Sleep quality in patients with rotator cuff disease

Objectives: Sleep disturbance may be an important prognostic variable driving patients to seek treatment for rotator cuff disease related shoulder pain. Currently, little is known on the influence of rotator cuff pathology on sleep. The purpose of this study was to determine which patient factors correlate with sleep disturbance in patients with atraumatic rotator cuff disease. Methods: A prospective, nonrandomized single surgeon cross-sectional cohort study was performed evaluating the effects of rotator cuff disease on sleep quality. Time-zero prior to treatment intervention outcomes data was collected including the Single Assessment Numeric Evaluation Rating (SANE), American Shoulder and Elbow Score (ASES), Pittsburgh Sleep Quality Index (PSQI), patient demographics and medical comorbidities. Statistical analysis included Pearson correlation and multiple regression analysis to determine which patient reported factors were associated with sleep quality disturbance. Results: 147 shoulders in 131 subjects 66 right 49 left 16 bilateral (66 male, 65 female) with a mean age 56.4 were enrolled. There were 92 subjects with rotator cuff tendinitis, and 34 subjects full thickness rotator cuff tears confirmed on MRI. The mean SANE was 48, VAS 4.85, ASES 52, PSQI 8.26±5.0, and 92% of subjects reported nocturnal shoulder pain. Pearson correlation coefficient determined that female sex (males -0.23, p=0.001), higher pain VAS score (+0.26, p=0.003)), depression (+0.39, p<0.0001), presence of low back pain (+0.36, p<0.0001) smoking (+0.22, p=0.01), diabetes (+0.19, p=0.03), presence of osteoarthritis (+0.19, p=0.03), and NSAID use (+0.17, p=0.05) were associated with poor sleep quality. Factors associated with worse sleep quality. Age, SANE, ASES, presence of full thickness RCT, presence of biceps pain, or cervical spine symptoms were not predictive and did not correlate with worse sleep quality. Conclusion: Based on our findings pain, female gender, depression, presence of low back pain, smoking, diabetes mellitus, and prior NSAID use are all factors associated with worse sleep quality in patients with rotator cuff disease. These results demonstrate that the sleep quality does not seem to correlate with severity of rotator cuff pathology.