Sleep Moderating the Relationship Between Pain and Health Care Use in Youth With Sickle Cell Disease

Valrie, Cecelia R.; Alston, Kristen; Fuh, Beng; Redding‐Lallinger, Rupa; Sisler, India

doi:10.1097/ajp.0000000000000783

Cited by 5 publications

(7 citation statements)

References 41 publications

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“…This suggests that patients with a history of frequent acute pain events may benefit from a formal assessment of sleep. These data are in contrast to one prior study that reported that poor sleep quality did not strengthen the relationship between high pain frequency and more healthcare utilization in youth with SCD 21 . Additionally, females demonstrated significantly higher sleep‐related impairment PROMIS scores than males, which is consistent with prior literature in healthy patients 33 …”

Section: Discussionsupporting

confidence: 84%

“…20 While prior studies have examined the association between sleep and pain in children with SCD, these studies have produced mixed results and typically focused on sleep apnea, duration, and efficiency. [21][22][23] We have observed late mid-sleep times and substantial social jetlag among adolescents and young adults with SCD. 24 Yet, few studies have examined these circadian factors and their potential impact on pain in the context of SCD.…”

Section: Introductionmentioning

confidence: 91%

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The relationship between pain and sleep in pediatric sickle cell disease

Padmanabhan

Tucker

Murdaugh

et al. 2023

Pediatric Blood & Cancer

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Background Pain and sleep disturbances are prevalent complications experienced by pediatric patients with sickle cell disease (SCD). This study aims to identify associations between pain and sleep, and to characterize sleep chronotype and social jetlag in children and adolescent patients with SCD. Methods We performed a cross‐sectional survey of 105 pediatric patients with SCD aged 8–17 years using PROMIS (Patient Reported Outcomes Measurement System) pain interference, sleep disturbance, and sleep‐related impairment item banks. The μMCTQ (Ultra‐short Munich Chronotype Questionnaire) assessed chronotype and social jetlag. Analyses were performed to assess associations between PROMIS measures, sleep patterns, and clinical variables. Results Female participants reported higher T‐scores for sleep‐related impairment than males (females: 56.7 ± 10 vs. males 50.2 ± 9.4, p = .0009). Patients with one or more emergency department (ED) visits for pain in the last 12 months reported greater sleep disturbance (55.0 ± 8.5 vs. 50.7 ± 10, p = .046) and sleep‐related impairment (57.1 ± 9.3 vs. 52.1 ± 10.2, p = .03) than patients without any ED visits for pain in the last 12 months. Pain interference was significantly associated with both sleep disturbance (r = .49, p < .0001) and sleep‐related impairment (r = .46, p < .0001). The average mid‐sleep time was 4:14 ± 1:44 a.m. and the average social jetlag (hh:mm) was 2:32 ± 1:35. Conclusion Our study demonstrates that pain interference is associated with both sleep disturbance and sleep‐related impairment. PROMIS measures can identify patients that suffer from pain and sleep disturbances and highlights the need to conduct longitudinal prospective studies to define the directionality of pain and sleep in SCD.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 91%

The relationship between pain and sleep in pediatric sickle cell disease

Padmanabhan

Tucker

Murdaugh

et al. 2023

Pediatric Blood & Cancer

View full text Add to dashboard Cite

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“…Our data revealed the strong relationship between sleepiness and HRQOL and suggest incorporating measures to explore coping in relation to sleep difficulties (e.g., sleep-disordered breathing) and sleep hygiene behaviours (e.g., bedtime routine) may be a valuable addition to coping interventions for children with SCD. Our findings add to a growing body of literature that has demonstrated that more sleep disturbances (i.e., parasomnias and movement at night) were related to greater daytime sleepiness (Kölbel et al, 2020 ) and that there is a bi-directional relationship between poor night-time sleep quality and higher daytime pain in youth with SCD (Valrie et al, 2020 ). Expanding upon the influence of sleep, fatigue (a feeling of tiredness or exhaustion) has also been shown to be more strongly related to cognitive deficits in children with SCD (Rogers et al, 2017 ).…”

