What is the Prevalence and Prognosis of Sleep Dysfunction in Patients Undergoing Surgery for Degenerative Lumbar Spondylolisthesis?: A Quality Outcomes Database Spine CORe® Study.

Abstract

Study designRetrospective 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.ObjectiveTo 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 dataImproved sleep after surgery for lumbar spinal stenosis has been reported in several studies but not in patients with spondylolisthesis.MethodsA 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.ResultsOverall, 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.ConclusionMost 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.