Postdoctoral Research Fellow Mayo Clinic Rochester Rochester, Minnesota, United States
Introduction: The purpose of this study is 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 (QOD).
Methods: The QOD was queried for patients with CSM, and sleep quality was assessed via the Neck Disability Index (NDI) 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 1,135 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 OR=1.85), have osteoarthritis (aOR=1.72), report baseline radicular paresthesia (aOR=1.51), and have neck pain of ≥4/10 on numeric ranking scale (NRS). 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 NRS 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.
How to Improve Patient Care: The evidence yielded from this study might be used to adjust preoperative expectations of patients with CSM and sleep disturbances, and to encourage the modification of risk factors towards optimizing sleep-related outcomes.
