title: Sleep disturbance, depression and pain in adults with sickle cell disease.
abstract: 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.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00011648.
authors.forename: Gwenyth R
authors.initials: GR
authors.lastname: Wallen
authors.forename: Caterina P
authors.initials: CP
authors.lastname: Minniti
authors.forename: Michael
authors.initials: M
authors.lastname: Krumlauf
authors.forename: Ellen
authors.initials: E
authors.lastname: Eckes
authors.forename: Darlene
authors.initials: D
authors.lastname: Allen
authors.forename: Anna
authors.initials: A
authors.lastname: Oguhebe
authors.forename: Cassie
authors.initials: C
authors.lastname: Seamon
authors.forename: Deepika S
authors.initials: DS
authors.lastname: Darbari
authors.forename: Mariana
authors.initials: M
authors.lastname: Hildesheim
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Schulden
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kato
authors.affiliation: 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. jamesta@mail.nih.gov.
authors.forename: James G
authors.initials: JG
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D057566:Self Report; D012890:Sleep; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D013405:Suicide / Q000523:psychology; D014481:United States / Q000453:epidemiology