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What is the Prevalence and Prognosis of Sleep Dysfunction in Patients Undergoing Surgery for Degenerative Lumbar
Stefan Mitrasinovic1, Praveen V Mummaneni2, Nathan J Winans1
1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, NY.
Study Design:
Retrospective analysis of patients from the prospective Quality Outcomes Database Spine CORe® Spondylolisthesis cohort to assess the prevalence of sleep dysfunction and factors associated with improved sleep after surgery.
Objective:
To characterize the prevalence of sleep disruption and identify factors associated with improved sleep among patients undergoing surgery for Meyerding grade I degenerative lumbar spondylolisthesis.
Summary Of Background Data:
Improved sleep after surgery for lumbar spinal stenosis has been reported in several studies but not in patients with spondylolisthesis.
Methods:
A total of 608 patients from the prospective Quality Outcomes Database Spine CORe® Spondylolisthesis cohort were retrospectively analyzed. Patients were included in this study if they responded to the sleep subitem of the Oswestry Disability Index (ODI) at baseline and 24-month follow-up. The level of sleep dysfunction was assessed and compared at baseline and 24-month follow-up using univariable and multivariable statistics.
Results:
Overall, 526 of the 608 patients met the inclusion criteria. At baseline, 455 patients (86.5%) had sleep disruption. At 24 months or greater, 325 patients (71.4% of the 455 impaired) had improved sleep, with 184 patients (40.4%) reporting no disruption of sleep postoperatively. In multivariable analyses, improvement in sleep was predicted by a higher baseline ODI (OR=1.01, 95% CI: 1.001-1.01, P<0.001). Following subgroup analysis by age, improvement in sleep was predicted by a higher baseline ODI (OR=1.01, 95% CI: 1.001-1.01, P=0.002) and higher ASA grade (OR=1.15, 95% CI: 1.02-1.30, P=0.03) in the 65 years or younger cohort, while minimally invasive techniques (OR=1.14, 95% CI: 1.01-1.30, P=0.04) were significant in the 65 years of age or older cohort.
Conclusion:
Most patients (86.5%) presenting for surgery for low-grade degenerative spondylolisthesis have impaired sleep. However, 24 months after surgery, over 70% of patients with baseline dysfunction reported improvements with 40.4% reporting no sleep dysfunction.
