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Observational Study
. 2023 Apr 14;20(8):5509.
doi: 10.3390/ijerph20085509.

REM Sleep Impairment May Underlie Sleep-Driven Modulations of Tinnitus in Sleep Intermittent Tinnitus Subjects: A Controlled Study

Affiliations
Observational Study

REM Sleep Impairment May Underlie Sleep-Driven Modulations of Tinnitus in Sleep Intermittent Tinnitus Subjects: A Controlled Study

Robin Guillard et al. Int J Environ Res Public Health. .

Abstract

(1) Background: Poor sleep and fragmented sleep are associated with several chronic conditions. Tinnitus is an auditory symptom that often negatively combines with poor sleep and has been associated with sleep impairment and sleep apnea. The relationship between tinnitus psychoacoustic characteristics and sleep is still poorly explored, notably for a particular subgroup of patients, for whom the perceived loudness of their tinnitus is highly modulated by sleep. (2) Methods: For this observational prospective study, 30 subjects with tinnitus were recruited, including 15 "sleep intermittent tinnitus" subjects, who had reported significant modulations of tinnitus loudness related to night sleep and naps, and a control group of 15 subjects displaying constant non-sleep-modulated tinnitus. The control group had matching age, gender, self-reported hearing loss grade and tinnitus impact on quality of life with the study group. All patients underwent a polysomnography (PSG) assessment for one complete night and then were asked to fill in a case report form, as well as a report of tinnitus loudness before and after the PSG. (3) Results: "Sleep Intermittent tinnitus" subjects had less Stage 3 sleep (p < 0.01), less Rapid-Eye Movement (REM) Sleep (p < 0.05) and more Stage 2 sleep (p < 0.05) in proportion and duration than subjects from the control group. In addition, in the "sleep Intermittent tinnitus" sample, a correlation was found between REM sleep duration and tinnitus overnight modulation (p < 0.05), as well as tinnitus impact on quality of life (p < 0.05). These correlations were not present in the control group. (4) Conclusions: This study suggests that among the tinnitus population, patients displaying sleep-modulated tinnitus have deteriorated sleep quality. Furthermore, REM sleep characteristics may play a role in overnight tinnitus modulation. Potential pathophysiological explanations accounting for this observation are hypothesized and discussed.

Keywords: REM; polysomnography; sleep; sleep apnea; sleep intermittent tinnitus.

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Conflict of interest statement

Damien Léger declares that in the past 5 years, he has been employed as an investigator or a consultant by Actellion-Idorsia, the Agence Spatiale Européenne, Bioprojet, iSommeil, ESAI, Jansenn, Jazz, Vanda, Merck, Philips, Rythm, Sanofi, Vitalaire, and Resmed. Robin Guillard declares that he is a shareholder and president in Siopi SAS and has a professional activity as independent as Robin Guillard EIRL. Louis Korczowski declares he is a shareholder in Siopi SAS employed by Robin Guillard EIRL. The other authors did not declare COI.

Figures

Figure A1
Figure A1
Anticorrelation between REM sleep percentage of total sleep time and overnight VAS-L variation, TST: total sleep time.
Figure 1
Figure 1
Comparison of absolute overnight tinnitus variation between groups, MML: Minimum Masking Level, VAS-L: Visual analog scale on tinnitus loudness, VAS-I: Visual analog scale on tinnitus intrusiveness. *: p < 0.05, **: p < 0.01.
Figure 2
Figure 2
General overview of sleep characteristics main difference between SIT group and matched Non-SIT group. Tinnitus dynamic display figure adapted with permission from Ref. [50]. 2002, Cecile Nicolas-Puel. *: p < 0.05, **: p < 0.01.
Figure 3
Figure 3
Anticorrelations between REM sleep duration (in min) and overnight tinnitus variations measured by Minimum Masking Level (MML), Visual Analog Scales on Tinnitus Loudness (VAS-L) and Intrusiveness (VAS-I).

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Grants and funding

This research was funded by Felicia and Jean-Jacques Lopez-Loreta Foundation grant to R.G.