Impact of Postmaneuver Sleep Position on Recurrence of Benign Paroxysmal Positional Vertigo

Abstract

BackgroundThe necessity of postural restriction to patients suffering from benign paroxysmal positional vertigo is controversial.ObjectiveTo investigate the impact of the sleep position after the repositioning maneuver on BPPV recurrence.Methods150 unilateral BPPV patients who were treated by repositioning maneuver were distributed into two groups. The patients in group A were instructed to sleep in a semi-sitting position at an angle of approximately 30 degrees and refrain from sleeping on their BPPV affected side for one week. The patients in group B were told to sleep in any preferred position. The comparison of recurrence rates according to different actual sleep positions in one week and one month was performed.ResultsThere was a statistically significant correlation between the sleeping side and the side affected by BPPV. Without instructions on postural restriction, most patients (82.9%, 73/88) avoided sleeping on their affected side. The patients sleeping on their affected side had a higher recurrence rate (35.3%) than ones sleeping in other positions in the first week after the repositioning maneuver (p<0.05, Chi-square test and Fisher's exact test). The patients sleeping randomly in following 3 weeks had a lower recurrence rate than ones sleeping in other position (p<0.05, Fisher's exact test).ConclusionsBPPV patients had a poor compliance to postural instructions. The habitual sleep side was associated with the side affected by BPPV. The patients sleeping on their affected side had a higher recurrence rate than those sleeping in other positions in first week after the repositioning maneuver.

The long-term follow-up of 61 horizontal canal BPPV after Gufoni and Barbecue maneuver: a prospective study

“…All the patients in our study are instructed with the postural restriction (avoid sudden head movements and lying on their affected side) in at least three days after the CRM, in order to prevent canalith from going back to the affected canal. There are some reports that show postural restrictions appeared significant as a post-treatment instruction [15], while some others show it did not affect the outcomes of CRM, as well as the recurrence rate [16]. There are also some reports about canal conversions after reposition.…”

Clinical Characteristics of Patients With Benign Paroxysmal Positional Vertigo Diagnosed Based on the Diagnostic Criteria of the Bárány Society

“…BPPV is characterized by positional vertigo and nystagmus that is triggered by changing head position, i.e., otoliths that detached from utricle are dropped into the canal and move along with gravity when head position changes ( 2 ). According to anatomical structures, BPPV can be divided into posterior canal BPPV (PC-BPPV), horizontal canal BPPV (HC-BPPV), anterior canal BPPV (AC-BPPV), and multiple canal BPPV (MC-BPPV) ( 3 ). PC-BPPV and HC-BPPV are more prevalent, and AC-BPPV is very rare ( 4 ).…”

Postural Restriction in Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial

“…[8][9][10][11][12] Further, a more recent clinical practice guideline did not recommend the routine application of postural restrictions after the CRP. 4 By contrast, Li et al 13 reported a higher recurrence rate in patients who sleep on the affected side, or who sleep in any preferred position compared with those instructed to sleep in the semi-sitting position; and refrain from sleeping on the affected side. Shim et al 14 also reported that the preferred head-lying side at the beginning of sleep correlated with the affected side by BPPV.…”