Ear, Nose and Throat, University Campus “St. Mother Theresa”, Skopje, Republic of Macedonia
| | - Nikola Nikolovski
- University Clinic of Ear, Nose and Throat, University Campus “St. Mother Theresa”, Skopje, Republic of Macedonia
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Ciorba A, Cogliandolo C, Bianchini C, Aimoni C, Pelucchi S, Skarżyński PH, Hatzopoulos S. Clinical features of benign paroxysmal positional vertigo of the posterior semicircular canal. SAGE Open Med 2019; 7:2050312118822922. [PMID: 30637105 PMCID: PMC6317147 DOI: 10.1177/2050312118822922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/10/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between age, gender and affected ear, in patients presenting benign paroxysmal positional vertigo. METHODS This was a retrospective study. Data from benign paroxysmal positional vertigo clinical reports (January 2009-December 2014) were analysed. A total of 174 patients affected by benign paroxysmal positional vertigo of the posterior semicircular canal have been identified. Pearson chi-square test has been used to evaluate the probability of benign paroxysmal positional vertigo occurrence in relation to gender and side, within the studied groups. The level of significance was set at a p < 0.05. RESULTS Considering age as a discriminant factor, three groups of patients were identified: group 1: 16 patients with an age <40 years; group 2: 79 patients with an age between 40 and 65 years and group 3: 79 patients with an age >65 years. In each group, the right posterior semicircular canal was involved in the majority of cases (group 1 incidence: 12/16; group 2 incidence: 49/79 and group 3 incidence: 52/79). In all three groups, female patients were significantly more affected (9/16 in group 1, 61/79 in group 2 and 55/79 in group 3). CONCLUSION Benign paroxysmal positional vertigo is most prevalent in female subjects having an age>40 years and mainly involves the right posterior semicircular canal.
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Affiliation(s)
- Andrea Ciorba
- Audiology and ENT Clinic, University of Ferrara, Ferrara, Italy
| | | | | | - Claudia Aimoni
- Audiology and ENT Clinic, University of Ferrara, Ferrara, Italy
| | | | - Piotr Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland
- Institute of Sensory Organs, Kajetany, Poland
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Olajide T, Adegbiji W, Olubi O, Olajuyin O, Aluko A. Clinicoepidemiology of benign paroxysmal positional vertigo in Nigerian. J Family Med Prim Care 2019; 8:3220-3224. [PMID: 31742145 PMCID: PMC6857368 DOI: 10.4103/jfmpc.jfmpc_555_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022] Open
Abstract
Objective: Benign paroxysmal positional vertigo (BPPV) is poorly reported in developing countries. This study aimed at determining the prevalence, aetiology, and comorbid illnesses of benign paroxysmal positional vertigo in our center. Materials and Methods: This was a prevalence hospital-based study of all patients with the diagnosis of benign paroxysmal positional vertigo (BPPV). Pretested interviewer assisted questionnaire was administered to obtain data. Otoscopic examination, otoneurologic review, followed by mandatory Dix Hallpike maneuver and supine roll test was performed on all patients to diagnose posterior, lateral or anterior canal benign paroxysmal positional vertigo. All the data obtained were collated and analyzed by using SPSS version 16.0. Results: Prevalence was 1.9%. Peak prevalence of 37.0% was at age group 41–50 years. Male accounted for 46.1% with male to female ratio of 1:1.2. Benign paroxysmal positional vertigo accounted for 62.3% urban dwellers, 33.1% postsecondary education, 39.6% Civil servant and 33.8% married. There were 99.4% unilateral and 64.3% right benign paroxysmal positional vertigo. Idiopathic was 70.1% while trauma, migraine, and inner ear disorder were 20.8%, 7.1%, and 1.9%, respectively. Benign paroxysmal positional vertigo was 66.2% posterior semicircular canal followed by 24.7% lateral semicircular canal and 0.6% anterior semicircular canal. Commonly associated comorbid illnesses were visual disorder, hypertension, arthritis, and diabetes mellitus in 27.9%, 23.4%, 22.1%, and 2.6%, respectively. Conclusion: Benign paroxysmal positional vertigo is common otologic disorder. It is associated with significant comorbid illnesses. Early detection will reduce morbidity and mortality. Improvement in the level of health care at primary level and health education to create awareness among the populace is to be encouraged.
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Wang Y, Xia F, Wang W, Hu W. Assessment of sleep quality in benign paroxysmal positional vertigo recurrence. Int J Neurosci 2018; 128:1143-1149. [PMID: 29883234 DOI: 10.1080/00207454.2018.1486835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing China
| | - Wei Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Pollak L, Huna-Baron R, Osherov M, Roni M. In whom does horizontal canal BPPV recur? Am J Otolaryngol 2018; 39:410-412. [PMID: 29650422 DOI: 10.1016/j.amjoto.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.
