Prevalence of Sleep Disturbance and Its Risk Factors in Patients Who Undergo Surgical Treatment for Degenerative Spinal Disease: A Nationwide Study of 106,837 Patients
Abstract
:1. Introduction
2. Patients and Methods
2.1. Database
2.2. Study Patients
2.3. Definitions of Sleep Disturbance
2.4. Factors Associated with Sleep Disturbance
2.5. Statistical Analysis
3. Results
3.1. Annual Prevalence of Sleep Disturbance According to the Three Definitions
3.2. Prevalence of Sleep Disturbance According to the Baseline Characteristics and Comorbidities
3.3. Prevalence of Sleep Disturbance According to Spinal Regions
3.4. Prevalence of Sleep Disturbance According to Concurrent Neuropsychiatric Disorders and Osteoarthritis of Extremities
3.5. Risk Factors for Sleep Disorder: Main Analysis
3.6. Validation of Risk Factors: Sensitivity Analysis
3.7. Validation of Estimates: Bootstrap Sampling
4. Discussions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Year | Spinal Surgery (n) | Patients Diagnosed with Sleep Disorder within One Year from the Index Surgery | Prevalence According to Sleep Medication during the Preexisting 90 Days | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Over 4-Week Sleep Medication | Over 8-Week Sleep Medication | |||||||||
(n) | Incidence (%) | 95% CI | (n) | Incidence (%) | 95% CI | (n) | Incidence (%) | 95% CI | ||
2016 | 35,507 | 1866 | 5.3% | [5.0–5.5] | 1839 | 5.2% | [4.9–5.4] | 1229 | 3.5% | [3.3–3.7] |
2017 | 35,459 | 1912 | 5.4% | [5.2–5.6] | 1932 | 5.4% | [5.2–5.7] | 1319 | 3.7% | [3.5–3.9] |
2018 | 35,871 | 2069 | 5.8% | [5.5–6.0] | 2093 | 5.8% | [5.6–6.1] | 1461 | 4.1% | [3.9–4.3] |
All | 106,837 | 5847 | 5.5% | [5.3–5.6] | 5864 | 5.5% | [5.4–5.6] | 4009 | 3.8% | [3.6–3.9] |
Variables | Categories | All | Patients Diagnosed with Sleep Disorder within One Year from the Index Surgery | Prevalence according to Sleep Medication during the Preexisting 90 days | ||||
---|---|---|---|---|---|---|---|---|
Over 4-Week Sleep Medication | Over 8-Week Sleep Medication | |||||||
Number of Patients | 106,837 | 5847 | 5.5% | 5864 | 5.5% | 4009 | 3.8% | |
Age | Mean ± SD | 62.9 ± 11.8 | 66.7 ± 10.5 | 66.9 ± 10.3 | 66.6 ± 10.4 | |||
20–49 | 14,014 | 378 | 2.7% | 358 | 2.6% | 266 | 1.9% | |
50–69 | 58,533 | 2857 | 4.9% | 2881 | 4.9% | 2007 | 3.4% | |
70–79 | 28,671 | 2115 | 7.4% | 2116 | 7.4% | 1393 | 4.9% | |
80+ | 5619 | 497 | 8.8% | 509 | 9.1% | 343 | 6.1% | |
Sex | Male | 51,242 | 2298 | 4.5% | 2203 | 4.3% | 1503 | 2.9% |
Female | 55,595 | 3549 | 6.4% | 3661 | 6.6% | 2506 | 4.5% | |
Region | Urban | 88,826 | 4953 | 5.6% | 4903 | 5.5% | 3323 | 3.7% |
