Resolution of Sleep Disturbance and Improved Functional Outcomes After Rotator Cuff Repair

Abstract

Background: Most patients experience sleep disturbances before rotator cuff repair, with these symptoms largely improving postoperatively. However, the relationship between the resolution or persistence of sleep disturbance and patient-reported outcomes after rotator cuff repair remains unknown. Purpose: To compare outcomes after rotator cuff repair between patients who reported a preoperative sleep disturbance and those who did not. Outcomes at various time points after surgery were also assessed in relation to the persistence or resolution of sleep disturbance. Study Design: Case-control study; Level of evidence, 3. Methods: Patients undergoing primary arthroscopic rotator cuff repair at a tertiary academic center were prospectively enrolled in a registry database. Patient characteristics were obtained preoperatively and validated patient-reported outcome measures (PROMs) were obtained pre- and postoperatively, including the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Veterans RAND 12-Item Health Survey Physical and Mental components. Sleep disturbance was evaluated via responses to Simple Shoulder Test question 2. Patients with and without sleep disturbance were compared before and after surgery. Results: In total, 293 patients were prospectively enrolled. A total of 262 (89.8%) patients reported a sleep disturbance preoperatively. Of these, 221 (84.4%) reported a resolution of sleep disturbance by 2 years postoperatively. After adjustment for age, workers’ compensation status, and Cofield tear size, patients with a preoperative sleep disturbance reported significantly worse baseline PROMs, apart from the Veterans RAND 12-Item Health Survey Mental component, before surgery. However, postoperatively, these patients had greater improvement in PROMs, and no significant remaining differences were seen at follow-up between patients with and without preoperative sleep disturbance. Among patients who reported a preoperative sleep disturbance, those whose symptoms resolved postoperatively had superior PROM scores as well as significantly greater improvements from preoperative baseline values compared with patients with persistent sleep disturbances after surgery. Conclusion: Patients with preoperative sleep disturbances reported worse baseline functional scores before rotator cuff repair compared with patients without sleep disturbance. These disturbances largely resolved after surgery, with postoperative outcomes comparable with those of patients who reported no preoperative sleep concerns. Patients whose sleep disturbances resolved postoperatively also reported superior PROM scores compared with patients whose sleep disturbances persisted postoperatively.

Improvements in Sleep After Shoulder Arthroscopy Are Correlated With Improvements in Various Patient-Reported Outcomes: A Systematic Review

“… 17 (2017) 31 9/22 28 (22-35) 61(26-75) 6 mo (NR) Zheng et al. 6 (2023) 293 145/148 28.7 ± 5.7 56.2 ± 9.7 2 yr (NR) Austin et al. 18 (2015) 56 27/29 29.6 (19-50) 59.8 (45-78) 6 mo (NR) Gumina et al.…”

“… 17 (2017) Case series IV 12 Primary arthroscopic RCR with full-thickness RCT that failed treatment with NSAIDs or physiotherapy after ≥3 mo Irreparable tears, revision surgery, open RCR, severe GHOA, adhesive capsulitis, sleep apnea disorder, neuropsychiatric disease, and patients taking medication for sleep disorder Arthroscopic RCR All full-thickness RCT Zheng et al. 6 (2023) Case-control study III 20 Patients aged >18 yr who underwent primary RCR and had complete preoperative baseline data, as well as preoperative response to SST question 2 (“Does your shoulder allow you to sleep comfortably?”) NR Arthroscopic RCR Full- or partial-thickness RCT Austin et al. 18 (2015) Case series IV 12 Male patients and nonpregnant female patients aged ≥18 yr with full-thickness RCT undergoing arthroscopic RCR surgery Patients receiving Workers’ Compensation benefits, those with irreparable tears, those undergoing revision surgery, and those with concomitant severe glenohumeral arthritis or concurrent adhesive capsulitis Arthroscopic RCR All full-thickness RCT Gumina et al.…”

“…An answer of no to question 2 on the SST form was used in some studies to identify patients with sleep disturbance. 6 , 22 The question asks, “Does your shoulder allow you to sleep comfortably?” Many studies used a wide array of questionnaires designed to identify patients with sleep disturbances.…”

“…The literature shows that preoperative and postoperative sleep outcome scores correlate with functional outcomes such as 36-Item Short Form (SF-36), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form scores. 1 , 6 , 7 , 8 Despite the abundance of literature regarding shoulder arthroscopy and sleep disturbance, few studies have aimed to summarize the literature and evaluate sleep disturbance across multiple domains of shoulder arthroscopy. Barandiaran et al.…”

Resolution of Sleep Disturbance and Improved Functional Outcomes After Rotator Cuff Repair: Letter to the Editor

“…The conclusion of Zheng and colleagues 8 in ''Resolution of Sleep Disturbance and Improved Functional Outcomes After Rotator Cuff Repair'' that surgery to address rotator cuff tendinopathy improves sleep is misleading. There is evidence to suggest that this might be a nonspecific effect, unrelated to changes in pathophysiology.…”