Date Presented 04/04/19
This study examined whether sleep quality is associated with hand function above and beyond what can be explained by pain and carpal tunnel syndrome (CTS) severity to hand function in clients with CTS. Manual Ability Measure-20, Pittsburgh Sleep Quality Index, Pain Visual Analogue Scale, and Electromyography for CTS diagnosis and severity level were measured outcomes in 53 participants. Sleep quality was significantly associated with manual ability after controlling for CTS severity and pain.
Primary Author and Speaker: Angela Goorman
Additional Authors and Speakers: Colleen Schneck, Doris Pierce
Contributing Authors: Spencer Dawson
PURPOSE: The purpose of this study was to test the hypothesis that sleep quality is positively associated with hand function above and beyond the association of pain and carpal tunnel syndrome (CTS) severity to hand function in clients with CTS. Although three prior studies demonstrated a correlation between CTS and sleep disturbances, they did not interface control for pain and CTS severity through electromyography and include an occupation-based hand function measure, thus limiting conclusions that may be drawn regarding the role of sleep in health and hand function in persons with CTS.
METHODS: In this cross-sectional design, 53 treatment-seeking adults at a Southwest orthopedic practice, ranging in age 30-86 years old who were diagnosed with CTS, completed the Manual Ability Measure-20 (MAM-20), Pittsburgh Sleep Quality Index (PSQI), and a visual analogue scale (VAS) for pain. Electromyography (EMG) determined CTS diagnosis and CTS severity level. Directly after CTS diagnosis, participants were verbally asked to enter the study then given cover letters and informed consent forms. Descriptive statistics for all continuous variables included mean, standard deviation, and range. Descriptive statistics for categorical variables included frequencies, percentages, and chi-square tests. Independent samples t-tests were used to assess gender differences on sleep and CTS measures. Pearson correlations were used to assess the association between measures. Hierarchical multiple regression was used to test the association between measures after controlling for the influence of other variables. SPSS 23 was used for data analysis.
RESULTS: The mean Rasch-derived manual ability was 62.76, the mean pain level was 5.96, and the mean PSQI score of 10.15 was above the cutoff score of 5 for detecting disturbed sleep. Average sleep duration was six hours per night. Sleep quality was significantly negatively correlated with manual ability: greater scores were associated with lower manual ability, r (53) =-.47, p = .001. Sleep disturbance was significantly positively correlated with pain: higher scores were associated with greater pain, r (53) =.364, p = .007. Both sleep disturbance and quantity were negatively correlated with manual ability: more disturbed sleep and shorter duration sleep were associated with lower manual ability, r’s=-.354 and -.276, p’s=.009 and .045 respectively. Both sleep disturbance and quantity were positively correlated with pain: more disturbed sleep and shorter duration were associated with greater pain, r’s=.378 and .278, p’s=.005 and .044 respectively. Sleep quality was significantly associated with manual ability after controlling for CTS severity and pain. Scores on the PSQI accounted for a unique 12.7% of the variance in manual ability.
IMPACT: A significant correlation exists between sleep quality and hand function in clients with CTS, after controlling for pain and CTS severity. CTS-practitioners should consider evaluation of sleep quality as a baseline for treatment and incorporate approaches beyond typical hand-specific rehabilitation.
CONCLUSIONS: Clients with CTS and disturbed sleep could benefit from occupational therapy interventions such as assistance adjusting sleeping position to decrease compression of the median nerve. Consideration of an occupational profile to see how the sleep disturbance is influencing other areas of occupation besides sleep could also be indicated. Further research is needed into how supports to sleep may shape recovery and hand function in clients with CTS.
References
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Patel, A., Culberston, M., Patel, A., Hashem, J., Jacob, J., Edelstein, D., & Choueka, J. (2014). The negative effect of Carpal Tunnel Syndrome on sleep quality. Sleep Disorders, 1-7. http://doi.org/10.1155/2014/962746.
Pereira, B. J., Pereira, V. C., Fonseca, R. G., Fernandes, T. D., Bertotti, M. F., & Resende, L. A. (2016). Sleep quality in patients with carpal tunnel syndrome. Clinical Neurophysiology, 127(9), e236-e237. http://doi.org/10.1016/j.clinph.2016.05.066.
Pierce, D. (Ed.) (2014). Occupational science for occupational therapy. Thorofare, NJ: SLACK Incorporated. ISBN: 9781556429330
