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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.
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Replies to This Discussion
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Permalink Reply by Alice Lindley on
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I find this article fascinating. Thank you for posting. I have bilateral hearing loss, vertigo, and tinnitus from Meniere's disease. I think that underlying UARS may have contributed to my Meniere's symptoms. I am having difficulty getting my sleep doctor to prescribe CPAP because my overnight sleep study did not yield the results that the insurance company likes to see. I have narrow nasal passages, receding jaw, large tongue base, and a floppy palate. I have had an oral surgeon and an ENT offer to perform surgery. I would like CPAP. can you recommend a doctor who would be willing to treat UARS based on anatomy?
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Could you please contact the University of Iowa about starting a research study on Meniere's Disease and sleep disordered breathing?
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Permalink Reply by Steven Y. Park, MD on
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Alice,
Sorry, but not too many sleep doctors or otolaryngologists will prescribe CPAP if you don't meet the criteria for obstructive sleep apnea. Your other option is to purchase it out of pocket or try a mandibular advancement device, but you still need a prescription. You may wish to print out this article which shows that CPAP can be helpful in some UARS patients. Good luck.
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While I agree that there may be a connection between the two conditions, no one will do a study like what you suggest since it's taken for granted that Meniere's is purely an inner ear condition.
Alice Lindley said:Could you please contact the University of Iowa about starting a research study on Meniere's Disease and sleep disordered breathing?
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