Relationship between electrodiagnostic findings and sleep disturbance in carpal tunnel syndrome: A controlled objective and subjective study

Carpal tunnel syndrome and sleep, a systematic review and meta-analysis

BACKGROUND

The most common symptom and reason patients seek treatment for carpal tunnel syndrome is lack of sleep. Our purpose was to determine how much sleep-related symptoms of carpal tunnel syndrome improve after carpal tunnel release using validated patient-reported outcome measures (PROMs) and objective sleep data as primary measures of interest.

METHODS

A PRISMA-guided literature search was conducted using Ovid MEDLINE, PubMed, Cochrane, and ClinicalTrials.gov. Only interventional clinical trials that examined primary outcome measures of interest were included. Patient-reported outcome measures underwent meta-analysis to determine how much scores improved following carpal tunnel release.

RESULTS

The Pittsburgh Sleep Quality Index improved significantly after carpal tunnel release, by 4.43 points and 6.02 points at 1-3 and 6-12 months postoperatively, respectively, and continued to improve up to 2 years. Improvement on the Insomnia Severity Index after carpal tunnel release was also significant, with improvement up to 1 year postoperatively, by 8.54 points and 9.05 points at 1-3 and 6-12 months, respectively. Insomnia Severity Index scores improved significantly after splinting as well.

CONCLUSIONS

The present meta-analysis determined to what extent patients can expect their sleep to improve after operative and non-operative intervention, as measured by various patient-reported outcome measures that assess sleep. The Pittsburgh Sleep Quality Index and Insomnia Severity Index correlated very well between studies and across hundreds of patients with carpal tunnel syndrome. Data are lacking to define the minimal clinically important difference and assess whether patients achieve a minimal clinically important difference for sleep questionnaires; more information on this topic is needed.

LEVEL OF EVIDENCE

III.

The Investigation of the Results of Clinical Evaluation, Pain, Functional Status and Sleep Quality According to Electrodiagnostic Test Results in Females with Carpal Tunnel Syndrome: A Pilot Study

Amaç: Çalışmamız, elektrodiagnostik test sonuçlarına göre hafif ve orta düzey Karpal Tünel Sendromu (KTS) tanısı almış kadın hastaların klinik semptom şiddetleri, el fonksiyonları ve uyku kalitelerinin karşılaştırılması ve hastaların semptom şiddetleri ile el fonksiyonelliği ve uyku kalitesi arasındaki ilişkinin incelenmesi amacıyla planlandı.Yöntem: Çalışmamız, Erzurum Atatürk Üniversitesi Eğitim ve Araştırma Hastanesi Fizik Tedavi Polikliniğine başvuran, hafif-orta düzey KTS tanısı alan ve 35-65 yaş aralığında olan 32 kadın hasta ile gerçekleştirildi. KTS şiddetinin elektrofizyolojik tanılaması için elektromiyografi (EMG), ağrı ölçümü için Vizüel Analog Skalası (VAS), KTS fonksiyonel durum şiddeti ve semptom şiddeti için Boston KTS Anketi, el fonksiyonelliği için Duruöz El İndeksi, uyku kalitesi için Jenkins Uyku Skalası kullanıldı. Veriler SPSS programı ile değerlendirildi.Bulgular: Çalışmamız sonuçlarına göre hafif ve orta şiddette KTS tanısı almış hastaların ağrı, Boston KTS Anketi, Jenkins Uyku Skalası sonuçlarının benzer olduğu (p>0.05); Duruöz El İndeksi sonuçlarının ise orta şiddette KTS tanısı almış hastalarda hafif şiddette KTS hastalarına göre daha yüksek olduğu belirlendi (p<0.05). Hastaların semptom şiddetleri ile el fonksiyonelliği ve uyku kalitesi arasındaki ilişki incelendiğinde ise; semptom şiddeti yüksek olan hastalarda fonksiyonel durum ve uyku kalitelerinin daha kötü olduğu belirlendi (p<0.01).Sonuç: KTS hastalarında EMG sonuçları ile klinik semptomlar her zaman birbiri ile uyumlu olmayabilmekte, EMG sonuçlarına göre farklı şiddette KTS’si olan hastaların yaşadığı semptomlar hastaya özgü değişiklikler gösterebilmektedir. Buna göre KTS hastalarının klinik durumları ile EMG sonuçlarının birlikte değerlendirilmesi ile hastaya özgü planlanacak tedaviler ile daha etkili sonuçlara ulaşılabileceğini düşünmekteyiz.

The correlation between shoulder pathologies and sleep disorders

OBJECTIVE

To assess and characterize the correlation between shoulder pathologies and sleep disturbances.

METHODS

Participants enrolled into this case-control study were divided into two groups: patients with an established clinical diagnosis of active shoulder pathology (study group), and patients without any shoulder pathology (control group). All patients completed the Insomnia Severity Index (ISI) questionnaire, in addition to questions related to participant demographics, health status, medication, and other known insomnia risk factors.

RESULTS

A total of 98 patients were included (46 in the study group and 52 controls). Mean ISI score was significantly higher (indicating more severe insomnia) in the study group versus control group (t[96] = -9.67), even after correcting for confounders (t[53.1] = -8.61). Additionally, in patients with shoulder pathology, those with comorbidities experienced more sleep disturbances than those without comorbidities (β = 0.36). Lastly, the shoulder pathology group was at a higher risk of having sleep disturbances compared with controls (relative risk 4.86, 95% confidence interval 2.24, 10.55).

CONCLUSIONS

Sleep disturbances are more common among patients with shoulder pathologies. Comorbidities and a shorter duration of pathology may predict more severe sleep disturbances.