Tinnitus, Hearing Loss, and Distracted Sleep
Overview
This study explores the intricate relationship between sleep characteristics, tinnitus, and hearing loss, focusing on whether hearing levels mediate the association between sleep disorders and tinnitus. Conducted as a cross-sectional analysis, the study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, encompassing 9693 adults aged 20 years and above who underwent audiometric testing and provided information on tinnitus and sleep patterns.
Key findings revealed that a considerable proportion of the cohort (29%) reported experiencing trouble sleeping, with 9% having received a diagnosis of sleep disorders. Despite these negative sleep characteristics, including shorter sleep durations and symptoms indicative of obstructive sleep apnea (OSA), no significant associations were observed between these factors and hearing loss as measured by audiometry, even after adjusting for demographic factors and comorbidities.
However, the study uncovered a significant link between negative sleep characteristics and bothersome tinnitus, which persisted even after accounting for variations in hearing levels. Specifically, individuals reporting fewer than eight hours of sleep per day, experiencing trouble sleeping, diagnosed with sleep disorders, or exhibiting symptoms of OSA were more likely to report bothersome tinnitus.
The conclusion drawn from these findings is that while negative sleep characteristics are associated with tinnitus, there is no clinically meaningful correlation between sleep patterns and hearing loss as assessed by audiometry. This suggests that the relationship between poor sleep and tinnitus is likely influenced by central processes rather than being primarily mediated through the peripheral auditory system.
Overall, this study provides valuable insights into the intricate interplay between sleep quality, tinnitus, and hearing loss, emphasizing the need to consider central processes in understanding the relationship between sleep disorders and tinnitus. These findings contribute to our understanding of the complex mechanisms underlying tinnitus and may inform future interventions aimed at alleviating its associated symptoms.
Introduction
Tinnitus, the perception of sound without external stimulus, is a complex phenomenon with diverse causes and impacts, posing challenges for both understanding and treatment. Its effects extend beyond mere auditory perception, often impairing daily functioning, quality of life, and mental well-being. The economic burden of tinnitus is substantial, with healthcare costs exceeding billions annually, particularly evident in compensation claims among veterans.
Sleep disturbances are closely intertwined with tinnitus, forming a bidirectional relationship where one exacerbates the other. Chronic tinnitus sufferers commonly experience insomnia, poor sleep quality, and other sleep disorders. Conversely, tinnitus severity is often exacerbated by sleep disturbances. Notably, obstructive sleep apnea (OSA) prevalence is higher among tinnitus patients, suggesting shared underlying mechanisms.
Recent evidence suggests a connection between sleep disorders, hearing loss, and tinnitus. Patients with OSA exhibit higher rates of hearing loss, potentially due to ischemic damage to the cochlea during sleep apnea episodes. However, no studies have explored the relationship between sleep characteristics, tinnitus, and audiometry-measured hearing loss as a potential mediator.
This study aims to bridge this gap by investigating the association between sleep patterns, tinnitus, and hearing loss in a large cohort of US adults. Of particular interest is the role of objectively measured hearing thresholds as a potential mediator in the relationship between negative sleep characteristics and tinnitus. Understanding these interconnections may offer insights into novel therapeutic approaches for managing tinnitus and associated sleep disturbances.
Method
This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) to investigate the relationship between tinnitus, audiometric assessment, sleep, and related demographic characteristics in a cohort of 9693 participants aged 20 and above. NHANES is a program designed to evaluate the health status of the civilian US population using a stratified, multistage probability sampling approach.
The study utilized five sleep-related variables obtained from NHANES data, including sleep duration, sleep disorder diagnosis, trouble with sleeping, and symptoms of obstructive sleep apnea (OSA). Audiometric assessment was conducted using established NHANES protocols, measuring hearing thresholds in a sound-isolated room. Tinnitus was defined based on participants’ self-reporting of bothersome ringing, roaring, or buzzing in the ears or head lasting for five minutes or more within the past 12 months.
Demographic and medical history data were collected through interviews, encompassing variables such as sex, race/ethnicity, education, household income, insurance status, smoking status, diabetes, hypertension, cardiovascular disease, stroke, occupational and recreational noise exposure, and depression.
Statistical analyses were performed with adjustments for sample weights to account for the complex survey design of NHANES and ensure the generalizability of results to the US population. Sensitivity analyses were conducted to explore associations between tinnitus and audiometry-measured hearing loss, considering both speech-frequency and high-frequency thresholds.
The study adhered to established NHANES protocols for audiometric assessment, quality assurance, and control, ensuring the reliability and validity of the data collected. Ethical considerations were addressed through institutional review board approval and exemption for the study protocol.
Overall, this research provides valuable insights into the epidemiology of tinnitus, sleep disorders, and hearing loss in the US population, contributing to the understanding of their associations with demographic and medical factors.
