Association Between Sleep and Vertigo Severity in Benign Paroxysmal Positional Vertigo: Mediating Role of Psychological Factors.

Objective: To investigate the relationship between sleep quality and vertigo severity among patients with benign paroxysmal positional vertigo (BPPV) and to elucidate the mediating effects of anxiety and depression on this association.

Methods: We analyzed baseline data from an ongoing cohort study of 1056 BPPV patients in Northwest China. Vertigo severity was assessed using the Dizziness Handicap Inventory (DHI), sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), and psychological states were evaluated using the Hospital Anxiety and Depression Scale (HADS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Multiple regression and mediation analysis were conducted to explore the relationships between sleep quality, psychological factors, and vertigo severity.

Results: Robust correlations were demonstrated between total PSQI scores and all DHI subscales (p < 0.001). Multivariate ordered logistic regression revealed that patients exhibiting sleep disorders manifested a substantially elevated risk of severe vertigo compared to those without (OR: 2.024; 95% CI: 1.571-2.608). Psychological factors emerged as significant mediators in this relationship, with anxiety accounting for 28.5% of the mediation effect, depression contributing 38%, and HADS mediating 37.7% of the association. A pronounced dose-response relationship was noted, with increased risk of vertigo severity as PSQI scores exceeded 7.

Conclusion: This study shows a strong correlation between poor sleep quality and increased vertigo severity in BPPV patients, with anxiety and depression as significant mediators. These findings emphasize the need to address sleep-related factors and psychological symptoms in BPPV management, suggesting integrated sleep therapy and psychological interventions.