Association of Sleep Characteristics with Tinnitus and Hearing Loss

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.

Keywords: NHANES; hearing loss; sleep; tinnitus.

Figure 1

Prevalence of negative sleep characteristics for the overall cohort and by presence of bothersome tinnitus in the past 12 months. Sleep Hours: Participants were asked the number of hours of sleep they usually get at night on weekdays or workdays in integers. Sleep Disorders: Answering “yes” to “Have you ever been told by a doctor or other health professional that you have a sleeping disorder?” Trouble Sleeping: Answering “yes” to “Have you ever told a doctor or other health professional that you have trouble sleeping?” OSA symptoms: Answering “occasionally” or “frequently” to all three of the following questions; “In the past 12 months, how often did you snore while you were sleeping?” “In the past 12 months, how often did you snort, gasp, or stop breathing while you were sleeping?” and “In the past month, how often did you feel excessively or overly sleepy during the day?” OSA, obstructive sleep apnea.

Figure 2

Path diagrams for the association among sleep characteristics, hearing loss, and tinnitus. a/a′: Models in Table 2. b′: Models in Table 3.