Statistical Analysis
The study employed a comprehensive approach to account for the complex sampling design, adhering to National Center for Health Statistics guidelines and utilizing sample weights in all analyses, except for Table 1. Through this meticulous methodology, the population prevalence of five sleep variables was estimated with 95% confidence intervals across the entire cohort, individuals without tinnitus, and those with tinnitus.
To investigate the association between sleep variables and tinnitus, logistic regression analysis was employed. Multivariable regression models were meticulously adjusted for age, demographic factors, medical history, and noise exposure in a sequential manner to ensure robust analysis.
Furthermore, linear and logistic regression analyses were utilized to probe the relationship between sleep variables and hearing loss, treating hearing loss both as a continuous and binary variable (threshold <25 and ≥25 dB HL). Statistical significance was rigorously set at P < .05, two‐tailed, to ensure the reliability of the findings.
All analytical procedures were executed using Stata software (version 16.1; StataCorp.), ensuring consistency and accuracy throughout the data analysis process. This meticulous approach aimed to provide insightful and reliable conclusions regarding the intricate relationships between sleep variables, tinnitus, and hearing loss, contributing to the body of knowledge in this field.
Result
The study encompassed a cohort of 9693 adults drawn from the 2005 to 2018 NHANES, providing a representative sample of the US population. Analysis revealed that a substantial proportion of adults reported negative sleep characteristics, including insufficient sleep duration, trouble sleeping, diagnosed sleep disorders, and symptoms of obstructive sleep apnea (OSA). Notably, the prevalence of these sleep disturbances was higher among individuals reporting bothersome tinnitus.
Statistical analyses, encompassing univariable and multivariable logistic regression models, elucidated significant associations between poor sleep characteristics and bothersome tinnitus, even after adjusting for relevant factors such as hearing levels, demographics, comorbidities, noise exposure, and depression. Specifically, sleeping less than 8 hours per night, experiencing trouble sleeping, and exhibiting symptoms of OSA were all linked to an increased risk of bothersome tinnitus.
Furthermore, the study explored the relationship between sleep-related variables and audiometry-measured hearing loss. While associations were observed in unadjusted models, the significance diminished after adjusting for confounding factors. Subsequent sensitivity analyses corroborated these findings, indicating no substantial changes in the results.
The study also investigated the potential mediating role of audiometry-measured hearing loss in the association between poor sleep characteristics and tinnitus. However, no significant mediation effect was observed, suggesting that the relationship between poor sleep and tinnitus is not primarily mediated by changes in hearing thresholds.
Overall, the findings underscore the intricate interplay between sleep disturbances, tinnitus, and hearing loss in adults. While poor sleep characteristics appear to be independently associated with bothersome tinnitus, the mediation analysis did not reveal a significant role of audiometry-measured hearing loss in this association. These insights contribute to our understanding of the multifaceted nature of sleep-related disorders and their impact on auditory health, highlighting the need for comprehensive approaches to address these interconnected issues.
Conclusion
This study conducted a thorough investigation into the relationship between sleep characteristics, tinnitus, and hearing loss using a nationally representative sample of US adults. The research aimed to elucidate whether hearing levels act as a mediator in the association between sleep disorders and tinnitus. The findings revealed a significant association between negative sleep characteristics and bothersome tinnitus, including fewer hours of sleep per night, diagnosed sleep disorders, trouble sleeping, and symptoms of obstructive sleep apnea (OSA). However, no significant correlation was found between negative sleep characteristics and audiometry-measured hearing loss.
The study’s results align with previous research indicating a robust association between negative sleep characteristics and tinnitus, corroborating the widely reported link between the severity of tinnitus and sleep disturbances. One proposed hypothesis suggests that severe tinnitus may lead to the inappropriate activation of the limbic and sympathetic nervous systems, which could exacerbate sleep disorder characteristics such as anxiety and depression. This activation shares similarities with the neural mechanisms implicated in sleep disturbances, suggesting potential implications for clinical treatment targeting these pathways.
Regarding audiometry-measured hearing loss, inconsistent findings were observed across cohort studies, with some reporting significant associations between increased sleep duration and subclinical hearing loss. However, this study did not find any clinically meaningful association between sleep-related variables and audiometry-measured hearing loss, even after adjusting for cardiovascular diseases.
While prior studies have explored the impact of continuous positive airway pressure (CPAP) treatment for OSA on hearing loss and tinnitus, results have been mixed. Some studies have shown improvements in tinnitus symptoms following CPAP use, possibly due to its effects on depression and anxiety, which are closely linked to tinnitus.
Several limitations were acknowledged, including the cross-sectional design, potential confounders and mediators not accounted for, reliance on self-reported data for sleep and tinnitus variables, and the use of questionnaires for sleep assessment. Despite these limitations, the study’s findings contribute to our understanding of the relationship between sleep disorders, tinnitus, and hearing loss, suggesting avenues for further research and potential implications for clinical management strategies targeting both conditions.
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