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Affiliation(s)
- L Pollak
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - R Huna-Baron
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel affiliated to Sackler Faculty of Medicine Tel Aviv University, Israel
| | - Michael Osherov
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Milo Roni
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
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Abstract
CONCLUSION Benign paroxysmal positional vertigo (BPPV) is strongly related to sleep. This study proposes a micro-otoconia accumulation theory in which the pathological debris is an aggregate of micro-otoconia over a long time period, and which begins to slide by its own weight during sleep. OBJECTIVES To examine the onset time of idiopathic BPPV and to investigate its etiology. METHOD Patients (n = 351) were classified as posterior canalolithiasis (PC), horizontal canalolithiasis (HC), and horizontal heavy cupula (HHC) according to nystagmus findings. This study examined the medical records, and categorized the onset times into the following four groups; (1) during sleep, (2) at the time of rising, (3) morning, and (4) afternoon. RESULTS PC (n = 135): In 33 patients, vertigo occurred during sleep, in 69 patients at rising, in 10 patients in the morning, and in 23 patients in the afternoon. HC (n = 87): In 38 patients, vertigo occurred during sleep, in 30 patients at rising, in eight patients in the morning, and in 11 patients in the afternoon. HHC (n = 129): In 27 patients, vertigo occurred during sleep, in 59 patients at rising, in 15 patients in the morning, and in 28 patients in the afternoon.
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Affiliation(s)
- Hiroaki Ichijo
- Department of Otolaryngology, Ichijo Ear, Nose and Throat Clinic, Hirosaki, Japan
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Yetiser S, Ince D. Demographic analysis of benign paroxysmal positional vertigo as a common public health problem. Ann Med Health Sci Res 2015; 5:50-3. [PMID: 25745577 PMCID: PMC4350063 DOI: 10.4103/2141-9248.149788] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular problem. However, demographic analysis is few. AIM The aim of this study was to document the demographic data of patients with BPPV regarding distribution of gender, age, associated problems, most common form, symptom duration, severity of nystagmus and cure rate. SUBJECTS AND METHODS A total of 263 patients with video-nystagmography confirmed BPPV were enrolled in this retrospective study (2009-2013). The data were collected in Anadolu Medical Center. Distribution of gender, age and affected side were reviewed. Associated problems were noted. Patients were analyzed according to the canal involvement, age, duration of symptoms, duration of nystagmus and recurrence. Mean values and standard deviations were calculated. One-way ANOVA test was used for the analysis of the data (Statistical Package for the Social Sciences 17.0 version, IBM, Chicago, III, USA). Statistical significance was set at P < 0.05. RESULTS Women were affected more frequently than men (1:1.5). Comparative analysis of average age between the two gender groups was not statistically significant (P = 0.84). BPPV was common at middle age group. The incidence of affected side was not significant (P = 0.74). Posterior canal-BPPV (PC-BPPV) was the most leading one (129/263; 49%) followed by lateral canal (LC)-canalolithiasis (60/263; 22.8%), LC-cupulolithiasis (38/263; 14.5%) and superior canal-BPPV (9/263; 3.4%). 55.1% of patients were defined as idiopathic (145/263). Associated problems were migraine (31/263; 11.8%), trauma (19/263; 7.2%), inner ear disorders (18/263; 6.8%) and other systemic problems (50/263; 19.1%). 72.6% of patients had symptoms <2 months (191/263). 23,6% of patients had intensive nystagmus lasting more than a minute regardless of canal involvement (62/263). 33% of patients required two or more maneuvers for the relief of symptoms (87/263). CONCLUSION Symptoms are prone to recur in those of traumatic origin, associated inner ear problems and systemic disorders. As the prognostic factors are illuminated, preventive measures will be more effective and more patients will be cured properly.
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Affiliation(s)
- S Yetiser
- Department of ORL, Anadolu Medical Center, Kocaeli, Turkey
| | - D Ince
- Department of ORL, Anadolu Medical Center, Kocaeli, Turkey
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Balikci HH, Ozbay I. Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo. Auris Nasus Larynx 2014; 41:428-31. [DOI: 10.1016/j.anl.2014.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 11/27/2022]
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Polysomnography reveals nystagmus from benign paroxysmal positional vertigo. Sleep Med 2014; 15:840-2. [PMID: 24891076 DOI: 10.1016/j.sleep.2013.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/12/2013] [Accepted: 12/16/2013] [Indexed: 11/21/2022]
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Impact of postmaneuver sleep position on recurrence of benign paroxysmal positional vertigo. PLoS One 2013; 8:e83566. [PMID: 24367602 PMCID: PMC3867465 DOI: 10.1371/journal.pone.0083566] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background The necessity of postural restriction to patients suffering from benign paroxysmal positional vertigo is controversial. Objective To investigate the impact of the sleep position after the repositioning maneuver on BPPV recurrence. Methods 150 unilateral BPPV patients who were treated by repositioning maneuver were distributed into two groups. The patients in group A were instructed to sleep in a semi-sitting position at an angle of approximately 30 degrees and refrain from sleeping on their BPPV affected side for one week. The patients in group B were told to sleep in any preferred position. The comparison of recurrence rates according to different actual sleep positions in one week and one month was performed. Results There was a statistically significant correlation between the sleeping side and the side affected by BPPV. Without instructions on postural restriction, most patients (82.9%, 73/88) avoided sleeping on their affected side. The patients sleeping on their affected side had a higher recurrence rate (35.3%) than ones sleeping in other positions in the first week after the repositioning maneuver (p<0.05, Chi-square test and Fisher's exact test). The patients sleeping randomly in following 3 weeks had a lower recurrence rate than ones sleeping in other position (p<0.05, Fisher's exact test). Conclusions BPPV patients had a poor compliance to postural instructions. The habitual sleep side was associated with the side affected by BPPV. The patients sleeping on their affected side had a higher recurrence rate than those sleeping in other positions in first week after the repositioning maneuver.
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