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American Association for Hand Surgery

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Carpal Tunnel, Cubital Tunnel, and Sleep: Preoperative Sleep Disturbance Scores and Correlation between Sleep Disturbance and Pain, Quality of Life, and Functional Ratings
Erica Smearman, MD PhD1, Beau M McGinley, BS1, Kevin Cuneo, BS1, Oluwakorede Omole, BS1, John T Hurt, BS2, Alexander M Dawes, BS3, Roy Toston, BS2, Eric R. Wagner, MD3 and Michael B. Gottschalk, MD3, (1)Emory University School of Medicine, Atlanta, GA, (2)Emory University School Medicine, Atlanta, GA, (3)Emory University, Atlanta, GA

Introduction: Carpal tunnel (CTS) and Cubital tunnel (CuTS) are two of the most common nerve compression conditions. While sleep disturbance is commonly reported for CTS, only one study to date has assessed sleep disturbance in CuTS patients specifically, and no study to our knowledge has compared sleep ratings across CTS and CuTS patients. Our study seeks to compare sleep ratings across these conditions, and explore whether sleep disturbance correlates with other patient-rated questionnaires on pain, quality of life, and function.

Materials & Methods: Patients with CTS and CuTS with planned decompressive surgery were prospectively assessed. All patients were administered validated questionnaires where higher scores represent more of the measured concept. Questionnaires include PROMIS Sleep Disturbance; Pain Visual Analog Scale (Pain VAS); PROMIS Pain Interference; European Quality of Life Questionnaire (EuroQOL), Single Assessment Numeric Evaluation (SANE) rating of the affected extremity, and the Patient-Rated Wrist Evaluation (PRWE) which assesses wrist pain and function.

Results: A total of 70 patients (34.3% males, 65.7% females, average age 54.9 +/- 16.0) were included. There were 39 patients with CTS and 31 patients with CuTS. For CTS, the average preoperative sleep disturbance score was 53.8 +/- 8.7, falling within a normal population range. For CuTS, average sleep was 58.4 +/- 10.4, falling within a mild-rating of sleep disturbance. The scores between the groups were not statistically different (p=0.11). Across the entire sample, higher scores on sleep disturbance significantly correlated with higher pain scores (p<0.001), as well as lower quality of life (p<0.001) and reduced extremity function (p<0.01; see Table 1 for details).

Conclusions: Sleep disturbance was not significantly different between CTS and CuTS in our sample, and was normal to mild disturbance overall. However, reports of greater sleep disturbance correlated with greater pain as well as reduced quality of life and function.


Table 1. Correlation between PROMIS Sleep Disturbance and Preoperative Self-Reported Questionnaires among Patients Planning to Undergo Carpal or Cubital Tunnel Release


Patient Reported Outcome


Correlation


P-Value


Pain VAS Score


0.28


<0.001*


Pain Interference T-Score


0.54


<0.001*


EuroQOL Score


-0.45


<0.001*


Affected Extremity SANE Score


-0.22


<0.01*


PRWE Score


0.05


0.85


Pearson correlations. See methods for details on the measures. * p<0.05.


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