Wright State University Department of Orthopaedics, Miami Valley Hospital, Dayton, Ohio.
Shelbourne Knee Center, Indianapolis, Indiana.
J Arthroplasty. 2024 Dec;39(12):2992-2995.e2. doi: 10.1016/j.arth.2024.06.035. Epub 2024 Jul 5.
Up to 20% of patients undergoing total knee arthroplasty (TKA) remain dissatisfied with their outcome, leading to the identification of risk factors for poor outcomes. The purpose of this study was to analyze the effect of chronic sleep disorders on patient-reported outcomes after primary TKA.
A retrospective review of patients undergoing primary TKA was conducted using a prospectively collected database of patients from a single institution between 2018 and 2022. The cohort was split based on the presence of documented chronic sleep disorders, identified preoperatively from the electronic medical record using current procedural terminology codes. The sample was further restricted to include all patients who have sleep disorders (SDs), as well as a 3:1 propensity-matched (on age, sex, body mass index, and American Society of Anesthesiologists class) cohort of patients who had no documented SDs (NSDs) prior to surgery. The final sample included 172 patients (SD: 43; NSD: 129). Repeated-measures linear mixed model analysis was used to analyze the progression of Knee Injury and Osteoarthritis Outcome Score (KOOS) through time between groups.
Those who had SDs had a lower preoperative mean total KOOS score (40.2) than the NSD group (44.1); however, this was not significantly different (P = .108). At 1 year postoperatively, those who had an SD had a significantly higher mean total KOOS score (87.2) than the NSD group (80.4), P = .005. When comparing total KOOS scores by group, over each time period, the SD group showed a better progression when compared to the NSD group, P = .001.
Compared to patients who did not have documented chronic sleep disorders, patients who had a prior history of chronic sleep disorders reported significantly greater improvements in most KOOS domains in the 12-month period following TKA.
多达 20%接受全膝关节置换术（TKA）的患者对其结果仍不满意，导致出现了不良预后的风险因素。本研究旨在分析慢性睡眠障碍对初次 TKA 后患者报告结局的影响。
对 2018 年至 2022 年期间一家机构的前瞻性数据库中接受初次 TKA 的患者进行回顾性研究。根据术前电子病历中使用当前手术术语代码确定的慢性睡眠障碍（SD）存在情况，将队列分为存在或不存在慢性睡眠障碍（SD）。样本进一步限制为包括所有患有睡眠障碍（SD）的患者，以及一组与术前无记录 SD（NSD）的患者相匹配的患者（按年龄、性别、体重指数和美国麻醉医师协会分级），比例为 3:1。最终样本包括 172 名患者（SD：43 人；NSD：129 人）。使用重复测量线性混合模型分析来分析两组间的膝关节损伤和骨关节炎结果评分（KOOS）随时间的进展。
患有 SD 的患者术前平均总 KOOS 评分（40.2）低于 NSD 组（44.1），但差异无统计学意义（P=0.108）。术后 1 年，SD 组的平均总 KOOS 评分（87.2）明显高于 NSD 组（80.4），P=0.005。比较两组的 KOOS 总分，在每个时间段内，SD 组的进展均优于 NSD 组，P=0.001。
与没有记录慢性睡眠障碍的患者相比，有慢性睡眠障碍病史的患者在 TKA 后 12 个月内，在大多数 KOOS 领域的报告中显示出了显著的改善。
