Tinnitus And Sleep Disturbances

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Comunicazione presentata al Meeting sul Tinnitus, svolto a Stresa nel giugno 2009. Relazione tra acufeni e disturbi del sonno.

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Tinnitus And Sleep Disturbances

  1. 1. G. Attanasio 1,2 R. Roukos 1 F. Y. Russo 1 M. Saponara 1 1: Sapienza – University of Rome – Dept. Neurology and Otolaryngology 2: Acufeni.net onlus Association
  2. 2. Introduction <ul><li>Sleep disorders impair the quality of life and are a common condition in patients with chronic tinnitus. The reported prevalence of sleep disturbances in these patients has been assessed in previous studies but still the relationship between sleep impairment and tinnitus is not yet clearly understood. </li></ul>
  3. 3. Objectives <ul><li>The aim of this pilot study is to explore the sleep architecture of patients with chronic tinnitus. </li></ul><ul><li>We also try to identify, when they existed, common patterns in the sleep architecture of these patients and the way they influence coping and adaptation to tinnitus. </li></ul>
  4. 4. Materials and Methods <ul><li>18 patients </li></ul><ul><ul><li>5 patients with OSA (AHI>5) and 1 patient who was not able to sleep were excluded. </li></ul></ul><ul><li>Gender: 12 males , 6 females </li></ul><ul><li>Age : 21 – 73 </li></ul><ul><li>Mean Age: 49,58 ± 14,97 </li></ul><ul><li>Patients Selection Criteria: </li></ul><ul><ul><li>Chronic Tinnitus with at least a 2-years history </li></ul></ul><ul><ul><li>No Pharmacological Treatment since at least one month </li></ul></ul>
  5. 5. Materials And Methods <ul><li>Polisomnography </li></ul><ul><ul><li>Montage (30 channels): </li></ul></ul><ul><ul><ul><li>Cardiorespiratory monitoring </li></ul></ul></ul><ul><ul><ul><li>Electroencephalographic monitoring: </li></ul></ul></ul><ul><ul><ul><ul><li>10-20 SYSTEM : </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>C3 , C4, O1, O2, A1, A2, EOG, EMG </li></ul></ul></ul></ul></ul>C4 C3 EOG1 EOG2 EMG O1 O2 A1 A2
  6. 6. Materials And Methods <ul><li>Polisomnography </li></ul><ul><ul><li>Parameters to evaluate: </li></ul></ul><ul><ul><ul><li>Sleep Efficiency = TST/TIB </li></ul></ul></ul><ul><ul><ul><ul><li>TST = Period of time between the Lights off and Lights on excluding all the Wake stages. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>TIB = Period of time between the Lights off and Lights on markers. </li></ul></ul></ul></ul><ul><ul><ul><li>%REM </li></ul></ul></ul><ul><ul><ul><li>Light Sleep = %stage 1 + %stage 2 . </li></ul></ul></ul><ul><ul><ul><li>Deep Sleep = %stage 3 + %stage 4. </li></ul></ul></ul><ul><ul><ul><li>AHI = Apnea Hypopnea Index. </li></ul></ul></ul>
  7. 7. Materials And Methods Software: DOMINO© by Somnomedics®. All PSG studies has been reviewed by a trained personnel (Rechtschaffen and Kales with AASM Manual).
  8. 8. Materials and Methods <ul><li>Questionnaires: </li></ul><ul><ul><li>Tinnitus handicap inventory (Newman et al.) </li></ul></ul><ul><ul><li>Questionnaire based on a rating scale system between 1 and 10: </li></ul></ul><ul><ul><ul><li>Subjective Sleep quality: </li></ul></ul></ul><ul><ul><ul><ul><li>Poor quality: 1-3 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Average: 4-7 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Good: 8-10 </li></ul></ul></ul></ul><ul><ul><ul><li>Tinnitus intensity before bedtime. </li></ul></ul></ul><ul><ul><ul><li>Tinnitus intensity at remembered nocturnal wakeup periods. </li></ul></ul></ul><ul><ul><ul><li>Tinnitus intensity at morning wakeup. </li></ul></ul></ul>
  9. 9. Results Sleep Efficiency % Subjective sleep Tinnitus before sleep (1-10) Tinnitus at wakeup (1-10) THI Score (Max=50) 91 Poor 1 5 30 93.3 average 3 6 41 88.4 average 6 2 5 77.9 poor 5 5 na 87.4 NA NA NA na 74 average 8 6 14 59.6 average 5 5 8 79.4 average 4 3 12 61.1 average 10 10 41 65.5 good 9 9 40 77.9 poor 7 2 13 60.4 poor 5 5 24
  10. 10. Results Efficient Sleep >85%
  11. 11. Results: Sleep stages All patients had abnormal percentages of sleep stages 1 and 2. The average of stage1+stage2 is 85,4% ± 6.3 while the normal values range between 50 and 65% REM sleep lacked in all our patients with an average of 6,4 ± 4,9 while normal values should be between 20 and 25%. %REM (N=20-25%) % stage 1 (N=3-8%) %stage 2 (N=45-55%) % stage 1 + stage2 (N=50-65%) 0.8 4.6 76.8 81.4 12.4 43 41.5 84.5 7.3 28.1 50.2 78.3 16 36.9 44.2 81.1 2.5 14.9 69.9 84.8 1.4 33.6 55.3 88.9 4.4 41.5 34.8 76.3 6 52.3 38.2 90.5 0.2 62.5 36.1 98.6 5.5 44.1 45.2 89.3 11.4 39.7 42 81.7 8.6 48.3 41.8 90.1
  12. 12. Results <ul><li>We could not find any link between the intensity of tinnitus before sleep and at wakeup times and the grade of sleep disturbance. </li></ul><ul><li>Interestingly we found a common sleep pattern in our studied patients: </li></ul><ul><ul><li>All patients had an abnormal high percentage of stage 1 and stage 2, which means they were all “light sleepers” with an excessive stage 1. </li></ul></ul><ul><ul><li>None of our patients had a normal percentage of REM sleep. </li></ul></ul>
  13. 13. Results sleep stages and THI score
  14. 14. Conclusions <ul><li>Our data evidenced a correlation between the THI score increase and the sleep stages 1 and 2 increase during sleep time and a decrease of REM stages corresponded to an increase of THI score in most of our cases. </li></ul><ul><li>These findings encourage to recruit more patients to include in our study so that we can find a statistically significant correlation between “light sleeping” and decreased tolerance to chronic tinnitus. </li></ul>
  15. 15. Conclusions <ul><li>Previous studies and our pilot study have shown that patients with chronic tinnitus with a concomitant impaired sleep have a decreased tolerance and difficulties adapting to their condition. </li></ul><ul><li>But it is important to note that further studies are needed to understand how chronic tinnitus is linked to sleep disorders and whether or not it is a direct cause of the sleep patterns (light sleeping and decreased REM) found in our study. </li></ul>
  16. 16. Conclusions <ul><li>In any case a polysomnographic study should be considered in chronic tinnitus patients with a high THI score so that in the case of sleep disturbances a multidisciplinary approach is advised to integrate an adequate sleep therapy within the global treatment of chronic tinnitus aiming at resolving adaptive difficulties and hard coping with this condition. </li></ul>

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