Majority of patients find sleep patterns return to normal 6 months following rotator cuff repair

Improvement in sleep disturbance following arthroscopic rotator cuff repair

BACKGROUND

Approximately 90% of patients express concerns with sleep shortly after developing shoulder-related symptoms. Previous small cohort studies have demonstrated the impact of rotator cuff repair (RCR) on sleep, but none have characterized the observed benefits. The purpose of this study is to evaluate sleep improvement after rotator cuff repair including the speed of sleep recovery, the time at which improvement plateaus, and the longer-term maintenance of improved sleep.

METHODS

A retrospective review of our institution's shoulder and elbow repository identified patients who underwent primary arthroscopic rotator cuff repair from 2012 to 2021 and reported sleep disturbance preoperatively. Patients were evaluated using sleep-related questions from the Simple Shoulder Test and American Shoulder and Elbow Surgeons score. Sleep outcomes were compared from a preoperative visit to 3-month, 6-month, 12-month, and most recent follow-ups to evaluate efficacy of treatment, speed of recovery, and improvement plateaus.

RESULTS

Among 677 RCR patients, 95.7% (648/677) reported sleep disturbance preoperatively. A total of 474 met inclusion criteria with median follow-up of 4.1 years (IQR, 2.1-6.1). At most recent follow-up, 81.8% were able to sleep comfortably and 65.7% were able to sleep on the affected side. A plateau in the ability to sleep comfortably was seen at 6 months while no plateau was observed in the ability to sleep on the affected side. More rapid improvement in the ability to sleep comfortably occurred during the first 3 months and from 3-6 months for the ability to sleep on the affected side.

CONCLUSION

The majority of patients with sleep disturbance who undergo RCR, report significant, rapid, and lasting improvement in the ability to sleep comfortably and the ability to sleep on the affected side.

Sleep alterations following elective shoulder surgery: A systematic review

Background

Poor sleep quality due to nocturnal pain is increasingly reported as a major symptom in several shoulder pathologies. Sleep disturbance has been reported in up to 89% after rotator cuff tears and is frequently reported as the primary reason for referring patients to surgery. As a result, it is important to understand the impact of shoulder surgery on a patient's sleep quality.

Methods

A systematic literature review in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was performed to identify primary research articles reporting the relationship between sleep and shoulder surgery. The initial query yielded 276 articles. After applying inclusion and exclusion criteria, 12 articles were included discussing the relationship between sleep and shoulder surgery.

Results

A total of 1097 patients were included in the 12 studies evaluating the impact of shoulder surgery on sleep quality, with the Pittsburgh Sleep Quality Index (PSQI) as the most used survey. Average preoperative PSQI across studies was 9.9 (poor sleep), and postoperative PSQI scores of 5.4 at 6 months (improved sleep).

Conclusion

Patients with shoulder pathologies have a poor sleep quality that improves after shoulder surgery. However, this improvement might not return sleep quality within the normal range, suggesting other factors might impact postoperative sleep quality.

Level of evidence

III.

Sleep disturbances in rotator cuff pathology: insights into mechanisms and clinical implications

Rotator cuff disease is highly prevalent and can have a detrimental effect on the quality of life of affected patients. One of the most common complaints from rotator cuff disease is sleep disturbance due to shoulder pain. Numerous studies have attempted to explore the relationship between rotator cuff disease and sleep disturbance, but results are inconsistent and limited. In this setting, the Pittsburgh Sleep Quality Index (PSQI) plays an important role in preoperative assessment and evaluation of sleep in rotator cuff patients. However, despite the current efforts, the literature presents conflicting results regarding the relationships between magnetic resonance imaging characteristics of rotator cuff tear and PSQI score, signifying a gap in understanding. That being said, it has been shown that rotator cuff repair surgery can alleviate sleep disturbances witnessed preoperatively in and can restore quality of life.

Effects of Melatonin on Sleep Quality and Patient-Reported Outcomes After Arthroscopic Rotator Cuff Surgery: A Prospective Randomized Controlled Trial

BACKGROUND

Sleep disturbance is a significant symptom associated with both rotator cuff tears and arthroscopic rotator cuff repair. Melatonin has been shown to be safe and effective in managing multiple sleep disorders, including secondary sleep disorders, with relatively minor adverse effects and lack of addictive potential.

