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

BMC Psychiatry

James G Taylor VI⁴  Gregory J Kato⁴  Jeffrey D Schulden²  Li Yang³  Mariana Hildesheim⁴  Deepika S Darbari¹  Cassie Seamon⁴  Anna Oguhebe⁴  Darlene Allen⁴  Ellen Eckes³  Michael Krumlauf³  Caterina P Minniti⁴  Gwenyth R Wallen³ 

[1] Center for Cancer and Blood Diseases, Children’s National Medical Center, Washington, DC, USA;Division of Epidemiology, Services, and Prevention Research, National Institute of Drug Abuse, National Institutes of Health, Bethesda, MD, USA;National Institutes of Health, Clinical Center, Bethesda, MD, USA;Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5140 MSC 1476, Bethesda 20892-1476 MD, USA

关键词: Bethesda sickle cell cohort study;    Patient reported outcomes;    Chronic pain;    Depression;    Sleep disturbance;    Sickle cell disease;   

Others  :  1123456
DOI  :  10.1186/1471-244X-14-207

 received in 2014-02-03, accepted in 2014-07-10,  发布年份 2014

【 摘 要 】

Background

Sleep 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.

Methods

Three 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.

Results

The 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).

Conclusions

More 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 registration

ClinicalTrials.gov identifier: NCT00011648.

