How sleep apnea affects hearing

This article discusses how hearing is affected by sleep apnea.

Sleep apnea may not only affect the quality of your sleep. New research suggests that the sleep disorder may be linked to hearing loss as well.

The study found that sleep apnea was associated with hearing impairment at both high and low frequencies. That finding held true even after the researchers adjusted the data for other possible causes of hearing loss.

These findings give further support to the idea that sleep apnea likely doesn't occur in isolation. Instead, it may be a sign of other underlying health conditions, the researchers said.

"Sleep apnea is more of a systemic and chronic disease than just something that happens when you're sleeping," said one of the study's authors, Dr. Neomi Shah, an associate director of the pulmonary sleep lab at Montefiore Medical Center in New York City.

"It probably affects multiple different organs, so I would probably urge we start thinking about sleep apnea as more like a chronic disease with vascular and inflammatory issues," Shah added.

Sleep apnea is a common disorder that affects about 18 million Americans, according to the National Sleep Foundation. Typically signaled by snoring with periodic gasping or "snorting" noises, sleep apnea interrupts sleep and can cause excessive daytime fatigue and other symptoms. The condition also has been associated with generalized inflammation, cardiovascular and endocrine problems.

What might the connection be between sleep apnea and hearing loss? It might be a combination of factors that cause inflammation and abnormal functioning in the blood vessels, according to Shah. "The ear is prone to this kind of injury," explained Shah.

The study tapped data from almost 14,000 U.S. participants in the Hispanic Community Health Study/Study of Latinos. About 53 percent were women and on average the subjects were 41 years old. All completed in-home sleep studies and audiometric (hearing) testing.

About 10 percent of the study volunteers had sleep apnea. Around 30 percent had some form of hearing impairment, according to the study.

The researchers took into account age, gender, Hispanic/Latino backgrounds and health-related issues such as high blood pressure, diabetes, fat levels in the blood, cigarette and alcohol use, history of hearing loss or snoring, and noise exposure.

People in the study were more likely to have hearing impairment if they were of Cuban and Puerto Rican backgrounds, had a higher body mass index (an indication of being overweight), were people who snored, or had been diagnosed as having sleep apnea.

The study authors found that sleep apnea was associated with a 31 percent increase in high frequency hearing impairment and a 90 percent increase in low frequency hearing impairment. Sleep apnea was also linked to a 38 percent increase in both high and low frequency hearing loss. Speech tends to fall in the low frequency range, according to Shah.

The research is slated to be presented May 20 at the American Thoracic Society annual meeting in San Diego, Calif. Because the study has not yet been published in a peer-reviewed journal, the data and conclusions should be viewed as preliminary.

Some experts urged caution in interpreting the results of the study, however.

"The number one thing I always say is, correlation is not causation; it doesn't mean if you have sleep apnea you're at risk for hearing impairment," said Rebecca Spencer, a neuroscientist and associate professor in the department of psychological and brain sciences at the University of Massachusetts, Amherst. "You wouldn't know if one comes before the other: sleep apnea appears before hearing loss, or hearing loss appears before sleep apnea and maybe they don't come together at all. They may not be related except by a third factor."

Because a possible link has been discovered between sleep apnea and hearing loss, the next step should be a smaller study that looks more closely at the question of whether sleep apnea actually causes hearing loss, said Spencer.

She also pointed out that the data drew only from people of Hispanic and Latino descent. It would be important to look at the association between hearing loss and sleep apnea among a broader ethnic and geographical group, she added.

Only one thing can be concluded from the study, Spencer said: "There is the potential that treating sleep apnea may improve hearing loss."

Shah, the research author, said people with sleep apnea should be screened for hearing impairment since it has been shown to be associated with the disorder. "Get evaluated," she urged.

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ADD and ADHD and its Mimics in Children with Down Syndrome

This article from the National Down Syndrome Society discusses the similarities between symptoms of ADHD, Down Syndrome, and other issues in children.

Attention deficit hyperactivity disorder, or ADHD, is a commonly diagnosed childhood problem. ADHD is characterized by consistent demonstration of the following traits: decreased attention span, impulsive behavior, and excessive fidgeting or other nondirected motor activity.

 All children, including children with Down syndrome, display these traits from time to time. But the child with Down syndrome may exhibit these traits more often than other children his age.  

How Common Is ADD in Children With Down Syndrome? 