PURPOSE

To investigate the effects of oral melatonin on postoperative sleep quality after arthroscopic rotator cuff repair.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

This was a prospective randomized clinical trial evaluating patients undergoing arthroscopic rotator cuff repair. Exclusion criteria included history of alcohol abuse, current antidepressant or sedative use, revision rotator cuff repair, severe glenohumeral arthritis, and concurrent adhesive capsulitis. Patients were randomly assigned in a 1:1 ratio to 1 of 2 groups: 5-mg dose of melatonin 1 hour before bedtime or standard sleep hygiene (≥6 hours per night, avoiding caffeine and naps in the evening). Patients in the melatonin group took their assigned melatonin dose for 6 weeks beginning the day of surgery. Patient-reported outcome assessments, including the Pittsburgh Sleep Quality Index (PSQI), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Single Assessment Numeric Evaluation (SANE), and pain medication charts were collected preoperatively as well as at 2 weeks, 6 weeks, 3 months, 4 months, and 6 months postoperatively. Numeric variables were analyzed using paired and unpaired t tests, with significance set at P < .05.

RESULTS

Eighty patients were included for final analysis (40 in the control group, 40 in the melatonin group). Patient characteristics such as age, sex, race, body mass index, and laterality did not differ significantly (P≥ .05). Preoperative ASES, SANE, and PSQI scores did not differ between groups (P≥ .055). PSQI scores were significantly lower (better quality sleep) in the melatonin group at the 6-week postoperative period (P = .036). There was a positive correlation between how patients rated the intensity of their pain and the PSQI at the 6-week postoperative period (0.566). The PSQI question regarding sleep quality was found to be significantly lower in the melatonin group at the 3-month, 4-month, and 6-month postoperative periods (P = .015, P = .041, and P≤ .05, respectively). SANE scores were significantly lower in the melatonin group (P = .011) at 6 weeks and then higher in the melatonin group (P = .017) at 6 months. ASES scores were significantly higher in the melatonin group at 4 and 6 months (P = .022 and P = .020, respectively). Lastly, patients who were randomized into the melatonin group were found to use significantly less narcotic medication at the 4-month postoperative period (P = .046).

CONCLUSION

Melatonin use after arthroscopic rotator cuff repair led to improved sleep quality (PSQI) in the early postoperative period as well as improved functional outcomes (ASES and SANE scores) and decreased narcotic use in the later postoperative period. Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin.

REGISTRATION

NCT04278677 (ClinicalTrials.gov identifier).

ChatGPT and Google Provide Mostly Excellent or Satisfactory Responses to the Most Frequently Asked Patient Questions Related to Rotator Cuff Repair

Purpose

To assess the differences in frequently asked questions (FAQs) and responses related to rotator cuff surgery between Google and ChatGPT.

Methods

Both Google and ChatGPT (version 3.5) were queried for the top 10 FAQs using the search term "rotator cuff repair." Questions were categorized according to Rothwell's classification. In addition to questions and answers for each website, the source that the answer was pulled from was noted and assigned a category (academic, medical practice, etc). Responses were also graded as "excellent response not requiring clarification" (1), "satisfactory requiring minimal clarification" (2), "satisfactory requiring moderate clarification" (3), or "unsatisfactory requiring substantial clarification" (4).

Results

Overall, 30% of questions were similar between what Google and ChatGPT deemed to be the most FAQs. For questions from Google web search, most answers came from medical practices (40%). For ChatGPT, most answers were provided by academic sources (90%). For numerical questions, ChatGPT and Google provided similar responses for 30% of questions. For most of the questions, both Google and ChatGPT responses were either "excellent" or "satisfactory requiring minimal clarification." Google had 1 response rated as satisfactory requiring moderate clarification, whereas ChatGPT had 2 responses rated as unsatisfactory.

Conclusions

Both Google and ChatGPT offer mostly excellent or satisfactory responses to the most FAQs regarding rotator cuff repair. However, ChatGPT may provide inaccurate or even fabricated answers and associated citations.

Clinical Relevance

In general, the quality of online medical content is low. As artificial intelligence develops and becomes more widely used, it is important to assess the quality of the information patients are receiving from this technology.

Improvements in Sleep After Shoulder Arthroscopy Are Correlated With Improvements in Various Patient-Reported Outcomes: A Systematic Review

Purpose

To determine the prevalence of sleep disturbances in patients before and after arthroscopic surgery of the shoulder and to evaluate the association between patient-reported outcomes and standardized sleep disturbance tools after shoulder arthroscopy.

Methods

A systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, was conducted by searching the PubMed, Embase, and Scopus databases using the terms "arthroscopic surgery" and "sleep." Two independent reviewers evaluated the studies based on the inclusion criteria focused on the effects of shoulder arthroscopy on sleep disturbance and the use of outcome measures related to sleep. Data on sleep quality and functional outcomes were collected and analyzed using various assessment tools, including the Pittsburgh Sleep Quality Index and American Shoulder and Elbow Surgeons score. The methodologic quality of included studies was assessed using the Methodological Index for Non-randomized Studies (MINORS) criteria.

