Temporal trends in insomnia and functional recovery after unilateral carpal tunnel release
Year: 2025
Type: article
Abstract: Background: Insomnia and sleep disturbances are common but often neglected symptoms in patients with carpal tunnel syndrome. In this study, generalized estimating equations were used to investigate temporal trends in insomnia severity and functional recovery following unilateral carpal tunnel release and to explore differences in outcomes with respect to carpal tunnel syndrome laterality. Materials and Methods: A prospective cohort of 39 patients with electrodiagnostically confirmed carpal tunnel syndrome underwent unilateral carpal tunnel release. Functional status and symptom severity were assessed with the Boston Carpal Tunnel Syndrome Questionnaire. Sleep quality and insomnia severity were measured with the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. Assessments were performed preoperatively and at 2, 6, and 12 weeks postoperatively. Time effects, group differences (unilateral vs. bilateral carpal tunnel syndrome), and interaction effects were analyzed with generalized estimating equations adjusted for age, sex, body mass index, disease severity, and surgical side. Results: Boston Carpal Tunnel Syndrome Questionnaire symptom, functional, and total scores ( P < 0.001); Insomnia Severity Index scores (median decline from 10 to 4; P < 0.001); and Pittsburgh Sleep Quality Index global scores ( P = 0.004) and domain scores for subjective sleep quality, sleep disturbances, and daytime dysfunction all improved significantly postoperatively. Generalized estimating equation analysis revealed significant time effects across all functional and sleep-related outcomes but no significant group-by-time interaction for Pittsburgh Sleep Quality Index or Insomnia Severity Index scores, suggesting similar temporal trajectories between unilateral and bilateral carpal tunnel syndrome groups. However, significantly greater improvement in Boston Carpal Tunnel Syndrome Questionnaire symptom severity was observed for patients with bilateral compared with unilateral carpal tunnel syndrome ( P = 0.047). Additionally, Boston Carpal Tunnel Syndrome Questionnaire total scores and carpal tunnel syndrome severity were independently associated with Insomnia Severity Index scores ( P < 0.05). Conclusions: Unilateral carpal tunnel release leads to rapid, substantial improvements in sleep disturbance and hand function, even among patients with bilateral carpal tunnel syndrome. These findings support the use of carpal tunnel release targeting the more symptomatic side and underscore the need to integrate structured sleep assessments into carpal tunnel syndrome management. They further indicate that generalized estimating equation modeling offers a powerful approach to capturing recovery trajectories beyond simple preoperative and postoperative comparisons.
Source: Formosan Journal of Surgery
Authors: Jui-Ming Sun, Yu-Hao Chen, Chih-Ta Huang, Hsin-Yi Yang, Ting-Lin Yen, Cheng-Ta Hsieh
Language: English
Topic: Peripheral Nerve Disorders
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4417144786