Benign Paroxysmal Positional Vertigo: A Systematic Review of the Effects of Comorbidities

Abstract

Background Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders, characterised by episodic vertigo provoked by head movement. Its prevalence increases with age, as does the occurrence of other chronic health conditions. BPPV has been reported to be associated with serum vitamin D deficiency, osteoporosis, hypertension, diabetes mellitus and cholesterol levels. It can severely impact the quality of life by reducing physical activity and increasing the risk of falls. BPPV is treated with canalith-repositioning procedures (CRPs). Although the treatment is relatively successful, its efficacy on the first attempt varies among patients. Evidence suggests that the underlying aetiology of BPPV may affect the treatment outcomes, delaying recovery. Several studies have examined the influence of risk factors and comorbidities on BPPV occurrence and the efficacy of initial CRPs. However, the findings are relatively controversial. Objective The objective of this study was to identify the comorbidities associated with BPPV occurrence and explore the influence of such comorbidities on the success of initial CRPs. Methods The electronic databases PubMed, Scopus, Web of Science, Embase, MEDLINE and CINAHL were systematically searched using the same relevant terms to identify eligible English original studies published from January 2019 to June 2024. All search results were reviewed based on our inclusion and exclusion criteria. A meta-analysis was not conducted due to the specific objective of our investigation. Therefore, we opted for a narrative synthesis to capture the detailed relationships and context- specific outcomes, providing a comprehensive examination of the existing literature. Results Of the 463 studies identified, 50 studies that satisfied the inclusion criteria were included and analysed, with their data extracted into a table. Among the included studies, 18 focused on BPPV occurrence, 24 on the initial-CRP outcome and eight on both BPPV occurrence and the initial-CRP outcome. The risk of bias was then assessed, classifying 30 studies as having a low risk, 18 studies as having an unclear risk and two studies as having a high risk. Twenty-eight risk factors and comorbidities were identified to be associated with BPPV occurrence, and 15 were noted to impact the efficacy of the initial CRP. Conclusions BPPV occurrence is associated with hypertension, anaemia, hyperlipidaemia, dyslipidaemia, stroke, diabetes mellitus, hypothyroidism, anxiety, obsessive– compulsive disorder, migraine, labyrinthitis, neuritis, Meniere’s disease, sleep disorder, peripheral neuropathy, osteopenia, osteoporosis, cervical spondylosis, head trauma, serum vitamin D levels, ischaemic and coronary heart diseases, hypotension, body mass indices and sensorineural hearing loss (SNHL). Conversely, the risk factors and comorbidities associated with poor prognosis of initial CRPs are hypertension, coronary heart disease, hyperlipidaemia, dyslipidaemia, stroke, diabetes mellitus, hypothyroidism, migraine, SNHL, osteoporosis, reduced cervical mobility, neck pain, head trauma, serum vitamin D levels and idiopathic BPPV. Identifying and addressing these risk factors and comorbidities associated with BPPV holds the potential to significantly enhance clinical practice. Protective management of these factors may contribute to the prevention of BPPV development and recurrence rate. Furthermore, identifying high-risk populations could aid in predicting the success of initial CRP while determining the likelihood of repeated sessions potentially improving clinical outcomes and decreasing the frequency of follow-up visits. Large- scale studies and a meta-analysis of these risk factors are needed to confirm the reliability of these results.