The Association Between Tinnitus Sensation–Level Loudness and Sleep Quality in Patients With Subjective Consecutive Tinnitus: A Mediation Analysis

Abstract

Purpose: So far, there have been no in-depth analyses of the connection between tinnitus sensation–level loudness and sleep quality. Accordingly, the present study was formulated as a mediation analysis focused on exploring this relationship. Method: Overall, 1,255 adults with consecutive subjective tinnitus who had sought outpatient treatment were enrolled in the present study. Results: Direct effects of tinnitus sensation–level loudness on sleep quality were not statistically significant (95% confidence intervals [CI] include zero), as measured by the point estimate, −0.016. However, the 95% CI for indirect effects did not include zero when assessing the Self-Rating Anxiety Scale (SAS) scores, the Self-Rating Depression Scale (SDS) scores, the visual analogue scale (VAS) scores, and self-reported tinnitus annoyance. Conclusions: These results suggest that tinnitus sensation–level loudness does not directly have an effect on sleep quality. However, it indirectly impacts sleep quality, mediated by SAS scores, SDS scores, the impact of tinnitus on life measured using the VAS, and self-reported tinnitus annoyance. As such, alleviating anxiety and depression in patients with tinnitus may result in reductions in their insomnia even if there is no reduction in tinnitus loudness. Importantly, otolaryngologists and other clinicians treating tinnitus should refer patients with tinnitus suffering from insomnia with comorbid depression or anxiety for appropriate psychological and/or psychiatric treatment.