Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury

Abstract

IntroductionTraumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often involves comorbid vestibular impairment. Sleep apnea is another comorbidity that may exacerbate, and/or be exacerbated by, vestibular dysfunction.ObjectiveTo examine the relationship between sleep apnea and vestibular complaints in V/SM diagnosed with TBI of any severity.DesignMulticenter cohort study; cross‐sectional sample.SettingIn‐patient TBI rehabilitation units within 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers.ParticipantsV/SM with a diagnosis of TBI (N = 630) enrolled in the VA TBI Model Systems study.InterventionNot applicable.MethodsA multivariable regression model was used to evaluate the association between sleep apnea and vestibular symptom severity while controlling for relevant covariates, e.g., posttraumatic stress disorder (PTSD).Main Outcome MeasuresLifetime history of sleep apnea was determined via best source reporting. Vestibular disturbances were measured with the 3‐item Vestibular subscale of the Neurobehavioral Symptom Inventory (NSI).ResultsOne third (30.6%) of the sample had a self‐reported sleep apnea diagnosis. Initial analysis showed that participants who had sleep apnea had more severe vestibular symptoms (M = 3.84, SD = 2.86) than those without sleep apnea (M = 2.88, SD = 2.67, p < 0.0001). However, when analyzing the data via a multiple regression model, sleep apnea no longer reached the threshold of significance as a factor associated with vestibular symptoms. PTSD severity was shown to be a significantly associated with vestibular symptoms within this sample (p < 0.001).ConclusionAnalysis of these data revealed a relationship between sleep apnea and vestibular complaints in V/SM with TBI. The significance of this relationship was impacted when PTSD symptoms were factored into a multivariable regression model. However, given that the mechanisms and directionality of these relationships are not yet well understood, we assert that in terms of clinical relevance, providers should emphasize screening for each of the three studied comorbidities (sleep apnea, vestibular symptoms, and PTSD).

The need for exclusion when exploring the relationship between sleep apnea and vestibular symptoms after traumatic brain injury

“…We read with pleasure the article by Skop et al, 1 titled "Exploring the Relationship Between Sleep Apnea and Vestibular Symptoms following Traumatic Brain Injury" and would like to offer additional commentary regarding selection criteria and survey choice. We hope these perspectives can provide insight into areas that may require further research and improvement.…”

“…Skop et al 1 selected a sample of veterans/service members registered with the Veterans' Affairs Traumatic Brain Injury Model Systems (VA TBIMS) National Database whose responses were analyzed via a multivariable linear regression model for an association between vestibular dysfunction and sleep apnea with a history of TBI diagnosis. The team concluded that sleep apnea and vestibular dysfunction symptoms were not significantly associated once posttraumatic stress disorder was included in the analysis.…”