Abstract
The objective of this work was to study the effect of nocturnal intermittent hypoxia on auditory function of simple snoring patients and subjects affected by OSAS; we compared the audiologic profile with the severity of OSAS to detect early signs of cochlear damage. One hundred-sixty patients underwent overnight polysomnography, micro-otoscopy, multi-frequency audiometry, acufenometry, TEOAE recording and d-ROMs test. All subjects were divided in four groups, based on presence/absence of AHI (simple snoring without OSAS, mild OSAS, moderate OSAS, severe OSAS). Sixty (37.5 %) patients were not affected by OSAS, 58 (36.25 %) presented a mild OSAS, 18 (11.25 %) a moderate OSAS and 24 (15 %) a severe OSAS; the 57.14 % of moderate to severe OSAS suffered from tinnitus with respect to the 31.03 % of mild OSAS (P = 0.024). A higher percentage (41.66 %) of hearing loss was found among individuals with moderate to severe degree of OSAS (P < 0.0001). All groups were characterized by a mean hearing threshold <25 dB HL for 0.25–3 kHz frequencies and a progressive decrease in hearing sensitivity, particularly for 6–16 kHz frequencies (P < 0.05). The analysis of otoacoustic emissions SNR mean values evidenced a significant difference between simple snoring and severe OSAS individuals for 3 and 4 kHz frequencies (P < 0.05). d-ROM levels resulted higher in patients with severe OSAS with respect to simple snoring subjects (P = 0.004). Our data underline the key role of chronic nocturnal intermittent hypoxia in the development of an early cochlear damage and a more marked high-frequency hearing loss in case of severe OSAS (P < 0.05).
Similar content being viewed by others
References
Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF (2001) Relation of sleep-disordered breathing to Cardiovascular Disease Risk. The Sleep Heart Health Study. Am J Epidemiology 154:50–59
Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373:82–93
Fletcher EC (1995) The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. Am J Med 98:118–128
Nazzaro P, Schirosi G, Clemente R, Battista L, Serio G, Boniello E, Carratù PL, Lacedonia D, Federico F, Resta O (2008) Severe obstructive sleep apnoea exacerbates the microvascular impairment in very mild hypertensives. Eur J Clin Invest 38:766–773
Gozal D, Kheirandish-Gozal L (2008) Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. Am J Respir Crit Care Med 177:369–375
Broderick M, Guilleminault C (2008) Neurological aspects of obstructive sleep apnea. Ann NY Acad Sci 1142:44–57
Dyken ME, Im KB (2009) Obstructive sleep apnea and stroke. Chest 136:1668–1677
Colrain IM, Campbell KB (2007) The use of evoked potentials in sleep research. Sleep Med Rev 11:277–293
Gupta PP, Sood S, Atreja A, Agarwal D (2008) Evaluation of brain stem auditory evoked potentials in stable patients with chronic obstructive pulmonary disease. Ann Thor Med 3:128–134
Ni D (1991) Auditory brain-stem response in obstructive sleep apnea syndrome. Zhonghua Er Bi Yan Hou Ke Za Zhi 26:284–286
Lazarini PR, Camargo AC (2006) Idiopathic sudden sensorineural hearing loss: etiopathogenic aspects. Braz J Otorhinolaryngol 72:554–561
Muchnik C, Rubel Y, Zohar Y, Hildesheimer M (1995) Auditory brainstem response in obstructive sleep apnea patients. J Basic Clin Physiol Pharmacol 6:139–148
Kotterba S, Rasche K (1996) Acoustic evoked potentials (AEP) in obstructive sleep apnea syndrome. Pneumologie 50:924–926
Atiş S, Ozge A, Sevim S (2001) The brainstem auditory evoked potential abnormalities in severe chronic obstructive pulmonary disease. Respirology 6:225–229
Casale M, Vesperini E, Potena M, Pappacena M, Bressi F, Baptista PJ, Salvinelli F (2012) Is obstructive sleep apnea syndrome a risk factor for auditory pathway? Sleep Breath 16:413–417
American Academy of Sleep Medicine (2005) International classification of sleep disorders. Diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester
