Systematic Review of Sleep Quality Before and After Arthroscopic Rotator Cuff Repair: Are Improvements Experienced and Maintained?

Kyle N Kunze, Kamran Movasagghi, David M Rossi, Evan M Polce, Matthew R Cohn, Aditya V Karhade, Jorge Chahla, Kyle N Kunze, Kamran Movasagghi, David M Rossi, Evan M Polce, Matthew R Cohn, Aditya V Karhade, Jorge Chahla

Abstract

Background: Poor sleep quality is prevalent among patients with rotator cuff tears (RCTs) and negatively influences the potential for healing and quality of life. However, there is a paucity of literature describing the magnitude and timing of changes in sleep quality after arthroscopic rotator cuff repair (RCR).

Purpose: (1) To evaluate the prevalence of poor sleep quality in patients undergoing arthroscopic RCR and (2) to determine the timing and magnitude of changes in sleep quality after RCR.

Study design: Systematic review; Level of evidence, 4.

Methods: PubMed, OVID/Medline, and Cochrane databases were queried in January 2020 for literature investigating the prevalence of poor sleep quality in patients with RCTs or changes in sleep quality after arthroscopic RCR. Data pertaining to study characteristics, risk of bias, sleep quality assessments, and clinical outcomes were extracted. A qualitative analysis of the prevalence of poor sleep quality and changes in sleep quality was performed.

Results: A total of 8 studies (1034 patients) were included. The mean Pittsburgh Sleep Quality Index (PSQI) ranged from 5.2 to 15.0 preoperatively among all studies, while the frequency of patients experiencing poor sleep quality ranged from 40.8% to 89.0% in 4 studies. Four studies reported the mean PSQI at a minimum of 6 months postoperatively, which ranged from 4.2 to 7.1. Four studies did not report the PSQI score or the proportion of patients who experienced poor postoperative sleep quality. One study evaluated the PSQI at 12 months postoperatively, which decreased to 4.2 from 5.8 at 6 months. One study evaluated the PSQI at 24 months postoperatively, which decreased to 5.5 from 6.2 at 6 months.

Conclusion: Patients with RCTs have a high prevalence of poor sleep quality. Consistent improvements in sleep quality are observed in the 6 months after arthroscopic RCR, but there is limited evidence based on the available data to characterize changes in sleep quality beyond this time. More evidence is needed to characterize changes in sleep quality beyond 6 months and how these changes are perceived by this patient population.

Keywords: Pittsburgh Sleep Quality Index; arthroscopic; repair; rotator cuff; sleep.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.C. has received educational support from Arthrex and Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart for study selection.
Figure 2.
Figure 2.
Forest plot displaying the mean Pittsburgh Sleep Quality Index (PSQI) and 95% CI before rotator cuff repair. The pooled preoperative PSQI for all studies was 9.5. The dotted line indicates a PSQI equal to 5, which is the threshold for poor sleep quality.
Figure 3.
Figure 3.
Forest plot displaying the mean Pittsburgh Sleep Quality Index (PSQI) and 95% CI at minimum 6-month follow-up after rotator cuff repair. The pooled postoperative PSQI for all studies was 5.7 (vs 9.5 preoperatively). The dotted line indicates a PSQI equal to 5, which is the threshold for poor sleep quality.

