Turbulent sink flows over smooth or rough walls with sand-grain roughness are studied using large-eddy and direct numerical simulations. Mild and strong levels of acceleration are applied, yielding a wide range of Reynolds number (Reθ = 372 − 2748) and cases close to the reverse-transitional state. Flow acceleration and roughness are shown to exert opposite effects on boundary-layer integral parameters, on the Reynolds stresses, budgets of turbulent kinetic energy, and properties of turbulent structures in the vicinity of the rough surface; statistics exhibit similarity when plotted using inner scaling for cases with the same roughness Reynolds number, k+. Acceleration leads to a decrease of k+, while roughness increases it. For cases with higher k+, the low-speed streaks become destabilized, and turbulent structures near the wall are distributed more uniformly in the wall-parallel plane; they are less extended in the streamwise direction, but more densely packed. Higher k+ also causes decorrelation of the outer-layer hairpin packets with the near-wall structures, probably due to the direct impact of random roughness elements on the hairpin legs. Wall-similarity applies for the fully turbulent cases, in which the outer-layer turbulent statistics are affected by acceleration only. It is shown that being in the hydraulically smooth regime is a necessary condition for reverse-transition, supporting the idea that relaminarization starts from the inner region, where roughness effects dominate.