Changes in sleep disturbance in patients with cervical myelopathy: comparison between surgical treatment and conservative treatment

Abstract

Background context: The clinical symptoms of cervical myelopathy (CM) are closely associated with the risk factors of sleep disturbance, and its pathophysiological process is similar to that of spinal cord injury. Therefore, patients with CM are also expected to have sleep disturbance like patients with spinal cord injury, who typically have various types of sleep disorders. Fortunately, sleep disturbance in patients with CM is expected to respond well to treatment, and clinical studies are required to establish proper treatment strategies for CM patients with sleep disturbance.

Purpose: To compare the effects of CM treatment on sleep quality between patients treated surgically and those managed conservatively and to identify predictors associated with sleep improvement.

Study design/setting: Prospective cohort study.

Patient sample: Patients diagnosed as having CM.

Outcome measures: Pittsburgh Sleep Quality Index (PSQI).

Methods: The effect of CM treatment on sleep improvement at the 6-month follow-up was evaluated using a multivariate logistic regression analysis of propensity score-matched patients. To investigate factors associated with significant sleep improvement, a subgroup analysis was performed.

Results: A total of 131 patients with CM and sleep disturbance were enrolled. Among these patients, 31 received surgical treatment and 100 received conservative treatment. Sleep quality improved rapidly and consistently after surgery, and significant sleep improvement was observed in most of the patients in the surgical group (26/31 patients, 83.9%) at the 6-month follow-up. However, sleep improvement only occurred in 27 (27%) of the 100 patients in the conservative group at the 6-month follow-up. The subgroup analysis revealed that the degree of CM determined by mJOA scores >13 was a significant predictor of sleep improvement after conservative treatment.

Conclusions: Clinicians should closely monitor patients with CM with sleep disturbance, and proper treatment strategies should be considered according to the severity of the conditions.

Keywords: Cervical myelopathy; Conservative treatment; Sleep; Surgical treatment; mJOA.