睡眠障碍和抑郁对腰椎手术后12个月预后的综合影响
The Combined Influence of Sleep Disturbance and Depression on 12-month Outcomes After Lumbar Spine Surgery.
作者信息
Coronado Rogelio A, Pennings Jacquelyn S, Master Hiral, Brintz Carrie E, Cole Keith R, Helmy Joseph, Oleisky Emily R, Davidson Claudia, Abtahi Amir M, Stephens Byron F, Archer Kristin R
机构信息
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN.
出版信息
Spine (Phila Pa 1976). 2024 Oct 1;49(19):1339-1347. doi: 10.1097/BRS.0000000000005000. Epub 2024 Apr 12.
STUDY DESIGN
Retrospective analysis of prospectively collected data.
OBJECTIVE
To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery (LSS).
SUMMARY OF BACKGROUND DATA
Psychological and behavioral factors are considered major risk factors for poor outcomes after LSS. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment.
METHODS
Data from 700 patients undergoing LSS were analyzed. Preoperative sleep disturbance and depression were assessed with PROMIS subscales. Established thresholds defined patients with moderate/severe symptoms. Outcomes for disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. Separate multivariable linear regressions examined the influence of each factor on 12-month outcomes with and without accounting for the other and in combination as a 4-level variable: (1) moderate/severe sleep disturbance alone, (2) moderate/severe depression alone, (3) both moderate/severe sleep disturbance and depression, (4) no moderate/severe sleep disturbance or depression.
RESULTS
Preoperative sleep disturbance and depression were associated with 12-month disability and pain ( P <0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes ( P <0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability and 1.5 points higher back and leg pain compared with patients without moderate/severe sleep disturbance or depression.
CONCLUSIONS
The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies.
LEVEL OF EVIDENCE
Level II.
研究设计
对前瞻性收集的数据进行回顾性分析。
目的
探讨术前睡眠障碍和抑郁对腰椎手术（LSS）后12个月患者报告结局的综合影响。
背景数据总结
心理和行为因素被认为是LSS后预后不良的主要危险因素。然而，有必要探讨术前因素如睡眠障碍和抑郁的综合影响。了解睡眠障碍和抑郁的影响可为基于证据的术前评估以及术前和术后治疗的共同决策提供依据。
方法
分析了700例行LSS患者的数据。使用PROMIS子量表评估术前睡眠障碍和抑郁情况。既定阈值定义为中度/重度症状患者。术前及术后12个月评估残疾情况（Oswestry残疾指数）以及腰腿痛情况（数字评定量表）。分别进行多变量线性回归分析，以检验每个因素在不考虑另一个因素以及作为一个四级变量组合时对12个月结局的影响：（1）仅中度/重度睡眠障碍，（2）仅中度/重度抑郁，（3）中度/重度睡眠障碍和抑郁两者兼具，（4）无中度/重度睡眠障碍或抑郁。
结果
术前睡眠障碍和抑郁与12个月时的残疾和疼痛相关（P<0.05）。在考虑抑郁因素后，术前睡眠障碍仍与残疾相关，而在调整睡眠障碍因素后，术前抑郁仍与所有结局相关（P<0.05）。与无中度/重度睡眠障碍或抑郁的患者相比，报告中度/重度睡眠障碍和中度/重度抑郁两者兼具的患者残疾得分高12.6分，腰腿痛得分高1.5分。
结论
睡眠障碍和抑郁的组合对术后结局有相当大的影响。中度/重度睡眠障碍和抑郁的高危患者群体可能受益于针对性的治疗策略。
证据级别
二级。
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