Temporal Trends in Insomnia and Functional Recovery After Unilateral Carpal Tunnel Release

Abstract

Background: Insomnia and sleep disturbances are common but often neglected symptoms in patients with carpal tunnel syndrome (CTS). In this study, generalized estimating equations (GEEs) were used to investigate temporal trends in insomnia severity and functional recovery following unilateral carpal tunnel release (CTR) and to explore differences in outcomes with respect to CTS laterality. Material and Methods: A prospective cohort of 39 patients with electrodiagnostically confirmed CTS underwent unilateral CTR. Functional status and symptom severity were assessed with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). Sleep quality and insomnia severity were measured with the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Assessments were performed preoperatively and at 2, 6, and 12 weeks postoperatively. Time effects, group differences (unilateral vs bilateral CTS), and interaction effects were analyzed with GEEs adjusted for age, sex, BMI, disease severity, and surgical side. Results: BCTSQ symptom, functional, and total scores ( P < .001); ISI scores (median decline from 10 to 4; P < .001); and PSQI global scores ( P = .004) and domain scores for subjective sleep quality, sleep disturbances, and daytime dysfunction all improved significantly postoperatively. GEE analysis revealed significant time effects across all functional and sleep-related outcomes but no significant group-by-time interaction for PSQI or ISI scores, suggesting similar temporal trajectories between unilateral and bilateral CTS groups. However, significantly greater improvement in BCTSQ symptom severity was observed for patients with bilateral compared with unilateral CTS ( P = .047). Additionally, BCTSQ total scores and CTS severity were independently associated with ISI scores ( P < .05). Conclusions: Unilateral CTR leads to rapid, substantial improvements in sleep disturbance and hand function, even among patients with bilateral CTS. These findings support the use of CTR targeting the more symptomatic side and underscore a need to integrate structured sleep assessments into CTS management. They further indicate that GEE modeling offers a powerful approach to capturing recovery trajectories beyond simple preoperative and postoperative comparisons.

Affiliated Institutions

• Cathay General Hospital TW
• Taipei Medical University TW
• Fooyin University TW
• Chia-Yi Christian Hospital TW

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