Horneff John G, Tjoumakaris Fotios, Wowkanech Charles, Pepe Matthew, Tucker Bradford, Austin Luke
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Sports Med. 2017 Jun;45(7):1670-1675. doi: 10.1177/0363546517692551. Epub 2017 Feb 1.
Sleep disturbance is a major complaint of patients with rotator cuff disease that often leads them to seek treatment. The authors previously reported a prospective analysis of patients who underwent rotator cuff repair and found that sleep disturbance significantly improved at 3 months after surgery. That improvement in sleep was maintained at 6 months.
In the current study, the authors sought to gain medium-term data on this same population at greater than 2 years. The hypotheses were that improvement in sleep disturbance after arthroscopic rotator cuff repair is maintained at 2-year follow-up and that the continued use of narcotic pain medication has a negative effect on sleep quality at 2-year follow-up.
Case series; Level of evidence, 4.
The original cohort of patients was contacted at a minimum of 24 months after their surgery. Thirty-seven of the 56 patients (66%) involved in the original study were available. Patient outcomes were scored using the Pittsburgh Sleep Quality Index (PSQI), Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Single Assessment Numeric Evaluation (SANE). The newly obtained scores were compared with prior scores, which ranged from preoperatively to 6 months postoperatively.
The statistically significant improvement of the PSQI score demonstrated in our prior analysis at 6 months postoperatively was maintained, with a mean PSQI score of 5.5 for the 37 patients followed beyond 24 months. Of those patients, 41% still had a PSQI score >5, indicative of sleep disturbance. However, even those patients in our study with a PSQI score >5, indicative of sleep disturbance, had an improved mean score of 9.3 at greater than 24 months compared with those patients with a PSQI score >5 at 6 months, who had a mean PSQI score of 11.5 ( P = .13). Both the SST and VAS scores displayed continued improvement at greater than 24 months, with both displaying moderate strength correlation to the PSQI score (VAS: Spearman rho = 0.479, P < .001; SST: Spearman rho = -0.505, P < .001). Regression models again demonstrated the continued use of narcotic pain medication correlating with poor sleep as the difference in the mean PSQI score between users and nonusers increased as postoperative time increased. At greater than 24 months after surgery, patients using narcotics had a mean PSQI score that was 7.4 points higher than narcotic nonusers (standard error [SE] = 1.93; P = .00017).
At greater than 24 months, 41% of patients still demonstrated sleep disturbance, with both SST and VAS scores showing improvement. The prolonged use of narcotic medication negatively affects sleep, with a greater effect seen over time.
睡眠障碍是肩袖疾病患者的主要诉求，常促使他们寻求治疗。作者此前报告了一项对接受肩袖修复手术患者的前瞻性分析，发现术后3个月睡眠障碍显著改善。这种睡眠改善在6个月时得以维持。
在本研究中，作者试图获取该人群超过2年的中期数据。假设为关节镜下肩袖修复术后睡眠障碍的改善在2年随访时得以维持，且持续使用麻醉性止痛药在2年随访时对睡眠质量有负面影响。
病例系列；证据等级，4级。
在患者手术后至少24个月联系最初的队列。最初研究中的56例患者中有37例（66%）可用。使用匹兹堡睡眠质量指数（PSQI）、简易肩关节测试（SST）、疼痛视觉模拟量表（VAS）和单项评估数字评价（SANE）对患者结局进行评分。将新获得的分数与术前至术后6个月的先前分数进行比较。
我们先前分析中术后6个月PSQI评分的统计学显著改善得以维持，24个月后随访的37例患者的平均PSQI评分为5.5。在这些患者中，41%的PSQI评分仍>5，表明存在睡眠障碍。然而，即使是我们研究中PSQI评分>5表明存在睡眠障碍的患者，与6个月时PSQI评分>5的患者相比，24个月后平均评分也有改善，6个月时PSQI评分>5的患者平均PSQI评分为11.5（P = 0.13）。SST和VAS评分在超过24个月时均持续改善，且两者与PSQI评分均显示中度强度相关性（VAS：Spearman相关系数rho = 0.479，P < 0.001；SST：Spearman相关系数rho = -0.505，P < 0.001）。回归模型再次表明，随着术后时间增加，麻醉性止痛药的持续使用与睡眠不佳相关，因为使用者和非使用者之间的平均PSQI评分差异增大。术后超过24个月，使用麻醉药的患者平均PSQI评分比未使用麻醉药的患者高7.4分（标准误[SE] = 1.93；P = 0.00017）。
超过24个月时，41%的患者仍存在睡眠障碍，SST和VAS评分均显示改善。麻醉药的长期使用对睡眠有负面影响，且随着时间推移影响更大。