References

    1. Ansok CB, Khalil LS, Muh S. Objective assessment of sleep quality in patients with rotator cuff tears. Orthop Traumatol Surg Res. 2020;106(1):61–66.
    1. Austin L, Pepe M, Tucker B, et al. Sleep disturbance associated with rotator cuff tear: correction with arthroscopic rotator cuff repair. Am J Sports Med. 2015;43(6):1455–1459.
    1. Badcock LJ, Lewis M, Hay EM, McCarney R, Croft PR. Chronic shoulder pain in the community: a syndrome of disability or distress? Ann Rheum Dis. 2002;61(2):128–131.
    1. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
    1. Cho CH, Jung SW, Park JY, Song KS, Yu KI. Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance? J Shoulder Elbow Surg. 2013;22(2):222–228.
    1. Cho CH, Seo HJ, Bae KC, Lee KJ, Hwang I, Warner JJ. The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair. J Shoulder Elbow Surg. 2013;22(9):1160–1166.
    1. Cho CH, Song KS, Hwang I, Warner JJ. Does rotator cuff repair improve psychologic status and quality of life in patients with rotator cuff tear? Clin Orthop Relat Res. 2015;473(11):3494–3500.
    1. Glogovac G, Schumaier AP, Kennedy ME, et al. Narcotic use and resiliency scores do not predict changes in sleep quality 6 months after arthroscopic rotator cuff repair. Orthop J Sports Med. 2019;7(7):2325967119856282.
    1. Gong L, Wang Z, Fan D. Sleep quality effects recovery after total knee arthroplasty (TKA)—a randomized, double-blind, controlled study. J Arthroplasty. 2015;30(11):1897–1901.
    1. Gumina S, Candela V, Passaretti D, Venditto T, Mariani L, Giannicola G. Sleep quality and disturbances in patients with different-sized rotator cuff tear. Musculoskelet Surg. 2016;100(suppl 1):33–38.
    1. Ha E, Lho YM, Seo HJ, Cho CH. Melatonin plays a role as a mediator of nocturnal pain in patients with shoulder disorders. J Bone Joint Surg Am. 2014;96(13):e108.
    1. Harris JD, Quatman CE, Manring MM, Siston RA, Flanigan DC. How to write a systematic review. Am J Sports Med. 2014;42(11):2761–2768.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560.
    1. Horneff JG, 3rd, Tjoumakaris F, Wowkanech C, Pepe M, Tucker B, Austin L. Long-term correction in sleep disturbance is sustained after arthroscopic rotator cuff repair. Am J Sports Med. 2017;45(7):1670–1675.
    1. Khazzam MS, Mulligan EP, Brunette-Christiansen M, Shirley Z. Sleep quality in patients with rotator cuff disease. J Am Acad Orthop Surg. 2018;26(6):215–222.
    1. Kunze KN, Leong NL, Beck EC, Bush-Joseph CA, Nho SJ. Hip arthroscopy for femoroacetabular impingement improves sleep quality postoperatively. Arthroscopy. 2019;35(2):461–469.
    1. Longo UG, Facchinetti G, Marchetti A, et al. Sleep disturbance and rotator cuff tears: a systematic review. Medicina (Kaunas). 2019;55(8):453.
    1. Manning BT, Kearns SM, Bohl DD, Edmiston T, Sporer SM, Levine BR. Prospective assessment of sleep quality before and after primary total joint replacement. Orthopedics. 2017;40(4):e636–e640.
    1. Martinez R, Reddy N, Mulligan EP, Hynan LS, Wells J. Sleep quality and nocturnal pain in patients with hip osteoarthritis. Medicine (Baltimore). 2019;98(41):e17464.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. BMJ. 2009;339:B2535.
    1. Onen SH, Onen F, Courpron P, Dubray C. How pain and analgesics disturb sleep. Clin J Pain. 2005;21(5):422–431.
    1. Reyes BA, Hull BR, Kurth AB, Kukowski NR, Mulligan EP, Khazzam MS. Do magnetic resonance imaging characteristics of full-thickness rotator cuff tears correlate with sleep disturbance? Orthop J Sports Med. 2017;5(11):2325967117735319.
    1. Serbest S, Tiftikci U, Askin A, Yaman F, Alpua M. Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients. Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2109–2113.
    1. Shakya H, Wang D, Zhou K, Luo ZY, Dahal S, Zhou ZK. Prospective randomized controlled study on improving sleep quality and impact of zolpidem after total hip arthroplasty. J Orthop Surg Res. 2019;14(1):289.
    1. Trouw AG, Patel A, Yang A, Jauregui J, Caligiuri D, Choueka J. Improvement in sleep quality after carpal tunnel release. J Long Term Eff Med Implants. 2018;28(1):55–61.
    1. Veldhuis JD, Iranmanesh A. Physiological regulation of the human growth hormone (GH)–insulin-like growth factor type I (IGF-I) axis: predominant impact of age, obesity, gonadal function, and sleep. Sleep. 1996;19(10):S221–S224.
    1. Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843–844.
    1. Weinberg M, Mollon B, Kaplan D, Zuckerman J, Strauss E. Improvement in sleep quality after total shoulder arthroplasty. Phys Sportsmed. 2020;48(2):194–198.
    1. Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am. 2003;85(1):1–3.

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