Sleep quality and nocturnal pain in patients with elbow disorders: a prospective multicenter study

Mental health disorders have become a growing global concern. Sleep quality is known to have a crucial impact on mental well-being. Poor sleep contributes to increasing economic costs owing to reduced productivity as well as the development of mental disorders. Conversely, anxiety and depression often lead to sleep disturbances. Pain is a key factor affecting sleep quality. Studies have shown that musculoskeletal disorders, especially in the shoulder, may cause sleep disturbances. Research on the relationship between elbow pain and sleep quality remains limited. This study aims to evaluate the impact of common elbow pathologies on sleep quality.

This prospective multicenter cohort study used self-reported outcome measures in patients with elbow disorders, including the Pittsburgh Sleep Quality Index (PSQI), to assess sleep quality. The PSQI was compared with other outcome measures.

A total of 664 patients (284 female, 380 male) were included, of whom 81% reported nocturnal pain. The mean age was 47.9 ± 14.2 years, body mass index (BMI) 26.9 ± 6.7 kg/m² and symptom duration 15.8 ± 7.3 months. The most common diagnoses were lateral epicondylar pain (66%), medial epicondylar pain, arthritis, ulnar nerve entrapment and biceps/triceps tendinopathies. The overall PSQI was 7.3 ± 3.8, disabilities of arm, shoulder and hand questionnaire (DASH) 35.0 ± 19.8, sports/performing art module of disabilities of arm, shoulder and hand questionnaire (spa-DASH) 16.2 ± 13.8, work module of disabilities of arm, shoulder and hand questionnaire (w-DASH) 29.2 ± 15.8, single assessment numeric evaluation elbow (SANE-E) 54.9 ± 25.4 and numeric rate scale (NRS) 3.1 ± 2.7. No significant differences in other scores were observed between pathology subgroups. Correlation analysis showed a moderate association between PSQI and DASH score (r = -0.372, p < 0.001), as well as between PSQI and NRS for pain (r = 0.255, p = 0.002), while other variables showed no significant correlations.

Nocturnal pain and sleep disturbances are highly prevalent in patients with elbow disorders. Evaluating and addressing sleep quality may improve functional outcomes and overall well-being. Future research should investigate how different treatment modalities affect pain, function and sleep quality.