Obstructive Sleep Apnea and Sensorineural Hearing Loss: A Systematic Review and Meta‐analysis

Abstract

Objectives To evaluate the associations between obstructive sleep apnea (OSA) and sensorineural hearing loss (SNHL) and the effects of continuous positive airway pressure (CPAP) therapy on SNHL. Data Sources Ovid Medline, Embase, and Scopus databases. Review Methods A systematic search was done for studies investigating relationships between OSA and SNHL in adults, with manual searches for additional references. The final update was done on December 22, 2021. The Risk of Bias Assessment Tool for Nonrandomized Studies was applied for quality assessments. Results The 20 included studies had a total of 34,442 participants (66% male; mean age, 46.6 years). The OSA group had a significantly worse mean hearing threshold level (HTL) than the control group for midfrequency ranges (500, 1000, 2000 Hz; mean difference, 4.00 dB; 95% CI, 2.40-5.61) and high-frequency ranges (4000, 8000 Hz; mean difference, 6.24 dB; 95% CI, 2.99-9.49). An association between OSA and SNHL was found. When compared with controls, patients with OSA had an odds ratio of 1.52 (95% CI, 1.12-2.06) for midfrequency hearing impairment and 1.19 (95% CI, 1.05-1.34) for high-frequency hearing impairment. However, we did not find significant improvements in midfrequency HTL after CPAP therapy. Conclusions HTL was significantly poorer among participants with OSA (especially in severe cases) than non-OSA controls. Studies on patients with OSA with SNHL treated with CPAP did not show significant improvements in midfrequency HTL. Further studies are warranted on these issues.

Consideration of health inequity in systematic reviews and primary studies on risk factors for hearing loss

“…A total of 11 reviews (64.71%) reported personal characteristics associated with discrimination at baseline (all relating to age) [38–41, 43, 44, 47, 49, 51–53], and three reviews (17.65%) reported data relating to personal characteristics associated with discrimination in the analysis of results (including one review which reported disability and two which reported age) (see Table 3) [38, 50, 53]. Less than half of SRs reported the gender of participants at baseline ( n = 7, 41.18%) [38, 40, 41, 43, 47, 49, 51], and two reported data relating to the gender of participants in the analysis of results (11.76%) (see Table 3) [38, 53]. Occupation was reported at baseline and in the analysis of results in three reviews (17.65%) [38, 51, 53].…”

“…Of the 64 SRs included in Briscoe et al [35], 17 met the inclusion criteria for this secondary analysis (see Table 2) [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. Of these, seven were published in 2021, and 10 were published in 2022.…”

“…Of the 17 included SRs, 10 considered physiological risk factors for hearing loss [38][39][40][41][42][43][44][45][46][47], four considered environmental risk factors [52][53][54], two considered demographic risk factors [49,50], and one considered behavioral risk factors [48]. Of the 251 primary studies, 248 were observational studies, and three were RCTs.…”

“…The occupation was the next most frequently reported data, including at baseline in 81 studies (32.66%) and in the results of 69 studies (27.82%) (see Table 3). All 17 SRs included studies which reported gender and personal characteristics at baseline, and 15 SRs included studies which reported gender and personal characteristics in the analysis of results, although in some reviews the latter was in a small proportion of included studies [38,[41][42][43][44][45][46][47][48][49][50][51][52][53][54]. Studies reporting data on occupation were included in a total of eight SRs [38,42,45,48,49,51,53,54].…”

Association of Sleep Characteristics with Tinnitus and Hearing Loss

“…A few prior studies have investigated the potential role of treatment for sleep disorders such as OSA on hearing and tinnitus. A meta‐analyses of 20 cohort, case‐control, and cross‐sectional studies that diagnosed OSA by polysomnography or sleep tests and hearing threshold level totaling 33,391 adult patients found that continuous positive airway pressure (CPAP) treatment for OSA did not show improvement in audiometry‐measured hearing loss 54 . In contrast, a prior non‐randomized, noncontrolled study assessing the impact of CPAP treatment on tinnitus found that the Tinnitus Handicap Inventory scores significantly decreased with CPAP use after 3 months for 14 patients with sleep‐disorder breathing and tinnitus symptoms 55 .…”