Sleep Disturbance Associated With Rotator Cuff Tear

Lee

2020

Sci Rep

Despite the importance of sleep and the evidence on its relationship with various chronic diseases, quality of sleep is not considered in patients with lumbar spinal stenosis (LSS). This prospective comparative study aimed to investigate the changes in sleep disturbance after treatment in patients with LSS. Patients with LSS and sleep disturbance (n = 201; 147 conservatively treated and 54 patients with surgical treatment) were included. The Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality. Propensity score matching was used to attenuate the potential bias. Clinical outcome of surgery, as determined by the Oswestry disability index, and the PSQI was compared between the two groups at 6 weeks, 3 months, and 6 months after enrollment. Multivariate logistic analysis was performed to adjust for possible confounders within the matched cohorts. Among the 201 patients, 96 (47.7%) patients were finally matched (48 patients in each group). Sleep quality was initially improved after treatment, regardless of the treatment method. Sleep quality in the surgical group was improved by 6 weeks after surgery and consistently improved during the 6-month follow-up period, despite less use of pain killer. Conversely, the improvement in sleep quality at 6-weeks following conservative treatment was not maintained during the follow-up, although the treatment outcome for LSS measured by ODI was continuously improved. After multivariate logistic regression analysis within propensity score matched cohorts, surgical treatment had a significantly greater chance to improve sleep quality compared to conservative treatment. The failure of sleep improvement in conservative group was significantly associated with depression presented by worse score in Hamilton depression rating scale, and more severe degree of foraminal-type stenosis, which should be carefully considered for conservative treatment of LSS patients with sleep disturbance.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improvement of sleep quality after treatment in patients with lumbar spinal stenosis: a prospective comparative study between conservative versus surgical treatment

Lee

2020

Sci Rep

Orthopaedic Journal of Sports Medicine

“…‡ Associations have been made between sleep disturbance and chronic neck and back pain, 1 , 12 , 14 knee pain, 17 carpal tunnel syndrome, 18 , 19 long-bone fractures, 22 and shoulder abnormalities, 6 , 16 including shoulder impingement syndrome 23 and rotator cuff tears. 3 , 16 To our knowledge, there has only been one study to find that pain levels in patients with shoulder impingement syndrome directly correlated with sleep quality. 23 However, others have demonstrated that sleep disturbance is more strongly associated with poor emotional status and ineffective coping strategies and less dependent on symptom intensity or functional status.…”

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confidence: 99%

Do Magnetic Resonance Imaging Characteristics of Full-Thickness Rotator Cuff Tears Correlate With Sleep Disturbance?

Reyes

Hull

Kurth

et al. 2017

Background:Many patients with rotator cuff tears suffer from nocturnal shoulder pain, resulting in sleep disturbance.Purpose:To determine whether rotator cuff tear size correlated with sleep disturbance in patients with full-thickness rotator cuff tears.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients with a diagnosis of unilateral full-thickness rotator cuff tears (diagnosed via magnetic resonance imaging [MRI]) completed the Pittsburgh Sleep Quality Index (PSQI), a visual analog scale (VAS) quantifying their shoulder pain, and the American Shoulder and Elbow Surgeons (ASES) questionnaire. Shoulder MRI scans were analyzed for anterior-posterior tear size (mm), tendon retraction (mm), Goutallier grade (0-4), number of tendons involved (1-4), muscle atrophy (none, mild, moderate, or severe), and humeral head rise (present or absent). Bivariate correlations were calculated between the MRI characteristics and baseline survey results.Results:A total of 209 patients with unilateral full-thickness rotator cuff tears were included in this study: 112 (54%) female and 97 (46%) male (mean age, 64.1 years). On average, shoulder pain had been present for 24 months. The mean PSQI score was 9.8, and the mean VAS score was 5.0. No significant correlations were found between any of the rotator cuff tear characteristics and sleep quality. Only tendon retraction had a significant correlation with pain.Conclusion:Although rotator cuff tears are frequently associated with nocturnal pain and sleep disruption, this study demonstrated that morphological characteristics of full-thickness rotator cuff tears, such as size and tendon retraction, do not correlate with sleep disturbance and have little to no correlation with pain levels.

Orthopaedic Journal of Sports Medicine

“…A previous study found that sleep disturbance is 3 to 6 times more common in patients with rotator cuff tears than the general population. 1 Poor sleep is often a salient factor in these patients’ decisions to seek care. Arthroscopic repair has been associated with improved sleep quality in many patients with full-thickness rotator cuff tears 1 ; however, some individuals continue to suffer from sleep disturbance postoperatively.…”

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confidence: 99%

“…1 Poor sleep is often a salient factor in these patients’ decisions to seek care. Arthroscopic repair has been associated with improved sleep quality in many patients with full-thickness rotator cuff tears 1 ; however, some individuals continue to suffer from sleep disturbance postoperatively. Previous studies have reported that up to 41% of patients continue to have poor sleep quality following repair of a full-thickness tear.…”

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confidence: 99%

Narcotic Use and Resiliency Scores Do Not Predict Changes in Sleep Quality 6 Months After Arthroscopic Rotator Cuff Repair

Glogovac

Schumaier

Kennedy

et al. 2019

Background: Patients with rotator cuff disease commonly complain of difficulty sleeping. Arthroscopic repair has been associated with improved sleep quality in many patients with rotator cuff tears; however, some individuals continue to suffer from sleep disturbance postoperatively. Purpose: To determine whether changes in sleep quality following rotator cuff repair are predicted by a patient’s narcotic use or ability to cope with stress (resilience). Study Design: Case series; Level of evidence, 4. Methods: A total of 48 patients undergoing arthroscopic rotator cuff repair were prospectively enrolled and completed the Connor-Davidson Resilience Scale (CD-RISC) preoperatively. The Pittsburgh Sleep Quality Index (PSQI) was administered preoperatively and at multiple intervals postoperatively for 6 months. Narcotic utilization was determined via a legal prescriber database. Pre- and postoperative sleep scores were compared using paired t tests and the McNemar test. Linear regression was used to determine whether narcotic use or CD-RISC score predicted changes in sleep quality. Results: An increased number of patients experienced good sleep at 6 months postoperatively ( P < .01). Mean ± SD nocturnal pain frequency improved from 2.5 ± 1.0 at baseline to 0.9 ± 1.1 at 6 months. CD-RISC score had a positive predictive value on changes in PSQI score ( R 2 = 0.09, P = .028) and nocturnal pain frequency ( R 2 = 0.08, P = .041) at 2 weeks. Narcotic use did not significantly predict changes in PSQI score or nocturnal pain frequency ( P > .05). Conclusion: Most patients with rotator cuff disease will experience improvement in sleep quality following arthroscopic repair. Patients demonstrated notable improvements in nocturnal pain frequency as soon as 6 weeks following surgery. CD-RISC resiliency scores had a significant positive predictive value on changes in sleep quality and nocturnal pain frequency at 2 weeks. Narcotic use was not associated with change in sleep quality.