Persistent dizziness after vestibular neuritis associated with obstructive sleep apnea despite improved gait and balance after early vestibular rehabilitation: A case report

We report a 74-year-old woman with right vestibular neuritis, also termed acute unilateral vestibulopathy, who underwent early physical therapy-led vestibular rehabilitation and was later diagnosed with severe obstructive sleep apnea (OSA) during evaluation for persistent dizziness. Vestibular rehabilitation began on hospital day 3 and continued daily during hospitalization and weekly after discharge. Gait and balance improved without falls, but dizziness-related handicap remained elevated with persistent postural-perceptual dizziness-like trigger-dependent symptoms. Serial video head impulse testing showed persistent vestibulo-ocular reflex gain impairment and changes in corrective saccade metrics. Polysomnography at week 28 demonstrated severe OSA. Continuous positive airway pressure therapy was temporally associated with a decrease in DHI from 64 to 34 and improvements in sleepiness and Niigata PPPD Questionnaire scores. This case suggests that OSA should be considered when post-vestibular neuritis dizziness persists despite improved gait and balance. be considered when post-vestibular neuritis dizziness persists despite improved gait and balance.