Sleep alterations following elective shoulder surgery: A systematic review.

Background: Poor sleep quality due to nocturnal pain is increasingly reported as a major symptom in several shoulder pathologies. Sleep disturbance has been reported in up to 89% after rotator cuff tears and is frequently reported as the primary reason for referring patients to surgery. As a result, it is important to understand the impact of shoulder surgery on a patient's sleep quality. Methods: A systematic literature review in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was performed to identify primary research articles reporting the relationship between sleep and shoulder surgery. The initial query yielded 276 articles. After applying inclusion and exclusion criteria, 12 articles were included discussing the relationship between sleep and shoulder surgery. Results: A total of 1097 patients were included in the 12 studies evaluating the impact of shoulder surgery on sleep quality, with the Pittsburgh Sleep Quality Index (PSQI) as the most used survey. Average preoperative PSQI across studies was 9.9 (poor sleep), and postoperative PSQI scores of 5.4 at 6 months (improved sleep). Conclusion: Patients with shoulder pathologies have a poor sleep quality that improves after shoulder surgery. However, this improvement might not return sleep quality within the normal range, suggesting other factors might impact postoperative sleep quality. Level of evidence: III.