Patients Undergoing Cervical Spine Surgery Achieve Improved Sleep Quality Over Time

Cervical spine disease impairs quality of life through increased pain, discomfort, and altered sleep. Surgery is known to improve many quality of life domains as measured by patient-reported outcome measures, yet the interplay of sleep quality and surgical outcomes after cervical spine surgery remains understudied. This study aimed to characterize changes in sleep quality after cervical spine surgery over time using patient-reported outcome measurement information system (PROMIS) sleep disruption (PROMIS-SD) scores and identify factors associated with postoperative sleep improvement.

This single-center retrospective cohort study included patients 18 years and older who underwent cervical spine surgery for degenerative disease. Preoperative and postoperative PROMIS-SD scores quantified sleep quality changes. Repeated-measures analysis of variance analyzed trends in sleep disruption over time and by demographic and clinical factors whereas latent class analysis identified how sleep disruption affected surgical success through other PROMIS measure domains.

Among 1015 patients (mean age: 61.5, 89.6% White), surgical approaches included anterior cervical diskectomy and fusion, arthroplasty, laminectomy and fusion, laminoplasty, and foraminotomy. Overall, PROMIS-SD scores improved postoperatively at 6 (P < .0001), 12 (P < .0001), 18 (P < .0001), and 24 months (P = .0419). Age at surgery (P = .0062) and preoperative sleep quality (P = .0007) were the strongest predictors of sleep improvement. Latent class analysis identified 6 patient outcome profiles. In our cohort, successfully meeting minimal clinically important difference for PROMIS mental health was only achieved in those patients also attaining minimal clinically important difference in either PROMIS physical health or PROMIS-SD.

Sleep improved or remained stable in >90% of patients after cervical spine surgery. Factors such as preoperative sleep scores and age most influenced changes in sleep improvement after surgery. Postoperative improvements in mental health were dependent on prerequisite improvements in physical health or sleep, and young patients with above average baseline sleep quality were most likely to experience postoperative sleep disruption.