ArticleBMC public health2025
Mediating roles of tinnitus and sleep disturbance in the effects of military noise on cognition: a structural equation modeling study with multi-method noise exposure assessment.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMilitary noise exposure is the most common occupational risk for soldiers. This study aims to investigate the relationships between various noise measurement indicators, tinnitus, sleep disturbance, and cognition, as well as their potential pathways.
methodsThis study conducted a cross-sectional survey in April 2024, enrolling 339 military personnel from China as study participants. Noise exposure was assessed using the cumulative noise exposure (CNE), kurtosis-adjusted CNE (CNE-K), and self-reported hearing protection-adjusted lifetime noise exposure. Tinnitus and sleep disturbance were evaluated using the 6-item tinnitus screener and the Pittsburgh Sleep Quality Index, respectively. Cognition was assessed using the Stroop test. Adjustments were made for covariates including sex, age, hearing loss, education, ethnicity, alcohol consumption, and depressive symptoms. Structural equation modeling (SEM) and bias-corrected bootstrapping were used to assess direct/indirect pathways, with p ≤ 0.05 or 95% bootstrapped CIs excluded zero taken as significant.
resultsThe mean age was 24.82 (SD, 3.80). Males accounted for 97.6% (331/339). A total of 58.7% (199/339) held a junior college degree. SEM results showed that objective exposure influences cognition through both direct and indirect pathways, whereas subjective exposure operates exclusively via indirect mediation. Besides, sleep disturbance explained most of the mediating process. Specifically, sleep disturbance was a significant simple mediator between noise and cognition in all models (β = -0.048 to -0.062, all p < 0.05). The simple mediating effect of tinnitus was not significant in any model (β = 0.013 to 0.022, all p > 0.05), but it could form a chain mediating process (β = -0.009 to -0.016, all p < 0.05) by aggravating sleep disturbance (β = 0.178 to 0.226, all p < 0.01).
conclusionsMilitary noise is associated with tinnitus, sleep disturbance, and cognitive impairment. Critically, it may affect cognition through simple mediation by sleep disturbance and chain mediation from tinnitus to sleep disturbance.
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