Sleep Physiology in Spine Disease: A Comparative Study of Cervical and Lumbar Patients

Introduction: Pain, fatigue, and postural problems often lead to sleep disturbances in patients with spine disease. However, it remains unclear whether such sleep disturbances impact patients with cervical and lumbar disease differently. Differentiating sleep physiology between cervical and lumbar patients may provide insights into sleep disturbance pathophysiology and highlight directions for future research and clinical care. Our study aims to compare Fitbit-collected sleep metrics between patients with cervical and lumbar spine diseases and explore correlations between these metrics and patient-reported outcome measures (PROMs), including self-reported sleep quality.

Methods: Patients aged 21–85 undergoing surgery for degenerative spine disease were included. Participants were passively monitored before surgery using Fitbit trackers. Raw Fitbit sleep data were extracted at the minute level and transformed into daily features such as time taken to fall asleep, duration asleep, number of waking episodes, and others. Preoperative PROMs included PROMIS pain interference, physical function, and pain intensity. Self-reported sleep quality was assessed using sleep-related question from the Oswestry Disability Index and Neck Disability Index. An Independent T-test was used to test for differences in sleep metrics between cervical and lumbar patients, and Spearman correlation was carried out between sleep metrics and PROMs.

Results: Our study included 155 patients, with a mean (SD) age of 59 (11.8) years, and 53% were female. 27 and 128 were in cervical and lumbar cohorts respectively. Cervical patients had greater self-reported sleep disturbances, while no significant differences were found in Fitbit sleep measures. Stronger correlations were found between sleep and pain measures in cervical patients.

Conclusion : Our study suggests that cervical and lumbar spine patients have similar objective sleep metrics despite cervical patients reporting greater sleep disturbances, that appear to be more correlated with spinal pain than in lumbar cohort. However, further research is needed to better understand the relationship between sleep and spine pathology.