Rural | 18,011 | 894 | 5.0% | 961 | 5.3% | 686 | 3.8% | |
Hospital | Tertiary | 18,442 | 1154 | 6.3% | 1169 | 6.3% | 814 | 4.4% |
General | 20,772 | 1257 | 6.1% | 1537 | 7.4% | 1072 | 5.2% | |
Others | 67,623 | 3436 | 5.1% | 3158 | 4.7% | 2123 | 3.1% |
Variables | Categories | All | Patients Diagnosed with Sleep Disorder within One Year from the Index Surgery | Prevalence According to Sleep Medication during the Preexisting 90 Days | ||||
---|---|---|---|---|---|---|---|---|
Over 4-Week Sleep Medication | Over 8-Week Sleep Medication | |||||||
Number of patients | 106,837 | 5847 | 5.5% | 5864 | 5.5% | 4009 | 3.8% | |
Charlson comorbidity index score | Mean ± SD | 1.14 ± 1.28 | 1.56 ± 1.44 | 1.67 ± 1.52 | 1.66 ± 1.54 | |||
0–2 | 75,632 | 4551 | 6.0% | 4423 | 5.8% | 3028 | 4.0% | |
3–5 | 27,691 | 1195 | 4.3% | 1310 | 4.7% | 887 | 3.2% | |
≥6 | 3514 | 101 | 2.9% | 131 | 3.7% | 94 | 2.7% | |
Comorbidities | Myocardial infarction | 967 | 72 | 7.4% | 73 | 7.5% | 51 | 5.3% |
Congestive heart failure | 3394 | 286 | 8.4% | 314 | 9.3% | 217 | 6.4% | |
Peripheral vascular disease | 12,062 | 969 | 8.0% | 934 | 7.7% | 644 | 5.3% | |
Chronic pulmonary disease | 24,116 | 1867 | 7.7% | 1825 | 7.6% | 1227 | 5.1% | |
Rheumatologic disease | 4010 | 292 | 7.3% | 298 | 7.4% | 198 | 4.9% | |
Peptic ulcer disease | 17,189 | 1341 | 7.8% | 1331 | 7.7% | 905 | 5.3% | |
Liver disease | ||||||||
Mild | 6686 | 485 | 7.3% | 496 | 7.4% | 341 | 5.1% | |
Moderate to severe | 83 | 7 | 8.4% | 9 | 10.8% | 5 | 6.0% | |
Diabetes | ||||||||
Uncomplicated | 23,105 | 1492 | 6.5% | 1660 | 7.2% | 1137 | 4.9% | |
Complicated | 6733 | 434 | 6.4% | 559 | 8.3% | 362 | 5.4% | |
Hemiplegia or paraplegia | 849 | 50 | 5.9% | 70 | 8.2% | 42 | 4.9% | |
Renal disease | 2053 | 179 | 8.7% | 211 | 10.3% | 157 | 7.6% | |
End stage renal disease | 379 | 39 | 10.3% | 57 | 15.0% | 39 | 10.3% | |
Osteoporosis | 15,495 | 1185 | 7.6% | 1189 | 7.7% | 813 | 5.2% | |
Concurrent neuropsychiatric disorders | Depressive disorder | 23,921 | 2818 | 11.8% | 3740 | 15.6% | 2806 | 11.7% |
Cerebrovascular disease | 9502 | 808 | 8.5% | 971 | 10.2% | 695 | 7.3% | |
Dementia | 1388 | 167 | 12.0% | 160 | 11.5% | 109 | 7.9% | |
Parkinson disease | 875 | 100 | 11.4% | 175 | 20.0% | 152 | 17.4% | |
Migraine | 3222 | 384 | 11.9% | 356 | 11.0% | 242 | 7.5% | |
Tension type headache | 3011 | 343 | 11.4% | 329 | 10.9% | 219 | 7.3% | |
Other-type headache | 4304 | 469 | 10.9% | 449 | 10.4% | 303 | 7.0% | |
Concurrent osteoarthritis of extremities | Shoulder | 8503 | 674 | 7.9% | 648 | 7.6% | 450 | 5.3% |
Elbow | 2276 | 141 | 6.2% | 121 | 5.3% | 86 | 3.8% | |
Wrist | 2268 | 183 | 8.1% | 192 | 8.5% | 135 | 6.0% | |
