Sleep Disturbance Associated with Rotator Cuff Tear; Correction with Arthroscopic Rotator Cuff Repair

Abstract

Sleep disturbance is a common complaint of patients with a rotator cuff tear (RCT). Poor or inadequate sleep, along with pain, are often the driving symptoms for patients to proceed with rotator cuff repair (RCR). To date, no studies examine sleep disturbance in patients undergoing RCR, and there is no evidence that RCR improves sleep disturbance. Since adequate sleep plays a role in postoperative healing and also in patient satisfaction, it is necessary to investigate and characterize sleep disturbances in patients undergoing RCR. With IRB approval, fifty-six consecutive patients undergoing arthroscopic RCR for full thickness RCT were enrolled in this prospective study. Irreparable tears, revision repairs, arthritis, and workers compensation patients were excluded. Patients were surveyed preoperatively and postoperatively at intervals of 2, 6, 12, 18 and 24 weeks. Patient outcomes were scored using the Pittsburgh Sleep Quality index (PSQI), Simple Shoulder Test (SST), Visual Analog Score (VAS) and single assessment numeric evaluation score (SANE). Demographic and surgical factors were also collected for analysis. Analyses were performed using R 2.15.3 (R Foundation for Statistical Computing, Vienna Austria) Ninety-two percent of patients reported pre-operative PSQI scores indicative of sleep disturbance (score >6 out of 21), with an average preoperative PSQI of 11.7(stdev + 4.61). A statistically significant improvement in PSQI was achieved at 3 months (mean score 8.4, p 0.0003, 81% follow-up) and continued to improve through 6 months. A PSQI score < 5, considered normal sleep, was achieved by 32% (16/50) at 3 months, 54% (22/41) at 4.5 months and 63% (32/51) at 6 months. Multivariable linear regression of all surgical and demographic factors vs. PSQI was performed. The addition of subacromial decompression (SAD) to RCR statistically improved PSQI score at 3 months (n=28, 9.4 vs. 7.13, p 0.0049). Furthermore, preoperative narcotic use was correlated with worse PSQI score at 3 months (n=10, 11.0 vs 7.7, p 0.067). : 92% of patients undergoing arthroscopic RCR have sleep disturbance. Sleep quality was statistically improved by 3 months postoperatively and continued through 6 months. At 6 months 63% of patients no longer had sleep disturbance. Patients not taking preoperative narcotics as well as patient's receiving SAD along with their RCR had better improvements in sleep.