title: Insomnia in patients with chronic tinnitus: Cognitive and emotional distress as moderator variables.
abstract: BACKGROUND
  Tinnitus is often associated with disturbed sleep, but there are also patients without sleep problems. The mechanisms for developing insomnia or not in tinnitus patients are still unknown. The aim of the present study was to extract possible tinnitus specific factors that increase the risk of developing insomnia based on the analysis of a large patient cohort suffering from chronic tinnitus.
  
  
  METHODS
  173 patients presenting at the multidisciplinary tinnitus center of a University Hospital completed a questionnaire measuring specific psychological symptoms of insomnia (RIS) and a tinnitus questionnaire (TQ). The scores of all ten RIS items were compared between tinnitus patients and 94 healthy individuals by separate ANOVAs in order to specify the extent of insomnia specific symptoms in the tinnitus group. In a second step a multiple linear regression analysis was performed in the tinnitus sample with subscales of the TQ (excluding the TQ sleep scale), age and duration of tinnitus as independent variables and the RIS score as the dependent variables.
  
  
  RESULTS
  Tinnitus patients differed from healthy controls not only in impaired sleep quality but also in insomnia specific concerns and anxiety. Tinnitus related emotional and cognitive distress and somatic complaints correlated with severity of insomnia, whereas no association of age or duration of tinnitus with severity of insomnia was found.
  
  
  CONCLUSIONS
  Our results suggest that chronic tinnitus patients have more sleeping difficulties and associated worries about sleep or negative emotions in contrast to healthy controls. Tinnitus-related distress is related to insomnia.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Germany. Electronic address: Tatjana.croenlein@medbo.de.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Crönlein
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Langguth
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Pregler
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Germany.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kreuzer
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Germany.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wetter
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schecklmann
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D002908:Chronic Disease; D003071:Cognition; D015987:Effect Modifier, Epidemiologic; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000150:complications* / Q000453:epidemiology / Q000523:psychology
keywords: Cognitive distress; Emotional distress; Insomnia; Sleep; Tinnitus