A Pilot Study on the Efficacy of Continuous Positive Airway Pressure on the Manifestations of Ménière's Disease in Patients with Concomitant Obstructive Sleep Apnea Syndrome

Abstract

Objective:To evaluate the effect of continuous positive airway pressure (CPAP) therapy on Ménière's disease patients with concomitant obstructive sleep apnea syndrome (OSAS), since recent reports suggest OSAS may cause dysfunction of the vestibular system. Study Design: Prospective study using CPAP administered to patients diagnosed with "Defi nite Ménière's disease" according to the guidelines of the American Academy of OtolaryngologyHead and Neck Surgery and combined with OSAS. Pathologically, Ménière's disease is associated with hydropic distension of the endolymphatic system, but the etiology of such hydrops remains unknown. Episodes of vertigo, which are often accompanied by nausea and vomiting, are the most prominent and disabling features of the disease. The presentation of Ménière's disease is highly variable, and its clinical course is characterized by acute exacerbation and spontaneous remission. [2][3][4] It is well known that insomnia is associated with increased psychological symptomatology and perceived stress, higher predisposition to arousal, and greater impairments to quality of health. [5][6][7] The relationship between Ménière's disease and stress is well documented, but that between Ménière's disease and insomnia is unclear. In our previous report, 8 we fi rst found BRIEF SUMMARYCurrent Knowledge/Study Rationale: Recent reports indicate that OSAS may cause vestibular dysfunction. The current study was designed to determine whether treatment of patients with Ménière's disease and concomitant OSAS using CPAP ameliorate the manifestations of Ménière's disease.

Concomitant Obstructive Sleep Apnoea in Patients with Meniere’s Disease: A Case Report and Literature Review

“…As illustrated by the present case report, concomitant OSA is potentially such a comorbidity that has often been underappreciated. e prevalence of clinically significant OSAS in the general adult population has been reported to be at least 8.5% [7]. In a longitudinal study, the association between MD and OSA patients was studied based on a nationwide 9year longitudinal cohort database of 1,025,340 South Korean patients [9].…”

“…The prevalence of MD has been reported to be between 12 and 46 per 100,000, with a geographical variation [ 7 ]. The otologist/neurotologist routinely manages MD patients, and standard medical therapy includes lifestyle changes such as dietary salt restriction and medications such as diuretics, migraine prophylaxis, and steroid therapy [ 15 ].…”

“…In recent years, there have been some reports linking MD and OSA [6][7][8][9][10]. Up to 15% of patients with MD have been found to have concomitant OSAS [11].…”

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

“…Recently, robust evidences show OSA patients have higher prevalence of vertigo, tinnitus and sudden deafness than non-OSA people and repeated nocturnal hypoxemia may be the link between OSA and inner ear disease but warrants further research to confirm [4] , [5] , [6] , [7] , [8] . Preliminary reports showed that continuous positive airway pressure (CPAP) therapy improved both OSA and inner ear symptoms at the same time [6] , [9] . Consequently, vertigo, tinnitus and sudden deafness may be additional indications for the treatment of OSA.…”

Meniere’s Disease: Nonsurgical Treatment

“…The first line of treatment is to encourage the patient to change his lifestyle into a healthier one. Regulation of sleeping cycle, avoiding stress, caffeine, alcohol, and tobacco, and changing into a low salt diet should be advised [60][61][62]. Caffeine is accused to increase the endolymph volume due to its sympathomimetic actions, and it is suggested to be restricted to 100 mg/day by AAO-HNS [63].…”