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Sleep Apnea, Hearing Loss and Thickened Blood
I came across this interesting article in Sleep Medicine, where they showed that in patients with obstructive sleep apnea, a significant number were hemodynamically hyperviscosity positive (282/610 patients). Hyperviscous means that blood is thicker and more prone to clog arteries. Of these 282 patients, 239 had brainstem AEP abnormalities. AEPs are tests for ear neurologic reflexes where clicks are given in one ear and brain waves are measured in response. It tests for inner ear and brainstem function.
Ones that didn't have hyperviscosity all had normal AEPs. Of these 239 patients, 57 had bilateral sensorineural hearing changes (no waves at all), and 182 patients had significant bilateral signal changes. After 6 months of CPAP, hyperviscosity was normalized in 159 patients. In 112 of these 159 patients a repeat AEP became normal. Of the 80 patients on CPAP that did not normalize, hemodilution therapy resulted in normalization in 61 patients. Hemodilution is when blood is made thinner by removing some blood and adding some saline.
This paper talks about bilateral conditions but also brings up the possibility of unilateral sudden sensorineural hearing loss being explained by this mechanism. It's in line with my personal observation that every patient that I see with sudden sensorineural hearing loss has a history and exam consistent with an underlying sleep-breathing disorder. The handful that agreed to undergo sleep studies showed significant obstructive sleep apnea in all cases. I think the implications of this paper are enormous.
Ones that didn't have hyperviscosity all had normal AEPs. Of these 239 patients, 57 had bilateral sensorineural hearing changes (no waves at all), and 182 patients had significant bilateral signal changes. After 6 months of CPAP, hyperviscosity was normalized in 159 patients. In 112 of these 159 patients a repeat AEP became normal. Of the 80 patients on CPAP that did not normalize, hemodilution therapy resulted in normalization in 61 patients. Hemodilution is when blood is made thinner by removing some blood and adding some saline.
This paper talks about bilateral conditions but also brings up the possibility of unilateral sudden sensorineural hearing loss being explained by this mechanism. It's in line with my personal observation that every patient that I see with sudden sensorineural hearing loss has a history and exam consistent with an underlying sleep-breathing disorder. The handful that agreed to undergo sleep studies showed significant obstructive sleep apnea in all cases. I think the implications of this paper are enormous.
Tags: aep, brainstem, hearing, hyperviscosity, loss, sensorineural
Replies to This Discussion
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Permalink Reply by Rock Hinkle on -
Save sleep, save the world. Great post Dr. Park. Another step in showing the many different ways apnea affects us.
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Permalink Reply by BeeAsleep on -
Well, I know this is anecdotal evidence, but I have been diagnosed with moderate hearing loss that came on over the last 2 years. I am 58 years old. No accidents head injuries, or other factors. I have had blood tests to rule out the common causes. Nothing wrong. So I just purchased hearing aids for my unexplained hearing loss. Very interesting. Thanks.
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Permalink Reply by bonesigh on -
Hmmm, perhaps this explains my diagnosis of auditory hearing loss. I initially went to get my hearing tested because my tinnitus, ringing in my ears, seemed worse and I thought this might be causing me to not hear well. Especially in situations where there was a lot of background noise, like at a restaurant. The hearing specialist said my hearing was fine but that I had an auditory processing problem and that my brain could hear the voices fine but could not figure out what was being said. I've been using my bi-pap faithfully for over 2 years now. No improvement of hearing however. Darn.
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Permalink Reply by Mike on -
i've casually observed that my hearing is getting poorer all the time. i'm only 35 and my wife and i always joke about how i need a hearing aid. wonder if this is connected to sleep apnea at all.
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Permalink Reply by Steven Y. Park, MD on -
Mike, there are many other good reasons for hearing loss. If it's really a problem, see an ENT out where you live and maybe even get a hearing test. Although this article implies that brain stem damage is possible with sleep apnea, I would take it with a grain of salt.
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Permalink Reply by Richard C. Davis on -
I was just recently diagnosed with sleep apnea and I just got my machine today. My sleep tests indicated, among other things, that my blood oxygen level would drop as low as 58%.
