Sleep Disturbance in Patients With Lumbar Spinal Stenosis: Association With Disability and Quality of Life

Comparative Study on the Efficacy of Pregabalin Versus Limaprost in Patients With Lumbar Spinal Stenosis: A Prospective, Randomized Controlled Trial

BACKGROUND

Patients with Lumbar Spinal Stenosis (LSS) typically complain of back pain and leg pain. These symptoms reduce the quality of life (QoL) and also cause sleep disturbances. This study compares pregabalin and limaprost's efficacy in LSS for pain, disability, QoL, and sleep, aiming to offer insights for medication selection.

METHODS

This study was designed as a prospective, randomized, single-center, single-blinded, clinical superiority trial targeting patients with LSS. For 6 weeks, 111 patients per group were administered medication following a standard regimen, after which patient-reported outcomes were measured. The primary outcome was the Visual Analogue Scale (VAS) for back and leg pain, and the secondary outcomes included the Oswestry Disability Index (ODI), European Quality of Life 5 Dimensions (EQ-5D), and sleep quality.

RESULTS

After 6 weeks of medication, there were significant improvements over time in the primary outcome, VAS for back pain and leg pain, in both groups, but no significant difference between the 2 groups. Similarly, for the secondary outcomes, ODI and EQ-5D, both groups showed significant improvements, yet there was no significant difference between them. In the subgroup analysis targeting poor sleepers (Pittsburgh sleep quality index, PSQI >5), both groups also exhibited significant improvements in sleep quality, but again, there was no significant difference between the groups.

CONCLUSIONS

Efficacy of pregabalin, limaprost in back and leg pain, ODI, EQ-5D, and sleep quality, but there was no significant difference between the 2 groups. Thus, it is advisable to prescribe based on individual drug responses and potential complications.

Assessment of Lumbar Spinal Stenosis as a Risk Factor for Development of Sleep Disorder: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS)

Purpose

Insomnia has been reported to coexist with various musculoskeletal disorders. Although lumbar spinal stenosis (LSS) is the most frequently operated on spinal disease, the causal relationship between LSS and development of sleep disorders remains unclear due to lack of longitudinal studies. This study aimed to determine whether LSS was a risk factor for developing new sleep disorders, primarily insomnia, using a prospective cohort of community residents.

Patients and Methods

This study was a prospective cohort study. Participants aged ≥65 years from the "Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS)" conducted in 2008 formed our study population. LSS was diagnosed using the self-administered, self-reported history questionnaire, a validated diagnostic support tool for LSS. Sleep disorder was investigated using a questionnaire during the 2-year follow-up. The impact of LSS on sleep disorder onset was analyzed after adjusting for potential confounders, such as age, sex, obesity, hypertension, diabetes, depression, and smoking habits, using propensity score matching.

Results

Of the 489 participants who were followed up for two years, 38 (7.8%) had newly developed a sleep disorder in 2010. After adjusting for confounding factors, a comparison of 133 participants each in the control and LSS groups showed significantly higher frequency of new-onset sleep disorders (19 [14.3%] in the LSS group versus 6 [4.5%] in the control group).

Conclusion

LSS was found to be an independent risk factor for sleep disorders.

Association Between Pharmacotherapy and Sleep Quality in Patients with Chronic Orofacial and Chronic Body Pain: A Cross-Sectional Study

Purpose

Sleep impairment is associated with many chronic pain disorders. While there is an association between chronic pain and sleep disturbances, little is known about the influence of pharmacotherapy for chronic pain conditions, particularly chronic opioid therapy, on sleep. This study aimed to 1) compare the sleep quality (SQ) in patients with two different pain conditions-chronic body pain and chronic orofacial pain; 2) assess the correlation of SQ and pain intensity; and 3) evaluate the association between pharmacotherapy and SQ.

Patients and Methods

The Pittsburgh Sleep Quality Index (PSQI) was used to measure the SQ in subjects with 1) chronic body pain (n = 100) and 2) chronic orofacial pain (n = 100). The visual analogue scale was applied for pain intensity rating. All subjects were adults recruited at Massachusetts General Hospital, United States. The subjects' demographic data, pain intensity, diagnosis and concurrent use of medications were extracted from their electronic medical records (EMR). Statistical analyses were performed using T-test and Pearson correlation coefficient.

