Sleep disturbance, depression and pain in adults with sickle cell disease

Abstract

BackgroundSleep disturbance and depression are commonly encountered in primary care. In sickle cell disease, depression is associated with pain, poor treatment compliance, and lower quality of life. The prevalence of sleep disturbance and its effect upon quality of life in adults with sickle cell disease is unknown. The goal of this study was to determine the prevalence of sleep disturbance and if it is associated with pain and depression in sickle cell disease.MethodsThree hundred twenty eight adults with sickle cell disease enrolled on the Bethesda Sickle Cell Cohort Study were assessed using the Pittsburgh Sleep Quality Index and Beck Depression Inventory II screening measures as a cross-sectional survey. Scores greater than 5 (Pittsburgh Sleep Quality Index) and 16 (Beck Depression Inventory II) defined sleep disturbance and depression, respectively. Clinical and laboratory parameters were also assessed.ResultsThe mean Pittsburgh Sleep Quality Index score was 8.4 (SD ± 4.2) indicating a 71.2% prevalence of sleep disturbance. The mean Beck Depression Inventory II score was 8.0 (SD ± 8.9). Sixty five (20.6%) participants had a score indicating depression, and half of these (10.0%) had thoughts of suicide. Both Pittsburgh Sleep Quality Index and Beck Depression Inventory II scores were significantly correlated (p < .001). The number of days with mild/moderate pain (p = .001) and a history of headaches (p = .005) were independently associated with depression by multivariate regression analysis. Patients with sleep disturbance were older (p = .002), had higher body mass index (p = .011), had more days of pain (p = .003) and more frequent severe acute painful events (emergency room visits and hospitalizations) during the previous 12 months (p < .001).ConclusionsMore than 70 percent of adults with sickle cell disease had sleep disturbance, while 21 percent showed evidence of clinical depression. Sleep disturbance and depression were correlated, and were most common among those with more frequent pain. Providers caring for adults with sickle cell disease and frequent pain should consider screening for these common co-morbidities. Additional study is needed to confirm these findings and to determine if treatments for pain, depression or sleep disturbances will improve quality of life measures in this patient population.Trial registrationClinicalTrials.gov identifier: NCT00011648.

The Effectiveness of Self Management Program on Pain, Fatigue, Depression, Anxiety, and Stress in Sickle Cell Patients: A Quasi-Experimental Study

“…Patients with SCD experience multiple disease-related complications; the physical, psychological, and social effects of these expose these patients to an evaluated risk of acute and chronic fatigue (12), as well as depression, anxiety, stress, and other mental health problems (3,6). This study's findings indicate that fatigue is significantly related to depression, anxiety, and stress; that pain frequency during the study period was significantly related to depression, anxiety, and stress; and that duration of pain was significantly related to depression, anxiety, and fatigue.…”

“…Dampier et al (13) demonstrated a significant relationship between pain and fatigue in SC patients. Other studies have shown that the prevalence of depression in SC patients is associated with sleep disturbance, poor adherence to treatment, and daily pain (3). Anxiety has been reported as a factor contributing to the frequency and severity of pain in SC patients, as well as reinforcing the pain state and stress; anxiety has also been identified as a precipitating factor in the onset of pain crises (21,22).…”

“…Extant research indicates a relationship between pain, fatigue, depression, anxiety, and stress in SCD patients (12). Severe pain in SC patients has been associated with reduced vitality, increased fatigue (11,13) and increased prevalence of depression, anxiety, and stress (3,21,22). Dampier et al (13) demonstrated a significant relationship between pain and fatigue in SC patients.…”

“…The disease is characterized by painful crises due to obstruction of blood vessels (2); it affects around 100,000 people in the United States and is one of the most common genetic diseases in United States (3). This disease is found in the southern provinces of Iran, especially in Khuzestan; there are approximately 500 sickle cell (SC) patients in this province (4).…”

“…This disease is found in the southern provinces of Iran, especially in Khuzestan; there are approximately 500 sickle cell (SC) patients in this province (4). Occlusive episodes cause complications characteristically associated with SCD such as pain, stroke, aplastic crisis, severe hemolytic anemia, acute chest syndrome, and chronic damage to organs (5); however, pain in the abdomen, chest, lower back, and joints are the most common problems reported by SC patients (6), which are considered the most common causes of referral to emergency departments (3,4,6).…”