Heart Rate Variability in Benign Paroxysmal Positional Vertigo

Istanbul Aydın University104 enrolled

Overview

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. Although the pathophysiology of BPPV is mainly attributed to the displacement of otoconia within the semicircular canals, recent studies suggest that psychological stress and anxiety may be associated with the onset or recurrence of the disease. However, the biological mechanisms underlying this relationship remain poorly understood, and objective evaluation of autonomic nervous system function in patients with BPPV is limited. Heart rate variability (HRV) is a non-invasive method widely used to assess autonomic nervous system activity. Short-term HRV measurements provide information about autonomic balance and vagal tone. In particular, parameters such as the root mean square of successive differences (RMSSD) and the coefficient of variation of RR intervals (COV RR/R) are considered indicators of parasympathetic activity. The aim of this prospective case-control study is to evaluate vagal tone in patients with BPPV using short-term HRV analysis and to compare the findings with age-, sex-, and body mass index-matched healthy controls. Participants will undergo standardized HRV measurements at rest and during controlled breathing. Perceived stress levels will also be assessed using the Perceived Stress Scale (PSS-10). The primary outcomes of the study are RMSSD and the coefficient of variation of RR intervals (COV RR/R), obtained from short-term HRV recordings. These parameters will be compared between BPPV patients and healthy controls, and their associations with perceived stress levels will also be explored. The findings of this study may provide insights into the role of autonomic regulation and stress-related mechanisms in the pathophysiology of BPPV.

Study Type

OBSERVATIONAL

Enrollment

104

Conditions

BPPV Stress and Anxiety

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * BPPV Group Age 18 years or older Clinical diagnosis of benign paroxysmal positional vertigo (BPPV) confirmed by positional testing (Dix-Hallpike and/or Roll test) with positional nystagmus No known history of cardiac disease Ability and willingness to provide written informed consent Healthy Control Group Age 18 years or older No history of vertigo or known vestibular disorder Age- and sex-matched to the BPPV group No known history of cardiac disease Ability and willingness to provide written informed consent Exclusion Criteria: * Age younger than 18 years Inability to provide informed consent or impaired mental capacity Known arrhythmia, heart failure, ischemic heart disease, or other clinically significant cardiac disorder Use of medications that may directly affect heart rate variability, including beta-blockers, non-dihydropyridine calcium channel blockers, antiarrhythmic drugs, digoxin, systemic corticosteroids, centrally acting sympatholytic agents, or psychotropic medications that may influence autonomic balance Active infection or systemic inflammatory disease

Outcomes

Primary Outcomes

Root Mean Square of Successive Differences (RMSSD)

Root Mean Square of Successive Differences (RMSSD), expressed in milliseconds (ms), obtained from short-term heart rate variability recordings using the UltraPro S100 EMG/NCS/EP Neurodiagnostic System. RR interval variability will be recorded through hand electrodes during two conditions: resting state and controlled breathing (6 breaths per minute for 60 seconds). RMSSD values will be compared between patients with benign paroxysmal positional vertigo (BPPV) and healthy control participants.

Time frame: Baseline (At the time of HRV assessment (single visit))

Coefficient of Variation of RR Intervals (COV RR)

Coefficient of variation of RR intervals (COV RR), expressed as percentage (%), derived from short-term heart rate variability recordings using the UltraPro S100 EMG/NCS/EP Neurodiagnostic System. RR interval variability will be recorded through hand electrodes during resting conditions and controlled breathing (6 breaths per minute for 60 seconds). COV RR values will be compared between patients with benign paroxysmal positional vertigo (BPPV) and healthy controls.

Time frame: Baseline (At the time of HRV assessment (single visit))

Secondary Outcomes

Change in RMSSD During Controlled Breathing (ΔRMSSD)

Change in Root Mean Square of Successive Differences (ΔRMSSD), expressed in milliseconds (ms), calculated as the difference between RMSSD measured during resting conditions and RMSSD measured during controlled breathing (6 breaths per minute for 60 seconds). This measure reflects vagal reserve and autonomic responsiveness.

Time frame: Baseline (single HRV assessment visit)

Change in COV RR During Controlled Breathing (ΔCOV RR)

Change in the coefficient of variation of RR intervals (ΔCOV RR), expressed as percentage points (%), calculated as the difference between COV RR measured during resting conditions and during controlled breathing (6 breaths per minute for 60 seconds).