Results

The review included 15 studies (9 Level IV, 5 Level III, and 1 Level II) comprising 1,818 arthroscopic patients (average age, 57.4 ± 8.86 years; follow-up range, 6 months to 75.7 months). The prevalence rates of sleep disturbances before and after shoulder arthroscopy ranged from 75.8% to 100% and from 19% to 62%, respectively. Every study included in this analysis reported an improvement in rates of sleep disturbances postoperatively compared with preoperatively. Improvements in standardized sleep disturbance scores were associated with functional outcomes.

Conclusions

Sleep disturbances are commonly observed before and after arthroscopic surgery of the shoulder. Arthroscopic surgery of the shoulder appears to improve sleep quality, and surgeons can expect functional outcomes, specifically the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, numeric rating scale or visual analog scale score, and Constant-Murley score, to improve in line with sleep quality.

Level of Evidence

Level IV, systematic review of Level II to IV studies.

Patients with rotator cuff tears present a psychological impairment, not only a functional deficit: a systematic review

INTRODUCTION

Psychological factors impact patients with rotator cuff tears (RCT) in terms of pain level, shoulder function, sleep disturbance, and quality of life (QoL). The aim of this study was to quantify the prevalence of psychological factors in those patients, evaluate their influence on patient-reported outcomes (PROMs), and assess the possible improvement with surgical treatment.

METHODS

The literature search was performed on PubMed, Web of Science, Wiley Cochrane Library up to January, 2023.

INCLUSION CRITERIA

RCT treated with arthroscopic rotator cuff reconstruction (ARCR), description of psychological variables evaluated with validated questionnaires, descriptions of PROMs.

RESULTS

Thirty-nine studies included 7021 patients. Depression was found in eight studies (19.2%), anxiety in 6 (13.0%), sleep disturbance in seven (71.3%), and distress in three studies (26.4%). Studies evaluating the relationship between psychological impairment and pain documented more pain and impaired shoulder function before and after ARCR in patients with altered psychological status.

DISCUSSION

An impaired psychological status has an important impact on patients' perception of their disease. RCT patients with psychological alterations often experience more pain and reduced shoulder function, thus having worse QoL.

CONCLUSION

This study underlines that psychological impairment largely affects RCT patient condition and treatment outcome, which underlines the importance of a multidisciplinary biopsychosocial intervention to achieve better results.

Resolution of Sleep Disturbance and Improved Functional Outcomes After Rotator Cuff Repair

BACKGROUND

Most patients experience sleep disturbances before rotator cuff repair, with these symptoms largely improving postoperatively. However, the relationship between the resolution or persistence of sleep disturbance and patient-reported outcomes after rotator cuff repair remains unknown.

PURPOSE

To compare outcomes after rotator cuff repair between patients who reported a preoperative sleep disturbance and those who did not. Outcomes at various time points after surgery were also assessed in relation to the persistence or resolution of sleep disturbance.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Patients undergoing primary arthroscopic rotator cuff repair at a tertiary academic center were prospectively enrolled in a registry database. Patient characteristics were obtained preoperatively and validated patient-reported outcome measures (PROMs) were obtained pre- and postoperatively, including the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Veterans RAND 12-Item Health Survey Physical and Mental components. Sleep disturbance was evaluated via responses to Simple Shoulder Test question 2. Patients with and without sleep disturbance were compared before and after surgery.

RESULTS

In total, 293 patients were prospectively enrolled. A total of 262 (89.8%) patients reported a sleep disturbance preoperatively. Of these, 221 (84.4%) reported a resolution of sleep disturbance by 2 years postoperatively. After adjustment for age, workers' compensation status, and Cofield tear size, patients with a preoperative sleep disturbance reported significantly worse baseline PROMs, apart from the Veterans RAND 12-Item Health Survey Mental component, before surgery. However, postoperatively, these patients had greater improvement in PROMs, and no significant remaining differences were seen at follow-up between patients with and without preoperative sleep disturbance. Among patients who reported a preoperative sleep disturbance, those whose symptoms resolved postoperatively had superior PROM scores as well as significantly greater improvements from preoperative baseline values compared with patients with persistent sleep disturbances after surgery.

CONCLUSION

Patients with preoperative sleep disturbances reported worse baseline functional scores before rotator cuff repair compared with patients without sleep disturbance. These disturbances largely resolved after surgery, with postoperative outcomes comparable with those of patients who reported no preoperative sleep concerns. Patients whose sleep disturbances resolved postoperatively also reported superior PROM scores compared with patients whose sleep disturbances persisted postoperatively.