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Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study

Authors: Zi-Jun Chen, Cheng-Ho Chang, Li-Yu Hu, Ming-Shium Tu, Ti Lu, Pan-Ming Chen, Cheng-Che Shen

Published in: BMC Psychiatry | Issue 1/2016

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Abstract

Background

The objective of this study was to evaluate the risk of benign peripheral persistent vertigo (BPPV) among patients with anxiety disorders by using the Taiwan National Health Insurance Research Database (NHIRD).

Methods

We conducted a retrospective study of 15,470 participants (7735 anxiety disorder patients and 7735 control patients) selected from the NHIRD. Patients were observed for a maximum of 9 years to determine the rates of newly diagnosed BPPV. A Cox regression model was used to evaluate the risk of BPPV among the patients with anxiety disorders.

Results

During the 9-year follow-up period, 178 (2.05 per 1000 person-years) anxiety disorder patients and 71 (0.81 per 1000 person-years) control patients were diagnosed with BPPV. The incidence risk ratio of BPPV between anxiety disorder patients and control patients was 2.52 (95 % confidence interval [CI], 1.90–3.37, P < .001). After adjustment for age, sex, and comorbidities, patients with anxiety disorders were found to be 2.17 times more likely to develop BPPV (95 % CI, 1.63–2.90, P < .001) than the control patients. Furthermore, female sex (HR = 1.81, 95 % CI, 1.31–2.50, P < .001) and cerebrovascular disease (HR = 1.53, 95 % CI, 1.00–2.34, P = .050) were independent risk factors for developing new-onset BPPV in patients with anxiety disorders.

