Combined Noise Exposure and Hearing Difficulty as Independent Correlates of Tinnitus-Related Trouble Falling Asleep: A Nationally Representative Analysis of U.S. Adults

Background: Noise exposure is an established risk factor for tinnitus, yet its association with tinnitus-related trouble falling asleep remains underexplored at the population level. This study examined associations between occupational and leisure noise exposure and tinnitus-related trouble falling asleep in U.S. adults, adjusting for hearing difficulty. Methods: Cross-sectional analysis of 36,697 adults aged ≥18 years from the 2014 National Health Interview Survey (NHIS), which included a hearing supplement. The primary outcome was tinnitus-related trouble falling asleep among adults with tinnitus (n = 4,292). Secondary outcomes included short sleep (>7 hours) in the full sample (n = 33,507). Noise exposure was categorized as: no exposure, occupational only, leisure only, or both. Survey-weighted logistic regression with design-based standard errors estimated adjusted odds ratios (aOR) controlling for age, sex, race/ethnicity, education, smoking, and hearing difficulty. Results: The weighted 12-month tinnitus prevalence was 11.5%. Among those with tinnitus, 41.8% reported trouble falling asleep. Combined occupational and leisure noise exposure was associated with the highest odds of tinnitus-related trouble falling asleep (aOR = 1.69, 95% confidence interval [CI]: 1.30–2.19, P < 0.001), followed by leisure noise only (aOR = 1.37, 95% CI: 1.03–1.84, P = 0.033); occupational noise alone was not independently significant (aOR = 1.13, 95% CI: 0.92–1.39, P = 0.23; P-for-trend < 0.001). Hearing difficulty was a strong independent predictor (aOR = 1.78, 95% CI: 1.47–2.15, P < 0.001). Conclusions: Combined noise exposure is associated with elevated odds of tinnitus-related trouble falling asleep after adjustment for hearing difficulty. Hearing difficulty is the strongest correlate, suggesting that hearing status should be routinely assessed in tinnitus patients with sleep complaints.