Sleep Disturbances in Cervical Spondylotic Myelopathy

Author:

Bisson Erica F.1,Mummaneni Praveen V.2,Michalopoulos Giorgos D.34,El Sammak Sally34,Chan Andrew K.5,Agarwal Nitin6,Wang Michael Y.7,Knightly John J.8,Sherrod Brandon A.1,Gottfried Oren N.9,Than Khoi D.9,Shaffrey Christopher I.9,Goldberg Jacob L.10,Virk Michael S.10,Hussain Ibrahim10,Shabani Saman11,Glassman Steven D.12,Tumialan Louis M.13,Turner Jay D.13,Uribe Juan S.13,Meyer Scott A.8,Lu Daniel C.14,Buchholz Avery L.15,Upadhyaya Cheerag16,Shaffrey Mark E.15,Park Paul17,Foley Kevin T.17,Coric Domagoj18,Slotkin Jonathan R.19,Potts Eric A.20,Stroink Ann R.21,Chou Dean5,Fu Kai-Ming G.10,Haid Regis W.22,Asher Anthony L.18,Bydon Mohamad34

Affiliation:

1. Department of Neurological Surgery, University of Utah, Salt Lake City, UT

2. Department of Neurological Surgery, University of California San Francisco, San Francisco, CA

3. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester

4. Department of Neurological Surgery, Mayo Clinic, Rochester, MN

5. Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, NY

6. Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO

7. Department of Neurosurgery, University of Miami, Miami, FL

8. Atlantic Neurosurgical Specialists, Morristown, NJ

9. Department of Neurological Surgery, Duke University Medical Center, Durham, NC

10. Department of Neurological Surgery, Weill Cornell Medical Center, New York

11. Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI

12. Norton Leatherman Spine Center, Louisville, KY

13. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ

14. Department of Neurosurgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA

15. Department of Neurosurgery, University of Virginia, Charlottesville, VA

16. Department of Neurosurgery, School of Medicine, University of North Carolina, Chapel Hill, NC

17. Department of Neurosurgery, University of Tennessee, Memphis, TN

18. Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas Healthcare System, Charlotte, NC

19. Department of Neurosurgery, Geisinger Health, Danville, PA

20. Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, IN

21. Central Illinois Neuro Health Science, Bloomington, IL

22. Atlanta Brain and Spine Care, Atlanta, GA

Abstract

Study Design: Prospective observational study, level of evidence 1 for prognostic investigations. Objectives: To evaluate the prevalence of sleep impairment and predictors of improved sleep quality 24 months postoperatively in cervical spondylotic myelopathy (CSM) using the quality outcomes database. Summary of Background Data: Sleep disturbances are a common yet understudied symptom in CSM. Materials and Methods: The quality outcomes database was queried for patients with CSM, and sleep quality was assessed through the neck disability index sleep component at baseline and 24 months postoperatively. Multivariable logistic regressions were performed to identify risk factors of failure to improve sleep impairment and symptoms causing lingering sleep dysfunction 24 months after surgery. Results: Among 1135 patients with CSM, 904 (79.5%) had some degree of sleep dysfunction at baseline. At 24 months postoperatively, 72.8% of the patients with baseline sleep symptoms experienced improvement, with 42.5% reporting complete resolution. Patients who did not improve were more like to be smokers [adjusted odds ratio (aOR): 1.85], have osteoarthritis (aOR: 1.72), report baseline radicular paresthesia (aOR: 1.51), and have neck pain of ≥4/10 on a numeric rating scale. Patients with improved sleep noted higher satisfaction with surgery (88.8% vs 72.9%, aOR: 1.66) independent of improvement in other functional areas. In a multivariable analysis including pain scores and several myelopathy-related symptoms, lingering sleep dysfunction at 24 months was associated with neck pain (aOR: 1.47) and upper (aOR: 1.45) and lower (aOR: 1.52) extremity paresthesias. Conclusion: The majority of patients presenting with CSM have associated sleep disturbances. Most patients experience sustained improvement after surgery, with almost half reporting complete resolution. Smoking, osteoarthritis, radicular paresthesia, and neck pain ≥4/10 numeric rating scale score are baseline risk factors of failure to improve sleep dysfunction. Improvement in sleep symptoms is a major driver of patient-reported satisfaction. Incomplete resolution of sleep impairment is likely due to neck pain and extremity paresthesia.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Orthopedics and Sports Medicine,Surgery

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