Sleep quality and response after rotator cuff repair, total shoulder arthroplasty, and reverse shoulder arthroplasty

Background

Sleep disturbance secondary to shoulder pathology is a common complaint. Previous studies have shown improvement in sleep quality after common shoulder procedures. The purpose of this study was to assess sleep quality response after arthroscopic rotator cuff repair (aRCR), anatomic total shoulder arthroplasty (aTSA), and reverse total shoulder arthroplasty (rTSA). Our hypothesis was that sleep disturbance is greater in degree and longer lasting in postoperative recovery after aRCR compared to shoulder arthroplasty.

Methods

The Pittsburgh Sleep Quality Index and Visual Analog Scale–Quality of Sleep were prospectively collected in consecutive patients undergoing aRCR, aTSA, and rTSA between 2018 and 2020. Sleep quality and patient reported outcome measures, including the American Shoulder and Elbow Surgeons shoulder score, Single Assessment Numeric Evaluation (SANE) score, and visual analog scale pain score, were measured preoperatively and at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Patient demographics, preoperative diagnosis, and comorbidities were recorded. Univariate and multivariate analyses were performed. Correlations between sleep quality metrics and patient reported outcome measures were assessed.

Results

One hundred forty-one patients who underwent shoulder surgery participated in this study (aRCR: n = 34, aTSA: n = 58, rTSA: n = 49). With all shoulder surgeries pooled together, there were significant improvements in sleep quality as measured by Pittsburgh Sleep Quality Index and Visual Analog Scale–Quality of Sleep from preoperative to final follow-up (8.8 vs. 6.0, 55.4 vs. 75.2, P < .01 for both, respectively). The rate and magnitude of sleep quality improvement varied by surgical intervention. Sleep quality after aTSA and rTSA showed statistical improvement by 6 weeks postoperatively, which was durable through final follow-up. In contrast, after aRCR patients demonstrated a trend toward worsening sleep quality at 2 weeks with improvement by 3 months postoperatively. In multivariable regression analyses, only the type of surgical intervention, and not preoperative diagnosis or comorbidities, was associated with sleep quality at the final follow-up. Quality of sleep strongly correlated with the SANE score (r = 0.45, P < .01).

Conclusion

Sleep quality improves after shoulder surgery, although the rate of recovery varies by surgical intervention. Sleep quality improves more rapidly after shoulder arthroplasty when compared to aRCR. The SANE score may be a useful surrogate metric in assessing sleep quality.