title: Sleep disturbance after fracture is related to emotional well-being rather than functional result.
abstract: OBJECTIVE
  The aim of this study was to investigate the rate, longitudinal improvement, and risk factors of sleep disturbance after 4 common orthopaedic traumatic conditions.
  
  
  METHODS
  The functional status of 1095 patients was prospectively assessed using validated questionnaires for patients with acute proximal humerus (n = 111), distal radius (n = 440), tibial plateau (n = 109), and ankle fractures (n = 435). Patient reported sleep difficulty was compared with the overall functional and emotional status of each patient at 3, 6, and 12 months after treatment.
  
  
  RESULTS
  Sleep difficulty at 3-month follow-up was reported in 41% of patients with proximal humerus fracture, 25% of patients with distal radius fracture, 36% of patients with tibial plateau, and 19% of patients with ankle fracture. By 12-month follow-up, less than 20% of patients with all fracture types reported sleep difficulty. At 12-month follow-up, the SF-36 Mental Health category for patients with distal radius fractures (P = 0.001) and the Short Musculoskeletal Function Assessment Emotional category for patients with tibial plateau fractures (P = 0.024) and ankle fractures (P ≤ 0.001) were independent predictors of poor sleep, whereas the respective functional status categories were not.
  
  
  CONCLUSIONS
  At 12-month follow-up, poor sleep was independently associated with poor emotional status but not associated with poor functional status. The mental health status of patients with sleep difficulty in the latter stages of fracture healing should be carefully assessed to provide the highest level of care. The results of this study should allow orthopaedic trauma surgeons to counsel patients regarding expectations of difficulty sleeping after acute fractures.
  
  
  METHODS
  Prognostic level II. See Instructions for authors for a complete description of levels of evidence.
authors: *NYU Department of Orthopaedic Surgery, Jamaica Hospital for Joint Diseases, New York, NY; and †Department of Orthoapedic Surgery Jamaica Hospital Medical Center, Jamaica, NY.
authors: Brandon S
authors: BS
authors: Shulman
authors: Frank A
authors: FA
authors: Liporace
authors: Roy I
authors: RI
authors: Davidovitch
authors: Raj
authors: R
authors: Karia
authors: Kenneth A
authors: KA
authors: Egol
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000523:psychology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000523:psychology; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000209:etiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome