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Awad M, Abdalla I, Jara SM, Huang TC, Adams ME, Choi JS. Association of Sleep Characteristics with Tinnitus and Hearing Loss. OTO Open 2024; 8:e117. [PMID: 38420352 PMCID: PMC10900921 DOI: 10.1002/oto2.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/21/2024] [Indexed: 03/02/2024] Open
Abstract
Objective The impact of poor sleep on tinnitus has been mainly attributed to central processes. There is an association between sleep disorders and hearing loss, but whether hearing levels mediate the association between sleep disorders and tinnitus is unknown. This study investigates the association between sleep characteristics, tinnitus, and hearing loss. Study Design Cross-sectional. Setting National Health and Nutrition Examination Survey (NHANES). Methods Study cohort includes 9693 adults (≥20 years) from the NHANES 2005 to 2018 who completed audiometric testing and questionnaires on tinnitus and sleep characteristics. Multivariable regression analyses were performed to quantify associations between sleep characteristics, tinnitus, and hearing loss. Results In this cohort, 29% (95% confidence interval [CI]: 28%-31%) reported trouble sleeping and 9% (95% CI: 8%-10%) reported being diagnosed with sleep disorders. Negative sleep characteristics (less hours of sleep, diagnosis of a sleep disorder, trouble sleeping, or OSA symptoms) were not associated with audiometry-measured hearing loss in multivariable models adjusted for demographics and comorbidities but were significantly associated with bothersome tinnitus. This association remained significant without substantial attenuation in multivariable models additionally adjusting for hearing levels: sleeping <8 h/day (vs ≥8) (odds ratio [OR]: 1.28 [95% CI: 1.08-1.52]), trouble sleeping (OR: 1.78 [95% CI: 1.45-2.19]), diagnosis of sleep disorders (OR: 1.57 [95% CI: 1.14-2.15]), and report of OSA symptoms (OR: 1.42 [95% CI: 1.08-1.88]). Conclusion Negative sleep characteristics were associated with tinnitus while there was no clinically meaningful association between sleep and hearing loss. Our findings suggest that the relationship between poor sleep and tinnitus is likely contributed by central processes without a major role of mediation via the peripheral auditory system.
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Affiliation(s)
- Matthew Awad
- University of Minnesota School of Medicine Minneapolis Minnesota USA
| | - Ibrahim Abdalla
- University of Minnesota School of Medicine Minneapolis Minnesota USA
| | - Sebastian M Jara
- Caruso Department of Otolaryngology-Head & Neck Surgery University of Southern California Los Angeles California USA
| | - Tina C Huang
- Department of Otolaryngology-Head & Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Meredith E Adams
- Department of Otolaryngology-Head & Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Janet S Choi
- Caruso Department of Otolaryngology-Head & Neck Surgery University of Southern California Los Angeles California USA
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Marks E, Hallsworth C, Vogt F, Klein H, McKenna L. Cognitive behavioural therapy for insomnia (CBTi) as a treatment for tinnitus-related insomnia: a randomised controlled trial. Cogn Behav Ther 2023; 52:91-109. [PMID: 35762946 DOI: 10.1080/16506073.2022.2084155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Insomnia is a significant difficulty and is reported by large proportion of people with tinnitus. Although cognitive behavioural therapy for insomnia (CBTi) might be an effective treatment, no controlled studies had been conducted to date. This randomised controlled trial evaluated the benefits of CBTi on a sample of 102 people with tinnitus-related insomnia. Participants were randomised to 1) CBTi, 2) Audiology-Based Care (ABC) or 3) Sleep Support Group (SSG). Primary outcomes included insomnia, sleep efficiency and total sleep time. Secondary outcomes measured sleep onset latency, sleep quality, tinnitus distress, psychological distress, functioning and quality of life. CBTi was superior at reducing insomnia and increasing sleep efficiency compared to ABC post-intervention and at 6-month follow-up. ABC was superior at reducing insomnia and increasing sleep efficiency compared to SSG. Both CBTi and ABC reported increased total sleep time compared to SSG at 6-month follow. More than 80% of participants in the CBTi group reported clinically meaningful improvements compared to 47% in ABC and 20% for those receiving social support. CBTi was more effective in reducing tinnitus distress and improving sleep quality, functioning and some aspects of mental health. CBTi and ABC offer effective treatments for tinnitus-related sleep disorder but CBTi offers a sizeable benefit.
