Sleep Architecture Variation in Chronic Tinnitus Patients

Objectives: The aim of the study was to evaluate the sleep architecture and its possible alterations in chronic tinnitus patients, and investigate any possible correlation between sleep architecture modifications and tinnitus perception, adaptation, and the degree of discomfort in these patients. Design: In a prospective, case-control, nonrandomized study, 18 patients affected by chronic tinnitus were compared with a homogeneous control group consisting of 15 healthy subjects. The experimental group was enrolled at the Tinnitus ambulatory at Policlinico Umberto I Department of Sensory Organs, and the control group was composed of voluntary subjects. A full overnight polysomnography was performed on both groups. Tinnitus patients answered two questionnaires: the tinnitus handicap inventory (THI) and a questionnaire concerning their subjective sleep quality, tinnitus intensity before bedtime, tinnitus intensity at remembered nocturnal wake-up periods, and tinnitus intensity at morning wake-up. Controls completed only the sleep quality questionnaire. Results: All tinnitus patients had a statistically significant alteration in sleep stages. Average percentage of stage 1 + stage 2 was 85.4% ± 6.3, whereas, in the control group, the average percentage of stage 1 + stage 2 was 54.9 ± 11.2 (p < 0.001). Stages 3 and 4 and rapid eye movement (REM) sleep was lacking in all tinnitus patients with an average percentage of 6.4 ± 4.9 of REM sleep, and 6.4 ± 4.9 of stages 3 + 4. The control group showed an average percentage of 21.5 ± 3.6 of REM sleep and 21.5 ± 3.6 of stages 3 + 4 (p < 0.001). No correlation was found between the decrease of REM and the increase of the THI score in the tinnitus group (r = 0.04). However, a mild correlation was found between the increase of light sleep (stage 1 + stage 2) and the THI score reported by the tinnitus group. Therefore, patients with light sleep report a higher THI score (r = 0.4). Conclusions: The significant alteration of sleep parameters assessed in tinnitus patients underlines the necessity to consider an adequate therapy that could improve patients’ sleep quality and also opens avenues for further investigations.

[1]  F. Reinoso-suárez,et al.  Functional Anatomy of Non-REM Sleep , 2011, Front. Neur..

[2]  Julie Carrier,et al.  Polysomnographic and quantitative electroencephalographic correlates of subjective sleep complaints in chronic tinnitus , 2011, Journal of sleep research.

[3]  Jack Katz editor-in-chief.  Handbook of clinical audiology , 2015 .

[4]  B. Nolan.  Boosting slow oscillations during sleep potentiates memory , 2008 .

[5]  J. Rauschecker,et al.  Tuning Out the Noise: Limbic-Auditory Interactions in Tinnitus , 2010, Neuron.

[6]  Naoki Oishi.  Tinnitus and hyperacusis , 2015 .

[7]  C. Stevens,et al.  Tinnitus and its effect on working memory and attention. , 2006, Journal of speech, language, and hearing research : JSLHR.

[8]  J B Spitzer,et al.  Development of the Tinnitus Handicap Inventory. , 1996, Archives of otolaryngology--head & neck surgery.

[9]  N Suga,et al.  Experience-dependent plasticity in the auditory cortex and the inferior colliculus of bats: role of the corticofugal system. , 2000, Proceedings of the National Academy of Sciences of the United States of America.

[10]  D. De Ridder,et al.  The neural network of phantom sound changes over time: a comparison between recent‐onset and chronic tinnitus patients , 2011, The European journal of neuroscience.

[11]  J. Shaver,et al.  Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. , 1999, The Journal of rheumatology.

[12]  J. Oleson,et al.  Clinical trials for tinnitus: study populations, designs, measurement variables, and data analysis. , 2007, Progress in brain research.

[13]  J. Alster,et al.  Sleep disturbance associated with chronic tinnitus , 1993, Biological Psychiatry.

[14]  R. Coles,et al.  Epidemiology of tinnitus: (1) Prevalence , 1984, The Journal of Laryngology & Otology.

[15]  Berthold Langguth,et al.  A review of tinnitus symptoms beyond ‘ringing in the ears’: a call to action , 2011, Current medical research and opinion.

[16]  Berthold Langguth,et al.  Tinnitus and insomnia. , 2007, Progress in brain research.

[17]  J. Huguenard,et al.  Resting Our Cortices by Going DOWN to Sleep , 2009, Neuron.

[18]  W. Noble,et al.  Considerations for the design of clinical trials for tinnitus , 2006, Acta oto-laryngologica. Supplementum.

[19]  M. Koller,et al.  Tinnitus Handicap Inventory for Evaluating Treatment Effects , 2011, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[20]  van Pim Dijk,et al.  Neural activity underlying tinnitus generation: Results from PET and fMRI , 2009, Hearing Research.

[21]  Naoki Oishi,et al.  Effects of Selective Serotonin Reuptake Inhibitor on Treating Tinnitus in Patients Stratified for Presence of Depression or Anxiety , 2009, Audiology and Neurotology.

[22]  H. Schulz,et al.  Phasic or transient? Comment on the terminology of the AASM manual for the scoring of sleep and associated events. , 2007, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[23]  J. Marriage,et al.  Is central hyperacusis a symptom of 5-hydroxytryptamine (5-HT) dysfunction? , 1995, The Journal of Laryngology & Otology.

[24]  R. S. Tyler,et al.  Difficulties experienced by tinnitus sufferers. , 1983, The Journal of speech and hearing disorders.

[25]  A Axelsson,et al.  Tinnitus--a study of its prevalence and characteristics. , 1989, British journal of audiology.

[26]  M. Tafti,et al.  Homeostatic process and sleep spindles in patients with sleep-maintenance insomnia: effect of partial (21 h) sleep deprivation. , 1998, Electroencephalography and clinical neurophysiology.

[27]  P. Giannini,et al.  Psychiatric comorbidity in a population of outpatients affected by tinnitus: Comorbilidad psiquiátrica en una población de pacientes de consulta externa afectados por tinnitus , 2003, International journal of audiology.