Improvement of Sleep Quality after Carpal Tunnel Release
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Published:
Oct 10, 2021
Keywords:
Carpal tunnel syndrome, carpal tunnel release, insomnia, sleep disturbance
Main Article Content
Abstract
Introduction: Sleep disturbances caused by night pain and paresthesia are usual symptoms in carpal tunnel syndrome (CTS), and are often the cause of medical consultation. Objective changes following the Carpal Tunnel Release (CTR) have been thoroughly analyzed. However, evidence related to improvement in sleep quality is lacking. We consider that the immediate improvement in sleep quality is directly related to CTR. The main purpose of this study is to assess these changes following this procedure. The secondary objective is to evaluate if the severity of the median nerve compression or patient-related factors could have an impact on sleep quality.
Materials and Methods: Prospective case study of 67 patients diagnosed with CTS who underwent CTR procedure. We grouped all cases based on age, sex, and nerve conduction study (NCS) results. Sleep quality was evaluated with the Athens Insomnia Score before surgery and in the fourth follow-up day, asking specifically about symptoms from the first night after the procedure.
Results: Sleep disorders were found in 74.62% of cases before surgery. After CTR, sleep quality improved in all cases (p<0.05). We found no relation between sleep quality improvement and sex, age, or NCS severity.
Conclusions: CTR is commonly indicated to stop nerve damage, and to improve sensitive and motor symptoms. However, sleep disturbances are not the main indication for it, even if it is a frequent reason for medical consultation. Sleep quality improves from the first night after CTR, and this outcome is independent of age, sex, or severity of CTS.
Materials and Methods: Prospective case study of 67 patients diagnosed with CTS who underwent CTR procedure. We grouped all cases based on age, sex, and nerve conduction study (NCS) results. Sleep quality was evaluated with the Athens Insomnia Score before surgery and in the fourth follow-up day, asking specifically about symptoms from the first night after the procedure.
Results: Sleep disorders were found in 74.62% of cases before surgery. After CTR, sleep quality improved in all cases (p<0.05). We found no relation between sleep quality improvement and sex, age, or NCS severity.
Conclusions: CTR is commonly indicated to stop nerve damage, and to improve sensitive and motor symptoms. However, sleep disturbances are not the main indication for it, even if it is a frequent reason for medical consultation. Sleep quality improves from the first night after CTR, and this outcome is independent of age, sex, or severity of CTS.
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How to Cite
Viollaz, G., Altamirano, N. N., Gómez, D., Muratore, Álvaro, Tedeschi, A., & Teruya, G. (2021). Improvement of Sleep Quality after Carpal Tunnel Release. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(5), 613-620. https://doi.org/10.15417/issn.1852-7434.2021.86.5.1310
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Clinical Research
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org/10.1016/j.jhsa.2017.02.009
23. Rubin G, Orbach H, Rinott M, Rozen N. The effectiveness of splinting and surgery on sleep disturbance in carpal tunnel syndrome. J Hand Surg (Eur vol) 2018;43(3):286-28. https://doi.org/10.1177/1753193417729110
24. Erickson J, Polatsch D, Beldner S, Melamed E. An assessment of sleep disturbance in patients before and after
carpal tunnel release. J Hand Surg Asian Pac Vol 2019;24(2):144-6. https://doi.org/10.1142/S2424835519500188
25. Niedermeier S, Pettit RJ, Frantz TL, Colvell K, Awan H. Early postoperative improvement in sleep and pain after
carpal tunnel release. Hand 2020;15(3):311-4. https://doi.org/10.1177/1558944718793984
