Sleep quality and nocturnal pain in patients with femoroacetabular impingement and acetabular dysplasia

Abstract

Background: Femoroacetabular impingement (FAI) syndrome and acetabular dysplasia (AD) are common pathologies that lead to pain in the young adult hip. Nocturnal pain in these patients is often reported, yet little is known regarding the effect of these hip pathologies on overall sleep quality. The purpose of this study was to evaluate sleep quality in patients with AD and FAI syndrome. Methods: This cross-sectional study consisted of 115 patients who complained of hip pain secondary to either FAI syndrome or AD. One hundred fifteen patients with hip pain secondary to FAI syndrome and AD were assessed using the Hip Outcome Score (HOS), Modified Harris Hip Score (mHHS), and then Hip disability and Osteoarthritis Outcome Score (HOOS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression, with adaptive LASSO variable selection, was used to assess factors associated with sleep quality. Results: Of the 115 patients, 62 had a diagnosis of FAI syndrome and 53 with AD. The mean age was 34.55 ± 11.66 (age range: 14 to 58 years), 76.52% had an ASA classification of 1 (ASA range: 1 to 3), and all Tonnis grades were either 0 or 1. The mean PSQI global score for all patients was 8.46 ± 4.35 (PSQI range: 0 to 21), indicating poor sleep quality. The adaptive LASSO-penalized least squares multiple linear regression revealed that HOOS Pain, SF-12 Role Emotional, and SF-12 Mental Health significantly predicted Sleep Quality (Adjusted R2 = 0.4041). Sleep quality improved as pain, emotional problems, and mental health improved. Conclusion: Patients with symptomatic FAI syndrome and AD have poor sleep quality. Worsening pain from a patient's hip pathology is associated with poor sleep, even prior to the onset of osteoarthrosis of the hip. Patients presenting with hip pain from FAI syndrome and AD should be screened for sleep disturbance and may benefit from a multidisciplinary treatment approach.

High Prevalence of Sleep Disturbance Is Associated with Femoroacetabular Impingement Syndrome

“…15 Reddy et al found that 79% of FAIS and 89% of acetabular dysplasia patients reported poor sleep quality based on the 19-question Pittsburgh Sleep Quality Index (PSQI). 16 Of the FAIS patients who had disrupted sleep in our study, the majority (59%) reported scores with moderate to severe levels of sleep disturbance. This is concerning, as both the prevalence and severity of chronic sleep dysfunction in FAIS patients may be underrecognized in a typical evaluation for FAIS by primary care physicians and orthopaedic surgeons.…”

“…Prior literature has recommended that patients with hip pain from FAIS or acetabular dysplasia pathology should potentially be screened for sleep disturbances and given considerations for a multidisciplinary treatment approach. 15,16 In most treatment algorithms of FAIS, there are no recommendations to address the chronic sleep dysfunction in these patients. [17][18][19][20][21][22] Most treatment modalities focus on addressing physical function with physical therapy for functional range of motion and strength training.…”

“…Prior literature has recommended that patients with hip pain from FAIS or acetabular dysplasia pathology should potentially be screened for sleep disturbances and given considerations for a multidisciplinary treatment approach. 15 , 16 …”

Improvements in Sleep Quality Are Maintained at a Minimum of 2 Years Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome

“…[7][8][9][10][11][12] This has largely been determined by the Pittsburgh Sleep Quality Index (PSQI), which is a 7-item, subjective questionnaire that captures subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction. 13 Specifically pertaining to hip arthroscopy, Reddy et al 14 evaluated sleep quality in 115 patients with acetabular dysplasia and femoroacetabular impingement syndrome (FAIS) and found that patients on average had a PSQI of 8.46 (range, 0-21), indicating poor sleep quality. Likewise, our group reported that 94.2% of patients suffered from poor sleep quality before undergoing hip arthroscopy for FAIS, which decreased to 21.7% at 6 months postoperatively.…”

Editorial Commentary: Arthrosomnology and the Solution to Coxalgia Somnia: Arthroscopic Hip Surgeons and Patients Increasingly Appreciate the Role of Sleep as Good Medicine

“…In nonarthritic individuals with femoroacetabular impingement (FAI) syndrome and acetabular dysplasia, sleep quality has been shown to be significantly affected. 12 Eighty-nine percent and 79% of patients with dysplasia and FAI syndrome report poor sleep quality, respectively. The latter was determined using the Pittsburgh Sleep Quality Index (PSQI) scale, with scores of 9.0 AE 4.4 and 8.0 AE 4.3, respectively.…”