The effect of carpal tunnel syndrome pain on sleep architecture
Date
2013-01-24
Authors
Mdluli, Dalingcebo Christopher
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Abstract
Carpal tunnel syndrome (CTS) is a neuropathic condition commonly caused by the
entrapment of the median nerve. The most common complaint presented by the CTS
patients is pricking sensation, numbness, pins and needles, burning sensation as well
as in the hand and sometimes the arm/s distribution of the affected side. The patients
with CTS usually complain of nocturnal periodic sleep disruption caused by the pain
discomfort. In my dissertation, I explore the extent to which the CTS pain influences
sleep architecture using neurophysiological measurements like an overnight
electroencephalogram (EEG), conduction tests as well as subjective questionnaires. I
initially conducted a pilot research study on 33 patients with CTS using subjective
questionnaires. The CTS patients reported sleep disturbance. I also demonstrated that
they (patients) had a minimal mood and psychological disturbance. I was prompted
therefore to investigate the influence of the CTS pain on the sleep architecture using
more objective empirical instruments like the polysomnogram as well as subjective
measurements such as Beck Depression Inventory, Profile of mood states, Visual
analogue scales as well as the McGill pain questionnaire to further investigate
changes. The patients were required to spend four nights in the sleep laboratory
divided into two nights before surgery and two nights at least two to six weeks
following the CTS surgery. The CTS surgery is commonly used to release the
compression of the median nerve at the wrist. The changes in subjective and objective
variables were compared before and after CTS surgery. The age and gender-matched
control group was introduced into the research study. The control group was required
to spend the same number of nights in the sleep laboratory as the CTS group. The
control group was also going to have a non-painful procedure of the same magnitude
as the experimental subjects. The conclusion I reached on this study was that the CTS
patients reported poor sleep quality. I also demonstrated that there were not many
changes in the polysomnogram and that there were minimum changes shown on the
nerve conduction studies variables as might have been expected based on the severity
of the carpal tunnel syndrome. Another important finding was that there was a
relationship between pain and depressive mood in CTS patients. The removal of pain
in CTS patients showed that there was a subsequent subjective improvement in mood
and psychological status and no significant improvement in subjective measurements.
There were no significant changes noted on the control subjects who were pain-free.