Surgical Decompression significantly improves Sleep Quality in Carpal Tunnel Syndrome

Surgical decompression significantly improves sleep quality and the hand symptoms and functions in patients with carpal tunnel syndrome, suggests a study recently published in the Indian Journal of Neurosurgery .

Carpal tunnel syndrome (CTS), first described by Sir James Paget in 1854, is the most common entrapment neuropathy of the upper extremity. This disease has been reported to affect mostly women. It is characterized by numbness, tingling, and pain in the median nerve distribution. Pain and numbness in nighttime has also been reported as common symptoms of CTS.

Night waking with numbness due to wrist position is an important problem of CTS which hinders the ability to sleep well. Disrupted sleep is also common in patients with CTS, with approximately 80% of patients with CTS having nighttime waking due to numbness. Due to frequent nighttime awakening and fragmented sleep, CTS also increases daytime sleepiness and dysfunction. Thus, relief of nighttime symptoms plays a key role in the treatment of CTS. While most conservative treatments do not work well with CTS with severe manifestations (e.g., nighttime symptoms), surgery is necessary. Carpal tunnel release (CTR) has shown to improve sleep disturbance in patients with CTS.

Trung Hieu et al form Vietnam performed a study in order to investigate the impact of CTR on sleep quality and the symptoms and functions of the hand in patients with CTS and poor sleep quality.

Their study showed consistent improvements of sleep quality as well as the symptoms and functions of the hand at 1 to 12 months after CTR, according to the PSQI and Boston symptom and function scores. The study also demonstrated that sleep quality highly correlates with the hand symptom and function scores. As good sleep quality is important and can reduce the risk of stress, depression, hypertension, overweight and obesity, it is important for patients to undergo CTR when having indication.

The seriousness of sleep disorder is thought to associate with the grade of nerve entrapment. This was proved in their study by the strong positive correlation between the PSQI score and the Boston symptom and function scores: the more severe symptom is associated with the worse sleep quality.

Handling the symptoms is essential in order to solve the sleep problem of patients with CTS. In patients with long time of having CTS, especially those with poor sleep quality due to CTS, most conservative treatments do not work well and surgery is the only choice.

In the study, the early improvements were more marked for the symptoms and functions of the hand, whereas the sleep quality improved more slowly. However, the study and others have a relatively short follow-up period (less than 1 year), so long-term outcomes of patients are still lacking.

The authors conclude that surgical decompression significantly improves sleep quality and the symptom and function of the hand in patients with CTS and poor sleep quality. These improvements start right after the surgery and remain until 12 months. More studies with long-term follow-up are needed, as there is lack of long-term results of the surgery in the treatment of CTS.

Reference

Improvement of Sleep Quality after Surgical Decompression in Carpal Tunnel Syndrome, Nguyen Le Trung Hieu , Nguyen Anh Sang , Nguyen Lam Vuong  ,Indian Journal of Neurosurgery 2023; 12(01): 059-063 DOI: 10.1055/s-0041-1741406