Changes in Sleep Problems in Patients Who Underwent Surgical Treatment for Degenerative Spinal Disease with a Concurrent Sleep Disorder: A Nationwide Cohort Study in 3183 Patients during a Two-Year Perioperative Period.

Abstract

Sleep disturbance is prevalent in patients with degenerative spinal disease, and recent studies have reported that surgical treatment is more effective for improving sleep quality than conservative treatment. We aimed to investigate the perioperative changes of sleep problems in patients who underwent surgical treatment for degenerative spinal disease with a concurrent sleep disorder, and presented them according to various clinical profiles possibly associated with sleep disturbance. In addition, we identified factors associated with poor sleep improvement after surgery. This study used data from the Korea Health Insurance Review and Assessment Service database from 2016 to 2018. We included 3183 patients aged ≥19 years who underwent surgery for degenerative spinal disease and had a concurrent sleep disorder. Perioperative changes in the two target outcomes, including the use of sleep medication and hospital visits owing to sleep disorders, were precisely investigated according to factors known to be associated with sleep disturbance, including demographics, comorbidities, and spinal regions. Logistic regression analysis was performed to identify factors associated with poor improvement in terms of sleep medication after surgery. All estimates were validated using bootstrap sampling. During the 1-year preoperative period, the use of sleep medications and hospital visits owing to sleep disorder increased continuously. However, they abruptly decreased shortly after surgical treatment, and throughout the 1-year postoperative period, they remained lower than those in the late preoperative period. At the 1-year follow-up, 75.6% (2407 of 3183) of our cohort showed improvement in sleep medication after surgery. Multivariable analysis identified only two variables as significant factors associated with non-improvement in sleep medication after surgery: depressive disorder (odds ratio (OR) = 1.25 [1.06-1.48]; p = 0.008), and migraine (OR = 1.42 [1.04-1.94]; p = 0.028). We could not investigate the actual sleep quality and resultant quality of life; however, our results justify the necessity for further high-quality studies that include such information and would arouse clinicians' attention to the importance of sleep disturbance in patients with degenerative spinal disease.