Conclusions

Anxiety disorder patients may have an increased risk of developing BPPV, especially those who are female or have cerebrovascular disease.
Literature
1.
go back to reference Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17:327–35.PubMedPubMedCentral Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17:327–35.PubMedPubMedCentral
2.
go back to reference Alonso J, Lepine JP. Overview of key data from the European Study of the Epidemiology of Mental Disorders (ESEMeD). J Clin Psychiatry. 2007;68 Suppl 2:3–9.PubMed Alonso J, Lepine JP. Overview of key data from the European Study of the Epidemiology of Mental Disorders (ESEMeD). J Clin Psychiatry. 2007;68 Suppl 2:3–9.PubMed
3.
go back to reference American Psychiatric Association. Anxiety disorders. In: American Psychiatric Association, editor. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington: American Psychiatric Association; 2013. p. 189–233. American Psychiatric Association. Anxiety disorders. In: American Psychiatric Association, editor. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington: American Psychiatric Association; 2013. p. 189–233.
4.
go back to reference Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry. 2005;162:1171–8.CrossRefPubMed Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry. 2005;162:1171–8.CrossRefPubMed
5.
go back to reference Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe--a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol. 2005;15:357–76.CrossRefPubMed Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe--a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol. 2005;15:357–76.CrossRefPubMed
6.
go back to reference Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med. 2014;370:1138–47.CrossRefPubMed Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med. 2014;370:1138–47.CrossRefPubMed
7.
go back to reference De Stefano A, Dispenza F, Suarez H, Perez-Fernandez N, Manrique-Huarte R, Ban JH, et al. A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. Auris Nasus Larynx. 2014;41:31–6.CrossRefPubMed De Stefano A, Dispenza F, Suarez H, Perez-Fernandez N, Manrique-Huarte R, Ban JH, et al. A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. Auris Nasus Larynx. 2014;41:31–6.CrossRefPubMed
9.
go back to reference Sari K, Yildirim T, Borekci H, Akin I, Aydin R, Ozkiris M. The relationship between benign paroxysmal positional vertigo and thyroid autoimmunity. Acta Otolaryngol. 2015;135:754–7.CrossRefPubMed Sari K, Yildirim T, Borekci H, Akin I, Aydin R, Ozkiris M. The relationship between benign paroxysmal positional vertigo and thyroid autoimmunity. Acta Otolaryngol. 2015;135:754–7.CrossRefPubMed
10.
go back to reference Wada M, Naganuma H, Tokumasu K, Hashimoto S, Ito A, Okamoto M. Arteriosclerotic changes as background factors in patients with peripheral vestibular disorders. Int Tinnitus J. 2008;14:131–4.PubMed Wada M, Naganuma H, Tokumasu K, Hashimoto S, Ito A, Okamoto M. Arteriosclerotic changes as background factors in patients with peripheral vestibular disorders. Int Tinnitus J. 2008;14:131–4.PubMed
11.
go back to reference Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology. 1987;37:371–8.CrossRefPubMed Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology. 1987;37:371–8.CrossRefPubMed
12.
go back to reference Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122:647–52.PubMed Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122:647–52.PubMed
13.
go back to reference Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Finana M. Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol. 2005;262:507–11.CrossRefPubMed Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Finana M. Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol. 2005;262:507–11.CrossRefPubMed
14.
go back to reference von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710–5.CrossRef von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710–5.CrossRef
15.
go back to reference Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47–81.CrossRefPubMed Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47–81.CrossRefPubMed
16.
go back to reference Monzani D, Genovese E, Rovatti V, Malagoli ML, Rigatelli M, Guidetti G. Life events and benign paroxysmal positional vertigo: a case-controlled study. Acta Otolaryngol. 2006;126:987–92.CrossRefPubMed Monzani D, Genovese E, Rovatti V, Malagoli ML, Rigatelli M, Guidetti G. Life events and benign paroxysmal positional vertigo: a case-controlled study. Acta Otolaryngol. 2006;126:987–92.CrossRefPubMed
