Sleep in Different Types of Dizziness

Sleep disturbances and dizziness are frequently comorbid, yet the specific sleep profiles across different vestibular disorders remain poorly characterized. This study aimed to investigate distinct sleep signatures in patients with benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), and persistent postural-perceptual dizziness (PPPD) compared to healthy controls.

We conducted a cross-sectional study with 90 participants: 24 healthy controls, 21 with BPPV, 23 with PPPD, and 22 with VM. Sleep was assessed using a multimodal approach: 14-day actigraphy, a single-night home sleep apnea test (Watch-PAT), and validated questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Dizziness Handicap Inventory (DHI), and Beck Anxiety/Depression Inventories.

All dizziness groups reported significantly worse subjective sleep quality and higher psychological burden than controls. However, each disorder presented a unique objective signature: BPPV: Characterized by objective sleep fragmentation and a markedly higher Apnea-Hypopnea Index (AHI: 31.5) and Oxygen Desaturation Index (ODI: 16). These patients also showed increased nocturnal restlessness (L5). PPPD: Demonstrated a "sleep paradox" with the highest objective sleep efficiency but the poorest subjective perception (PSQI: 11.0). Patients showed reduced daytime activity (M10) and rigid sleep routines with virtually no weekend-weekday get-up time difference. VM: Distinguished by the shortest total sleep time and pronounced, though not statistically significant, "social jetlag", reflected by a 120-min discrepancy between weekend and weekday get-up times.

Dizziness is not a homogeneous entity regarding sleep. The distinct signatures found suggest that clinical management should be tailored: screening for sleep apnea in BPPV, addressing the objective-subjective disconnect in PPPD via cognitive-behavioral approaches, and managing sleep deprivation and circadian regularity in VM.