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Affiliation(s)
| | | | - Florian Vogt
- Department of Psychology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Laurence McKenna
- Department of Psychology, University College London Hospitals NHS Foundation Trust, London, UK
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Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Ghasemi H, Mohammadi M, Shohaimi S. The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review. BMC Neurol 2020; 20:300. [PMID: 32791960 PMCID: PMC7425538 DOI: 10.1186/s12883-020-01883-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/10/2020] [Indexed: 01/11/2023] Open
Abstract
Background Acceptance and Commitment Therapy (ACT), as a type of behavioral therapy, attempts to respond to changes in people’s performance and their relationship to events. ACT can affect sleep quality by providing techniques to enhance the flexibility of patients’ thoughts, yet maintaining mindfullness. Therefore, for the first time, a systematic review on the effects of ACT on sleep quality has been conducted. Methods This systematic review was performed to determine the effect of ACT on insomnia and sleep quality. To collect articles, the PubMed, Web of Science (WOS), Cochrane library, Embase, Scopus, Science Direct, ProQuest, Mag Iran, Irandoc, and Google Scholar databases were searched, without a lower time-limit, and until April 2020. Results Related articles were derived from 9 research repositories, with no lower time-limit and until April 2020. After assessing 1409 collected studies, 278 repetitive studies were excluded. Moreover, following the primary and secondary evaluations of the remaining articles, 1112 other studies were removed, and finally a total of 19 intervention studies were included in the systematic review process. Within the remaining articles, a sample of 1577 people had been assessed for insomnia and sleep quality. Conclusion The results of this study indicate that ACT has a significant effect on primary and comorbid insomnia and sleep quality, and therefore, it can be used as an appropriate treatment method to control and improve insomnia.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
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Abstract
OBJECTIVE Determine the prevalence of clinical insomnia and its associations with anxiety, depression, and tinnitus in adult cochlear implant (CI) users. DESIGN Self-reported information on tinnitus, sleep, and demographic variables was collected from adult CI users (n = 127). Tinnitus presence, its persistence, related emotional distress, and difficulties with sleep were assessed using questions from the UK Biobank study (www.ukbiobank.ac.uk). Tinnitus-related handicap was assessed using the Tinnitus Handicap Inventory. Clinical insomnia symptoms were characterized using the Insomnia Severity Index (ISI), and clinical anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS). Regression models were used to compare the data from CI users with and without tinnitus, and to test the associations between clinical insomnia, anxiety, depression and tinnitus handicap. RESULTS About a half (53%) of CI users reported tinnitus, of whom 54% described it as persistent, 41% as emotionally distressing and 73% reported having difficulties with sleep based on the UK Biobank questions. The ISI suggested that clinically abnormal insomnia symptoms were more likely to occur with tinnitus (odds ratio [OR] = 2.60, 95% confidence interval 1.04 to 6.45; p = 0.040) and were found in 41% of CI users with tinnitus. Post-hoc exploratory analyses on the ISI suggested that CI users with tinnitus experienced greater levels of difficulty falling asleep, lower satisfaction with sleep patterns, greater interference of sleep problems with daily activities, and a greater impact on their quality of life. The HADS scores suggested that those with tinnitus were also more likely to have clinically abnormal anxiety (42%; OR = 3.50, 95% confidence interval 1.49 to 8.22; p = 0.004) and depression symptoms (14%; OR = 6.18, 95% confidence interval 1.17 to 32.82; p = 0.032). The clinical insomnia observed in CI users with tinnitus was associated with tinnitus handicap (p = 0.028), and the levels of clinical anxiety (p = 0.012) and depression (p < 0.001). CONCLUSIONS Clinically abnormal insomnia symptoms are prevalent, potentially affecting over 40% of CI users with tinnitus. The associations between clinical insomnia, anxiety, and depression symptoms, and tinnitus-related handicap suggest that all of these symptoms should be considered when assessing the tinnitus-related burden and its impact on the quality of life after cochlear implantation. The present findings also have potential implications for the clinical management of CI recipients with tinnitus, in whom it may be advisable to monitor sleep problems so that they can be addressed where appropriate. Further research is needed to investigate the mechanisms and causal links behind insomnia and tinnitus-related symptoms in this population. Future studies should also investigate the feasibility and effectiveness of night time use of CIs to alleviate tinnitus-related insomnia. The potential impact of insomnia on the quality of life of CI users with tinnitus highlights the importance of including sleep measures in future evaluations of the effectiveness of cochlear implantation for the alleviation of tinnitus.
