Effects of otolaryngological diseases on sleep quality, anxiety, and depression: a multicenter observational study

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BACKGROUND: The impact of otolaryngological diseases on sleep quality, anxiety, and depression has garnered significant attention. However, research has primarily focused on unveiling the effects of only one or two specific diseases, without analyzing the impact of multiple concurrent diseases. Furthermore, investigation into the interaction mechanisms among these factors has been lacking. OBJECTIVES: This study reveals the effects of different otolaryngological diseases on sleep quality, anxiety, and depression, and investigates their interaction mechanisms. METHODS: In total, 2,080 patients with otolaryngological diseases were recruited from six centers in mainland China. Data on sociodemographics, history of smoking and alcohol consumption, diagnosis, anxiety, depression, and sleep quality were collected through hospital information system queries and questionnaires. We uncovered the psychological status and sleep quality of otolaryngology outpatients with different diseases and revealed the interaction mechanisms between these diseases and anxiety, depression, and sleep quality. Multivariable polynomial linear regression models explored the impact of different otolaryngological diseases on anxiety, depression and sleep quality, and mediation analysis explored the interaction mechanisms. RESULTS: Chronic laryngitis, eustachian tube disorders, laryngeal swelling, laryngopharyngeal reflux, neck lymphatic inflammation, snoring, sudden deafness, tinnitus, nasopharyngeal lesions, and trauma had a significant impact on Pittsburgh Sleep Quality Index scores. Chronic tonsillitis, chronic laryngitis, and laryngopharyngeal reflux had a significant impact on Zung Self-Rating Depression Scale scores. Patients with giddiness (P = 0.006) and tinnitus (P = 0.006) tended to have higher Zung Self-Rating Anxiety Scale scores. Anxiety mediated the effect of tinnitus on sleep quality (70.41%; 95% confidence interval [CI]: 40.07, 76.00), and depression also had a mediation effect (13.24%; 95% CI: 4.46, 28.58). Other diseases also exhibited mediating effects and interactions with anxiety, depression, and sleep quality. CONCLUSIONS: Sleep quality significantly mediates the relationships of specific otolaryngological diseases with anxiety and depression. Similarly, anxiety and depression play important mediating roles in the relationships of different diseases with sleep quality. By revealing the interactive effects of different otolaryngological diseases on anxiety, depression, and sleep quality, this study could aid early interventions aiming to reduce anxiety and depression and improve patients' sleep quality and quality of life.

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