0880 Tinnitus Severity in Posttraumatic Stress Disorder (PTSD) is Inversely Correlated with Rapid Eye Movement (REM) Sleep Percentage and Duration and Directly Correlated with Indices of Hyperarousal

Abstract

Introduction: Tinnitus has been studied primarily in war veterans and refugees with PTSD, often exposed to head injury. A 50% tinnitus prevalence is reported in PTSD (versus a 10%-15% general population prevalence). Tinnitus in PTSD patients has been attributed to various factors including increased arousal, mild traumatic head injury including blast exposure, and a conditioned response to memories of being struck in the head. Tinnitus is associated with both cochlear and central nervous pathologies including limbic activation. Overnight polysomnography of non-psychiatric tinnitus patients has revealed lower %REM (6.4%+/-4.9%) in tinnitus patients versus controls (21.5%+/-3.6%)(Attanasio G, 2013). To my knowledge, there are no polysomnographic studies of PTSD patients with tinnitus. Methods: 57 consenting civilian PTSD patients (52 female; mean+/-SD age: 46.91+/-13.09 years), with no head trauma history, underwent ≥1 nights of Level 3 polysomnography (WatchPAT200; Itamar Medical, Israel) and completed a battery of instruments including the Tinnitus Functional Index (TFI), a 25-item instrument that measures both severity and negative impact of tinnitus, the Pennebaker Inventory of Limbic Languidness (PILL), and PTSD Checklist for DSM-5(PCL-5). Results: 33/57(57.9%) endorsed experiencing tinnitus. TFI scores correlated directly (Pearson r=0.520, p=0.002) with PCL-5 scores (mean+/-SD PCL-5 score: 37.82+/-19.02). Multiple regression analysis using TFI score as dependent variable and PCL-5 clusters, PILL scores and age as independent variables revealed that only PCL-5 Cluster E(hyperarousal)(β=0.524,t=3.372,p=0.002) remained a significant predictor of TFI. Both %REM (r= -0.390, p=0.025) and REM duration ( r=-0.430, p=0.012) were significantly inversely correlated with TFI. Conclusion: Tinnitus was associated with PTSD severity, especially the hyperarousal cluster, in civilian PTSD patients with no head trauma histories. Higher baseline REM sleep has been associated with reduced fear conditioning in humans, therefore an inverse relation of tinnitus with REM sleep percentage and duration may be indicative of a greater propensity for fear conditioning in PTSD patients with higher tinnitus levels. Tinnitus may be a core symptom of activation and limbic dysregulation in PTSD, independent of traumatic brain injury.