Sleep profile and its clinical correlates in patients with carpal tunnel syndrome

Abstract

Background & Objective: Nocturnal pain and paresthesias are common in carpal tunnel syndrome (CTS). However, there is limited literature on the impact of CTS on sleep profile. The aim of this study was to systematically analyse sleep profile in CTS and to correlate with clinical and electrophysiological features.

Methods: Prospective evaluation of 44 patients diagnosed to have CTS was carried out using Visual Analog Scale (VAS), Functional Severity Scale (FSS) and Symptom Severity Scale (SSS) components of Boston Carpal Tunnel Questionnaire (BCTQ), Historic and objective scale (HiOb), and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). Sleep was assessed using Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and overnight polysomnography (PSG).

Results: Cases had significantly higher mean PSQI, ESS, ISI and STOP-BANG scores as compared to controls. PSQI, ESS, and ISI correlated significantly with FSS, SSS and QuickDASH. PSQI and ISI correlated with VAS. No significant correlation was found between sleep questionnaires and electrophysiological severity. PSG, carried out in 16 cases, showed reduced total sleep time and sleep efficacy, reduced duration of N2 and rapid eye movement (REM) sleep, and higher wake after sleep onset (WASO), wake index, and stage shift index (p<0.05). Sleep efficacy, sleep onset latency, WASO and wake percentage were better in those with clinical and electrophysiological severe grades of CTS.

Conclusion: CTS causes poor sleep quality, and fragmented and reduced sleep, which is under- recognised, but causes significant distress to the patients. Longitudinal alterations in sleep profile including the impact of medical/surgical intervention need to be delineated.