186. Persistent sleep disturbance after spine surgery is associated with failure to achieve meaningful improvements in pain and health related quality of life

Abstract

<h3>BACKGROUND CONTEXT</h3> The relationship between biopsychosocial factors (the interaction of biologic factors, behavioral factors, and social factors that affect overall health) and quality of life is well established in spine surgery patients. Sleep hygiene is an important component of wellbeing and is closely linked to mental health. Despite the importance of sleep hygiene and the strong association between poor sleep and mental health disorders, little is known about how sleep disturbance (SD) in patients with spine conditions correlates with validated health-related quality-of-life (HRQOL) measures or the degree to which SD changes after surgery. <h3>PURPOSE</h3> Our objectives were to determine the (1) prevalence of SD among patients presenting for spine surgery at a large academic medical center; (2) correlation between SD and HRQOL scores; and (3) association between postoperative SD resolution and short-term HRQOL. We hypothesized that SD would be significantly correlated with HRQOL in patients undergoing elective spine surgery. In addition, we hypothesized that postoperative resolution of SD would be significantly associated with improved HRQOL. <h3>STUDY DESIGN/SETTING</h3> The current study is a retrospective review of these prospectively collected data from patients who presented for spine surgery at an academic medical center. <h3>PATIENT SAMPLE</h3> Eligible patients were English-speaking, were aged 18 years or older, had undergone elective surgery for degenerative lumbar or cervical spine disease or for correction of spinal deformity, and had completed preoperative and immediate postoperative assessments. Of 1,193 patients enrolled, we included the 508 (43%) who met our inclusion criteria. Of these, 226 (44%) had complete 1-year follow-up. Participants' mean age was 60 years (standard deviation, 13 years), and most were non-Hispanic (98%), and White (73%). All participants were treated at the same center by 5 fellowship-trained, board-certified spine surgeons with 6–26 years in practice. We found no significant differences in age (P = 0.98), sex (P = 0.73), or prevalence of SD (P = 0.17) between included and excluded patients. <h3>OUTCOME MEASURES</h3> Participants completed an assessment before surgery of sociodemographic and clinical information. Sociodemographic information comprised age, sex, race/ethnicity, highest educational attainment, annual household income, and relationship status. Highest educational attainment was categorized as less than 4-year college degree; 4-year college degree; or post-graduate degree. Annual household income was categorized as <$30,000; $30,000–$80,000; or >$80,000. Relationship status was used to determine whether a participant lived alone or with a partner. Clinical information was presence of comorbid conditions, current use of opioid medication, and presence of intraoperative and/or postoperative complications. Participants completed assessments of their health and wellness before and after surgery. After surgery, assessments were completed during the immediate postoperative period (6–12 weeks) and at 6, 12, and 24 months. These assessments were the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI) and the Patient-Reported Outcome Measurement Information System (PROMIS-29) health domains. <h3>METHODS</h3> Using preoperative PROMIS SD scores, we grouped participants as having no sleep disturbance (score <55), mild disturbance (score, 55–60), moderate disturbance (score 60–70), or severe disturbance (score, 70). For the final analysis, we collapsed these categories into no/mild and moderate/severe. Pearson correlation tests were used to assess correlations between SD and HRQOL measures. Regression analysis (adjusting for age, sex, comorbidities, current opioid use, and occurrence of complications) was used to estimate the effect of postoperative resolved or continuing SD on HRQOL scores and the likelihood of achieving clinically meaningful improvements in HRQOL. Alpha = 0.05. <h3>RESULTS</h3> Preoperative SD was reported by 127 participants (25%). SD was significantly correlated with worse ODI/NDI values and worse scores in all PROMIS health domains (all, P < 0.001). At the immediate postoperative assessment, SD had resolved in 80 of 127 participants (63%). Compared with participants who reported no preoperative SD, those with ongoing SD were significantly less likely to achieve clinically meaningful improvements in Pain Interference (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28, 0.84), Physical Function (OR, 0.32; 95% CI, 0.13, 0.82), and Satisfaction with Participation in Social Roles (OR, 0.57; 95% CI, 0.37, 0.80). <h3>CONCLUSIONS</h3> One-quarter of spine surgery patients reported preoperative SD of at least moderate severity. Poor preoperative sleep quality and ongoing postoperative sleep disturbance were significantly associated with worse scores on several HRQOL measures. These results highlight the importance of addressing patients' sleep disturbance both before and after surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.