Sleep and Breathing

, Volume 16, Issue 2, pp 413–417 | Cite as

Is obstructive sleep apnea syndrome a risk factor for auditory pathway?

  • Manuele Casale
  • Emanuela Vesperini
  • Massimiliano Potena
  • Marco Pappacena
  • Federica Bressi
  • Peter Jarden Baptista
  • Fabrizio Salvinelli
Original Article



The transduction mechanism of the inner ear and the transmission of nerve impulses along the auditory way are highly dependent upon the cochlear oxygen supply. Several studies have considered the possibility that obstructive sleep apnea–hypopneas during sleep can interfere with these processes, and the results are not uniform. The aim of the study is to evaluate the auditory function in adult patients affected by severe obstructive sleep apnea syndrome (OSAS).


Thirty-nine patients in this study were included and divided in OSAS group, with severe OSAS (Apnea–Hypopnea Index, AHI > 30), and control group with snoring without OSAS (AHI < 5). Each patient was subjected to pure-tone audiogram (PTA), otoacoustic emission (OAE), and brainstem auditory evoked potentials.


The OSAS group showed a PTA significantly higher than the control group (14.23 ± 6.25 vs. 7.45 ± 2.54; p < 0.01), a lower TEOAE reproducibility (0.57 ± 0.10 vs. 0.92 ± 0.10; p < 0.01) such as a lower signal-to-noise 0atio (p < 0,01) and a lower DPOAE amplitude (5.96 ± 6.34; 13.18 ± 2.97; p < 0.01). The mean latencies of waves I, III, and V were prolonged in OSAS group as compared to the healthy people, especially for wave V (p < 0.05). The interpeak latency (IPL) of I–V was significantly higher (p < 0.01) in the OSAS patients (5.84 ± 0.15) as compared to the control group (5.4 ± 0.12), such as IPLs I–III and III–V (p < 0.05).


Our data showed an auditory dysfunction in patients affected by severe OSAS, suggesting that severe OSAS could represent a risk factor for auditory pathway.


