Investigation of sleep position and triggered movement in patients with benign paroxysmal positional vertigo
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摘要: 目的 探讨良性阵发性位置性眩晕(BPPV)患者的习惯睡眠姿势、眩晕诱发体位等特点。方法 调查446例确诊为特发性管石型BPPV并复位成功的患者，分析耳石脱落的侧别、管别与习惯睡眠姿势、眩晕诱发体位的关系。结果 ① 446例患者中，女性所占比例最高(319例，占71.5%)，41~60岁组所占比例最高(192例，占43.0%)，后半规管所占比例最高(289例，占64.8%); ②病变侧别与习惯睡眠姿势有关(P < 0.05，ES=0.392)，常采用左侧或右侧卧位者同侧耳发病更多见; ③病变管别间的诱发体位差异有统计学意义(P < 0.05，ES=0.380)，多半规管、水平半规管和后半规管BPPV均更多见多个体位变化诱发眩晕及眼震。结论 在接诊疑似BPPV患者时，应重视病史采集包括习惯睡姿姿势、诱发体位等来预测病变侧别和管别，滚转试验及Dix-Hallpike试验相结合更利于准确判别耳石脱落的位置。Abstract: Objective To investigate the characteristics of habitual sleeping position and triggered movement in patients with benign paroxysmal positional vertigo(BPPV).Methods The patients with idiopathic tubulitic BPPV who the symptoms were relieved after repositioning were enrolled in this study. The relationship between the side, the tube of otolith detachment and habitual sleeping position and triggered movement was analyzed.Results ① Among the 446 patients, female gender predominated(319 cases, 71.5%), 41-60 years old group accounted for the highest proportion(192 cases, 43.0%), and posterior semicircular canal patients accounted for the highest proportion(289 cases, 64.8%); ②The affected side was associated with habitual sleep postion(P < 0.05, ES=0.392), ipsilateral ear was more common in left or right decubitus; ③There were statistically significant differences in the triggered movement in different types of BPPV(P < 0.05, ES=0.380), BPPV of multiple semicircular canals. Horizontal semicircular canals and posterior semicircular canals were more likely to induce vertigo and nystagmus.Conclusion Habitual sleeping position and triggered movement could be collected during the diagnosis of BPPV, to predict the affected side and tube. The combination of Roll test and Dix-Hallpike test is more conducive to accurately distinguish the location of otolith shedding.
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Key words:
- vertigo /
- sleep position /
- induced position
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表 1 病变侧别与习惯睡眠姿势
例(%) 习惯睡眠姿势 左侧半规管 右侧半规管 合计 仰卧位 22(45.8) 26(54.2) 48(10.8) 左侧卧位 89(78.1)1) 25(21.9)1) 114(25.6) 右侧卧位 43(28.3)1)2)3) 109(71.7)1)2)3) 152(34.1) 双侧交替卧位 52(39.4) 80(60.6) 132(29.6) 合计 206(46.2) 240(53.8) 446(100.0) 与仰卧位比较，1)P < 0.05;与双侧交替卧位比较，2)P < 0.05; 与左侧卧位比较，3)P < 0.05。 
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表 2 病变管别与习惯睡眠姿势
例(%) 睡姿 前半规管 水平半规管 后半规管 多半规管 合计 仰卧位 1(2.1) 15(31.2) 31(64.6) 1(2.1) 48(10.8) 左侧卧位 3(2.6) 41(36.0) 67(58.8) 3(2.6) 114(25.6) 右侧卧位 6(3.9) 33(21.7) 105(69.1) 8(5.3) 152(34.1) 双侧交替卧位 4(3.0) 36(27.3) 86(65.2) 6(4.5) 132(29.6) 合计 14(3.1) 125(28.0) 289(64.8) 18(4.0) 446(100.0)
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表 3 病变管别与诱发体位
例(%) 诱发体位 例数 垂直位活动诱发 水平位活动诱发 垂直位+水平位活动诱发 只有起床 只有躺下 起床+躺下 垂直位活动合计 只有翻身 起床或(和)躺下+翻身 水平半规管 125 0(0) 0(0) 0(0) 0(0) 10(8.0) 115(92.0) 前半规管 14 2(14.3) 3(21.4) 4(28.6) 9(64.3)1) 0(0) 5(35.7)1) 后半规管 289 0(0) 4(1.4) 107(37.0) 111(38.4)1) 0(0) 178(61.6)1) 多半规管 18 0(0) 0(0) 0(0) 0(0) 0(0) 18(100.0) 合计 446 2(0.4) 7(1.6) 111(24.9) 120(26.9) 10(2.2) 316(70.9) 与水平半规管BPPV诱发体位比较，1)P < 0.05。
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