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McKenna L, Vogt F, Marks E. Current Validated Medical Treatments for Tinnitus: Cognitive Behavioral Therapy. Otolaryngol Clin North Am 2020; 53:605-615. [PMID: 32334871 DOI: 10.1016/j.otc.2020.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tinnitus distress results from a weave of physical and psychological processes. Reducing the power of the psychological processes will therefore reduce the degree of suffering. The main psychological therapy in this context is cognitive behavioral therapy (CBT). This seeks to understand and change the influence of thinking processes, including information processing biases, and the behaviors that these motivate, on the experience of tinnitus. The results of systematic reviews and meta-analyses indicate that CBT is the tinnitus management approach for which there is the most robust evidence. In spite of this, it remains difficult to access for people with tinnitus.
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Affiliation(s)
- Laurence McKenna
- Department Clinical Psychology, Royal National Ear Nose Throat and Eastman Dental Hospital, University College Hospital London, 6th Floor West, Ground Floor North, 250 Euston Road, London WN1 2PG, UK; UK & Ear Institute, University College London, 332 Grays Inn Rd, London WC1X 8EE, UK.
| | - Florian Vogt
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Elizabeth Marks
- Department Clinical Psychology, Royal National Ear Nose Throat and Eastman Dental Hospital, University College Hospital London, 6th Floor West, Ground Floor North, 250 Euston Road, London WN1 2PG, UK
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Liu D, Liu S, Zhu L, Li D, Huang D, Deng H, Guo H, Huang D, Liao Y, Mao Z, Miao Q, Liu W, Xiu M, Zhang X. Prevalence and Related Factors of Insomnia Among Chinese Medical Staff in the Middle and Late Stage of COVID-19. Front Psychiatry 2020; 11:602315. [PMID: 33364990 PMCID: PMC7750428 DOI: 10.3389/fpsyt.2020.602315] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The outbreak of novel coronavirus disease (COVID-19) has brought serious psychological pressure to people, especially medical health staff. At present, there are few studies on insomnia and related factors of medical health staff in the middle and late stage of the epidemic of COVID-19. Therefore, the purpose of this study was to investigate the prevalence of insomnia and its related risk factors among medical workers in China in the middle and later stage of COVID-19 epidemic, as well as the relationship between insomnia and psychological resilience. Methods: From February 14 to March 29, 2020, a cross-sectional survey was conducted among 606 medical staff in China through Ranxing Technology's "SurveyStar" network platform. All subjects were assessed with the Insomnia Severity Index (ISI) and simplified Chinese version of Connor-Davidson Resilience scale (CD-RISC-10). Results: In the middle and later stages of the COVID-19 outbreak, the incidence of insomnia among medical staff was 32.0%. Compared with non-insomnia group, the insomnia group had younger age, lower education level, longer daily working hours and less psychological resilience. In addition, the prevalence of insomnia was higher in medical staff with a history of somatic diseases. The severity of insomnia of Chinese medical staff was associated with age, education level, daily working hours, psychological resilience and somatic diseases. Conclusions: Our study shows that nearly 1/3 of Chinese medical workers suffer from insomnia nearly a month after the COVID-19 outbreak. Compared with the general population, medical staff who are working with COVID are more prone to insomnia. Risk factors for insomnia include younger age, lower education level, longer working hours per day, and physical illness. The tenacious dimension of psychological resilience is a protective factor for insomnia.
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Affiliation(s)
- Dianying Liu
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Shaohua Liu
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Lin Zhu
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Dongbin Li
- School of Education Science, Gannan Normal University, Ganzhou, China
| | - Donghua Huang
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Hongdong Deng
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Huiyun Guo
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Dan Huang
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Yuanping Liao
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Zhongzhen Mao
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Qiumei Miao
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Wanglin Liu
- Department of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xiangyang Zhang
- Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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