Results of two cross-sectional database analyses regarding nap-induced modulations of tinnitus

Abstract

The influence of naps on tinnitus was systematically assessed by exploring the frequency, clinical and demographic characteristics of this phenomenon. 9,724 data from two different tinnitus databases (Tinnitus Hub: n = 6115; Tinnitus Research Initiative (TRI): n = 3627) were included. After separate analysis of the databases, these results were then compared with each other. In the Tinnitus Hub survey database, a total of 31.1% reported an influence on tinnitus by taking a nap (26.9% in the TRI database), with much more frequent worsening after a nap than improvement (23.0% a little or a lot worse; TRI: 17.7% worse; 8.1% a little or a lot better; TRI: 9.2% better). The influence of napping on tinnitus was associated in both databases with other clinical features, such as the dependence of tinnitus on night quality, stress and somatosensory maneuvers. The present study confirms the clinical observation that more tinnitus sufferers report worsening after a nap than tinnitus sufferers reporting an improvement. It was consistently shown that tinnitus sufferers reporting nap-induced modulation of tinnitus also report more frequently an influence of night sleep on their tinnitus. Further clinical and polysomnographic research is warranted to better understand the interaction between sleep and tinnitus. Tinnitus is defined as the perception of a sound in the absence of an external acoustic source 1,2. The prevalence is high at about 10-15%, with about 1-2% of the general population also having severe tinnitus 3-8. Tinnitus shows a high clinical heterogeneity, e.g., regarding loudness, pitch, sound quality, laterality and continuity 2. While some tinnitus patients have constant tinnitus, some have variable tinnitus, e.g., intermittent or fluctuating in intensity 9. Tinnitus patients often report that some factors can modulate their tinnitus, causing either an improvement or a worsening. In this context, the clinical phenomenon that a daytime nap can have an effect on tinnitus is well known. In clinical settings, this phenomenon is queried in the frequently used Tinnitus Sample Case History Questionnaire (TSCHQ) of the Tinnitus Research Initiative (TRI) with question 22 (influence by nap: worsens/improves/no effect) 10 , as well as in the ESIT-SQ questionnaire of the European School of Interdisciplinary Tinnitus research (ESIT) as a potential modulatory factor of tinnitus (question B18 on factors decreasing tinnitus and question B19 on factors increasing tinnitus) 11. It is remarkable that individually different effects are possible and that a measure intuitively assessed as relaxing can have negative effects on tinnitus. To date, this phenomenon has only been rudimentarily investigated scientifically 12-14 and sometimes compared to the rare parasomnia figuratively called OPEN