title: The effect of sleep continuity on pain in adults with sickle cell disease.
abstract: This analysis examined the influence of quantifiable parameters of daily sleep continuity, primarily sleep duration and sleep fragmentation, on daily pain in adults with sickle cell disease. Seventy-five adults with sickle cell disease completed baseline psychosocial measures and daily morning (sleep) and evening (pain) diaries over a 3-month period. Mixed-effect modeling was used to examine daily between- and within-subjects effects of sleep continuity parameters on pain, as well as the synergistic effect of sleep fragmentation and sleep duration on pain. Results revealed that nights of shorter sleep duration and time in bed, increased fragmentation, and less efficient sleep (relative to one's own mean) were followed by days of greater pain severity. Further, the analgesic benefit of longer sleep duration was attenuated when sleep fragmentation was elevated. These results suggest that both the separate and combined effects of sleep duration and fragmentation should be considered in evaluating pain in adults with sickle cell disease.
  
  
  CONCLUSIONS
  Subjective parameters of sleep continuity (eg, sleep duration, fragmentation, and efficiency) predict clinical pain in individuals with sickle cell disease. Additionally, sleep duration should not be considered in isolation, and its association with pain may be qualified by sleep fragmentation. Research and practice should include assessments of both when addressing pain severity.
authors.affiliation: Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland. Electronic address: gmoscou1@jhu.edu.
authors.forename: Gyasi
authors.initials: G
authors.lastname: Moscou-Jackson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Finan
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Campbell
authors.affiliation: Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Smyth
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Haythornthwaite
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D058443:Catastrophization; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D010146:Pain / Q000150:complications* / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
keywords: Daily diaries; pain; sickle cell disease; sleep continuity; sleep fragmentation
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