{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:37:58Z","timestamp":1781530678108,"version":"3.54.1"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002767","name":"Hunan Provincial Science and Technology Department","doi-asserted-by":"publisher","award":["2025JJ80491"],"award-info":[{"award-number":["2025JJ80491"]}],"id":[{"id":"10.13039\/501100002767","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>While insomnia and vitamin D deficiency are known risk factors for BPPV, their interactive effect on the dizziness-related handicap is unknown. Given that both may independently promote pro-inflammatory states, a synergistic interaction is biologically plausible. Therefore, this study aimed to investigate both the independent and interactive effects of insomnia and 25-OH-D levels on the dizziness-related handicap in BPPV patients. We specifically hypothesized that insomnia amplifies the detrimental impact of low vitamin D, aiming to provide an empirical basis for integrated clinical management strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this cross-sectional study, 125 patients with BPPV were enrolled. Serum 25-OH-D levels and Dizziness Handicap Inventory (DHI) scores were measured. A multivariable linear regression model, refined by a systematic variable selection procedure, was used to assess the effects of insomnia and 25-OH-D on log-transformed DHI scores after adjusting for potential confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After multivariable adjustment in the final parsimonious model, insomnia, lower 25-OH-D levels, and their interaction term all remained highly significant predictors of higher dizziness-related handicap (all <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.01). The interaction indicated that the negative association between 25-OH-D and DHI was significantly stronger in patients with insomnia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Insomnia and vitamin D deficiency are independently associated with greater dizziness-related handicap in BPPV patients, and they demonstrate a significant synergistic interaction. However, due to the study\u2019s design, a definitive causal relationship cannot be established. Assessing and managing both conditions may be crucial for mitigating the handicap imposed by BPPV.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1656528","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T04:23:34Z","timestamp":1760502214000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The synergistic interaction of vitamin D deficiency and insomnia on dizziness-related handicap in patients with benign paroxysmal positional vertigo"],"prefix":"10.3389","volume":"16","author":[{"given":"Bo","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minghua","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqin","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2252","DOI":"10.1007\/s00415-020-09831-2","article-title":"Etiologic 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