17.
go back to reference Cheng TM. Taiwan’s new national health insurance program: genesis and experience so far. Health Aff (Millwood). 2003;22:61–76.CrossRef Cheng TM. Taiwan’s new national health insurance program: genesis and experience so far. Health Aff (Millwood). 2003;22:61–76.CrossRef
18.
go back to reference Yang NP, Lin T, Wang CS, Chou P. Community-based survey of low quantitative ultrasound values of calcaneus in Taiwan. J Clin Densitom. 2003;6:131–41.CrossRefPubMed Yang NP, Lin T, Wang CS, Chou P. Community-based survey of low quantitative ultrasound values of calcaneus in Taiwan. J Clin Densitom. 2003;6:131–41.CrossRefPubMed
19.
go back to reference Clark MR, Sullivan MD, Katon WJ, Russo JE, Fischl M, Dobie RA, et al. Psychiatric and medical factors associated with disability in patients with dizziness. Psychosomatics. 1993;34:409–15.CrossRefPubMed Clark MR, Sullivan MD, Katon WJ, Russo JE, Fischl M, Dobie RA, et al. Psychiatric and medical factors associated with disability in patients with dizziness. Psychosomatics. 1993;34:409–15.CrossRefPubMed
20.
go back to reference Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord. 2003;17:369–88.CrossRefPubMed Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord. 2003;17:369–88.CrossRefPubMed
21.
go back to reference Kirby SE, Yardley L. Cognitions associated with anxiety in Meniere’s disease. J Psychosom Res. 2009;66:111–8.CrossRefPubMed Kirby SE, Yardley L. Cognitions associated with anxiety in Meniere’s disease. J Psychosom Res. 2009;66:111–8.CrossRefPubMed
22.
go back to reference Godemann F, Linden M, Neu P, Heipp E, Dorr P. A prospective study on the course of anxiety after vestibular neuronitis. J Psychosom Res. 2004;56:351–4.CrossRefPubMed Godemann F, Linden M, Neu P, Heipp E, Dorr P. A prospective study on the course of anxiety after vestibular neuronitis. J Psychosom Res. 2004;56:351–4.CrossRefPubMed
23.
go back to reference Wiltink J, Tschan R, Michal M, Subic-Wrana C, Eckhardt-Henn A, Dieterich M, et al. Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey. J Psychosom Res. 2009;66:417–24.CrossRefPubMed Wiltink J, Tschan R, Michal M, Subic-Wrana C, Eckhardt-Henn A, Dieterich M, et al. Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey. J Psychosom Res. 2009;66:417–24.CrossRefPubMed
24.
go back to reference Best C, Tschan R, Eckhardt-Henn A, Dieterich M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience. 2009;164:1579–87.CrossRefPubMed Best C, Tschan R, Eckhardt-Henn A, Dieterich M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience. 2009;164:1579–87.CrossRefPubMed
25.
go back to reference Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope. 2003;113:1714–8.CrossRefPubMed Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope. 2003;113:1714–8.CrossRefPubMed
26.
go back to reference Cohen HS, Kimball KT, Stewart MG. Benign paroxysmal positional vertigo and comorbid conditions. ORL J Otorhinolaryngol Relat Spec. 2004;66:11–5.CrossRefPubMed Cohen HS, Kimball KT, Stewart MG. Benign paroxysmal positional vertigo and comorbid conditions. ORL J Otorhinolaryngol Relat Spec. 2004;66:11–5.CrossRefPubMed
27.
go back to reference Furman JM, Redfern MS, Jacob RG. Vestibulo-ocular function in anxiety disorders. J Vestib Res. 2006;16:209–15.PubMed Furman JM, Redfern MS, Jacob RG. Vestibulo-ocular function in anxiety disorders. J Vestib Res. 2006;16:209–15.PubMed
28.
go back to reference Xu Z, Zhao P, Yang X, Liu X, Chen X, Zhang S, et al. The hearing and vestibular evoked myogenic potentials test in patients with primary benign paroxysmal positional vertigo. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015;29:20–3.PubMed Xu Z, Zhao P, Yang X, Liu X, Chen X, Zhang S, et al. The hearing and vestibular evoked myogenic potentials test in patients with primary benign paroxysmal positional vertigo. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015;29:20–3.PubMed
29.
go back to reference Frohman EM, Kramer PD, Dewey RB, Kramer L, Frohman TC. Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. Mult Scler. 2003;9:250–5.CrossRefPubMed Frohman EM, Kramer PD, Dewey RB, Kramer L, Frohman TC. Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. Mult Scler. 2003;9:250–5.CrossRefPubMed
30.
go back to reference Oliveira Miranda D, de Lima TA S, Ribeiro Azevedo L, Feres O, da Rocha JJ R. Pereira-da-Silva G. Proinflammatory cytokines correlate with depression and anxiety in colorectal cancer patients. Biomed Res Int. 2014;2014:739650.CrossRefPubMedPubMedCentral Oliveira Miranda D, de Lima TA S, Ribeiro Azevedo L, Feres O, da Rocha JJ R. Pereira-da-Silva G. Proinflammatory cytokines correlate with depression and anxiety in colorectal cancer patients. Biomed Res Int. 2014;2014:739650.CrossRefPubMedPubMedCentral
31.
go back to reference Prather AA, Vogelzangs N, Penninx BW. Sleep duration, insomnia, and markers of systemic inflammation: results from the Netherlands Study of Depression and Anxiety (NESDA). J Psychiatr Res. 2015;60:95–102.CrossRefPubMed Prather AA, Vogelzangs N, Penninx BW. Sleep duration, insomnia, and markers of systemic inflammation: results from the Netherlands Study of Depression and Anxiety (NESDA). J Psychiatr Res. 2015;60:95–102.CrossRefPubMed
32.
go back to reference Kitaoka S, Furuyashiki T. Roles of inflammation-related molecules in emotional changes induced by repeated stress. Nihon Shinkei Seishin Yakurigaku Zasshi. 2014;34:109–15.PubMed Kitaoka S, Furuyashiki T. Roles of inflammation-related molecules in emotional changes induced by repeated stress. Nihon Shinkei Seishin Yakurigaku Zasshi. 2014;34:109–15.PubMed
33.
34.
go back to reference Gacek RR. Pathology of benign paroxysmal positional vertigo revisited. Ann Otol Rhinol Laryngol. 2003;112:574–82.CrossRefPubMed Gacek RR. Pathology of benign paroxysmal positional vertigo revisited. Ann Otol Rhinol Laryngol. 2003;112:574–82.CrossRefPubMed
35.
go back to reference Harada K, Oda M, Yamamoto M, Nomura T, Ohbayashi S, Kitsuda C. A clinical observation of benign paroxysmal positional vertigo (BPPV) after vestibular neuronitis (VN). Acta Otolaryngol Suppl. 1993;503:61–3.CrossRefPubMed Harada K, Oda M, Yamamoto M, Nomura T, Ohbayashi S, Kitsuda C. A clinical observation of benign paroxysmal positional vertigo (BPPV) after vestibular neuronitis (VN). Acta Otolaryngol Suppl. 1993;503:61–3.CrossRefPubMed
36.
go back to reference Juhn SK, Rybak LP, Prado S. Nature of blood-labyrinth barrier in experimental conditions. Ann Otol Rhinol Laryngol. 1981;90:135–41.CrossRefPubMed Juhn SK, Rybak LP, Prado S. Nature of blood-labyrinth barrier in experimental conditions. Ann Otol Rhinol Laryngol. 1981;90:135–41.CrossRefPubMed
37.
go back to reference Fuchs E, Flugge G. Chronic social stress: effects on limbic brain structures. Physiol Behav. 2003;79:417–27.CrossRefPubMed Fuchs E, Flugge G. Chronic social stress: effects on limbic brain structures. Physiol Behav. 2003;79:417–27.CrossRefPubMed
38.
go back to reference Horner KC, Cazals Y. Stress in hearing and balance in Meniere’s disease. Noise Health. 2003;5:29–34.PubMed Horner KC, Cazals Y. Stress in hearing and balance in Meniere’s disease. Noise Health. 2003;5:29–34.PubMed
39.
go back to reference Herdman SJ. Advances in the treatment of vestibular disorders. Phys Ther. 1997;77:602–18.PubMed Herdman SJ. Advances in the treatment of vestibular disorders. Phys Ther. 1997;77:602–18.PubMed
40.
go back to reference Hemenway WG, Lindsay JR. Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol Rhinol Laryngol. 1956;65:692–706.CrossRefPubMed Hemenway WG, Lindsay JR. Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol Rhinol Laryngol. 1956;65:692–706.CrossRefPubMed
41.
go back to reference Sunami K, Tochino R, Tokuhara Y, Yamamoto H, Tomita S, Koshimo N, et al. Effects of cigarettes and alcohol consumption in benign paroxysmal positioning vertigo. Acta Otolaryngol. 2006;126:834–8.CrossRefPubMed Sunami K, Tochino R, Tokuhara Y, Yamamoto H, Tomita S, Koshimo N, et al. Effects of cigarettes and alcohol consumption in benign paroxysmal positioning vertigo. Acta Otolaryngol. 2006;126:834–8.CrossRefPubMed
42.
go back to reference Shigeno K, Ogita H, Funabiki K. Benign paroxysmal positional vertigo and head position during sleep. J Vestib Res. 2012;22:197–203.PubMed Shigeno K, Ogita H, Funabiki K. Benign paroxysmal positional vertigo and head position during sleep. J Vestib Res. 2012;22:197–203.PubMed
43.
go back to reference Gizzi M, Ayyagari S, Khattar V. The familial incidence of benign paroxysmal positional vertigo. Acta Otolaryngol. 1998;118:774–7.CrossRefPubMed Gizzi M, Ayyagari S, Khattar V. The familial incidence of benign paroxysmal positional vertigo. Acta Otolaryngol. 1998;118:774–7.CrossRefPubMed
Metadata
Title
Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study
Authors
Zi-Jun Chen
Cheng-Ho Chang
Li-Yu Hu
Ming-Shium Tu
Ti Lu
Pan-Ming Chen
Cheng-Che Shen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0950-2

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