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Volume 14 No. 12
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Accepted Papers

Scientific Investigations

Increased Risk of Benign Paroxysmal Positional Vertigo in Patients With Non-Apnea Sleep Disorders: A Nationwide, Population-Based Cohort Study

Cheng-Ping Shih, MD, PhD1; Chih-Hung Wang, MD, PhD1; Chi-Hsiang Chung, PhD2,3; Hung-Che Lin, MD1; Hsin-Chien Chen, MD, PhD1; Jih-Chin Lee, MD, PhD1; Wu-Chien Chien, PhD2,3,4
1Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; 2School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China; 3Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, Republic of China; 4Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China

Study Objectives:

To investigate the association between non-apnea sleep disorders (NSD) and subsequent benign paroxysmal positional vertigo (BPPV) risk.


This retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database from 2000 to 2013. We established an NSD group (n = 24,624) and an age-, sex- and index year-matched comparison group (n = 98,496). The primary outcome was the occurrence of BPPV. The incidence rates of BPPV in the two cohorts were compared with a 14-year follow-up. Cox proportional hazard regression analysis was used to evaluate the effects of NSD on BPPV risk.


The incidence rate of BPPV was 43.33 per 100,000 person-years for the NSD cohort and 29.33 per 100,000 person-years for the comparison cohort. NSD significantly increased the risk of BPPV (adjusted hazard ratio [HR] = 2.487; 95% confidence interval = 1.996–3.099, P < .001). Subgroup analysis revealed that NSD increase the risk of development of BPPV by 2.357- to 3.658-fold in patients with hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and hyperlipidemia. Furthermore, when comparing different types of NSD, chronic insomnia carries the highest risk of BPPV (adjusted HR = 3.563), followed by organic sleep disorders (adjusted HR = 2.763), sleep disturbance (adjusted HR = 2.506), and acute insomnia (adjusted HR = 2.237).


We demonstrate that NSD are associated with an increased risk of BPPV. Relative to other types of NSD, patients with chronic insomnia are at the highest risk for development of BPPV.


Shih CP, Wang CH, Chung CH, Lin HC, Chen HC, Lee JC, Chien WC. Increased risk of benign paroxysmal positional vertigo in patients with non-apnea sleep disorders: a nationwide, population-based cohort study. J Clin Sleep Med. 2018;14(12):2021–2029.

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