Examination of Sleep in African American Adults with Sickle Cell Disease

insomnia symptomatology;quality of life;sickle cell disease;sleep continuity;symptom management;not listed

Moscou-Jackson, Gyasi EsheSmith, Michael T. ;

Johns Hopkins University

关键词: insomnia symptomatology;    quality of life;    sickle cell disease;    sleep continuity;    symptom management;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39389/MOSCOU-JACKSON-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: A growing body of research suggests that adults with sickle cell disease (SCD) experience sleep disturbances, specifically difficulty falling asleep and staying asleep, which are two symptoms of insomnia. Despite this evidence, there is a paucity of scientific literature that has systematically explored insomnia symptoms in this population. The present study addresses this gap by examining the prevalence, risk factors, and potential outcomes of insomnia symptoms, in community-dwelling adults with SCD. Methods: This study was a secondary analysis of data from two prospective cohort studies of individuals with SCD. Participants were conveniently sampled from outpatient SCD clinics in the Baltimore-Washington Metropolitan area. Between datasets, the Insomnia Severity Index and a daily electronic diary were used to measure sleep characteristics and insomnia symptoms. Descriptive statistics, regression analyses, and multi-level modeling were used.Datasets: Improving Patient Outcomes with Respect and Trust (IMPORT) and Clinical Implications of Pain Phenotypes in Sickle Cell Disease.Results: Among 263 adults with SCD from the IMPORT study, 41% reported clinically relevant insomnia symptoms. Depression and pain were identified as independent statistical predictors of insomnia symptom severity. Using the Pain Phenotype cohort of 75 adults with SCD, a bidirectional relationship between sleep and pain was noted. Analyses of up to three months of daily electronic diaries revealed that short sleep duration, long sleep onset latency, and increased sleep fragmentation, were predictors of increased clinical pain in adults with SCD. Further, the analgesic benefit of longer sleep duration was attenuated when sleep fragmentation was elevated.Finally, preliminary evidence using the IMPORT cohort suggested that insomnia symptom severity is associated with increased health care utilization.Conclusions: Sleep disturbances, specifically insomnia symptoms, are prevalent among adults with SCD and are associated with depression and pain severity. Insomnia symptoms may also be associated with increased healthcare utilization. While a randomized control trial may be premature, clinicians working with this population should regularly assess for sleep disturbances and provided interventions that include treatment of depressive symptoms and pain as needed.