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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Improvement in Perceived Sleep Quality Following Carpal Tunnel Release
Andrew Yang, MD1; Harleen Kaur, BA1; Jack Choueka, MD2; Arie G. Trouw, MD1; John J. Kelly, BS1; Karan Dua, MD1; Daniel Caligiuri, MD1; (1)State University of New York, Downstate Medical Center, Brooklyn, NY, (2)Maimonides Medical Center, Brooklyn, NY

Introduction:
Carpal tunnel syndrome (CTS) may have multiple implications for patient quality of life. Increases in CTS symptoms have reportedly been correlated with proportional increases in sleep latency and decreases in total sleep hours and sleep quality, resulting in sleep deprivation in extreme cases. Carpal tunnel release (CTR) surgery may aid in resolving these disturbances. This study aims to investigate the improvement in overall sleep quality associated with median nerve decompression and to quantify the timeframe of nocturnal symptom relief following CTR.

Methods:
Patients who underwent open median nerve decompression, had positive clinical and EMG findings, and failed conservative management were prospectively followed for two years following CTR. Patients were asked to complete a Pittsburgh Sleep Quality Index (PSQI), Visual Analogue Scale (VAS) for pain and sleep perception, and both components (Symptom Severity and Functional Status Scale [SSS and FSS]) from the Levine-Katz carpal tunnel questionnaire. Baseline patient-reported outcome scores were compared to scores from follow-up visits using two-tailed student's t-tests.

Results:
Twenty-one patients (mean age: 63 years; 16:5 F:M) met inclusion criteria. On average, patients experienced pre-operative symptoms for 24 months. Patients showed an overall improvement in outcome metrics post-operatively. However, the improvement in PSQI became significant at the 12-month follow-up (pre-operative: 8.9 points; post-operative: 6.2 points, p=0.01), while both VAS scores significantly improved at an earlier 6 month follow-up. VAS pain scores significantly decreased by 31 points (post-operative mean VAS pain: 27 points, p=0.004). VAS sleep perception scores decreased by 26 points (post-operative mean VAS sleep: 35 points, p=0.03). Both SSS and FSS components of the Levine-Katz questionnaire significantly improved in the immediate 3-6-week period post-surgery (all p<0.03).

Discussion/Conclusion:
Overall, patient perception of pain and sleep quality was observed to improve at a much earlier time point when compared to PSQI scores. These results provide a general timeline that surgeons can employ to help patients develop realistic expectations following carpal tunnel release with respect to restoration of sleep quality.


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