The relationship between pain and sleep in pediatric sickle cell disease.

Abstract

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. We performed a cross-sectional survey of 105 pediatric patients with SCD aged 8-17years 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. 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 12months 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 12months. 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. 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.