2. Tinel J. Le signe du “fourmillement” dans les lésions des nerfs périphériques. Presse Médi 1915;47:388-9.
3. Durkan JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am 1991;73:535-8. PMID: 1796937
4. Phalen GS. The carpal-tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 1966;48(2):211-28. PMID: 5934271
5. Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Scratch collapse test for evaluation of carpal and
cubital tunnel syndrome. J Hand Surg 2008;33(9):1518-24. https://doi.org/10.1016/j.jhsa.2008.05.022
6. Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 1981;63:380-3. PMID: 7204435
7 . McCabe S, Uebele A, Pihur V, Rosales R, Atroshi I. Epidemiologic associations of carpal tunnel syndrome and
sleep position: is there a case for causation? Hand (N Y) 2007;2(3):127-34. https://doi.org/10.1007/s11552-007-9035-5
8. Wilbourn A. The electrodiagnostic examination with peripheral nerve injuries. Clin Plast Surg 2003;30:139-54.
https://doi.org/10.1016/s0094-1298(02)00099-8
9. Louie DL, Earp BE, Collins JE, Losina E, Katz JN, Black EM, et al. Outcomes of open carpal tunnel release at a
minimum of ten years. J Bone Joint Surg Am 2013;95:1067-73. https://doi.org/10.2106/JBJS.L.00903
10. Graham B, Regehr G. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006;31(6):919-24. PMID: 16886290
11. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011;44(4):597-607. https://doi.org/10.1002/mus.22208
12. Soldatos C. The assessment of insomnia: rationale for a new scale based on ICD-10 principles. En: Szelenberger W, Kukwa A (eds). Sleep: physiology and pathology. Warsaw: Elma Books; 1995.
13. Soldatos C, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res 2000;48:555-60. https://doi.org/10.1016/s0022-3999(00)00095-7
14. Portocarrero AN, Jimenez Genchi A. Estudio de Validación al español de la Escala Atenas de Insomnio.
Salud Mental 2005;28(5):35-9. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid
=S0185-33252005000500034
15. Learmonth J. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am 1933;13:905-13.
16. Kadzielski J , Malhotra LR, Zurakowski D, Lee SGP, Jupiter JB, Ring D. Evaluation of preoperative expectations
and patient satisfaction after carpal tunnel release. J Hand Surg Am 2008,33(10):1783-8. https://doi.org/10.1016/j.
jhsa.2008.06.019
17. Leit M, Weiser R, Tomaino M. Patient-reported outcome after carpal tunnel release for advanced disease: a
prospective and longitudinal assessment in patients older than age 70. J Hand Surg Am 2004;24(3):379-83. https://doi.org/10.1016/j.jhsa.2004.02.003
18. Jerosch-Herold C, Chojnowski A. A qualitative study of the experiences and expectations of surgery in patients with carpal tunnel syndrome. J Hand Ther 2008;21:54-61. https://doi.org/10.1197/j.jht.2007.09.001
19. American Academy of Sleep Medicine (AASM). The International Classification of Sleep Disorders. 2nd ed.
Westchester, IL: American Academy of Sleep Medicine; 2005.
20. Gaspar M, Kane P. Evaluation and management of sleep disorders in the hand surgery patient. J Hand Surg Am 2016;41(10):1019-26. https://doi.org/10.1016/j.jhsa.2016.08.006
21. Patel J, McCabe S. Characteristics of sleep disturbance in patients with carpal tunnel syndrome. Hand (N Y)
2012;7(1):55-8. https://doi.org/10.1007/s11552-011-9373-1
22. Tulipan J, Nayoung K, Abboudi J, Jones C, Liss F, Kirkpatrick W, et al. Prospective evaluation of sleep
improvement following carpal tunnel release surgery. J Hand Surg Am 2017;42(5):390.e1-390.e6. https://doi.
org/10.1016/j.jhsa.2017.02.009
23. Rubin G, Orbach H, Rinott M, Rozen N. The effectiveness of splinting and surgery on sleep disturbance in carpal tunnel syndrome. J Hand Surg (Eur vol) 2018;43(3):286-28. https://doi.org/10.1177/1753193417729110
24. Erickson J, Polatsch D, Beldner S, Melamed E. An assessment of sleep disturbance in patients before and after
carpal tunnel release. J Hand Surg Asian Pac Vol 2019;24(2):144-6. https://doi.org/10.1142/S2424835519500188
25. Niedermeier S, Pettit RJ, Frantz TL, Colvell K, Awan H. Early postoperative improvement in sleep and pain after
carpal tunnel release. Hand 2020;15(3):311-4. https://doi.org/10.1177/1558944718793984