Hypoxia Obstructive sleep apnea syndrome Auditory brainstem response Otoacoustic emissions Audiometry 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373:82–93PubMedCrossRefGoogle Scholar
  2. 2.
    Redline S, Tishler P (2003) The genetics of sleep apnea. Sleep Med Rev 4:583–602CrossRefGoogle Scholar
  3. 3.
    Fletcher EC (1995) The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. Am J Med 98:118–128PubMedCrossRefGoogle Scholar
  4. 4.
    Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RS, Bradley TD (2001) High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 19:2271–2277PubMedCrossRefGoogle Scholar
  5. 5.
    Hui DS, Choy DK, Wong LK, Ko FW, Li TS, Woo J, Kay R (2002) Prevalence of sleep disordered breathing and continuous positive airway pressure compliance: results in Chinese patients with first-ever ischemic stroke. Chest 122:852–860PubMedCrossRefGoogle Scholar
  6. 6.
    Hui DS, Wong TY, Ko FW, Li TS, Choy DK, Wong KK, Szeto CC, Lui SF, Li PK (2000) Prevalence of sleep disturbances in Chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 36:783–788PubMedCrossRefGoogle Scholar
  7. 7.
    Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA (1998) Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences and presentations. Circulation 97:2154–2159PubMedGoogle Scholar
  8. 8.
    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 38:766–773PubMedCrossRefGoogle Scholar
  9. 9.
    Gozal D, Kheirandish-Gozal L (2008) Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. Am J Respir Crit Care Med 177:369–375PubMedCrossRefGoogle Scholar
  10. 10.
    Fanfulla F, Grassi M, Taurino AE, Lupo ND, Trentin R (2008) The relationship of daytime hypoxemia and nocturnal hypoxia in obstructive sleep apnea syndrome. Sleep 31(2):249–255PubMedGoogle Scholar
  11. 11.
    Colrain IM, Campbell KB (2007) The use of evoked potentials in sleep research. Sleep Med Rev August 11(4):277–293CrossRefGoogle Scholar
  12. 12.
    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 3:128–134CrossRefGoogle Scholar
  13. 13.
    Ni D (1991) Auditory brain-stem response in obstructive sleep apnea syndrome. Zhonghua Er Bi Yan Hou Ke Za Zhi 26(284–6):317Google Scholar
  14. 14.
    Van Dijk P, Wit HP (1987) The occurrence of click-evoked oto-acoustic emissions (“Kemp echoes”) in normal-hearing ears. Scand Audiol 16:62–64PubMedCrossRefGoogle Scholar
  15. 15.
    Bonfils P, Avan P (1992) Distortion-product otoacoustic emissions. Values for clinical use. Arch Otolaryngol Head Neck Surg 118:1069–1076PubMedCrossRefGoogle Scholar
  16. 16.
    Gaskill SA, Brown AM (1990) The behavior of the acoustic distortion product, 2f1-f2, from the human ear and its relation to auditory sensitivity. J Acoust Soc Am 88:821–839PubMedCrossRefGoogle Scholar
  17. 17.
    Celesia GG, Bodis-Wollner I, Chatrian GE, Harding GF, Sokol S, Spekreijse H (1993) Recommended standards for electroretinograms and Visual evoked potentials: report of an IFCN committee. Electroencephalogr Clin Neurophysiol 87:421–436PubMedCrossRefGoogle Scholar
  18. 18.
    Mishra UK, Kalita J (2004) Clinical neurophysiology, 1st edn. Reed Elsevier India Private Limited, New Delhi, pp 267–286Google Scholar
  19. 19.
    Carlile S, Paterson DJ (1992) The effects of chronic hypoxia on human auditory system sensitivity. Aviat Space Environ Med 63:1093–1097PubMedGoogle Scholar
  20. 20.
    Mazurek B, Haupt H, Georgiewa P, Klapp BF, Reisshauer A (2006) A model of peripherally developing hearing loss and tinnitus based on the role of hypoxia and ischemia. Med Hypotheses 67:892–899PubMedCrossRefGoogle Scholar
  21. 21.
    Gafni M, Sohmer H (1976) Intermediate endocochlear potential levels induced by hypoxia. Acta Otolaryngol 82:354–358PubMedCrossRefGoogle Scholar
  22. 22.
    She WD, Zhang Q, Chen F, Jiang P, Wang J (2004) Peri-uvulopalatopharyngoplasty otoacoustic emissions in patients with obstructive sleep apnea-hypopnea syndrome. Zhonghua Er Bi Yan Hou Ke Za Zhi 39:48–51PubMedGoogle Scholar
  23. 23.
    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 155:1–8PubMedCrossRefGoogle Scholar
  24. 24.
    Fischer Y, Yakinthou A, Mann WJ (2003) Prevalence of obstructive sleep apnea syndrome (OSA) in patients with sudden hearing loss. A pilot study. HNO 51:462–466PubMedCrossRefGoogle Scholar
  25. 25.
    Mehra R, Redline S (2008) Sleep apnea: a proinflammatory disorder that coaggregates with obesity. J Allergy Clin Immunol 121(5):1096–1102PubMedCrossRefGoogle Scholar
  26. 26.
    Chung S, Yoon IY, Lee CH, Kim JW (2010) The association of nocturnal hypoxemia with arterial stiffness and endothelial dysfunction in male patients with obstructive sleep apnea syndrome. Respiration 79(5):363–369PubMedCrossRefGoogle Scholar
  27. 27.
    Sohmer H, Freeman S, Schmuel M (1989) ABR threshold is a function of blood oxygen level. Hear Res 40:87–92PubMedCrossRefGoogle Scholar
  28. 28.
    Muchnik C, Rubel Y, Zohar Y, Hildesheimer M (1995) Auditory brainstem response in obstructive sleep apnea patients. J Basic Clin Physiol Pharmacol 6:139–148PubMedCrossRefGoogle Scholar
  29. 29.
    El-Kady MA, Durrant JD, Tawfik S, Abdel-Ghany S, Moussa AM (2006) Study of auditory function in patients with chronic obstructive pulmonary diseases. Hear Res 212:109–116PubMedCrossRefGoogle Scholar
  30. 30.
    Miyamoto T, Miyamoto M, Takekawa H, Kubo J, Hirata K, Katayama S (2001) A comparison of middle latency auditory-evoked response in obstructive sleep apnea syndrome before and after treatment. Psychiatry Clin Neurosci 55:251–252PubMedCrossRefGoogle Scholar
  31. 31.
    Dziewas R, Schilling M, Engel P, Boentert M, Hor H, Okegwo A, Lüdemann P, Ringelstein EB, Young P (2007) Treatment for obstructive sleep apnoea: effect on peripheral nerve function. J Neurol Neurosurg Psychiatr 78:295–297PubMedCrossRefGoogle Scholar
  32. 32.
    Pfeifer G, Kunze K, Bruch M, Kutzner M, Ladurner G, Malin JP (1990) Polyneuropathy associated with chronic hypoxaemia: prevalence in patients with chronic obstructive pulmonary disease. J Neurol 237:230–233CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Manuele Casale
    • 1
  • Emanuela Vesperini
    • 1
  • Massimiliano Potena
    • 1
  • Marco Pappacena
    • 1
  • Federica Bressi
    • 1
  • Peter Jarden Baptista
    • 2
  • Fabrizio Salvinelli
    • 1
  1. 1.Area of OtolaryngologyCampus Bio-Medico UniversityRomeItaly
  2. 2.Departamento de OtorrinolaringologíaClínica Universitaria de NavarraPamplonaSpain

Personalised recommendations