Martines F, Bentivegna D, Martines E, Sciacca V, Martinciglio G (2010) Assessing audiological, pathophysiological and psychological variables in tinnitus patients with or without hearing loss. Eur Arch Otorhinolaryngol 267:1685–1693
Martines F, Bentivegna D, Martines E, Sciacca V, Martinciglio G (2010) Characteristics of tinnitus with or without hearing loss: clinical observations in Sicilian tinnitus patients. Auris Nasus Larynx 37:685–693
Martines F, Bentivegna D, Di Piazza F, Martines E, Sciacca V, Martinciglio G (2010) Investigation of tinnitus patients in Italy: clinical and audiological characteristics. Int J Otolaryngol. doi:10.1155/2010/265861
Martines F, Sireci F, Cannizzaro E, Costanzo R, Martines E, Mucia M, Plescia F, Salvago P (2014) Clinical observations and risk factors for tinnitus in a Sicilian cohort. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-3275-0
Simiakakis M, Kapsimalis F, Chaligiannis E, Loukides S, Sitaras N, Alchanatis M (2012) Lack of effect of sleep apnea on oxidative stress in obstructive sleep apnea syndrome (OSAS) patients. PLoS One 7:e39172
Palmieri B, Sblendorio V (2007) Oxidative stress tests: overview on reliability and use. Part II. Eur Rev Med Pharmacol Sci 11:383–399
Broderick M, Guilleminault C (2008) Neurological aspects of obstructive sleep apnea. Ann NY Acad Sci 1142:44–57
Ryan S, Taylor CT, McNicholas WT (2005) Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 112:2660–2667
Yamauchi M, Kimura H (2008) Oxidative stress in obstructive sleep apnea: putative pathways to the cardiovascular complications. Antioxid Redox Signal 10:755–768
Sha SH, Taylor R, Forge A, Schacht J (2001) Differential vulnerability of basal and apical hair cells is based on intrinsic susceptibility to free radicals. Hear Res 155:1–8
Sheu JJ, Wu CS, Lin HC (2012) Association between obstructive sleep apnea and sudden sensorineural hearing loss: a population-based case-control study. Arch Otolaryngol Head Neck Surg 138:55–59
Nakayama M, Kabaya K (2013) Obstructive sleep apnea syndrome as a novel cause for Ménière’s disease. Curr Opin Otolaryngol Head Neck Surg 21:503–508
Kilic T, Karatas E, Toplu Y, Koc A, Bulam N, Kaya O (2014) Evaluation of auditory functions in patients with asthma. Eur Rev Med Pharmacol Sci 18:2615–2620
She WD, Zhang Q, Chen F, Jiang P, Wang J (2004) Peri-uvulopalatopharyng oplasty otoacoustic emissions in patients with obstructive sleep apnea-hypopnea syndrome. Zhonghua Er Bi Yan Hou Ke Za Zhi 39:48–51
Xu Y, He X, Cai Q, Liang X, Zheng Y, Zhang S, Ji s (2008) Influence of childhood obstructive sleep apnea-hypopnea syndrome on hearing. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 22:436–438
Yamauchi M, Nakano H, Maekawa J, Okamoto Y, Ohnishi Y, Suzuki T, Kimura H (2005) Oxidative stress in obstructive sleep apnea. Chest 127:1674–1679
Schulz R, Mahmoudi S, Hattar K, Sibelius U, Olschewski H, Mayer K, Seeger W, Grimminger F (2000) Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med 162:566–570
Svatikova A, Wolk R, Lerman LO, Juncos LA, Greene EL, McConnell JP, Somers VK (2005) Oxidative stress in obstructive sleep apnoea. Eur Heart J 26:2435–2439
Wali SO, Bahammam AS, Massaeli H, Pierce GN, Iliskovic N, Singal PK, Kryger MH (1998) Susceptibility of LDL to oxidative stress in obstructive sleep apnea. Sleep 21:290–296
Patt BT, Jarjoura D, Haddad DN, Sen CK, Roy S, Flavahan S, Khayat RN (2010) Endothelial dysfunction in the microcirculation of patients with obstructive sleep apnea. Am J Respir Crit Care Med 182:1540–1545
Shi A (2011) Physiopathology of the cochlear microcirculation. Hear Res 282:10–24
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
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 273, 1419–1424 (2016). https://doi.org/10.1007/s00405-015-3714-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-015-3714-6