Does Sleep Comfort Predict Recovery After Primary and Revision Reverse Shoulder Arthroplasty?

Background Sleep disturbances are common among patients with shoulder pathology and are often associated with poor postoperative outcomes, diminished quality of life, and increased healthcare use. Shoulder arthroplasty (SA) is a well-established treatment for functional limitations and pain due to glenohumeral osteoarthritis, with relief from nighttime pain and improved sleep quality frequently influencing patients’ decisions to undergo surgery. While prior studies have documented the link between sleep disturbances and functional outcomes in shoulder surgery, the role of sleep in overall recovery remains unclear. This study evaluates the relationship between sleep comfort and recovery in patients undergoing primary and revision reverse shoulder arthroplasty (RSA). Methods A retrospective review of patients who underwent RSA by a single fellowship-trained orthopaedic surgeon from 2015-2020 was conducted. Patients were separated into two groups: 1) pRSA and 2) rRSA. Demographic variables, composite ASES scores, and individual responses to the sleep component of the ASES score were collected at 3, 6, 12, and 24 months postoperatively. Patients rated their ability to comfortably sleep on a 0-3 scale (0=“unable”, 1=“very difficult”, 2=“slightly difficult”, 3=“normal”). If a score of 0-2 was obtained, patients were considered to have “difficulty” sleeping. Utilizing the ASES score, patients were deemed “recovered” if they obtained a postoperative score of 70 or greater based on previously defined methods.22,23 Patients were further grouped into “not recovered” and “recovered” groups and statistically compared to their sleep scores using a chi-square analysis. Results A total of 476 RSA patients (pRSA=386, rRSA=90) were included in the final analysis. Patients who underwent pRSA had a mean age of 73 years, BMI of 29.2 kg/m² and consisted of 37% males. Patients who underwent rRSA had a mean age of 68 years, BMI of 29.7 kg/m² and consisted of 51.7% males. Most patients that recovered indicated “no difficulty” sleeping by 3 months (pRSA group = 61.1%, rRSA group = 63.6%) and this incrementally improved up to one year for both pRSA and rRSA patients (6 months (RSA group = 69.1%, rRSA group = 73.3%), 12 months (RSA group = 69.4%, rRSA group = 75%). The recovered patients demonstrated significantly higher rates of “no difficulty” sleeping when compared to their respective “not recovered” patients at each time point (p < 0.001). Conclusion This study demonstrates a significant association between normal sleep restoration and recovery after RSA, with most patients achieving improved sleep by 3 months postoperatively. Sleep quality continued to improve through 12 months but plateaued thereafter, indicating a stabilization of recovery. These findings highlight the importance of sleep as a key indicator of recovery and suggest that surgeons can use sleep quality as a simple metric for assessing patient progress.