【 授权许可】

   
2014 Wallen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Bonds DR: Three decades of innovation in the management of sickle cell disease: the road to understanding the sickle cell disease clinical phenotype. Blood Rev 2005, 19(2):99-110.
• [2]Gladwin MT, Vichinsky E: Pulmonary complications of sickle cell disease. N Engl J Med 2008, 359(21):2254-2265.
• [3]Steinberg MH: Sickle cell anemia, the first molecular disease: overview of molecular etiology, pathophysiology, and therapeutic approaches. Sci World J 2008, 8:1295-1324.
• [4]Platt OS, Thorington BD, Brambilla DJ, Milner PF, Rosse WF, Vichinsky E, Kinney TR: Pain in sickle cell disease. Rates and risk factors. N Engl J Med 1991, 325(1):11-16.
• [5]Ameringer S, Smith WR: Emerging biobehavioral factors of fatigue in sickle cell disease. J Nurs Scholarsh 2011, 43(1):22-29.
• [6]Edwards RR, Calahan C, Mensing G, Smith M, Haythornthwaite JA: Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol 2011, 7:216-224.
• [7]Asnani MR, Fraser R, Lewis NA, Reid ME: Depression and loneliness in Jamaicans with sickle cell disease. BMC Psychiatry 2010, 10:40.
• [8]Hasan SP, Hashmi S, Alhassen M, Lawson W, Castro O: Depression in sickle cell disease. J Natl Med Assoc 2003, 95(7):533-537.
• [9]Laurence B, George D, Woods D: Association between elevated depressive symptoms and clinical disease severity in African-American adults with sickle cell disease. J Natl Med Assoc 2006, 98(3):365-369.
• [10]Levenson JL, McClish DK, Dahman BA, Bovbjerg VE, de A Citero V, Penberthy LT, Aisiku IP, Roberts JD, Roseff SD, Smith WR: Depression and anxiety in adults with sickle cell disease: the PiSCES project. Psychosom Med 2008, 70(2):192-196.
• [11]Centers for Disease C, Prevention: Current depression among adults---United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep 2010, 59(38):1229-1235.
• [12]Davies SC, Stebbens VA, Samuels MP, Southall DP: Upper airways obstruction and cerebrovascular accident in children with sickle cell anaemia. Lancet 1989, 2(8657):283-284.
• [13]Hargrave DR, Wade A, Evans JP, Hewes DK, Kirkham FJ: Nocturnal oxygen saturation and painful sickle cell crises in children. Blood 2003, 101(3):846-848.
• [14]Kirkham FJ, Hewes DK, Prengler M, Wade A, Lane R, Evans JP: Nocturnal hypoxaemia and central-nervous-system events in sickle-cell disease. Lancet 2001, 357(9269):1656-1659.
• [15]Becker PM: Insomnia: prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Psychiatr Clin North Am 2006, 29(4):855-870. abstract vii
• [16]Maddern BR, Reed HT, Ohene-Frempong K, Beckerman RC: Obstructive sleep apnea syndrome in sickle cell disease. Ann Otol Rhinol Laryngol 1989, 98(3):174-178.
• [17]Wittig RM, Roth T, Keenum AJ, Sarnaik S: Snoring, daytime sleepiness, and sickle cell anemia. Am J Dis Child 1988, 142(6):589.
• [18]Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, Klug PP: Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med 1994, 330(23):1639-1644.
• [19]Sogutlu A, Levenson JL, McClish DK, Rosef SD, Smith WR: Somatic symptom burden in adults with sickle cell disease predicts pain, depression, anxiety, health care utilization, and quality of life: the PiSCES project. Psychosomatics 2011, 52(3):272-279.
• [20]Smith WR, Bovbjerg VE, Penberthy LT, McClish DK, Levenson JM, Roberts JD, Gil K, Roseff SD: Aisiku I P: understanding pain and improving management of sickle cell disease: the PiSCES study. J Natl Med Assoc 2005, 97(2):183-193.
• [21]Jordan L, Swerdlow P, Coates TD: Systematic review of transition from adolescent to adult care in patients with sickle cell disease. J Pediatr Hematol Oncol 2013, 35(3):165-169.
• [22]Steinberg MH, Forget BG, Higgs DR, Weatherall DJ: Disorders of Hemoglobin: Genetics Pathophysiology, and Clinical Management. New York: Cambridge University Press; 2009.
• [23]Taylor JG, Ackah D, Cobb C, Orr N, Percy MJ, Sachdev V, Machado R, Castro O, Kato GJ, Chanock SJ, Gladwin MT: Mutations and polymorphisms in hemoglobin genes and the risk of pulmonary hypertension and death in sickle cell disease. Am J Hematol 2008, 83(1):6-14.
• [24]Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961, 4:561-571.
• [25]Foreman MD: Measuring Cognitive Status. In Instruments for Clinical Health-Care Research. Edited by Frank-Stromborg M, Olsen SJ. Sudbury, Massachusetts: Jones and Bartlett Publishers; 2004:86-113.
• [26]Gallagher D, Breckenridge J, Steinmetz J, Thompson L: The beck depression inventory and research diagnostic criteria: congruence in an older population. J Consult Clin Psychol 1983, 51(6):945-946.
• [27]Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989, 28(2):193-213.
• [28]Jerrell JM, Tripath A, McIntyre RS: Prevalence and treatment of depression in children and adolescents with sickle cell disease: a retrospective cohort study. Primary Care Companion for CNS Disorders 2011, 13(2):10m01063.
• [29]Dampier C, Lieff S, LeBeau P, Rhee S, McMurray M, Rogers Z, Smith-Whitley K, Wang W: Health-related quality of life in children with sickle cell disease: a report from the comprehensive sickle cell centers clinical trial consortium. Pediatr Blood Cancer 2010, 55(3):485-494.
• [30]Jennings JR, Muldoon MF, Hall M, Buysse DJ, Manuck SB: Self-reported sleep quality is associated with the metabolic syndrome. Sleep 2007, 30(2):219-223.
• [31]Mavanji V, Billington CJ, Kotz CM, Teske JA: Sleep and obesity: a focus on animal models. Neurosci Biobehav Rev 2012, 36(3):1015-1029.
• [32]Naughton F, Ashworth P, Skevington SM: Does sleep quality predict pain-related disability in chronic pain patients? The mediating roles of depression and pain severity. Pain 2007, 127(3):243-252.
• [33]Raymond I, Nielsen TA, Lavigne G, Manzini C, Choiniere M: Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients. Pain 2001, 92(3):381-388.
• [34]Espana RA, Scammell TE: Sleep neurobiology from a clinical perspective. Sleep 2011, 34(7):845-858.
• [35]Dimsdale JE, Norman D, DeJardin D, Wallace MS: The effect of opioids on sleep architecture. J Clin Sleep Med 2007, 3(1):33-36.
• [36]Jackowska M, Dockray S, Hendrickx H, Steptoe A: Psychosocial factors and sleep efficiency: discrepancies between subjective and objective evaluations of sleep. Psychosom Med 2011, 73(9):810-816.
• [37]Wellington C, Edwards CL, McNeil J, Wood M, Crisp B, Feliu M, Byrd G, McDougald C, Edwards L, Whitfield KE: Somatization in the conceptualization of sickle cell disease. J Natl Med Assoc 2010, 102(11):1079-1083.