Exploratory mediation analyses suggested that Otolin-1 and otoconin-90 statistically accounted for approximately 40 and 29% of the sleep-symptom association, respectively, with consistent findings across sensitivity and subgroup analyses.<h4>Conclusion</h4>These findings indicate that otolith-related inner-ear structural biomarkers are associated with both the presence and severity of BPPV and may partially explain the relationship between sleep quality and vertigo symptoms. Here, OTOL1 is linked to Vertigo.