Insomnia, Anxiety and Depression in Adult Cochlear Implant Users With Tinnitus

Abstract

Objective: Determine the prevalence of clinical insomnia and its associations with anxiety, depression and tinnitus in adult CI users.Design: Self-reported information on tinnitus, sleep and demographic variables were collected from adult cochlear implant users (n = 127). Tinnitus presence, its persistence, related emotional distress, and difficulties with sleep were assessed using questions from the UK Biobank study (www.ukbiobank.ac.uk). Tinnitus-related handicap was assessed using the Tinnitus Handicap Inventory. Clinical insomnia symptoms were characterized using the Insomnia Severity Index (ISI), and clinical anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS). Regression models were used to compare the data from cochlear implant users with and without tinnitus, and to test the associations between clinical insomnia, anxiety, depression and tinnitus handicap.Results: About a half (53%) of cochlear implant users reported tinnitus, of whom 54% described it as persistent, 41% as emotionally distressing and 73% reported having difficulties with sleep based on the UK Biobank questions. The ISI suggested that clinically abnormal insomnia symptoms were more likely to occur with tinnitus (Odds Ratio (OR) = 2.60, 95% confidence interval 1.04 to 6.45; p = 0.040) and were found in 41% of cochlear implant users with tinnitus. Post-hoc exploratory analyses on the ISI suggested that cochlear implant users with tinnitus experienced greater levels of difficulty falling asleep, lower satisfaction with sleep patterns, greater interference of sleep problems with daily activities, and a greater impact on their quality of life. The HADS scores suggested that those with tinnitus were also more likely to have clinically abnormal anxiety (42%; OR = 3.50, 1.49 to 8.22; p = 0.004) and depression symptoms (14%; OR = 6.18, 1.17 to 32.82; p = 0.032). The clinical insomnia observed in cochlear implant users with tinnitus was associated with tinnitus handicap (p = 0.028), and the levels of clinical anxiety (p = 0.012) and depression (p < 0.001).

Evaluation of factors predicting tinnitus outcomes following cochlear implantation: Protocol for a prospective quasi-experimental study

“…The ISI has been found to be a reliable measure for detecting clinically abnormal insomnia symptoms [ 40 , 41 ]. It has been widely used in studies investigating insomnia in the general tinnitus population [ 35 , 42 , 43 ], cochlear implant recipients [ 17 ], and clinical trials evaluating effectiveness of interventions for insomnia [ 44 ]. The ISI is scored from 0 to 28, with higher scores indicating more severe insomnia.…”

The Relationship Between Sleep Traits and Tinnitus in UK Biobank: A Population-Based Cohort Study

“…The severity of tinnitus was additionally classified as “upsetting tinnitus” (answered as “severe” or “moderate” tinnitus) and “not upsetting tinnitus” (answered as “slight” or “not at all”). The detailed definition of tinnitus was described as per those provided in previous literature (Pierzycki et al 2016; Pierzycki & Kitterick 2021).…”

Cochlear implant in tinnitus management

“…A recent study [19] involving 127 adult cochlear implant users evaluated previous tinnitus, its persistence after surgery, related emotional distress and insomnia. Regression models were used to compare the data from cochlear implant users with and without tinnitus, and to test the associations between clinical insomnia, anxiety, depression and tinnitus handicap.…”

“…Its findings demonstrate potential implications for the clinical management of cochlear implant recipients with tinnitus, in whom it may be advisable to monitor sleep problems so that they can be addressed whenever appropriate. Its authors also suggest that further research should also investigate the feasibility and effectiveness of night time use of cochlear implants to alleviate tinnitus-related insomnia [19].…”