Epidemiologic Associations of Carpal Tunnel Syndrome and Sleep Position: Is There a Case for Causation?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Carpal tunnel syndrome (CTS) is thought to be due to compression of the median nerve in the carpal tunnel. It is known that carpal tunnel pressures are elevated in wrist postures of flexion and extension and in those patients with CTS. Classic symptoms of CTS include night waking with pain, tingling, and numbness. These classic symptoms stimulated our interest in the relationship of sleep to the development of CTS.
We reviewed the literature surrounding the epidemiology of CTS and the literature regarding sleep disturbances. Through careful distillation of these studies and a process of reasoning, we have developed a hypothesis for a causal mechanism of CTS.
Epidemiologically, it has been shown that CTS is associated with age, gender, increased body mass index (BMI), diabetes, pregnancy, and is more common in some populations. The same associations noted above for CTS are strongly associated with sleep disturbances. Sleep disturbances due to age, gender, BMI, pregnancy, and population variations are all associated with sleeping in the lateral position supporting the hypothesis that a common causative mechanism of CTS is sleeping in a lateral position.
We believe that the epidemiologic associations with CTS act through a common causative mechanism, increased sleeping in the lateral position which puts the wrist at increased risk of flexion or extension, compressing the median nerve in the carpal tunnel. This hypothesis is simple and explains the connection between a previously unconnected group of epidemiologic associations. This realization has real clinical significance in that it focuses our attention on the early disorder when it is completely reversible. It clarifies previously confused clinical circumstances, creates research questions that can be tested, and it invites us to change our clinical perspective in this most common form of nerve compression.
- Akerstedt T. Shift work and disturbed sleep/wakefulness. Occup Med (Lond) 2003;53:89–94. CrossRef
- Al-Delaimy WK, Manson JE, Willett WC, Stampfer MJ, Hu FB. Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol 2002;155:387–93. CrossRef
- Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282:153–8. CrossRef
- Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002;113:1429–34. CrossRef
- Bixler EO, Kales A, Soldatos CR, Kales JD, Healey S. Prevalence of sleep disorders in the Los Angeles metropolitan Area. Am J Psychiatry 1979;136:1257–62.
- Bland JD. The relationship of obesity, age, and carpal tunnel syndrome: more complex than was thought? Muscle Nerve 2005;32:527–32. CrossRef
- Bland JP, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry 2003;74:1674–9. CrossRef
- Bloom BJ, Owens JA, McGuinn M, Nobile C, Schaeffer L, Alario AJ. Sleep and its relationship to pain, dysfunction, and disease activity in juvenile rheumatoid arthritis. J Rheumatol 2002;29:169–73.
- Boz C, Ozmenoglu M, Altunayoglu V, Velioglu S, Alioglu Z. Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index, and hand anthropometric measurements. Clin Neurol Neurosurg 2004;106:294–9. CrossRef
- Cheyne JA. Situational factors affecting sleep paralysis and associated hallucinations: position and timing effects. J Sleep Res 2002;11:169–77. CrossRef
- Cirignotta F, Mondini S, Zucconi M, Lenzi PL, Lugaresi E. Insomnia: an epidemiological survey. Clin Neuropharmacol 1985;8 Suppl 1:S49–54.
- Costa G. Shift work and occupational medicine. Occup Med (Lond) 2003;53:83–8. CrossRef
- Enright PL, Newman AB, Wahl PW, Manolio TA, Haponik EF, Boyle PJ. Prevalence and correlates of snoring and observed apneas in 5,201 older adults. Sleep 1996;19:531–8.
- Ferry S, Hannaford P, Warskyj M, Lewis M, Croft P. Carpal tunnel syndrome: a nested case-control study of risk factors in women. Am J Epidemiol 2000;151:566–74.