Results

Among 200 subjects (mean age 51.01 ± 15.52 years), 141 (70.5%) were females. PSQI and pain intensity were statistically significantly different between the two groups (p < 0.05 and p < 0.0001, respectively) and higher in subjects with chronic body pain. There was a positive correlation between PSQI and pain intensity (chronic orofacial pain r = 0.3535, p = 0.0004; chronic body pain: r = 0.2247, p < 0.026). PSQI was higher in chronic orofacial pain subjects utilizing opioids and benzodiazepines (PSQI = 15.25).

Conclusion

Chronic pain impairs SQ, which is noticeably worse in subjects with body pain conditions. In addition, pain intensity was correlated with poorer SQ, which in turn was linked to the concomitant use of opioid and benzodiazepine therapy in chronic orofacial pain.

The associations of depression, anxiety, and insomnia at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain: a prospective cohort study

BACKGROUND

No previous study has investigated the associations of depression, anxiety, and insomnia at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain (CLBP). The study aimed to simultaneously compare the associations of depression, anxiety, and sleep quality at baseline with disability at a 5-year follow-up point among patients with CLBP.

METHODS

Two-hundred and twenty-five subjects with CLBP were enrolled at baseline, and 111 subjects participated at the five-year follow-up point. At follow-up, the Oswestry Disability Index (ODI) and total months of disability (TMOD) over the past five years were used as the indices of disability. The depression (HADS-D) and anxiety (HADS-A) subscales of the Hospital Anxiety and Depression Scale and the Insomnia Severity Index (ISI) were used to assess depression, anxiety, and insomnia at baseline and follow-up. Multiple linear regression was employed to test the associations.

RESULTS

The scores of the HADS-D, HADS-A, and ISI were correlated with the ODI at the same time points (both at baseline and follow-up). A greater severity on the HADS-D, an older age, and associated leg symptoms at baseline were independently associated with a greater ODI at follow-up. A greater severity on the HADS-A and fewer educational years at baseline were independently associated with a longer TMOD. The associations of the HADS-D and HADS-A at baseline with disability at follow-up were greater than that of the ISI at baseline, based on the regression models.

CONCLUSION

Greater severities of depression and anxiety at baseline were significantly associated with greater disability at the five-year follow-up point. The associations of depression and anxiety at baseline with disability at the long-term follow-up point might be greater than that of insomnia at baseline.

Impact of Sleep Disturbance on Clinical Outcomes in Lumbar Decompression

OBJECTIVE

To examine the impact of Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (PROMIS-SD) on clinical outcomes in patients undergoing lumbar decompression.

METHODS

Patients undergoing lumbar decompression with preoperative PROMIS-SD scores were retrospectively included. Patients were separated into 2 cohorts: none to slight sleep disturbance (PROMIS-SD <55) and mild to severe sleep disturbance (PROMIS-SD ≥55). Patient-reported outcome measures including PROMIS Physical Function, PROMIS Anxiety, PROMIS Pain Interference, PROMIS SD, 9-item Patient Health Questionnaire, visual analog scale back/leg, and Oswestry Disability Index were collected preoperatively and up to 1 year postoperatively.

RESULTS

Of 87 patients identified, 48 patients had PROMIS-SD scores ≥55. Regardless of preoperative PROMIS-SD score, patients reported significant improvement in physical function, anxiety, pain interference, depression, pain, and disability outcomes in at least 1 time point. Patients in the PROMIS-SD ≥55 cohort reported postoperative improvement in sleep disturbance. Patients in the PROMIS-SD <55 cohort reported superior preoperative patient-reported outcome measures in all domains and superior postoperative improvement in pain interference and sleep disturbance. Minimum clinically important difference attainment rates were higher in the PROMIS-SD ≥55 cohort in physical function, anxiety, pain interference, sleep disturbance, and pain.

CONCLUSIONS

Patients undergoing lumbar decompression demonstrated significant postoperative improvement in most clinical outcomes regardless of preoperative sleep disturbance. Patients with mild to severe sleep disturbance had higher minimum clinically important difference attainment rates for physical function, mental function, and pain. Patients undergoing lumbar decompression with greater preoperative sleep disturbance may experience more clinically noticeable improvement.