Why does tinnitus vary with naps? A polysomnographic prospective study exploring the somatosensory hypothesis

• Published in: Hearing research 2025-01, Vol.455, p.109152, Article 109152
• Main Authors: Guillard, Robin, Philippe, Vincent, Hessas, Adam, Faraut, Brice, Michiels, Sarah, Park, Minchul, Congedo, Marco, Londero, Alain, Léger, Damien
• Format: Article
• Language: English
• Subjects: Acoustic Stimulation; Adult; Aged; Female; Humans; Loudness Perception; Male; Middle Aged; Nap; Perceptual Masking; Polysomnography; Prospective Studies; Sleep; Sleep apnea; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - physiopathology; Snoring; Snoring - physiopathology; Somatosensory modulations; Time Factors; Tinnitus; Tinnitus - diagnosis; Tinnitus - physiopathology; Tinnitus - psychology
• ISSN: 0378-5955; 1878-5891; 1878-5891
• DOI: 10.1016/j.heares.2024.109152

•Demonstration of tinnitus nap-induced modulations under polysomnographic control.•Nap sleep duration, snoring and sleep apnea appear to correlate such modulations.•Methodological robustness: patients are compared to themselves over 6 naps. Tinnitus, defined as the conscious awareness of a noise without any identifiable corresponding external acoustic source, can be modulated by various factors. Among these factors, tinnitus patients commonly report drastic increases of tinnitus loudness following nap sleep. Previous studies have suggested that this clinical pattern could be attributed to a somatosensory modulation of tinnitus. To our knowledge, no polysomnographic study has been carried out to assess this hypothesis. For this observational prospective study, 37 participants reporting frequent increases of tinnitus following naps were recruited. They participated to six full-polysomnography nap attempts over two days. Audiological and kinesiologic tests were conducted before and after each nap attempt. 197 naps were collected. Each nap at each time of day elicited an overall significant increase in tinnitus minimum masking level (MML). Each inter nap period elicited an overall significant decrease. Tinnitus modulations were found significantly correlated with nap sleep duration (Visual numeric scale on tinnitus loudness, VNS-L, p < 0.05), with snoring duration (MML, p < 0.001), with snoring average sound level (VNS on tinnitus intrusiveness, VNS-I, p < 0.05) and with sleep apnea count (VNS-I, p < 0.001). This study confirms objectively that tinnitus may increase following naps. No association was found between these modulations and somatosensory modulations involving the temporomandibular joint and cervical areas. However, it may be possible that nap-induced tinnitus modulations are a hidden form of somatosensory modulation as snoring and sleep apnea events are often related to tensor veli palatini muscle dysfunction.