Associations between sleep disorders and anxiety in patients with tinnitus: A cross-sectional study

A U-shaped relationship between sleep duration and tinnitus incidence: analysis of 13,871 participants from NHANES

Sleep duration is associated to various health impairments, while its comprehensive association with tinnitus is rarely investigated. The current study aimed to explore the relationship between sleep duration and tinnitus incidence, and to determine the optimal sleep duration relating to the lowest tinnitus risk. Data of participants from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2012 and 2015 to 2018 were retrieved. A total of 13,871 participants were eligible and included in the analysis. Generally, sleep duration was lower in participants with tinnitus compared to those without (7.15±1.76 vs 7.30±1.51 h, P<0.001). After adjustment by demographics, lifestyle, and chronic diseases, a U-shaped relationship between sleep duration and tinnitus incidence was observed, with the inflection point at 8.5 h. Interestingly, in participants with sleep duration <8.5 h, sleep duration exhibited an independent negative correlation with tinnitus risk [OR=0.88 (95%CI: 0.84-0.93), P<0.001], while in participants with sleep duration ≥8.5 h, sleep duration had an independent positive association with tinnitus risk [OR=1.16 (95%CI: 1.04-1.28), P=0.006]. In conclusion, a U-shaped relationship was found between sleep duration and tinnitus incidence, with a sleep duration of about 8.5 h being associated with the lowest tinnitus risk.

Effects of otolaryngological diseases on sleep quality, anxiety, and depression: a multicenter observational study

BACKGROUND

The impact of otolaryngological diseases on sleep quality, anxiety, and depression has garnered significant attention. However, research has primarily focused on unveiling the effects of only one or two specific diseases, without analyzing the impact of multiple concurrent diseases. Furthermore, investigation into the interaction mechanisms among these factors has been lacking.

OBJECTIVES

This study reveals the effects of different otolaryngological diseases on sleep quality, anxiety, and depression, and investigates their interaction mechanisms.

METHODS

In total, 2,080 patients with otolaryngological diseases were recruited from six centers in mainland China. Data on sociodemographics, history of smoking and alcohol consumption, diagnosis, anxiety, depression, and sleep quality were collected through hospital information system queries and questionnaires. We uncovered the psychological status and sleep quality of otolaryngology outpatients with different diseases and revealed the interaction mechanisms between these diseases and anxiety, depression, and sleep quality. Multivariable polynomial linear regression models explored the impact of different otolaryngological diseases on anxiety, depression and sleep quality, and mediation analysis explored the interaction mechanisms.

RESULTS

Chronic laryngitis, eustachian tube disorders, laryngeal swelling, laryngopharyngeal reflux, neck lymphatic inflammation, snoring, sudden deafness, tinnitus, nasopharyngeal lesions, and trauma had a significant impact on Pittsburgh Sleep Quality Index scores. Chronic tonsillitis, chronic laryngitis, and laryngopharyngeal reflux had a significant impact on Zung Self-Rating Depression Scale scores. Patients with giddiness (P = 0.006) and tinnitus (P = 0.006) tended to have higher Zung Self-Rating Anxiety Scale scores. Anxiety mediated the effect of tinnitus on sleep quality (70.41%; 95% confidence interval [CI]: 40.07, 76.00), and depression also had a mediation effect (13.24%; 95% CI: 4.46, 28.58). Other diseases also exhibited mediating effects and interactions with anxiety, depression, and sleep quality.

CONCLUSIONS

Sleep quality significantly mediates the relationships of specific otolaryngological diseases with anxiety and depression. Similarly, anxiety and depression play important mediating roles in the relationships of different diseases with sleep quality. By revealing the interactive effects of different otolaryngological diseases on anxiety, depression, and sleep quality, this study could aid early interventions aiming to reduce anxiety and depression and improve patients' sleep quality and quality of life.

Correlation between the Degree of Hearing Loss and the Levels of Anxiety and Depression in Patients with Tinnitus

Objectives

This study aimed to explore the correlation between the degree of hearing loss (HL) and the degrees of anxiety and depression in patients with tinnitus.

Materials and Methods

This retrospective study involved the use of basic clinical data from 600 enrolled patients with tinnitus who visited the otolaryngology clinic in Affiliated Jinhua Hospital, Zhejiang University School of Medicine from April 2020 to June 2022. The tinnitus handicap inventory (THI) scale was used to assess the tinnitus status among the participants. The pure tone audiometry (PTA) test was used to conduct audiological assessments for all patients to determine their hearing condition. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the levels of anxiety and depression among the participants, respectively. The correlation between the HL and anxiety/depression scores from the questionnaires was tested through Pearson correlation analysis.

Results

Among the 600 enrolled patients with tinnitus, most patients had mild-to-moderate degree of tinnitus, accounting for 248 cases (41.3%) and 179 cases (29.8%), respectively. PTA results showed that a large proportion of patients with tinnitus were accompanied with HL (467 cases, 77.8%). Among them, patients with mild HL accounted for the largest proportion with a total of 241 cases (40.2%). Based on the results of SAS and SDS test, almost half of the patients had symptoms of anxiety and depression, accounting for 52.3% (314 cases) and 48.8% (293 cases), respectively. Similarly, patients with mild anxiety and depression occupy the largest proportion, accounting for 35.8% (215 cases) and 23% (138 cases), respectively. Pearson correlation analysis showed that the degree of HL was closely related to THI/SAS/SDS scores (P < 0.001).

Conclusion

These findings indicate a strong positive correlation between the degree of HL and anxiety/depression scores in patients with tinnitus.

Clinical characteristics and psychoacoustic analysis of acute and chronic subjective tinnitus

Objective

This study aimed to understand the demographics, clinical characteristics, and psychoacoustic status of subjective tinnitus patients to explore the factors associated with acute and chronic tinnitus in the general hospitals of Shanghai.

Methods

A cross-sectional study was conducted to investigate the clinical characteristics and psychoacoustic status of subjective tinnitus patients with history greater than 1 month. Data were collected during January 2021 and January 2022 from eight general hospitals in five districts of Shanghai, China. All patients accepted questionnaires and acoustic examination, then SPSS 22.0 and GraphPad Prism 8.0.2 were applied for data analysis.

Results

Among the 359 tinnitus patients, 126 cases were diagnosed with acute tinnitus, 58 cases were subacute tinnitus, and 175 cases were chronic tinnitus. Patients with acute and chronic tinnitus differed in terms of side of tinnitus, hearing loss, frequency of tinnitus, severity of tinnitus, anxiety, depression, and sleep status. Different characteristics were included in the multivariate ordinal logistic regression analysis. Persistent tinnitus (OR = 2.00, p = .008), high frequency hearing loss (OR = 4.77, p < .001), depression (OR = 1.23, p < .001) were found to be positively associated with the course of tinnitus. Unilateral tinnitus (OR = 0.48, p = .003), mild (OR = 0.29, p = .001) and moderate (OR = 0.46, p = .038) hearing loss, VAS scores (OR = 0.82, p = .032), anxiety (OR = 0.81, p < .001), THI scores (OR = 0.98, p = .002), and sleep disorders (OR = 0.94, p = .025) were found to be negatively associated with the course of tinnitus.

Conclusion

Patients with acute tinnitus were at greater risk for anxiety, sleep disturbances, and exacerbation of tinnitus perception, and those with chronic tinnitus were at greater risk for depression.

Lay Summary

Our study demonstrated that patients with acute tinnitus were at greater risk for anxiety, sleep disturbances, and exacerbation of tinnitus perception, and those with chronic tinnitus were at greater risk for depression.