Is there a relation between sleep apnea, tinnitus, and hearing Loss?

Yıl 2023, Cilt: 13 Sayı: 2, 288 - 293, 22.03.2023

Nurcan Yurtsever Kum Serpil Alluşoğlu Mehmet Ali Çetin Fatma Cemre Sazak Kundi Ali Rıza Yağmur Mustafa Çolak Aykut İkincioğulları Prof.dr. Kürşat Murat Özcan Haci Hüseyin Dere

https://doi.org/10.16899/jcm.1246971

Öz

Abstract
Background
Chronic hypoxia may lead to auditory dysfunction in patients with obstructive sleep apnea (OSA), and this dysfunction may worsen OSA, creating a vicious circle. The aim of this study was to investigate tinnitus and hearing loss in OSA patients.
Methods
A total of 147 patients were included in the study. After polysomnography (PSG), the patients with an apnea-hypopnea index (AHI) ≥ 5 were included in OSA group, and the ones with an AHI<5 were included in the simple snoring group. The OSA patients were divided into three OSA severity subgroups as mild, moderate and severe OSA subgroups. Standard pure-tone audiometry (PTA) (0.5, 1, 2, 4 kHz) and high-frequency audiometry (8, 10, 12 kHz) were performed, and Tinnitus Handicap Inventory (THI) was applied to all participants. Audiological results and THI scores were compared among the study groups.
Results
The OSA group consisted of 46 (36.5%) female, 80 (63.5%) male, and a total of 126 patients. The simple snoring group included 13 (61.9%) female, 8 (38.1%) male, and a total of 21 patients. The mean body mass index, hearing thresholds in all tested frequencies and THI scores were significantly higher in OSA group (p=0.024, p=0.001, p=0.015, p=0.017, p=0.039, p=0.002 and p=0.001, respectively). THI score showed a statistically significant and positive correlation with the AHI (p=0.004; r=0.252). The mean THI score was significantly lower in mild OSAS subgroup compared to moderate and severe OSA subgroups (p=0.019).
Conclusions
OSA, hearing impairment and tinnitus are either comorbidities or related etiologically. Higher prevalence of hearing impairment in OSA patients compared to simple snorers suggests that intermittent nocturnal hypoxia, rather than sound of snoring plays a role in hearing impairment.

Anahtar Kelimeler

Hearing loss, Obstructive sleep apnea, Polysomnography, Tinnitus., İşitme kaybı, Obstrüktif uyku apnesi, Polisomnografi

Destekleyen Kurum

none

Proje Numarası

Date: 05.10.2017, Decree no: E17-1411

Teşekkür

none

Uyku apnesi, tinnitus ve işitme kaybı arasında bir ilişki var mı?

Öz

ÖZ
Amaç: Kronik hipoksi, tıkayıcı uyku apnesi (TUA) olan hastalarda işitme sisteminde işlev bozukluğuna yol açabileceği gibi, işitsel işlev bozukluğu da TUA'yı kötüleştirerek bir kısır döngü oluşturabilir. Bu çalışmanın amacı TUA'da tinnitus ve işitme kaybını araştırmaktı.
Gereç ve Yöntemler: Çalışmaya toplam 147 hasta dahil edildi. Polisomnografi (PSG) sonrası apne-hipopne indeksi (AHİ) ≥5 olan hastalar TUA grubuna, AHI<5 olanlar ise basit horlama grubuna dahil edildi. TUA hastaları hafif, orta ve şiddetli TUA alt grubu olarak üç alt gruba ayrıldı. Tüm katılımcılara standart saf ses odyometri (SSO) (0,5, 1, 2, 4 kHz), yüksek frekans odyometri (8, 10, 12 kHz) ve Tinnitus Handikap Envanteri (THE) anketi uygulandı. Çalışma grupları arasında odyolojik sonuçlar ve THE skorları karşılaştırıldı.
Bulgular: TUA grubu 46 (%36,5) kadın, 80 (%63,5) erkek olmak üzere toplam 126 hastadan oluşmaktaydı. Basit horlama grubuna 13 (%61,9) kadın, 8 (%38,1) erkek olmak üzere toplam 21 hasta dahil edildi. Ortalama vücut kitle indeksi, test edilen tüm frekanslarda işitme eşikleri ve THE skorları TUA grubunda anlamlı olarak yüksekti (sırasıyla, p=0,024, p=0,001, p=0,015, p=0,017, p=0,039, p=0,002 ve p=0,001). THE skoru, AHİ ile istatistiksel olarak anlamlı ve pozitif korelasyon gösterdi (p=0,004; r=0,252). Ortalama THE skoru hafif TUA alt grubunda orta ve şiddetli TUA alt gruplarına göre anlamlı olarak düşüktü (p=0,019).
Sonuçlar: TUA, işitme kaybı ve kulak çınlaması ya komorbiditelerdir ya da etiyolojik olarak ilişkilidir. Basit horlayanlara kıyasla TUA hastalarında işitme bozukluğu prevalansının daha yüksek olması, horlama sesinden ziyade aralıklı gece hipoksisinin işitme bozukluğunda daha fazla rol oynadığını düşündürmektedir.