The frequency of ADHD in children with Down syndrome is not known with certainty. However, ADHD-like symptoms are more common in young children with Down syndrome compared to children from the general population. Compounding symptoms such as stereotypy (repetitiveness), anxiety or extreme irritability in the presence of ADHD-like symptoms may indicate another disorder such as autism, bipolar disorder or obsessive compulsive disorder.

Uncomplicated ADHD is common in younger children with Down syndrome. However, many school age children with ADHD frequently have other behavioral conditions including oppositional defiant disorder, disruptive behavior disorder or obsessive compulsive traits.

Does That Mean That Your Child Has ADHD?

It may, but more often it means that a medical problem needs to be addressed, or that your child's educational program or communication method needs some adjustment. In children with Down syndrome who have difficulty paying attention, ADHD is a diagnosis of exclusion. Other problems must be ruled out first. 

What Are Medical Problems That Can Look Like ADHD? 

HEARING AND VISION ISSUES

In order for a child to pay attention to classroom material, she has to be able to hear and to see it. Both hearing and visual problems are common in children with Down syndrome. Ear infections are overwhelmingly common and, even if treated, can cause hearing loss for weeks. People with Down syndrome have middle ear structural abnormalities that can cause lifetime mild to moderate hearing loss.

Both near- and far-sightedness are common in individuals with Down syndrome, as well as cataracts and "lazy eye."

RULING OUT SIGNIFICANT HEARING AND/OR VISUAL LOSS AS A CAUSE OF ATTENTIONAL PROBLEMS

To monitor hearing, an auditory brainstem response test (ABR) or otoacoustic emission (OAE) should be performed early in the child's life (by three months of age at the latest) as a baseline. Hearing screens should be performed annually until three years of age, and every other year thereafter. Children with abnormal hearing evaluations should be seen by an ear-nose-throat physician (otolaryngologist) to manage treatable causes of hearing loss.

A child with Down syndrome should be evaluated by an eye doctor during the first year of her life, and yearly thereafter. Some children may need more frequent followup depending on their visual diagnosis.

GASTROINTESTINAL ISSUES

People with Down syndrome are at increased risk for an intestinal condition called celiac disease, which is a condition in which the body cannot process a protein found in wheat and certain other grains. While typical symptoms of celiac disease include loose stools, diarrhea, and poor weight gain, the condition often presents only with subtle effects on energy and behavior. People with Down syndrome are also predisposed to significant constipation, which when severe can cause abdominal pain, lack of appetite, and restlessness.

Current recommendations for gastrointestinal monitoring include screening for celiac disease between two and three years of age. This screening should include measurement of IgA antiendomysium antibodies, as well as total IgA. Your child's primary care provider will want to review your child's bowel status with you at each visit, as well.

THYROID ISSUES

About 30% of people with Down syndrome have thyroid disease at some point in life. Most have hypothyroidism, or underactive thyroid gland; a few have disease that results in overactive thyroid gland (Graves' disease). An underactive thyroid gland can, among other things, make a child very tired and apathetic.

Too much thyroid activity can cause agitation and restlessness. Therefore, both conditions can look like poor attention and behavior.

Because thyroid disease is so prevalent in this population, and because it is difficult for doctors to detect just by examining your child, an annual blood test for thyroid hormone is recommended by the Down Syndrome Health Care Guidelines.  

SLEEP ISSUES

Sleep disorders are extremely common in Down syndrome. These disorders are a group of conditions with many different causes but one thing in common: they all interfere with getting a good night's sleep. As a parent, you know that tired children can behave very differently from tired adults: they can become restless, whiny, and difficult to calm. And people of all ages have difficulty focusing and learning new information when they are sleep deprived.

Sleep apnea, or short periods of not breathing during sleep, is especially common. People with Down syndrome have small, often "floppy" airways, which can sometimes be completely or partially blocked during sleep by large tonsils and adenoids, or by the floppy walls of the airway collapsing as air is exhaled. Regardless of the cause of obstruction, the sleeper must awaken briefly to resume breathing. Some patients with sleep apnea awaken hundreds of times per night.

Symptoms associated with but not specific to sleep apnea include snoring, lots of "thrashing" while asleep, excessive daytime sleepiness, mouth breathing, and unusual sleep positions such as sleeping in a seated or hunched forward position.

