But he has seemingly been able to put the controversy behind him, manoeuvring his way through tough tests against Britain's Jack Draper and 2021 champion Medvedev.
"My aunt is not feeling well health-wise and I don't know how much longer I have her in my life," he said.
The 26-year-old recovered well to win three games in a row, but he continued to falter on serve and Sinner capitalised to take the opener and subdue the expectant mood on Arthur Ashe Stadium.
"If there was a wish I could make, I would wish good health on everyone but unfortunately it's not possible."
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Refusing to dwell on the first set, Fritz improved and made the second a closer affair, losing just two points in four service games.
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Junto a Praticamente las novedades comunicadas por la competición o presente sábado, que pelo son pocas, la del fichaje do Lamine Yamal encumbra el arranque de una nueva temporada en la de que se espera seguir creciendo.
Having failed to make the most of three break point opportunities early in the third set, Fritz brought the crowd to life with two brilliant winners to break for a 4-3 lead and keep alive his hopes.
It has been nearly 50 years since a man won their first and second Grand Slam titles in the same season, and Sinner is now a long way clear of the rest at the top of the rankings.
It comes just 19 days after it was revealed he had been cleared of any wrongdoing after twice testing positive for a banned substance in March.
Tom Hanks stars in an intense thriller based on true events. VideoTom Hanks stars in an intense thriller based on true events
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Just six days before the main draw got under way, it was announced he had twice tested positive for low levels of a metabolite of clostebol - a steroid that can be used to build muscle mass - in March.
However, Sinner then underlined his status as world number one, upping the ante when it mattered most to strike the crucial blow as Fritz served to stay in the set at 5-4 down.
Sinner was ruled to bear pelo fault or negligence for the positive tests by the International Tennis Integrity Agency (ITIA), 星空体育 which found he had been inadvertently contaminated by his physiotherapist.
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The 23-year-old held his arms aloft and looked up to the sky as he became the first player since Guillermo Vilas in 1977 to win his first two Grand Slam titles in the same season.
"I know we have been waiting for a champion for a long time so I'm sorry I couldn't get it done this time," said Fritz.