Abstract
Purpose. Tinnitus and sleep disturbance are prevalent in veterans, and a better understanding of their relationship can help with tinnitus treatment. Materials and Methods. Retrospective chart review of 94 veterans seen in audiology clinic between 2010 and 2013 is presented. Results. The mean age was 62 years, and 93 of 94 veterans were males. The majority (96%) had hearing loss. The positive predictive value of the ESS for sleep disorder was 97% and the negative predictive value was 100%. Veterans with a Tinnitus Handicap Inventory (THI) score ≥38 had significantly higher Epworth Sleepiness Scale (ESS) scores compared to those with THI score <38 (P = 0.006). The former had a significantly higher incidence of PTSD, anxiety, and sleep disorder. A subgroup of patients had normal sleep despite rising THI scores. Bilateral tinnitus, vertigo, and anxiety were found to be predictors of sleep disturbance. Conclusions. The ESS can be used as a tool in the initial assessment of sleep disorders in veterans with tinnitus. Higher tinnitus handicap severity is significantly associated with greater sleep disturbance. Optimal management of tinnitus may require concomitant treatment of sleep disorder, PTSD, anxiety, and depression.
Highlights
Tinnitus, defined as the perception of sound without an external source, affects an estimated 35 to 50 million Americans or 5 to 15% of the general population [1,2,3,4,5]
The Epworth Sleepiness Scale (ESS) can be used as a tool in the initial assessment of sleep disorders in veterans with tinnitus, with a positive predictive value (PPV) of 97% and negative predictive value (NPV) of 100%
We discovered a higher rate of posttraumatic stress disorder (PTSD) (82%) in veterans with tinnitus than previously reported in the literature and found that veterans may suffer from comorbidities such as PTSD, anxiety, and depression which appear to act synergistically to worsen sleep disturbance and/or tinnitus
Summary
Tinnitus, defined as the perception of sound without an external source, affects an estimated 35 to 50 million Americans or 5 to 15% of the general population [1,2,3,4,5]. The majority of those affected by tinnitus habituate to the condition and do not seek treatment, 10–20% experience tinnitus as a severe handicap [6] Those who live with tinnitus may be burdened by comorbid stressors such as sleep disorders, depression, anxiety disorder, and suicidal ideation [7,8,9]. These conditions negatively impact many aspects of daily life, causing impairments in work and memory and reducing quality of life [7, 8, 10]. It has been shown that sleep disturbance strongly predicts lower tinnitus tolerance, while successful treatment of tinnitus results in fewer sleep complaints [11, 17, 19,20,21]
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