title: Sleep Disturbance and Upper-Extremity Disability.
abstract: BACKGROUND
  Although upper-extremity disability correlates with psychosocial aspects of illness the association with sleep disturbance in upper extremity disability is less certain. To evaluate whether sleep disturbance is associated with upper-extremity disability among patients with upper extremity illness, accounting for sociodemographic, condition-related, and psychosocial factors.
  
  
  METHODS
  A cohort of 111 new or follow-up patients presenting to an urban academic hospital-based hand surgeon completed a sociodemographic survey and measures of sleep disturbance (PROMIS Sleep Disturbance), disability (PROMIS Upper-Extremity Physical Function), ineffective coping strategies (PROMIS Pain Interference), and depression (PROMIS Depression). Bivariate and multivariable linear regression modeling were performed.
  
  
  RESULTS
  Sleep disturbance correlated with disability (r=-0.38; P<0.001) in bivariate analysis. Symptoms of depression (r=-0.44; P<0.001) and ineffective coping strategies (r=-0.71; P<0.001) also correlated with upper-extremity specific disability in bivariate analysis. Pain Interference was the only factor associated with disability in multivariable analysis.
  
  
  CONCLUSIONS
  Sleep disturbance is not as strongly or directly associated with symptom intensity and magnitude of disability as ineffective coping strategies. Interventions to reduce pain interference (e.g. cognitive behavioral therapy) hold great potential to decrease musculoskeletal symptom intensity and magnitude of disability, and perhaps even sleep disturbance.
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Yawkey Center, Massachusetts General Hospital, Boston, USA.
authors.forename: Rinne Marijn
authors.initials: RM
authors.lastname: Peters
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Yawkey Center, Massachusetts General Hospital, Boston, USA.
authors.forename: Mariano Esteban
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Yawkey Center, Massachusetts General Hospital, Boston, USA.
authors.forename: Jos Jasper
authors.initials: JJ
authors.lastname: Mellema
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Yawkey Center, Massachusetts General Hospital, Boston, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Yawkey Center, Massachusetts General Hospital, Boston, USA.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
keywords: Disability; Pain interference; Sleep disturbance; Upper extremity