How Patients Sleep After Rotator Cuff Repair: A Prospective Analysis of Pain, Position, and Recovery.

Abstract

Sleep disturbance is common among patients undergoing rotator cuff repair (RCR), yet the perioperative course of pain-related sleep disruption and the influence of behavioral factors are not well defined. Patients frequently ask perioperative sleep-related questions that lack evidence-based answers. This study aimed to characterize changes in sleep quality and sleeping patterns before and after RCR. Adults undergoing primary elective RCR at a single academic center (November 2021-October 2024) were prospectively enrolled. Surveys were completed preoperatively and at 2, 6, 12, and 24 weeks postoperatively. The primary outcome was the Pain and Sleep Questionnaire 3-item index (PSQ-3; 0-300). Secondary measures included the Sleep Hygiene Index (SHI), sleep position, sling use, and 24-hour visual analog scale (VAS) for pain. Analyses used Chi-square/Fisher's tests, Kruskal-Wallis/ANOVA, and Spearman correlations, all with Bonferroni correction to evaluate sleep position changes and candidate predictors. Primary mixed-effects models used 2 weeks as the reference time and preoperative PSQ-3 and VAS scores as a covariate to identify predictors of postoperative PSQ-3 and VAS pain. Secondary models used preoperative scores as the reference to determine when outcomes improved beyond baseline. Sixty-three patients were enrolled; 50 (51 shoulders) completed final follow-up. Mean age was 59.9 ± 9.7 years, BMI 31.4 ± 6.0 kg/m², baseline SHI 10.2 ± 5.9. and PSQ-3 of 130.6 ± 99.1. At 2 weeks, back sleeping increased (85% from 39.2%, p < 0.001) and side sleeping declined (27.5% from 64.7%, p = 0.011). By 6 weeks, side sleeping partially recovered; by 24 weeks, sleep positions resembled baseline. Mixed-effects modeling demonstrated worse PSQ-3 at 2 weeks (β = +30.98, p = 0.039), followed by significant improvement below baseline by 6 weeks (β = -32.64, p = 0.030), 12 weeks (β = -56.20, p < 0.001), and 24 weeks (β = -92.55, p < 0.001). By 24 weeks, 55% of patients reported no nighttime sleep disturbance (PSQ-3 = 0). Nicotine use and preoperative side sleeping were independently associated with worse postoperative PSQ-3 and VAS scores. Additionally, Workers' Compensation status and higher preoperative pain predicted higher postoperative VAS. Sleep after RCR worsens transiently but improves by 6 weeks, with continued improvement by 12 weeks and 24 weeks. Most patients resume preoperative sleep positions by 6 months. Nicotine use and preoperative side sleeping are predictors of increased pain-related awakenings during RCR recovery.