The Cardiac Autonomic Control System Response to Vestibular Stimulation in Subjects With and Without BPPV
Condition: Benign Paroxysmal Positional Vertigo; Vertigo; Autonomic Nervous System
MeSH terms: Vertigo; Benign Paroxysmal Positional Vertigo; Dizziness
Study type: Observational

Summary: 
      The vestibular system in the inner year is an important system in the body which is
      responsible for balance. In addition, there is evidence that the vestibular system plays a
      role in maintaining blood pressure while changing body position, such as moving from lying
      down in bed to sitting. Dysfunction of the vestibular system may affect the ability to
      maintain blood pressure, therefore the aim of this study is to assess if a specific problem
      in the vestibular system (Benign Paroxysmal Positional Vertigo- BPPV) may cause changes in
      the interaction between the vestibular system and the cardiovascular system. We assume that
      patients with this medical condition (BPPV) will have different heart rate parameters in
      comparison with healthy patients.
    

Detailed description: 
      This is a case-control study, that will consist of one routine assessment by a vestibular
      physiotherapist in an outpatient clinic in Tel Aviv ("Clalit Health Services"). The session
      will last approximately 90 minutes, and will include 40-60 participants.

      Two groups of patients (30-70 years old) will be assigned to this study:

        1. Patients with Benign Paroxysmal Positional Vertigo (BPPV).

        2. Healthy patients (Control Group).

      Both groups will undergo routine physical assessment which is done to diagnose if the patient
      has BPPV or not. The physical assessment includes quick changes in body and head position.

      In addition to the routine physical assessment, heart rate variability parameters will be
      monitored during the whole session in patients in both groups (using Polar watch RS800CX).
      Furthermore, all patients will be asked to test their grip strength (using a hand-held
      dynamometer), moving from sitting to standing 5 times in a row and to fill two
      questionnaires.

      The patients that were diagnosed with BPPV will be treated with the routine vestibular
      physiotherapy, performed by the same physiotherapist who did the physical assessment.

      Statistical analysis of the data will be performed in IBM SPSS Statistics software (version
      24), and a statistical significance level of a p-value < 0.05 will be considered significant.
      Normality distribution will be tested with the Kolmagorov-Smirnov test.

      Parametric tests suitable for the analysis of the data in this study are:

        1. Paired and unpaired t-tests.

        2. Repeated Measures Analysis of Variance (ANOVA).

      Non-parametric tests suitable for the analysis of the data in this study are:

        1. Mann-Whitney.

        2. Wilcoxon.

      Spearman coefficient will be used to examine correlations.
    

Intervention name(s): Heart rate variability parameters monitoring
Intervention type(s): Diagnostic Test
Intervention description(s): No intervention- only additional monitoring of heart rate, physical tests and filling of questionnaires:
Heart rate variability parameters monitoring- by wearing a Polar watch (RS800CX).
Isometric grip test- by using a Jamar Hand Held Dynamometer.
Questionnaires:
Dizziness Handicap Inventory (DHI) - hebrew version.
Stait-Trait Anxiety Inventory (STAI)
Other intervention name(s): Isometric grip test; Five times sit to stand; Questionnaires
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with and without BPPV will be recruited to the study in an outpatient
        physiotherapy clinic (community sample), "Clalit Health Services", in Tel Aviv.
      
Keywords: Benign Paroxysmal Positional Vertigo; BPPV; Vertigo; Autonomic Nervous System; Heart Rate Variability; Vestibulo Sympathetic Response; Vestibulo Sympathetic Reflex