The relationship between obstructive sleep apnea with hearing and balance: A scoping review

Sleep Med. 2022 Jul:95:55-75. doi: 10.1016/j.sleep.2022.04.005. Epub 2022 Apr 18.


Background: Obstructive sleep apnea (OSA) has been linked to multiple co-morbidities, and some research points to a potential relationship between OSA and hearing and balance dysfunction, and the benefits of continuous positive airway pressure (CPAP) treatment.

Objective: The present study was undertaken as a scoping review of research on OSA and its impact on hearing and balance function in adults and children and whether the treatment of CPAP would affect hearing and balance function.

Method: Online databases were used to identify 45 papers published that used hearing and balance assessments concerning OSA and CPAP therapy as a primary outcome. The secondary outcome was the subjective perception through validated questionnaires.

Results: Whilst the data on the effect of OSA on middle ear function remains inconclusive, most papers demonstrate an increase in hearing thresholds, an absence of otoacoustic emissions (OAE) and delayed auditory brainstem response (ABR) in adults with OSA. Nystagmus and abnormal vestibular evoked myogenic potentials (VEMPs) were observed in the small number of papers. The positive pressure from CPAP significantly and transiently increases middle ear pressure, however, its effects on other auditory regions and the vestibular system remains inconclusive. Research on hearing and balance function in children with OSA is limited.

Conclusions: Narrow assessments of hearing and balance are not sufficient to understand the nature of hearing and balance function in OSA patients and the effect of CPAP therapy. More comprehensive assessments are necessary to observe peripheral and central changes in the auditory and vestibular pathways.

Keywords: Balance; Continuous positive airway pressure; Hearing; Obstructive sleep apnea.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Child
  • Comorbidity
  • Continuous Positive Airway Pressure / adverse effects
  • Hearing
  • Humans
  • Sleep Apnea, Obstructive* / complications
  • Sleep Apnea, Obstructive* / therapy
  • Surveys and Questionnaires