Section: Discussionsupporting

confidence: 70%

Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease

et al. 2021

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Sickle cell disease (SCD) refers to a group of inherited blood disorders with considerable morbidity that causes severe pain, reduces life expectancy, and requires significant self-management. Acute painful episodes are the hallmark of SCD, but persistent daily pain is also highly prevalent in this population. Characterising the impact and experience of SCD-related morbidity (i.e., sleep disruption, frequent emergency department visits, cognitive dysfunction) on health-related quality of life (HRQOL) requires multiple assessment methods to best capture the underlying mechanisms. To gain a greater understanding of the effect of common symptom categories on HRQOL and to determine potential pain coping targets, the present study investigated whether demographic, socioeconomic, sleepiness, pain burden, frequency of emergency department (ED) visits, and cognition predicted HRQOL in a paediatric sample of patients with SCD. Our study was a secondary analysis of baseline assessment data of children with SCD aged 8–15 years (n = 30) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Patients completed cognitive testing (IQ, Processing Speed Index, Delis-Kaplan Executive Function Scale (DKEFS) Tower, Conner's Continuous Performance Test), sleepiness (Epworth Sleepiness Scale), and HRQOL (PedsQL Sickle Cell Module) at baseline. Patients reported pain burden (Sickle Cell Pain Burden Inventory-Youth) each month over 8 visits. Caregivers provided demographic information and reported their child's executive function (Behavioural Rating Inventory of Executive Function) at baseline. Data from our analysis demonstrated that demographic factors (i.e., age, gender, level of neighbourhood deprivation) and treatment variables (i.e., hydroxyurea use) did not independently predict HRQOL, and laboratory values (i.e., haemoglobin, haematocrit, mean oxygen saturation) were not significantly correlated with HRQOL (ps > 0.05). However, sleepiness, pain burden, ED visits, and executive dysfunction independently predicted HRQOL (R2 = 0.66) with large effects (η2 = 0.16 to 0.32). These findings identify specific, measurable symptom categories that may serve as targets to improve HRQOL that are responsive to change. This knowledge will be useful for multimodal interventions for paediatric patients with SCD that include sleep management, pain coping strategies, and executive function training.

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“…Guardians reported healthcare utilization during the Structured Pain Interview for Parents (SPI‐P). To assess healthcare utilization due to pain within the past year, three items were used: (a) “How many times have your child gone to see a doctor?” (b) “Number of times your child has been hospitalized,” and (c) “Number of emergency room visits.” The SPI‐P measure has been used extensively for assessing healthcare use in youth with SCD and has acceptable interrater and test–retest reliability over a 9–12‐month period 30,37,38 …”

Section: Methodsmentioning

confidence: 99%

“…The SPI-P measure has been used extensively for assessing healthcare use in youth with SCD and has acceptable interrater and test-retest reliability over a 9-12-month period. 30,37,38…”

Section: Intrapersonal Factorsmentioning

confidence: 99%

Intraindividual pain variability metrics for youth with sickle cell disease: Relations to health outcomes

Pascale

Sisler

Smith

et al. 2023

Pediatric Blood & Cancer

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Background While the majority of pediatric sickle cell disease (SCD) research has used mean pain intensity as the only pain metric, recent evidence suggests this metric alone is inadequate in describing the intraindividual variability in SCD pain experiences and subsequent impact. There is limited information on other intraindividual pain metrics in youth with SCD, or how they relate to health outcomes in this population. The aims of this study were to describe differing patterns of intraindividual pain metrics derived from ecological momentary assessments (EMAs) of youth with SCD and to characterize the unique relationships between these metrics and health outcomes. Methods Eighty‐eight youth with SCD, aged 8–17 (mean age = 11.6), were recruited from three regional pediatric SCD clinics in the United States. At baseline, youth and their guardians reported on demographic and disease information. Then youth completed twice daily EMAs for up to 4 weeks. Pain metrics derived from EMA data were calculated including mean daily pain intensity (DP), SD‐DP (standard deviation of DP), proportion of pain days (PPD), and 90th percentile of DP (p90). Pearson correlations were calculated between pain metrics and health outcomes. Results High DP and SD‐DP were correlated with more anxiety symptoms, while high SD‐DP and p90 were correlated with more depression symptoms. High SD‐DP was correlated with low self‐esteem, and high DP and PPD were correlated with low sickle cell self‐efficacy. For healthcare utilization due to pain, high p90 was correlated with more emergency department visits, while high DP, p90, and PPD were correlated with more healthcare contacts. Conclusion There are distinct associations between pain variability metrics beyond DP and health outcomes. Collectively, the patterns of associations suggest the utility of these pain metrics for determining risk in relation to specific health outcomes for youth with SCD.

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Sleep Moderating the Relationship Between Pain and Health Care Use in Youth With Sickle Cell Disease

Cited by 5 publications

References 41 publications

The relationship between pain and sleep in pediatric sickle cell disease

The relationship between pain and sleep in pediatric sickle cell disease

Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease

Intraindividual pain variability metrics for youth with sickle cell disease: Relations to health outcomes

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