Poorer sleep quality among adult patients with pectus excavatum in Taiwan: A pilot study Yeung-Leung Cheng, MD, PhD, Chou-Chin Lan, MD, PhD, Yao-Kuang.

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Poorer sleep quality among adult patients with pectus excavatum in Taiwan: A pilot study Yeung-Leung Cheng, MD, PhD, Chou-Chin Lan, MD, PhD, Yao-Kuang Wu, MD, Wen-Lin Su, MD, PhD, Mei-Chen Yang, MD The Journal of Thoracic and Cardiovascular Surgery Volume 157, Issue 2, Pages 769-780.e1 (February 2019) DOI: 10.1016/j.jtcvs.2018.07.050 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Comparison of QOL (SF-36 V2) among the control, outpatient, and inpatient groups at baseline. The inpatient group had worse PCS (including worse PF, RP, GH components) and MCS (including SF, RE, and MH) than the control group. The outpatient group had worse PF and GH than the control group (minimum, maximum, median, Q1 and Q3 values are presented in box-and-whisker plots). a, Significantly different between control group and a given group, P < .01. b, Significantly different between outpatient group and a given group, P < .01. c, Significantly different between inpatient group and a given group, P < .01. *P < .01. PCS (%), Physical component score (0-100); MCS (%), mental component score (0-100); PF, physical functioning norm-based score (0-100); RP, role physical norm-based score (0-100); BP, bodily pain norm-based score (0-100); GH, general health norm-based score (0-100); VT, vitality norm-based score (0-100); SF, social functioning norm-based score (0-100); RE, role emotional norm-based score (0-100); MH, mental health norm-based score (0-100). B, Comparison of QOL (SF-36 V2) before and after Nuss surgery in the inpatient group. Six months after Nuss surgery, MCS and GH improved, but BP was worse (minimum, maximum, median, Q1 and Q3 values are presented in box-and-whisker plots.) ∗P < .01, significant difference between 2 groups. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 769-780.e1DOI: (10.1016/j.jtcvs.2018.07.050) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Comparison of PSQI total scores among control, outpatient, and inpatient groups at baseline (left) before and 6 months after Nuss surgery only in the inpatient group (right). The sleep quality of the inpatient group was poorer than that of the control group (left) and could be improved by Nuss surgery (right). Minimum, maximum, median, Q1, and Q3 values are presented in box-and-whisker plots and the measurements results were also shown under the figure. ∗P < .01, significant difference between 2 groups. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 769-780.e1DOI: (10.1016/j.jtcvs.2018.07.050) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Spearman's correlation among participants' characteristics, QOL, and sleep quality of sleep in the 3 groups (A, control group; B, outpatient group; C, inpatient group). In the control group, the BDI-II had a medium correlation with PCS (A). In the outpatient group, the BSRS-5 had a medium correlation with the BDI-II and a high correlation with the MCS. The BDI-II had a medium correlation with the MCS. There was no correlation with the PSQI (B). In the inpatient group, the BSRS-5 had a medium correlation with the BDI-II and MCS. The BDI-II was highly correlated with the MCS. The PSQI had a medium correlation with both the MCS and BDI-II (C). ∗P < .01, significant correlation between 2 variables. VAS, Visual analog scale for pain; BSRS-5, Brief Symptom Rating Scale; BDI-II, Beck Depression Inventory; PCS (%), physical component score (0–100); MCS (%), mental component score (0-100); PSQI, Pittsburgh sleep quality index total scores. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 769-780.e1DOI: (10.1016/j.jtcvs.2018.07.050) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Spearman's correlation among participants' characteristics, QOL, and sleep quality of sleep in the 3 groups (A, control group; B, outpatient group; C, inpatient group). In the control group, the BDI-II had a medium correlation with PCS (A). In the outpatient group, the BSRS-5 had a medium correlation with the BDI-II and a high correlation with the MCS. The BDI-II had a medium correlation with the MCS. There was no correlation with the PSQI (B). In the inpatient group, the BSRS-5 had a medium correlation with the BDI-II and MCS. The BDI-II was highly correlated with the MCS. The PSQI had a medium correlation with both the MCS and BDI-II (C). ∗P < .01, significant correlation between 2 variables. VAS, Visual analog scale for pain; BSRS-5, Brief Symptom Rating Scale; BDI-II, Beck Depression Inventory; PCS (%), physical component score (0–100); MCS (%), mental component score (0-100); PSQI, Pittsburgh sleep quality index total scores. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 769-780.e1DOI: (10.1016/j.jtcvs.2018.07.050) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Spearman's correlation among participants' characteristics, QOL, and sleep quality of sleep in the 3 groups (A, control group; B, outpatient group; C, inpatient group). In the control group, the BDI-II had a medium correlation with PCS (A). In the outpatient group, the BSRS-5 had a medium correlation with the BDI-II and a high correlation with the MCS. The BDI-II had a medium correlation with the MCS. There was no correlation with the PSQI (B). In the inpatient group, the BSRS-5 had a medium correlation with the BDI-II and MCS. The BDI-II was highly correlated with the MCS. The PSQI had a medium correlation with both the MCS and BDI-II (C). ∗P < .01, significant correlation between 2 variables. VAS, Visual analog scale for pain; BSRS-5, Brief Symptom Rating Scale; BDI-II, Beck Depression Inventory; PCS (%), physical component score (0–100); MCS (%), mental component score (0-100); PSQI, Pittsburgh sleep quality index total scores. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 769-780.e1DOI: (10.1016/j.jtcvs.2018.07.050) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Surgical repair could improve poorer sleep quality for patients with PE. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 769-780.e1DOI: (10.1016/j.jtcvs.2018.07.050) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 This is a case of a 29-year-old man receiving a modified Nuss procedure using bilateral thoracoscopic assistance. Lots of studies had showed that patients with PE had a poor QOL, which can be improved after surgical correction. On average, humans spend one fourth to one third of the day asleep. We suggested sleep quality should be included while evaluating QOL. However, sleep quality had never been studied in patients with PE. Therefore, we conducted a pilot clinical study to evaluate if sleep quality is affected by PE and if surgical correction could improve patients' sleep quality. Our findings suggested sleep quality is poorer in patients with PE in Taiwan that can be attributed to the resulting psychologic issues, rather than the PE itself. The poorer sleep quality could be improved after Nuss repair surgery for correction of PE. At present, sleep quality is not routinely evaluated in patients with PE before and after surgical correction. We suggested both subjective or objective evaluations of sleep quality might be considered before and after a patient undergoes surgical correction for PE. Video available at: https://www.jtcvs.org/article/S0022-5223(18)32041-5/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 769-780.e1DOI: (10.1016/j.jtcvs.2018.07.050) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions