睡姿在老年人耳后半规管良性阵发性位置性眩晕偏侧优势中的作用

Effect of sleep position on lateral-predominance in posterior semicircular canal benign paroxysmal positional vertigo in the elderly patients

目的研究老年患者耳后半规管良性阵发性位置性眩晕的发病率，评价睡姿与受累耳偏侧优势的相关性。方法回顾性研究114例单侧耳后半规管良性阵发性位置性眩晕老年患者的睡眠史，平均年龄（67．4±7．5）岁，人组患者均要求能确定优势侧睡姿。所有患者均详细询问病史并进行神经系统体格检查，包括姿势和步态、眼球运动、Dix-Hallpike试验、仰卧侧头位试验、纯音测听法和声导抗检查等。结果右侧Dix-Hallpike试验阳性72例，左侧Dix-Hallpike试验阳性42例。睡眠时，61例偏爱右侧卧位，34例习惯左侧卧位，19例习惯仰卧位。在114例单侧Dix-Hallpike试验阳性患者中，患耳与睡姿在同侧的有78例，其中52例右侧，26例左侧；36例患耳与睡姿在不同侧，其中9例右侧卧位者左侧Dix-Hallpike试验阳性，8例左侧卧位者右侧Dix-Hallpike试验阳性，19例仰卧位患者中，12例右侧Dix—Hallpike试验阳性，7例左侧Dix-Hallpike试验阳性。患耳与同侧睡姿的相关性具有统计学意义（X2=35．737，P〈0．01），Pearson列联系数为0．4885。结论老年患者后半规管良性阵发性位置性眩晕以右侧居多，且患者偏爱右侧卧位，患耳与睡姿的偏侧性具有相关性，对于预防良性阵发性位置性眩晕可能有一定价值。

Objective To investigate the frequency of posterior semicircular canal benign paroxysmal positional vertigo （PC-BPPV） in each ear, and to explore the effect of sleep position in lateral-predominance of ear by PC-BPPV during sleep onset in elderly patients. Methods Totally 114 patients aged （67. 4± 7.5） years with unilateral PC-BPPV confirmed by a positive Dix Hallpike test, were retrospectively reviewed. All patients included in the study were able to define a leteral predominant, favorate head-lying side （right, left or supine position） during sleep onset. Results The Dix Hallpike test was found to be positive on the right side in 72 patients and positive on the left side in 42 cases. During sleep onset, 61 patients habitually laid their head on the right side, 84 laid their head on the left, and the remaining 19 cases on the supine position. Among 114 cases with positive Dix Hallpike test, there were 78 cases with the same side between affected ear and sleep position （52 cases right, 26 cases left）, 36 cases with different side （9 cases with right position and left positive Dix Hallpike test, 8 cases left position and right positive Dix Hallpike test, 19 cases slept in a supine position including 12 cases with right positive Dix Hallpike test and 7 cases with left positive）. The association between affected ear and head-lying side during sleep onset was statistically significant （X2= 35. 737, P〈0.01） and Pearson coefficient of continency was 0. 4885. Conclusions Among the elderly, right-sided PC-BPPV is popular, and these patients favorite right head-lying position during sleep. There is association between the affected side by PC-BPPV and the head-lying side during sleep.