Hip | 7104 | 542 | 7.6% | 531 | 7.5% | 357 | 5.0% | |
Knee | 24,338 | 1828 | 7.5% | 1898 | 7.8% | 1274 | 5.2% | |
Ankle | 4024 | 368 | 9.1% | 353 | 8.8% | 239 | 5.9% |
Spinal Regions | According to Concurrent Neuropsychiatric Disorders | Cases (n) with Its Proportion (%) | Patients Diagnosed with Sleep Disorder within one Year from the Index Surgery | Prevalence According to Sleep Medication during the Preexisting 90 Days | |||||
---|---|---|---|---|---|---|---|---|---|
Over 4-Week Sleep Medication | Over 8-Week Sleep Medication | ||||||||
Cervical | All cases | 18,819 | (100) | 837 | 4.4% | 812 | 4.3% | 563 | 3.0% |
Depressive disorder | 3660 | 19.4% | 372 | 10.2% | 526 | 14.4% | 403 | 11.0% | |
Cerebrovascular disease | 1380 | 7.3% | 107 | 7.8% | 136 | 9.9% | 97 | 7.0% | |
Dementia | 103 | 0.5% | 10 | 9.7% | 14 | 13.6% | 11 | 10.7% | |
Parkinson disease | 88 | 0.5% | 8 | 9.1% | 20 | 22.7% | 17 | 19.3% | |
Migraine | 566 | 3.0% | 60 | 10.6% | 54 | 9.5% | 37 | 6.5% | |
Tension type headache | 513 | 2.7% | 49 | 9.6% | 45 | 8.8% | 29 | 5.7% | |
Other-type headache | 742 | 3.9% | 71 | 9.6% | 59 | 8.0% | 37 | 5.0% | |
Thoracic | All cases | 1027 | (100) | 71 | 6.9% | 63 | 6.1% | 42 | 4.1% |
Depressive disorder | 271 | 26.4% | 30 | 11.1% | 36 | 13.3% | 24 | 8.9% | |
Cerebrovascular disease | 127 | 12.4% | 16 | 12.6% | 12 | 9.4% | 7 | 5.5% | |
Dementia | 18 | 1.8% | 1 | 5.6% | 0 | 0.0% | 0 | 0.0% | |
Parkinson disease | 6 | 0.6% | 1 | 16.7% | 2 | 33.3% | 2 | 33.3% | |
Migraine | 24 | 2.3% | 2 | 8.3% | 3 | 12.5% | 2 | 8.3% | |
Tension type headache | 31 | 3.0% | 3 | 9.7% | 2 | 6.5% | 1 | 3.2% | |
Other-type headache | 45 | 4.4% | 3 | 6.7% | 3 | 6.7% | 1 | 2.2% | |
Lumbar | All cases | 86,991 | (100) | 4939 | 5.7% | 4989 | 5.7% | 3404 | 3.9% |
Depressive disorder | 19,990 | 23.0% | 2416 | 12.1% | 3178 | 15.9% | 2379 | 11.9% | |
Cerebrovascular disease | 7995 | 9.2% | 685 | 8.6% | 823 | 10.3% | 591 | 7.4% | |
Dementia | 1267 | 1.5% | 156 | 12.3% | 146 | 11.5% | 98 | 7.7% | |
Parkinson disease | 781 | 0.9% | 91 | 11.7% | 153 | 19.6% | 133 | 17.0% | |
Migraine | 2632 | 3.0% | 322 | 12.2% | 299 | 11.4% | 203 | 7.7% | |
Tension type headache | 2467 | 2.8% | 291 | 11.8% | 282 | 11.4% | 189 | 7.7% | |
Other-type headache | 3517 | 4.0% | 395 | 11.2% | 387 | 11.0% | 265 | 7.5% |
Spinal Regions | Categories | Extremities | Cases (n) with ItsProportion | Patients Diagnosed with Sleep Disorder within One Year from the Index Surgery | Prevalence According to Sleep Medication during the Preexisting 90 Days | |||||
---|---|---|---|---|---|---|---|---|---|---|
