title: Sleep quality and disturbances in patients with different-sized rotator cuff tear.
abstract: BACKGROUND
  The literature is unanimous in saying that shoulder pain, due to rotator cuff tear (RCT), may be mostly at night; to our knowledge, this statement is not supported by scientific evidence. Our aim was to investigate sleep quality and disturbances in patient with RCT and in a control group.
  
  
  METHODS
  A case-control design study was used. We enrolled 324 consecutive patients (Group A) (156M-168F, mean age ± SD: 64.94 ± 6.97; range 47-74) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group (Group B) included 184 subjects (80M-104F, mean age ± SD = 63.34 ± 6.26; range 44-75) with no RCT. All participants were submitted to two standardized self-reported questionnaires evaluating sleep quality and disturbances: the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Data were submitted to statistics.
  
  
  RESULTS
  We found no significant differences between the two groups according to both PSQI (Group A: 5.22 ± 2.59; Group B: 5.21 ± 2.39) and ESS (Group A: 2.59 ± 2.54; Group B: 5.76 ± 2.63), p > 0.05. Patients with small tears had average PSQI and ESS higher than patients with large and massive lesions (p < 0.005). Pearson's test showed that tear severity was negatively correlated with both sleep latency (r2= -0.35, β = 0.069, p < 0.005) and sleep disturbances (r2= -0.65, β = 0.053, p < 0.001).
  
  
  CONCLUSIONS
  RCT is only one of the responsible causes for sleep disturbance in middle-aged and elderly subjects. Patients with small tears have a poorer sleep quality with respect to those with a more severe tear; particularly, they not only take more time to fall asleep, but also have a more disturbed sleep compared to patients with large and massive tears.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gumina
authors.affiliation: Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy. vittorio.candela@yahoo.it.
authors.forename: V
authors.initials: V
authors.lastname: Candela
authors.affiliation: Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Passaretti
authors.affiliation: Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, Rome, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Venditto
authors.affiliation: Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Mariani
authors.affiliation: Department of Orthopaedics and Traumatology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Giannicola
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D000070636:Rotator Cuff Injuries / Q000150:complications* / Q000601:surgery*; D012890:Sleep; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Epworth Sleepiness Scale; Nocturnal shoulder pain; Pittsburgh Sleep Quality Index; Rotator cuff tear; Rotator cuff tear symptoms; Shoulder pain; Sleep disturbances; Sleep quality