About 12 to 13 years ago I experienced sudden bilateral hearing loss together with infrequent but severe spinning vertigo attacks. I sought help from my PCP who recommended a specialist who recommended another specialist at MEEI in Boston. The original diagnosis was bilateral Meniere's syndrome, Meniere's being, as you know, an idiopathic diagnosis. My hearing loss continued in a step-wise, episodic fashion over the years until now, where my hearing loss is approaching cochlear implant territory (85-95db with < 40% speech recognition). The last diagnosis I got from MEEI (about 5 years ago) was that I had "some sort of degenerative hearing loss of unknown origin". No one ever suggested sleep apnea as a possible cause. I have always been in generally good health and there is no history of hearing loss in my family.
Do you think that long-term oxygen deprivation from sleep apnea could have been a cause of my hearing loss?
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Permalink Reply by Steven Y. Park, MD on
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Richard,
This is a good explanation based on this paper and all the other research studies. However, it's not mainstream thinking (yet). It's also difficult to prove. If you happen to get the test that the study participants got, it may confirm this finding.
Richard C. Davis said:I was just recently diagnosed with sleep apnea and I just got my machine today. My sleep tests indicated, among other things, that my blood oxygen level would drop as low as 58%.
About 12 to 13 years ago I experienced sudden bilateral hearing loss together with infrequent but severe spinning vertigo attacks. I sought help from my PCP who recommended a specialist who recommended another specialist at MEEI in Boston. The original diagnosis was bilateral Meniere's syndrome, Meniere's being, as you know, an idiopathic diagnosis. My hearing loss continued in a step-wise, episodic fashion over the years until now, where my hearing loss is approaching cochlear implant territory (85-95db with < 40% speech recognition). The last diagnosis I got from MEEI (about 5 years ago) was that I had "some sort of degenerative hearing loss of unknown origin". No one ever suggested sleep apnea as a possible cause. I have always been in generally good health and there is no history of hearing loss in my family.
Do you think that long-term oxygen deprivation from sleep apnea could have been a cause of my hearing loss?
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Permalink Reply by Kathy Keller on
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As a person who is hearing impaired, having lost 40% in one ear and I'm deaf in the other ear.....is this article saying that IF the technology had been available when I was much younger to test for OSA, that I probably would have been diagnosed that long ago?
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Permalink Reply by Richard C. Davis on
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An additional piece of information regarding the treatment of Meniere's is that the condition is thought to be caused by a fluid imbalance between perilymph and endolymph in the cochlear. Meniere's is commonly treated with a diuretic in an attempt to redress the "fluid imbalance". If the Meniere's symptoms (tinnitus, vertigo, feeling of fullness, hearing loss) are actually being caused by the effects of blood hyperviscosity, it would seem that diuretics would only aggravate the problem.
Steven Y. Park, MD said:Richard,
This is a good explanation based on this paper and all the other research studies. However, it's not mainstream thinking (yet). It's also difficult to prove. If you happen to get the test that the study participants got, it may confirm this finding.
Richard C. Davis said:I was just recently diagnosed with sleep apnea and I just got my machine today. My sleep tests indicated, among other things, that my blood oxygen level would drop as low as 58%.
About 12 to 13 years ago I experienced sudden bilateral hearing loss together with infrequent but severe spinning vertigo attacks. I sought help from my PCP who recommended a specialist who recommended another specialist at MEEI in Boston. The original diagnosis was bilateral Meniere's syndrome, Meniere's being, as you know, an idiopathic diagnosis. My hearing loss continued in a step-wise, episodic fashion over the years until now, where my hearing loss is approaching cochlear implant territory (85-95db with < 40% speech recognition). The last diagnosis I got from MEEI (about 5 years ago) was that I had "some sort of degenerative hearing loss of unknown origin". No one ever suggested sleep apnea as a possible cause. I have always been in generally good health and there is no history of hearing loss in my family.
Do you think that long-term oxygen deprivation from sleep apnea could have been a cause of my hearing loss?
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