- Fukuda K, Ogilvie RD, Chilcott L, Vendittelli A, Takeuchi T. The prevalence of sleep paralysis among Canadian and Japanese college students. Dreaming 1998;8:59–66. CrossRef
- Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA 2002;288:1245–51. CrossRef
- Gislason T, Benediktsdottir B, Bjornsson JK, Kristbjarnarson H. Prevalence of sleep apnea syndrome in Sweden and Iceland. In: Kuna ST, Suratt PM, Pemmers JE, editors. Sleep and respiration in aging adults. New York: Elsevier Science Publishing Company Inc.;1991. p. 137–43.
- Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, et al. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 2005;165:863–7. CrossRef
- Gupta R, Rummler L, Steward O. Understanding the biology of compressive neuropathies. CORR 2005;436:251–60. CrossRef
- Han SY, Yoon JW, Jo SK, Shin JH, Shin C, Lee JB, et al. Insomnia in diabetic hemodialysis patients. Prevalence and risk factors by a multicenter study. Nephron 2002;92:127–32. CrossRef
- Itasaka Y, Miyazaki S, Ishikawa K, Togawa K. The influence of sleep position and obesity on sleep apnea. Psychiatry Clin Neurosci 2000;54:340–1. CrossRef
- Katsumata K, Okada T, Miyayo M, Katsumata Y. High incidence of sleep apnea syndrome in a male diabetic population. Diabetes Res Clin Pract 1991;13:45–51. CrossRef
- Katz JN, Larson MG, Sabra A, Krarup C, Stirrat CR, Sethi R, et al. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med 1990;112:321–7.
- Keller RB, Largay AM, Soule DN, Katz JN. Maine Carpal Tunnel Study: small area variations. J Hand Surg 1998;23A:692–6
- Khurram M, Paracha SJ, Khar HT, Hasan Z. Obesity related complications in 100 obese subjects and their age matched controls. J Pak Med Assoc 2006;56:50–3.
- Klink M, Quan SF. Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 1987;9:540–6.
- Kubota T, Ohshima N, Kunisawa N, Murayama R, Okano S, Mori-Okamoto J. Characteristic features of the nocturnal sleeping posture of healthy men. Sleep Biol Rhythms 2003;1:183–5 CrossRef
- Labyak SE, Bourguignon C, Docherty S. Sleep quality in children with juvenile rheumatoid arthritis. Holist Nurs Pract 2003;17:193–200.
- Mackinnon SE, Novak CB. Repetitive motion injuries. J Hand Surg 1997;22A 1:1–18.
- Metlaine A, Leger D, Choudat D. Socioeconomic impact of insomnia in working populations. Ind Health 2005;43:11–9. CrossRef
- Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002;58:289–94.
- Nathan PA. Effects of an aerobic exercise program on median nerve conduction and symptoms associated with carpal tunnel syndrome. J Occup Environ Med 2002;44:303–4.
- Nathan PA, Keniston RC. Carpal tunnel syndrome and its relation to general physical condition. Hand Clin 1993;9:253–61.
- Nathan PA, Takigawa K, Keniston RC, Meadows KD, Lockwood RS. Slowing of sensory conduction of the median nerve and carpal tunnel syndrome in Japanese and American industrial workers. J Hand Surg [Br] 1994;19:30–4. CrossRef
- National Sleep Foundation (2005). Summary of findings: 2005 sleep in America poll. Available at http://www.sleepfoundation.org/_content/hottopics/2005_summary_of_findings.pdf. Accessed June 5, 2005.
- Nicassio PM, Wallston KA. Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol 1992;101:514–20. CrossRef
- Nordstrom DL, Vierkant RA, DeStefano F, Layde PM. Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med 1997;54:734–40. CrossRef
- Novak CB, Mackinnon SE. Multilevel nerve compression and muscle imbalance in work-related neuromuscular disorders. Am J Ind Med 2002;41 5:343–52. CrossRef
- Odgen CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–55. CrossRef
- Ohayon MM. Relationship between chronic painful physical condition and insomnia. J Psychiatr Res 2005;39:151–9. CrossRef
- Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A. Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest 2000;118:1018–24. CrossRef
- Oksenburg A, Silverberg DS, Arons E, Radwan H. Positional vs. nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic and multiple sleep latency test data. Chest 1997;112:629–39.
