May vestibular rehabilitation reduce apnea-hypopnea index in patients with obstructive sleep apnea? A pilot study

Introduction: The vestibular system is essential for maintaining the perception of head orientation and acceleration in all directions. The Functional Head Impulse Test (fHIT) is a novel tool for assessing the vestibulo-ocular reflex (VOR) and forms the basis for a recently developed vestibular rehabilitation system. This pilot study aimed to determine whether vestibular rehabilitation alone could objectively improve clinical parameters in patients with obstructive sleep apnea (OSA). Methods: Twenty male patients diagnosed with OSA underwent baseline polysomnography (PSG) and fHIT assessment. Participants then completed a 10-day vestibular rehabilitation program using the reHAB system, after which PSG and fHIT were repeated. Results: Initial fHIT analysis indicated impaired vestibular function in 30% of patients. The Wilcoxon signed-rank test demonstrated a statistically significant reduction in the apneahypopnea index (AHI) following rehabilitation (p = 0.003), while the change in oxygen desaturation index (ODI) did not reach statistical significance (p = 0.082). Scatter plot analysis revealed a moderate positive correlation between changes in AHI and ODI pre-and post-rehabilitation. Discussion: These preliminary findings suggest a functional connection between vestibular inputs and sleep–wake pathways, possibly mediated by parabrachial circuits and orexinergic modulation.