Correlation Between Shoulder Pathologies And Sleep Disorders

Pathologies And Sleep Disorders


Objective: To assess and characterize the correlation between shoulder pathologies and sleep disturbances. Methods: Participants enrolled in this case-control study were divided into two groups: patients with an established clinical diagnosis of active shoulder pathology (study group), and patients without any shoulder pathology (control group). All patients completed the Insomnia Severity Index (ISI) questionnaire, in addition to questions related to participant demographics, health status, medication, and other known insomnia risk factors. Results: A total of 98 patients were included (46 in the study group and 52 controls). The mean ISI score was significantly higher (indicating more severe insomnia) in the study group versus the control group (t[96] 1⁄4 –9.67), even after correcting for confounders (t[53.1] 1⁄4 –8.61). Additionally, in patients with shoulder pathology, those with comorbidities experienced more sleep disturbances than those without comorbidities (b 1⁄4 0.36). Lastly, the shoulder pathology group was at a higher risk of having sleep disturbances compared with controls (relative risk 4.86, 95% confidence interval 2.24, 10.55). Conclusions: Sleep disturbances are more common among patients with shoulder pathologies. Comorbidities and a shorter duration of pathology may predict more severe sleep disturbances. 

Keywords: Insomnia, rotator cuff, shoulder, sleep, insomnia severity index, sleep disturbance


Insomnia (sleep disturbance) is very common, affecting approximately 30% of the general population. A long sleep latency, frequent night awakenings, or prolonged periods of arousal during the time ‘dedicated’ to sleep can be considered reflective of insomnia. As many as 40% of adults with insomnia are thought to be affected by an additional psychiatric disorder, mainly in the form of depression.Risk factors related to a higher incidence of insomnia include older age, female sex, and medical (particularly psychiatric) pathologies. Sleep disturbances are detrimental to cognitive and physical functions and are also associated with a variety of functional disabilities in several mental and emotional areas during waking hours. Patients with sleep disturbances and related pathologies are more prone to be involved in motor vehicle accidents, have higher absence rates from work and worse work performance, experience a decreased quality of life (QoL), and are more inclined to use the medical system.

Patients and methods 

Study population: This observational case-control study followed the tenets of the Declaration of Helsinki, and was approved by the Emek Medical Centre Ethics Committee. Written informed consent was obtained from all participants and copies of the written consent are available for review by the Editor-in-Chief of this journal. The reporting of this study conforms to STROBE guidelines.

Evaluation tools: The severity of insomnia was determined with the ISI questionnaire. The questionnaire includes seven items and its purpose is to assess the existence, severity, and effect of insomnia in adults, for example: ‘How much do you consider the sleep problem interferes with your functioning (fatigue, mood, concentration, memory, doing work)?’. Each item is answered with a severity score ranging from 0 to 4, and for each participant, the sum of the answers in the questionnaire is calculated. A high total score on the questionnaire indicates the likely presence of problematic sleep disturbance.

Statistical analyses: Data are presented as mean  SD or n (%) prevalence, and were analyzed using SPSS, version 24 (IBM Corp; Armonk, NY, USA). Between-group differences in categorical variables were assessed with v2 -test. Student’s independent samples t-test was applied to assess between-group differences in continuous variables, including mean ISI scores.

The present study has several limitations, one of which is the relatively small number of participants and a disproportion between the subgroups characterized by specific pathologies. In addition, the measurement of sleep disorders was conducted subjective ly through direct reporting of the participants, and not through quantitative, objective device measurements. 

The ISI scale is a subjective tool and as such does not guarantee precise reflection. Finally, in the current study, no matching was conducted between the groups based on demographic variables, and the participants were not sampled in a probabilistic manner. This issue may explain the significant differences in age and BMI between the groups.

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Tekeoglu, I., Ediz, L., Hiz, O., Toprak, M., Yazmalar, L., & Karaaslan, G. (2013). The relationship between shoulder impingement syndrome and sleep quality. Eur Rev Med Pharmacol Sci17(3), 370-4.

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