Clinical and electrophysiological factors associated with poor sleep quality in carpal tunnel syndrome: a cross-sectional study

Carpal tunnel syndrome (CTS) commonly impairs sleep quality due to nocturnal exacerbations of paresthesia and pain. However, the relative contributions of clinical, symptomatic, and electrophysiological factors to poor sleep quality in CTS patients remain unclear. This study evaluated these factors in patients with electrodiagnostically confirmed CTS. This single-center, prospective, cross-sectional study included 120 symptomatic patients with electrodiagnostically confirmed CTS. Assessments included the Pittsburgh Sleep Quality Index (PSQI), Boston Carpal Tunnel Questionnaire (BCTQ), Visual Analog Scale (VAS) for pain, Patient Health Questionnaire-9 (PHQ-9), and Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-BANG). Median nerve distal motor latency (DML), distal sensory latency (DSL), sensory nerve action potential (SNAP), compound muscle action potential (CMAP), and electrophysiological severity were recorded. Poor sleep quality was defined as PSQI > 5. Multivariate logistic regression and sensitivity analyses (using a modified PHQ-9 score excluding the sleep item) were performed. The mean patient age was 48.6 ± 11.3 years; 78.3% were female. Poor sleep quality was observed in 66.7%. BCTQ symptom severity (OR = 20.87; p = 0.0009), nocturnal pain VAS (OR = 2.25; p = 0.0007), and PHQ-9 score (OR = 1.40; p = 0.0023) were independently associated with poor sleep quality. This association remained significant with the modified PHQ-9 score (OR = 1.35; p = 0.0032). No statistically significant independent association was detected for electrophysiological severity and obstructive sleep apnea risk. Poor sleep quality is prevalent in CTS. Nocturnal pain, symptom severity, and depressive burden are independently associated factors, whereas no independent association between electrophysiological severity and poor sleep quality was detected in this sample. Systematic evaluation of these clinical factors is essential in CTS management. Given the cross-sectional correlational design of this study, these findings represent clinical associations and do not imply causal relationships.