Sleep Quality in Patients With Rotator Cuff Disease

J Am Acad Orthop Surg. 2018 Mar 15;26(6):215-222. doi: 10.5435/JAAOS-D-16-00547.


Background: Little is known about the influence of rotator cuff pathology on sleep. The purpose of this study was to determine which patient-reported factors correlate with sleep disturbance in patients with rotator cuff disease.

Methods: A nonrandomized, cross-sectional cohort study was performed to evaluate the effects of rotator cuff disease on sleep quality. Data collected at time zero (before any treatment) included the Single Assessment Numeric Evaluation rating, the American Shoulder and Elbow Surgeons score, the Pittsburgh Sleep Quality Index, patient demographics, and medical comorbidities. Statistical analysis included the Pearson correlation and multiple regression analysis to determine which patient-reported factors were associated with sleep disturbance.

Results: Nocturnal pain was reported by 91% of the 391 participants (274 with tendinitis and 117 with rotator cuff tears). Participants had a mean age of 57 years. Pearson correlation coefficients determined that poor sleep quality in one group or both the tendinitis and the rotator cuff tear groups was associated with higher pain visual analog scale scores (0.27 and 0.31; P = 0.004 and P < 0.0001, respectively), depression (0.27 and 0.30; P < 0.01), female sex (0.24 and 0.27; P < 0.001), presence of low back pain (0.25 and 0.27; P < 0.01), diabetes mellitus (0.24 in the rotator cuff tear group; P < 0.01), and increased body mass index (0.22 and 0.27; P = 0.02).

Discussion: The status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with worse sleep quality as measured by the Pittsburgh Sleep Quality Index. These results support the theory that worsening symptoms of shoulder pain may not be clearly associated with rotator cuff disease severity.

Conclusion: Worse sleep quality scores in patients with rotator cuff disease are associated with pain, depression, female sex, low back pain, diabetes mellitus, and high body mass index. Overall, sleep quality did not differ among patients with varying rotator cuff disease severity. Only hypertension (in patients with rotator cuff tears) and concurrent cervical pathology (in patients with tendinitis) were uniquely related to the disease classification. Further investigation is needed to better define how these factors interact and influence nocturnal shoulder pain and sleep quality in patients with rotator cuff disease.

Level of evidence: Level III prognostic cohort study.

Publication types

  • Evaluation Study

MeSH terms

  • Arthralgia / etiology*
  • Arthralgia / physiopathology
  • Arthralgia / psychology
  • Circadian Rhythm / physiology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Rotator Cuff Injuries / complications*
  • Rotator Cuff Injuries / physiopathology
  • Rotator Cuff Injuries / psychology
  • Severity of Illness Index
  • Shoulder / physiopathology
  • Sleep / physiology
  • Sleep Wake Disorders / etiology*
  • Sleep Wake Disorders / physiopathology
  • Sleep Wake Disorders / psychology