Anahtar Kelimeler

Tinnitus., İşitme kaybı, Obstrüktif uyku apnesi, Polisomnografi

Proje Numarası

Date: 05.10.2017, Decree no: E17-1411

Kaynakça

• 1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328 (17):1230-5.
• 2. Kent BD, Ryan S, McNicholas WT. Obstructive sleep apnea and inflammation: relationship to cardiovascular co-morbidity. Respir Physiol Neurobiol 2011;178 (3):475-81.
• 3. Young T, Palta M, Dempsey J, Peppard PE, Nieto FJ, Hla KM. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ 2009;108 (5):246-9.
• 4. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177 (9):1006-14.
• 5. Jastreboff PJ, Hazell JW. A neurophysiological approach to tinnitus: clinical implications. Br J Audiol 1993;27 (1):7-17.
• 6. Andersson G, Lyttkens L. A meta-analytic review of psychological treatments for tinnitus. Br J Audiol 1999;33 (4):201-10.
• 7. Chopra A, Jung M, Kaplan RC et al. Sleep Apnea Is Associated with Hearing Impairment: The Hispanic Community Health Study/Study of Latinos. J Clin Sleep Med 2016;12 (5):719-26.
• 8. Wang C, Xu F, Chen M et al. Association of Obstructive Sleep Apnea-Hypopnea Syndrome with hearing loss: A systematic review and meta-analysis. Front Neurol 2022;13 1017982.
• 9. Lai JT, Shen PH, Lin CY, Liu CL, Liu TC. Higher prevalence and increased severity of sleep-disordered breathing in male patients with chronic tinnitus: Our experience with 173 cases. Clin Otolaryngol 2018;43 (2):722-25.
• 10. Newman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg 1996;122 (2):143-8.
• 11. Berry RB, Budhiraja R, Gottlieb DJ et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8 (5):597-619.
• 12. Aksoy S, Firat Y, Alpar R. The Tinnitus Handicap Inventory: a study of validity and reliability. Int Tinnitus J 2007;13 (2):94-8.
• 13. Zhang J, Huo Y, Lui G, Li M, Tyler RS, Ping H. Reliability and Validity of the Tinnitus Handicap Inventory: A Clinical Study of Questionnaires. J Int Adv Otol 2022;18 (6):522-29.
• 14. Kiely JL, McNicholas WT. Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. Eur Respir J 2000;16 (1):128-33.
• 15. Hatipoglu U, Rubinstein I. Inflammation and obstructive sleep apnea syndrome pathogenesis: a working hypothesis. Respiration 2003;70 (6):665-71.
• 16. Lee S, Thomas RJ, Kim H et al. Association between high nocturnal blood pressure and white matter change and its interaction by obstructive sleep apnoea among normotensive adults. J Hypertens 2014;32 (10):2005-12; discussion 12.
• 17. Konig O, Winter E, Fuchs J et al. Protective effect of magnesium and MK 801 on hypoxia-induced hair cell loss in new-born rat cochlea. Magnes Res 2003;16 (2):98-105.
• 18. Fischer AQ, Chaudhary BA, Taormina MA, Akhtar B. Intracranial hemodynamics in sleep apnea. Chest 1992;102 (5):1402-6.
• 19. Song Z, Wu Y, Tang D et al. Tinnitus Is Associated With Extended High-frequency Hearing Loss and Hidden High-frequency Damage in Young Patients. Otol Neurotol 2021;42 (3):377-83.
• 20. Vorlova T, Dlouha O, Kemlink D, Sonka K. Decreased perception of high frequency sound in severe obstructive sleep apnea. Physiol Res 2016;65 (6):959-67.
• 21. Lu CT, Lee LA, Lee GS, Li HY. Obstructive Sleep Apnea and Auditory Dysfunction-Does Snoring Sound Play a Role? Diagnostics (Basel) 2022;12 (10).
• 22. Seo YJ, Chung HJ, Park SY et al. Lowest Oxyhemoglobin Saturation May Be an Independent Factor Influencing Auditory Function in Severe Obstructive Sleep Apnea. J Clin Sleep Med 2016;12 (5):653-8.
• 23. Martines F, Ballacchino A, Sireci F et al. Audiologic profile of OSAS and simple snoring patients: the effect of chronic nocturnal intermittent hypoxia on auditory function. Eur Arch Otorhinolaryngol 2016;273 (6):1419-24.
• 24. Biswas R, Hall DA. Prevalence, Incidence, and Risk Factors for Tinnitus. Curr Top Behav Neurosci 2021;51 3-28.
• 25. Tunkel DE, Bauer CA, Sun GH et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg 2014;151 (2 Suppl):S1-S40.
• 26. McCormack A, Edmondson-Jones M, Somerset S, Hall D. A systematic review of the reporting of tinnitus prevalence and severity. Hear Res 2016;337 70-9.
• 27. Koo M, Hwang JH. Risk of tinnitus in patients with sleep apnea: A nationwide, population-based, case-control study. Laryngoscope 2017;127 (9):2171-75.