J Am Acad Audiol 2019; 30(09): 802-809
DOI: 10.3766/jaaa.18020
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Factors Related to Insomnia in Adult Patients with Tinnitus and/or Hyperacusis: An Exploratory Analysis

Hashir Aazh
*   Audiology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
,
David M. Baguley
†   NIHR Nottingham Biomedical Research Centre, Nottingham, UK
‡   Otology and Hearing, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
,
Brian C. J. Moore
§   Department of Experimental Psychology, University of Cambridge, Cambridge, UK
› Author Affiliations
Further Information

Publication History

16 July 2018

Publication Date:
25 May 2020 (online)

Abstract

Background:

People with tinnitus and/or hyperacusis often experience insomnia. However, it is unclear what factors are most strongly associated with insomnia.

Purpose:

To explore factors related to insomnia in patients with tinnitus and/or hyperacusis.

Research Design:

This was a retrospective study using multiple-regression analysis.

Study Sample:

Data were assessed for 444 consecutive patients who sought help concerning their tinnitus and/or hyperacusis from a specialist audiology center in the UK National Health Service. The average age of the patients was 54 years (standard deviation = 15 years).

Data Collection and Analysis:

The results of audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Multiple-regression analysis was used to assess the relationship between insomnia and other variables.

Results:

Sixty-nine percent of patients with tinnitus experienced some form of insomnia as measured via the Insomnia Severity Index (ISI). A multiple-regression model showed that ISI scores were significantly associated with depression scores measured via the depression subscale of the Hospital Anxiety and Depression Scale (HADS) (regression coefficient [b] = 0.44, p < 0.001), tinnitus annoyance measured via the visual analog scale (VAS) (b = 0.49, p = 0.001), anxiety measured via the anxiety subscale of the HADS (b = 0.21, p = 0.012), and tinnitus handicap measured via the Tinnitus Handicap Inventory (b = 0.07, p < 0.001). The model explained 45% of the variance in ISI scores. VAS scores for tinnitus loudness, hyperacusis-related measures, hearing thresholds, age, and gender were not significantly related to insomnia.

Conclusions:

The prevalence of insomnia in patients with tinnitus is high. Both tinnitus-related factors and psychological factors are related to the severity of insomnia. Hyperacusis is not significantly associated with insomnia.

