Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD 21287, USA.
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD 21287, USA.
Spine J. 2021 Aug;21(8):1325-1331. doi: 10.1016/j.spinee.2021.03.021. Epub 2021 Mar 25.
Little is known about the effects of sleep disturbance (SD) on clinical outcomes after spine surgery.
To determine the (1) prevalence of SD among patients presenting for spine surgery at an academic medical center; (2) correlations between SD and health-related quality of life (HRQoL) scores; and (3) associations between postoperative SD resolution and short-term HRQoL.
Retrospective review of prospectively collected data.
We included 508 adults undergoing spine surgery at 1 academic center between December 2014 and January 2018.
Participants completed the Oswestry Disability Index (ODI) or Neck Disability Index (NDI) and Patient Reported Outcome Measurement System (PROMIS-29) questionnaire preoperatively, during the immediate postoperative period (6-12 weeks), and at 6, 12, and 24 months after surgery.
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.
Preoperative SD was reported by 127 participants (25%). SD was significantly correlated with worse ODI and/or NDI values and worse scores in all PROMIS health domains (all, p<.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).
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.
关于睡眠障碍（SD）对脊柱手术后临床结果的影响，我们知之甚少。
确定（1）在学术医疗中心就诊的脊柱手术患者中 SD 的患病率；（2）SD 与健康相关生活质量（HRQoL）评分之间的相关性；以及（3）术后 SD 缓解与短期 HRQoL 之间的关联。
前瞻性收集数据的回顾性研究。
我们纳入了 2014 年 12 月至 2018 年 1 月期间在 1 家学术中心接受脊柱手术的 508 名成年人。
参与者在术前、术后即刻（6-12 周）以及术后 6、12 和 24 个月时完成了 Oswestry 残疾指数（ODI）或颈部残疾指数（NDI）和患者报告的结果测量系统（PROMIS-29）问卷。
使用术前 PROMIS SD 评分，我们将参与者分为无睡眠障碍（评分<55）、轻度障碍（评分 55-60）、中度障碍（评分 60-70）或重度障碍（评分 70）。在最终分析中，我们将这些类别合并为无/轻度和中/重度。使用 Pearson 相关检验评估 SD 与 HRQoL 测量之间的相关性。回归分析（调整年龄、性别、合并症、当前阿片类药物使用和并发症发生情况）用于估计术后缓解或持续的 SD 对 HRQoL 评分的影响，以及在 HRQoL 方面取得临床显著改善的可能性。α=0.05。
127 名参与者（25%）报告了术前 SD。SD 与 ODI 和/或 NDI 值较差以及所有 PROMIS 健康领域的评分较差显著相关（均 p<.001）。在术后即刻评估时，127 名参与者中有 80 名（63%）SD 已缓解。与报告无术前 SD 的参与者相比，持续存在 SD 的参与者在疼痛干扰（优势比 [OR]，0.49；95%置信区间 [CI]，0.28，0.84）、身体功能（OR，0.32；95% CI，0.13，0.82）和参与社会角色的满意度（OR，0.57；95% CI，0.37，0.80）方面取得临床显著改善的可能性显著降低。
四分之一的脊柱手术患者报告术前 SD 至少为中度严重程度。术前睡眠质量差和术后持续的睡眠障碍与多项 HRQoL 测量评分较差显著相关。这些结果强调了在术前和术后都要解决患者睡眠障碍的重要性。
