Heart Rate Variability in Benign Paroxysmal Positional Vertigo (BPPV-HRV)

Evaluation of Autonomic Function Using Short-Term Heart Rate Variability in Patients With Benign Paroxysmal Positional Vertigo: A Prospective Case-Control Study

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. Although the pathophysiology of BPPV is mainly attributed to the displacement of otoconia within the semicircular canals, recent studies suggest that psychological stress and anxiety may be associated with the onset or recurrence of the disease. However, the biological mechanisms underlying this relationship remain poorly understood, and objective evaluation of autonomic nervous system function in patients with BPPV is limited.

Heart rate variability (HRV) is a non-invasive method widely used to assess autonomic nervous system activity. Short-term HRV measurements provide information about autonomic balance and vagal tone. In particular, parameters such as the root mean square of successive differences (RMSSD) and the coefficient of variation of RR intervals (COV RR/R) are considered indicators of parasympathetic activity.

The aim of this prospective case-control study is to evaluate vagal tone in patients with BPPV using short-term HRV analysis and to compare the findings with age-, sex-, and body mass index-matched healthy controls. Participants will undergo standardized HRV measurements at rest and during controlled breathing. Perceived stress levels will also be assessed using the Perceived Stress Scale (PSS-10).

The primary outcomes of the study are RMSSD and the coefficient of variation of RR intervals (COV RR/R), obtained from short-term HRV recordings. These parameters will be compared between BPPV patients and healthy controls, and their associations with perceived stress levels will also be explored. The findings of this study may provide insights into the role of autonomic regulation and stress-related mechanisms in the pathophysiology of BPPV.

Study Overview

• Status: Recruiting
• Conditions: BPPV; Stress and Anxiety
• Intervention / Treatment: Other: Short-term HRV measurement

• Study Type: Observational
• Enrollment (Estimated): 104

Contacts and Locations

• Study Contact: Name: Dastan Temirbekov, assistan professor; Phone Number: +90 05314013014; Email: dasekeeee@gmail.com

Study Locations

• Turkey (Türkiye)
  • Küçükçekmece
    • Istanbul, Küçükçekmece, Turkey (Türkiye), 34295
      • Recruiting
      • Medicalpark Florya Hospital
      • Contact: Nilay Turğut; Phone Number: +90 5387175333; Email: niba.1907@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of adult patients presenting to the otolaryngology outpatient clinic of Istanbul Aydın University Hospital with complaints of vertigo and diagnosed with benign paroxysmal positional vertigo (BPPV) based on clinical evaluation and positional testing (Dix-Hallpike and/or Roll test). The control group will include age- and sex-matched healthy volunteers without a history of vertigo or vestibular disorders. All participants will be recruited from individuals attending the same hospital during the study period.

Description

Inclusion Criteria:

• BPPV Group

Age 18 years or older

Clinical diagnosis of benign paroxysmal positional vertigo (BPPV) confirmed by positional testing (Dix-Hallpike and/or Roll test) with positional nystagmus

No known history of cardiac disease

Ability and willingness to provide written informed consent

Healthy Control Group

Age 18 years or older

No history of vertigo or known vestibular disorder

Age- and sex-matched to the BPPV group

No known history of cardiac disease

Ability and willingness to provide written informed consent

Exclusion Criteria:

• Age younger than 18 years

Inability to provide informed consent or impaired mental capacity

Known arrhythmia, heart failure, ischemic heart disease, or other clinically significant cardiac disorder

Use of medications that may directly affect heart rate variability, including beta-blockers, non-dihydropyridine calcium channel blockers, antiarrhythmic drugs, digoxin, systemic corticosteroids, centrally acting sympatholytic agents, or psychotropic medications that may influence autonomic balance

Active infection or systemic inflammatory disease

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
BPPV Group; Patients diagnosed with benign paroxysmal positional vertigo (BPPV) based on positional testing in the otolaryngology clinic.	Other: Short-term HRV measurement; Short-term heart rate variability (HRV) assessment performed using a non-invasive device that records RR interval variability through hand electrodes. Measurements will be obtained at rest and during controlled breathing to evaluate vagal tone and autonomic nervous system activity.
Healthy Control Group; Age-, sex-, and body mass index-matched healthy volunteers without a history of vestibular disorders	Other: Short-term HRV measurement; Short-term heart rate variability (HRV) assessment performed using a non-invasive device that records RR interval variability through hand electrodes. Measurements will be obtained at rest and during controlled breathing to evaluate vagal tone and autonomic nervous system activity.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Root Mean Square of Successive Differences (RMSSD)	Root Mean Square of Successive Differences (RMSSD), expressed in milliseconds (ms), obtained from short-term heart rate variability recordings using the UltraPro S100 EMG/NCS/EP Neurodiagnostic System. RR interval variability will be recorded through hand electrodes during two conditions: resting state and controlled breathing (6 breaths per minute for 60 seconds). RMSSD values will be compared between patients with benign paroxysmal positional vertigo (BPPV) and healthy control participants.	Baseline (At the time of HRV assessment (single visit))
Coefficient of Variation of RR Intervals (COV RR)	Coefficient of variation of RR intervals (COV RR), expressed as percentage (%), derived from short-term heart rate variability recordings using the UltraPro S100 EMG/NCS/EP Neurodiagnostic System. RR interval variability will be recorded through hand electrodes during resting conditions and controlled breathing (6 breaths per minute for 60 seconds). COV RR values will be compared between patients with benign paroxysmal positional vertigo (BPPV) and healthy controls.	Baseline (At the time of HRV assessment (single visit))

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in RMSSD During Controlled Breathing (ΔRMSSD)	Change in Root Mean Square of Successive Differences (ΔRMSSD), expressed in milliseconds (ms), calculated as the difference between RMSSD measured during resting conditions and RMSSD measured during controlled breathing (6 breaths per minute for 60 seconds). This measure reflects vagal reserve and autonomic responsiveness.	Baseline (single HRV assessment visit)
Change in COV RR During Controlled Breathing (ΔCOV RR)	Change in the coefficient of variation of RR intervals (ΔCOV RR), expressed as percentage points (%), calculated as the difference between COV RR measured during resting conditions and during controlled breathing (6 breaths per minute for 60 seconds).	Baseline (single HRV assessment visit)

Collaborators and Investigators

• Sponsor: Istanbul Aydın University

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: March 11, 2026
• First Submitted That Met QC Criteria: March 13, 2026
• First Posted (Actual): March 16, 2026

Study Record Updates

• Last Update Posted (Actual): April 16, 2026
• Last Update Submitted That Met QC Criteria: April 13, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: stress; HRV; Benign paroxysmal positional vertigo; heart rate variability; BPPV
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Otorhinolaryngologic Diseases; Ear Diseases; Labyrinth Diseases; Vestibular Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Vertigo; Anxiety Disorders; Benign Paroxysmal Positional Vertigo
• Other Study ID Numbers: IAU/BPPV/HRV/2026

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No