- Padua L, Aprile I, Caliandro P, Carboni T, Meloni A, Massi S, et al. Symptoms and neurophysiological picture of carpal tunnel syndrome in pregnancy. Clin Neurophysiol 2001;112:1946–51. CrossRef
- Passarelli CM, Roizenblatt S, Len CA, Moreira GA, Lopes MC, Guilleminault C, et al. A case-control sleep study in children with polyarticular juvenile rheumatoid arthritis. J Rheumatol 2006;33:796–802.
- Phalen GS. The carpal-tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966;48A:211–28.
- Power JD, Perruccio AV, Badley EM. Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Rheum 2005;53:911–19. CrossRef
- Punjabi, NM, Shahar, E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep Heart Health Study Investigators. Sleep-disordered breathing, glucose intolerance, and insulin resistance. The Sleep Heart Health Study. Am J Epidemiol 2004;160:521–30. CrossRef
- Redline S. Age-related differences in sleep apnea: generalizability of findings in older populations. In: Kuna ST, Suratt PM, Pemmers JE, editors. Sleep and respiration in aging adults. New York: Elsevier Science Publishing Company Inc.; m1991. p. 89–193.
- Roost M, Nilsson P. Sleep disorders-a public health problem. Potential risk factor in the development of type 2 diabetes, hypertension, dyslipidemia, and premature aging. Läkartidningen 2005;99:154–157 (article in Swedish).
- Roth T, Roehrs T. Insomnia: epidemiology, characteristics, and consequences. Clin Cornerstone 2003;5:5–15. CrossRef
- Rothman KJ, Greenland S. Am J Public Health 2005;95:S144–50 CrossRef
- Schmidt-Nowara WW. Snoring, sleepiness, and sleep apnea in population surveys: effect of age and gender. In: Kuna ST, Suratt PM, Pemmers JE, editors. Sleep and respiration in aging adults. New York: Elsevier Science Publishing Company Inc.; 1991. p. 153–8.
- Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E, et al. Long-term effectiveness of steroid injection and splinting in mild and moderate carpal tunnel syndrome. Neurol Sci 2004;25:48–52. CrossRef
- Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 2005;28:309–14.
- Singh R, Gamble G, Cundy T. Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 Diabetes. Diabet Med 2005;22:625–30. CrossRef
- Skomro RP, Ludwig S, Salamon E, Kryger MH. Sleep complaints and restless legs syndrome in adult type 2 diabetics. Sleep Med 2001;2:417–22. CrossRef
- Sridhar GR, Madhu K. Prevalence of sleep disturbances in diabetes mellitus. Diabetes Res Clin Pract 1994;23:183–6. CrossRef
- Stolp-Smith KA, Pascoe MK, Ogburn PL Jr. Carpal tunnel syndrome in pregnancy: frequency, severity, and prognosis. Arch Phys Med Rehabil 1998;79:1285–7. CrossRef
- Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML. Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Arch Hys Med Rehabil 2005;86:609–18. CrossRef
- Weiss ND, Gordon L, Bloom T, So Y, Rempel DM. Position of the wrist associated with the lowest carpal-tunnel pressure: implications for splint design. J Bone Joint Surg Am 1995;77:1695–9.
- Zohn DA, Hughes AC, Haase KH. Carpal tunnel syndrome—a review. Arch Phys Med Rehabil 1962;43:420–5.
- Epidemiologic Associations of Carpal Tunnel Syndrome and Sleep Position: Is There a Case for Causation?
Volume 2, Issue 3 , pp 127-134
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Carpal tunnel syndrome
- Sleep disturbance
- Sleep position
- Industry Sectors
- Author Affiliations
- 1. Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, The University of Louisville, 555 South Floyd Street, Suite 400, Louisville, KY, 40202, USA
- 2. School of Medicine, The University of Louisville, 555 South Floyd Street, Suite 400, Louisville, KY, 40202, USA
- 3. Unit for Hand & Micro Surgery, GECOT, Tenerife, Spain
- 4. Department of Orthopedics, Lund University, Lund, Sweden
- 5. Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Kristianstad, Sweden