Over 4-Week Sleep Medication | Over 8-Week Sleep Medication | |||||||||
Cervical | All cases | 18,819 | (100) | 837 | 4.4% | 812 | 4.3% | 563 | 3.0% | |
Upper extremities | Shoulder | 2214 | 11.8% | 156 | 7.0% | 142 | 6.4% | 101 | 4.6% | |
Elbow | 568 | 3.0% | 25 | 4.4% | 24 | 4.2% | 18 | 3.2% | ||
Wrist | 532 | 2.8% | 39 | 7.3% | 42 | 7.9% | 27 | 5.1% | ||
Lower extremities | Hip | 446 | 2.4% | 38 | 8.5% | 45 | 10.1% | 29 | 6.5% | |
Knee | 2283 | 12.1% | 155 | 6.8% | 173 | 7.6% | 123 | 5.4% | ||
Ankle | 459 | 2.4% | 46 | 10.0% | 38 | 8.3% | 31 | 6.8% | ||
Thoracic | All cases | 1027 | (100) | 71 | 6.9% | 63 | 6.1% | 42 | 4.1% | |
Upper extremities | Shoulder | 94 | 9.2% | 8 | 8.5% | 4 | 4.3% | 2 | 2.1% | |
Elbow | 27 | 2.6% | 3 | 11.1% | 3 | 11.1% | 2 | 7.4% | ||
Wrist | 25 | 2.4% | 2 | 8.0% | 3 | 12.0% | 2 | 8.0% | ||
Lower extremities | Hip | 94 | 9.2% | 8 | 8.5% | 10 | 10.6% | 5 | 5.3% | |
Knee | 334 | 32.5% | 31 | 9.3% | 34 | 10.2% | 23 | 6.9% | ||
Ankle | 68 | 6.6% | 6 | 8.8% | 9 | 13.2% | 8 | 11.8% | ||
Lumbar | All cases | 86,991 | (100) | 4939 | 5.7% | 4989 | 5.7% | 3404 | 3.9% | |
Upper extremities | Shoulder | 6195 | 7.1% | 510 | 8.2% | 502 | 8.1% | 347 | 5.6% | |
Elbow | 1681 | 1.9% | 113 | 6.7% | 94 | 5.6% | 66 | 3.9% | ||
Wrist | 1711 | 2.0% | 142 | 8.3% | 147 | 8.6% | 105 | 6.1% | ||
Lower extremities | Hip | 6564 | 7.5% | 496 | 7.6% | 476 | 7.3% | 323 | 4.9% | |
Knee | 21,721 | 25.0% | 1642 | 7.6% | 1691 | 7.8% | 1128 | 5.2% | ||
Ankle | 3497 | 4.0% | 316 | 9.0% | 306 | 8.8% | 200 | 5.7% |
Variables | Categories | Model 1 (Univariable) | Model 2 (Fully Adjusted) | Model 3 (Bootstrap Validation after Fully Adjusted) | |||
---|---|---|---|---|---|---|---|
Odds Ratio (95% Confidence Interval) | p-Value | Adjusted Odds Ratio (95% Confidence Interval) | p-Value | Adjusted Odds Ratio (95% Confidence Interval) | Relative Bias (%) | ||
Age | 50–69 vs. 20–49 years | 1.85 [1.66–2.06] | <0.001 | 1.40 [1.25–1.57] | <0.001 | 1.41 [1.29–1.56] | 2.21 |
70–79 vs. 20–49 years | 2.87 [2.57–3.21] | <0.001 | 1.80 [1.60–2.03] | <0.001 | 1.81 [1.64–2.04] | 0.89 | |
80+ vs. 20–49 years | 3.50 [3.05–4.02] | <0.001 | 2.22 [1.92–2.58] | <0.001 | 2.23 [1.96–2.55] | 0.80 | |
Sex | Female vs. male | 1.45 [1.38–1.53] | <0.001 | 1.14 [1.07–1.21] | <0.001 | 1.13 [1.08–1.20] | −4.45 |
Region | Urban vs. rural | 1.13 [1.05–1.22] | 0.001 | 1.18 [1.09–1.27] | <0.001 | 1.17 [1.11–1.24] | −2.97 |
Hospital | Tertiary vs. others | 1.25 [1.16–1.34] | <0.001 | 1.08 [1.00–1.16] | 0.047 | 1.08 [1.00–1.15] | −3.33 |
Comorbidities | Peripheral vascular disease | 1.61 [1.50–1.73] | <0.001 | 1.22 [1.13–1.32] | <0.001 | 1.22 [1.13–1.31] | 0.68 |
