The Clinical Spectrum of Dizziness in Sleep Apnea

Abstract

OBJECTIVE: Sleep apnea has been associated with dizziness, but the clinical characteristics of this dizziness have not been fully described. This study evaluated clinical descriptions of dizziness, vestibular diagnoses, and the response to treatment of dizzy patients with sleep apnea. PATIENTS: All subjects had a new diagnosis of sleep apnea with a confirmatory pulse oximetry or polysomnogram and received treatment for sleep apnea through our center. Fifty-two patients met these criteria, with a mean age of 55 years and a mean BMI of 31. INTERVENTION: Continuous positive airway pressure or uvulopalatopharyngoplasty. MAIN OUTCOME MEASURES: Reported symptoms of dizziness and vestibular diagnoses were collected retrospectively in all patients. Nineteen patients with a complete resolution of dizziness with treatment of sleep apnea on mean follow-up of 4 years were used to define the clinical syndrome and their symptoms were compared with the remainder of the group. RESULTS: Repeated spells of sudden momentary vertigo were common. Vestibular migraine, Menière's disease, and sudden sensorineural hearing loss occurred in a much higher frequency than in the general population. CONCLUSIONS: Brief spells of nonpositional vertigo that recur throughout the day, phenotypically similar to vestibular paroxysmia, responded to treatment of sleep apnea, and could represent a new vestibular entity. The greatly elevated risk of migraine, Menière's disease and sudden sensorineural hearing loss are likely due to enhanced vascular risks associated with sleep apnea. A history of snoring should be sought in all dizzy patients.