 
  • REFERENCES

  • Aazh H, Lammaing K, Moore BCJ. 2017; Factors related to tinnitus and hyperacusis handicap in older people. Int J Audiol 56: 677-684
  • Aazh H, Moore BCJ. 2017; Factors related to uncomfortable loudness levels for patients seen in a tinnitus and hyperacusis clinic. Int J Audiol 56: 793-800
  • Aazh H, Moore BCJ. 2018; Prevalence and characteristics of patients with severe hyperacusis among patients seen in a tinnitus and hyperacusis clinic. J Am Acad Audiol 29: 626-633
  • Aazh H, Moore BCJ. 2019; Tinnitus loudness and the severity of insomnia: a mediation analysis. Int J Audiol 58: 208-212
  • Aazh H, Moore BCJ, Lammaing K, Cropley M. 2016; Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: patients’ evaluations of the effectiveness of treatments. Int J Audiol 55: 514-522
  • American Psychiatric Association 2000. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR® . Washington, DC: American Psychiatric Association Publishing;
  • Andersson G, Edvinsson E. 2008; Mixed feelings about living with tinnitus: a qualitative study. Audiol Med 6: 48-54
  • Baguley DM. 2018. Reflections on the association between tinnitus and hyperacusis. In: Fagelson M, Baguley DM. Hyperacusis and Disorders of Sound Tolerance. San Diego, CA: Plural;
  • Baliatsas C, van Kamp I, Swart W, Hooiveld M, Yzermans J. 2016; Noise sensitivity: symptoms, health status, illness behavior and co-occurring environmental sensitivities. Environ Res 150: 8-13
  • Bastien CH, Vallieres A, Morin CM. 2001; Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med 2: 297-307
  • British Society of Audiology (BSA) 2011. a Pure-Tone Air-Conduction and Bone-Conduction Threshold Audiometry with and without Masking: Recommended Procedure. Reading, UK: British Society of Audiology;
  • British Society of Audiology (BSA) 2011. b Recommended Procedure: Determination of Uncomfortable Loudness Levels. Reading, UK: British Society of Audiology;
  • Buysse DJ, Reynolds 3rd CF, Monk TH, Berman SR, Kupfer DJ. 1989; The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28: 193-213
  • Cronlein T, Langguth B, Popp R, Lukesch H, Pieh C, Hajak G, Geisler P. 2013; Regensburg Insomnia Scale (RIS): a new short rating scale for the assessment of psychological symptoms and sleep in insomnia; study design: development and validation of a new short self-rating scale in a sample of 218 patients suffering from insomnia and 94 healthy controls. Health Qual Life Outcomes 11: 65
  • Cronlein T, Langguth B, Pregler M, Kreuzer PM, Wetter TC, Schecklmann M. 2016; Insomnia in patients with chronic tinnitus: cognitive and emotional distress as moderator variables. J Psychosom Res 83: 65-68
  • Fioretti AB, Fusetti M, Eibenstein A. 2013; Association between sleep disorders, hyperacusis and tinnitus: evaluation with tinnitus questionnaires. Noise Health 15: 91-95
  • Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. 1995; Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 18: 425-432
  • Folmer RL, Griest SE. 2000; Tinnitus and insomnia. Am J Otolaryngol 21: 287-293
  • Hallam RS, Jakes SC, Hinchcliffe R. 1988; Cognitive variables in tinnitus annoyance. Br J Clin Psychol 27 (Pt 3) 213-222
  • Hebert S, Carrier J. 2007; Sleep complaints in elderly tinnitus patients: a controlled study. Ear Hear 28: 649-655
  • Khalfa S, Dubal S, Veuillet E, Perez-Diaz F, Jouvent R, Collet L. 2002; Psychometric normalization of a hyperacusis questionnaire. ORL J Otorhinolaryngol Relat Spec 64: 436-442
  • Kutner MH, Nachtsheim C, Neter J. 2004. Applied Linear Regression Models. 4th ed. New York, NY: McGraw-Hill Education;
  • Lasisi AO, Gureje O. 2011; Prevalence of insomnia and impact on quality of life among community elderly subjects with tinnitus. Ann Otol Rhinol Laryngol 120: 226-230
  • Meikle MB, Vernon J, Johnson RM. 1984; The perceived severity of tinnitus. Some observations concerning a large population of tinnitus clinic patients. Otolaryngol Head Neck Surg 92: 689-696
  • Miguel GS, Yaremchuk K, Roth T, Peterson E. 2014; The effect of insomnia on tinnitus. Ann Otol Rhinol Laryngol 123: 696-700
  • Newman CW, Jacobson GP, Spitzer JB. 1996; Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 122: 143-148
  • Nordin M, Nordin S. 2016; Sleep and sleepiness in environmental intolerances: a population-based study. Sleep Med 24: 1-9
  • Park J, Chung S, Lee J, Sung JH, Cho SW, Sim CS. 2017; Noise sensitivity, rather than noise level, predicts the non-auditory effects of noise in community samples: a population-based survey. BMC Public Health 17: 315
  • Schecklmann M, Pregler M, Kreuzer PM, Poeppl TB, Lehner A, Crönlein T, Wetter TC, Frank E, Landgrebe M, Langguth B. 2015; Psychophysiological associations between chronic tinnitus and sleep: a cross validation of tinnitus and insomnia questionnaires. Biomed Res Int 2015: 461090
  • Steer RA, Ball R, Ranieri WF, Beck AT. 1997; Further evidence for the construct validity of the Beck depression Inventory-II with psychiatric outpatients. Psychol Rep 80: 443-446
  • Tyler RS, Baker JL. 1983; Difficulties experienced by tinnitus sufferers. J Speech Hear Disord 48: 150-154
  • Visser P, Hofman WF, Kumar A, Cluydts R, de Diana IPF, Marchant P, Bakker HJ, van Diest R, Poelstra PAM. 1978. Sleep and mood: measuring the sleep quality. In: Priest RG, Pletscher A, Ward J. Proceedings of the Northern European Symposium on Sleep Research. Basel, Lancaster: MTP Press Limited; 135-145
  • Wilson PH, Henry J, Bowen M, Haralambous G. 1991; Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. J Speech Hear Res 34: 197-201
  • Xu Y, Yao J, Zhang Z, Wang W. 2016; Association between sleep quality and psychiatric disorders in patients with subjective tinnitus in China. Eur Arch Otorhinolaryngol 273: 3063-3072
  • Zigmond AS, Snaith RP. 1983; The hospital anxiety and depression scale. Acta Psychiatr Scand 67: 361-370
  • Zung WW. 1971; A rating instrument for anxiety disorders. Psychosomatics 12: 371-379
  • Zung WW. 1974; The measurement of affects: depression and anxiety. Mod Probl Pharmacopsychiatry 7: 170-188