Chronic pulmonary disease | 1.66 [1.57–1.76] | <0.001 | 1.31 [1.23–1.40] | <0.001 | 1.30 [1.23–1.38] | −1.42 | |
Peptic ulcer disease | 1.60 [1.50–1.70] | <0.001 | 1.26 [1.17–1.35] | <0.001 | 1.26 [1.19–1.34] | −0.91 | |
Mild liver disease | 1.38 [1.26–1.52] | <0.001 | 1.27 [1.14–1.41] | <0.001 | 1.26 [1.17–1.37] | −1.68 | |
Comorbidities associated neuropsychiatric disorders | Depressive disorder | 3.52 [3.34–3.72] | <0.001 | 2.86 [2.70–3.02] | <0.001 | 2.86 [2.72–3.00] | 0.03 |
Cerebrovascular disease | 1.70 [1.58–1.84] | <0.001 | 1.12 [1.10–1.20] | 0.040 | 1.10 [1.02–1.19] | −16.00 | |
Dementia | 2.41 [2.04–2.83] | <0.001 | 1.49 [1.26–1.78] | <0.001 | 1.50 [1.32–1.71] | 0.96 | |
Parkinson disease | 2.25 [1.83–2.78] | <0.001 | 1.51 [1.22–1.88] | <0.001 | 1.50 [1.21–1.83] | −1.63 | |
Migraine | 2.43 [2.18–2.71] | <0.001 | 1.61 [1.44–1.82] | <0.001 | 1.62 [1.45–1.79] | 1.76 | |
Other-type headache | 2.21 [2.00–2.44] | <0.001 | 1.25 [1.03–1.52] | 0.023 | 1.24 [1.06–1.44] | −2.75 | |
Concurrent osteoarthritis | Shoulder | 1.55 [1.43–1.69] | <0.001 | 1.15 [1.06–1.26] | 0.002 | 1.15 [1.08–1.24] | 1.17 |
Knee | 1.59 [1.50–1.68] | <0.001 | 1.11 [1.04–1.18] | 0.002 | 1.11 [1.05–1.17] | −1.40 | |
Ankle | 1.79 [1.60–2.00] | <0.001 | 1.32 [1.17–1.48] | <0.001 | 1.32 [1.18–1.46] | 0.67 |
Variables | Categories | Univariable | Model 2 (Fully Adjusted) | Model 3 (Bootstrap Validation after Fully Adjusted) | |||
---|---|---|---|---|---|---|---|
Odds Ratio (95% Confidence Interval) | p-Value | Adjusted Odds Ratio (95% Confidence Interval) | p-Value | Adjusted Odds Ratio (95% Confidence Interval) | Relative Bias (%) | ||
Age | 50–69 vs. 20–49 years | 1.97 [1.77–2.21] | <0.001 | 1.32 [1.17–1.49] | <0.001 | 1.31 [1.19–1.44] | −2.60 |
70–79 vs. 20–49 years | 3.04 [2.71–3.41] | <0.001 | 1.54 [1.36–1.75] | <0.001 | 1.53 [1.37–1.71] | −0.78 | |
80+ vs. 20–49 years | 3.80 [3.31–4.37] | <0.001 | 1.95 [1.68–2.27] | <0.001 | 1.94 [1.71–2.22] | −0.69 | |
Sex | Female vs. male | 1.57 [1.49–1.66] | <0.001 | 1.20 [1.13–1.27] | <0.001 | 1.19 [1.14–1.26] | −3.96 |
Hospital | Tertiary vs. others | 1.38 [1.29–1.48] | <0.001 | 1.17 [1.08–1.15] | <0.001 | 1.16 [1.09–1.24] | −4.46 |
General vs. others | 1.63 [1.53–1.74] | <0.001 | 1.38 [1.29–1.47] | <0.001 | 1.38 [1.30–1.46] | −0.34 | |
Comorbidities | Congestive heart failure | 1.80 [1.60–2.03] | <0.001 | 1.16 [1.02–1.33] | 0.023 | 1.17 [1.06–1.32] | 6.99 |
Peripheral vascular disease | 1.53 [1.42–1.65] | <0.001 | 1.09 [1.00–1.18] | 0.040 | 1.09 [1.01–1.18] | −0.67 | |
Chronic pulmonary disease | 1.60 [1.51–1.69] | <0.001 | 1.21 [1.13–1.29] | <0.001 | 1.20 [1.13–1.27] | −4.26 | |
