Recent research suggests a significant proportion of patients experience sleep disturbances before rotator cuff repair, and the symptoms improve significantly after surgical repair.
Now, researchers at Brigham and Women’s Hospital have provided evidence that the resolution or persistence of sleep disturbance affects patient-reported functional outcomes.
Elizabeth G. Matzkin, MD, surgical director of Women’s Musculoskeletal Health and chief of Women’s Sports Medicine in the Department of Orthopaedic Surgery at the Brigham, Evan T. Zheng, MD, of the Harvard Combined Orthopaedic Residency Program, and colleagues report in The American Journal of Sports Medicine.
The team retrospectively reviewed the Surgical Outcomes System (SOS), a prospectively collected global registry. They identified 293 adults who underwent primary arthroscopic rotator cuff repair between August 29, 2012, and January 8, 2021, and reported sleep quality both pre- and postoperatively. The mean age at the time of surgery was 56, and 51% of patients were female.
Before and after surgery, five patient-reported outcome measures (PROMs) were administered:
- Visual analog scale for pain
- American Shoulder and Elbow Surgeons evaluation
- Single Assessment Numeric Evaluation
- Simple Shoulder Test
- Veterans RAND 12-Item Health Survey (VR-12)
Key observations were the following:
- Preoperatively, 263 patients (90%) reported a sleep disturbance; 84% of them had their sleep disturbance resolve within two years after surgery
- A comparison of patients with and without preoperative sleep disturbance did not identify any patient factor more likely to be associated with sleep symptoms
- In an analysis adjusted for age, workers’ compensation status, tear size as defined by the Cofield classification, and preoperative PROM values, there was no significant association between preoperative sleep disturbance and achievement of the minimum clinically important difference on any PROM
- At each time point studied after surgery, patients who had resolution of sleep disturbance reported superior PROM scores, with the exception of VR-12 Mental score, and larger changes from preoperative scores than patients whose sleep disturbances persisted
Applying the Results
When a patient presents with shoulder complaints, clinicians should inquire about sleep quality. Identifying individuals with sleep disturbances is important to recognize to discuss expectations regarding resolution of these symptoms after surgery.