Children suspected of having a sleep disorder should undergo a sleep study evaluation at an accredited sleep center.

What Types of Communication Difficulties Can Look Like ADHD?  

People with Down syndrome may have many barriers to effective communication. The receptive language skills of children with Down syndrome (how well they understand what is being said) are often much stronger than their expressive language skills (how well they can say it). Parents often comment, "He knows what he wants to tell us, he just can't seem to put the words together or we can't make out what he is saying." Classroom participation is thus more difficult, as well. The child may express his frustration by acting out or by inattention.

What Types of Educational Problems Can Look Like ADHD?  

Children with Down syndrome have a wide range of learning styles. Your child's educational team may need to try more than one method of presenting material before finding the one that works best for your child. If material is presented in a way that is not compatible with a child's learning style (for example, oral lectures for a student who needs visual aids and prompts) that child may appear bored, fidgety, and hyperactive.

The level of the material may also be a problem. If a child is presented with concepts that are too difficult for his cognitive level, he might "tune out" and appear inattentive. A child who is bored with overly easy material also may attend poorly and act out.

What Types of Emotional Issues Can Look Like ADHD?

Because of the communication problems discussed above, people with Down syndrome may have difficulty talking about things that make them sad or angry. Major life changes such as loss or separation may prompt decreases in appropriate behavior at school or work.

What Are the Next Steps?

If you are concerned about decreased attention span, impulsive behavior, and excessive fidgeting or other non-directed motor activity in your child, it is appropriate to consult your pediatrician, a developmental and behavioral pediatrician or child psychiatrist.

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Study links sleep apnea and sudden deafness

Sudden hearing loss might be tied to an underlying sleep disorder that interrupts breathing, suggests a new study from Taiwan.

Consulting a large health insurance database, researchers found that people who'd suffered sudden deafness were more likely to have a previous diagnosis of sleep apnea than a comparison group without hearing loss.

The absolute difference was small: 1.7 percent of those with hearing loss had sleep apnea, compared to 1.2 percent without hearing trouble.

"If there is sudden hearing loss, I would investigate the presence of apnea as well, given that it's easy to diagnose and it's easy to treat," said Dr. Seva Polotsky, a sleep apnea researcher from Johns Hopkins University School of Medicine in Baltimore who wasn't involved in the new study.

"Obviously we don't know from this paper whether treating apnea will reduce hearing loss," or the chance of having hearing problems in the first place.

For now, he said, "There are more questions than answers."

Polotsky added, it's possible that sleep apnea, which is known to increase the buildup of plaque in blood vessels, could affect vessels in areas of the brain that control hearing, or vessels that feed the nerves responsible for hearing.

But he said more research will be needed to find out what could be behind this link -- or whether something besides the apnea, itself, might explain an increased risk of deafness.

There are about 4,000 new cases of sudden deafness each year in the United States, according to the National Institutes of Health, and there are many possible causes, including infections and head injuries.

Typically the deafness only occurs in one ear, and most people regain their hearing over a period of weeks, sometimes aided by steroid treatment. But occasionally the hearing loss becomes more serious.

Looking at health records of one million Taiwanese, researchers led by Dr. Jau-Jiuan Sheu, of Taipei Medical University Hospital, found almost 3,200 had been diagnosed with sudden deafness between 2000 and 2008. For each of those people, they picked out another five of the same age and sex without hearing loss to serve as a comparison.

Out of those 19,000 people in total, 240 had been diagnosed with sleep apnea before the episode of sudden deafness occurred.

When researchers took into account health and lifestyle factors that may be related to both sleep problems and hearing loss -- such as obesity and heart disease -- they found that men with sudden deafness were 48 percent more likely to have a previous sleep apnea diagnosis than men without hearing loss.

The association for women was less clear, the researchers reported in the Archives of Otolaryngology-Head & Neck Surgery.

Sleep apnea is characterized by closing off of the airways during sleep, leading to repeated drops in oxygen levels in the blood and frequent short wake-ups, along with snoring. It's often treated with a mask and breathing device, called continuous positive airway pressure, or CPAP, but one of the most effective treatments is weight loss.

The new study doesn't prove that sleep apnea causes sudden hearing loss. The researchers couldn't account for people's smoking and drinking, for example, which may affect the risk of both conditions.

Read more: http://www.nlm.nih.gov/medlineplus/news/fullstory_121056.html