Peptic ulcer disease | 1.58 [1.48–1.68] | <0.001 | 1.20 [1.11–1.29] | <0.001 | 1.20 [1.13–1.29] | −0.34 | |
Mild liver disease | 1.42 [1.29–1.56] | <0.001 | 1.27 [1.14–1.40] | <0.001 | 1.27 [1.17–1.39] | −0.13 | |
Uncomplicated diabetes | 1.46 [1.38–1.55] | <0.001 | 1.12 [1.04–1.20] | 0.002 | 1.11 [1.05–1.19] | −4.17 | |
Renal disease | 2.01 [1.74–2.32] | <0.001 | 1.23 [1.01–1.49] | 0.042 | 1.22 [1.01–1.48] | −5.03 | |
End stage renal disease | 3.07 [2.31–4.07] | <0.001 | 1.97 [1.39–2.79] | <0.001 | 1.96 [1.45–2.71] | −0.76 | |
Comorbidities associated neuropsychiatric disorders | Depressive disorder | 7.05 [6.67–7.45] | <0.001 | 5.84 [5.51–6.18] | <0.001 | 5.84 [5.57–6.16] | 0.01 |
Cerebrovascular disease | 2.15 [2.00–2.31] | <0.001 | 1.28 [1.18–1.39] | <0.001 | 1.28 [1.19–1.38] | 0.54 | |
Dementia | 2.28 [1.93–2.69] | <0.001 | 1.33 [1.11–1.59] | 0.002 | 1.32 [1.13–1.55] | −1.68 | |
Parkinson disease | 4.41 [3.73–5.21] | <0.001 | 2.80 [2.34–3.36] | <0.001 | 2.83 [2.46–3.32] | 1.00 | |
Migraine | 2.21 [1.98–2.48] | <0.001 | 1.30 [1.15–1.47] | <0.001 | 1.31 [1.18–1.44] | 1.88 | |
Concurrent osteoarthritis | Shoulder | 1.47 [1.35–1.60] | <0.001 | 1.08 [1.02–1.17] | 0.013 | 1.08 [1.01–1.17] | 3.82 |
Knee | 1.68 [1.58–1.77] | <0.001 | 1.14 [1.06–1.21] | <0.001 | 1.13 [1.07–1.19] | −5.13 | |
Ankle | 1.70 [1.52–1.90] | <0.001 | 1.19 [1.06–1.35] | 0.004 | 1.20 [1.09–1.32] | 5.14 |
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Kim, J.; Kang, M.S.; Kim, T.-H. Prevalence of Sleep Disturbance and Its Risk Factors in Patients Who Undergo Surgical Treatment for Degenerative Spinal Disease: A Nationwide Study of 106,837 Patients. J. Clin. Med. 2022, 11, 5932. https://doi.org/10.3390/jcm11195932
Kim J, Kang MS, Kim T-H. Prevalence of Sleep Disturbance and Its Risk Factors in Patients Who Undergo Surgical Treatment for Degenerative Spinal Disease: A Nationwide Study of 106,837 Patients. Journal of Clinical Medicine. 2022; 11(19):5932. https://doi.org/10.3390/jcm11195932
Chicago/Turabian StyleKim, Jihye, Min Seong Kang, and Tae-Hwan Kim. 2022. "Prevalence of Sleep Disturbance and Its Risk Factors in Patients Who Undergo Surgical Treatment for Degenerative Spinal Disease: A Nationwide Study of 106,837 Patients" Journal of Clinical Medicine 11, no. 19: 5932. https://doi.org/10.3390/jcm11195932
APA StyleKim, J., Kang, M. S., & Kim, T.-H. (2022). Prevalence of Sleep Disturbance and Its Risk Factors in Patients Who Undergo Surgical Treatment for Degenerative Spinal Disease: A Nationwide Study of 106,837 Patients. Journal of Clinical Medicine, 11(19), 5932. https://doi.org/10.3390/jcm11195932