Patients with elbow disorders may experience nocturnal pain and poor sleep quality. Poorer sleep quality could be associated with greater pain and functional disability.
The study enrolled 664 adult patients presenting with common elbow disorders at five orthopedic surgery centers between December 2020 and May 2024. The patients completed validated patient-reported outcome measures before physician evaluation, including the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality; the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Single Assessment Numeric Evaluation-Elbow; and a numeric rating scale for pain. Patients with previous elbow surgery, diagnosed sleep disorders, documented mood disorders, recent fractures, substance abuse, or other musculoskeletal conditions likely to affect sleep were excluded. The investigators evaluated sleep quality and its association with pain intensity and functional impairment, compared sleep quality across diagnostic subgroups, and identifiied patient characteristics associated with impaired sleep.
Overall, 81% of the patients reported nocturnal pain, and the mean PSQI score was 7, exceeding the established threshold. Lateral epicondylar pain accounted for 66% of cases followed by medial epicondylar pain, arthritis, ulnar nerve entrapment, and biceps or triceps tendinopathies. Poor sleep quality was observed across all major diagnostic groups, and the investigators reported no statistically significant differences in PSQI scores among the pathologies studied.
The investigators reported that poorer sleep quality was associated with greater upper extremity disability and higher pain intensity. Those with worse DASH and higher pain scores tended to report poorer sleep quality. By contrast, there were no statistically significant associations between sleep quality and age, sex, body mass index, or symptom duration, suggesting sleep disturbance in these patients may be more closely related to pain and functional impairment than to a specific diagnosis.
Subgroup analyses showed that poor sleep was common across elbow disorders. Up to 70% of patients in the major diagnostic categories had PSQI scores above the threshold for poor sleep quality. Although patients with arthritis had numerically lower PSQI scores compared with other diagnostic groups, the difference was not statistically significant.
The investigators acknowledged several limitations. Sleep quality was assessed using a self-reported questionnaire rather than objective measures such as actigraphy, introducing the potential for reporting bias. The investigators could not establish causality. Additionally, patients with known mood disorders or diagnosed sleep disorders were excluded, which may limit the generalizability of the findings, and isolated cases of elbow instability may have been inadvertently included despite predefined exclusion criteria.
The investigators noted that future studies should evaluate whether treatments such as physiotherapy, injections, or surgery improve sleep quality alongside pain and function.
"By assessing and addressing sleep quality in the management of elbow disorders, clinicians might improve functional outcomes and general well-being," wrote lead study author Marco M. Schneider, of the University of Witten/Herdecke in Germany, and colleagues.
The study authors reported no conflicts of interest.