Pain interference is associated with both sleep disturbance and sleep-related impairment in pediatric patients with sickle cell disease (SCD), according to a recent study published in Pediatric Blood & Cancer.

The researchers performed a cross-sectional survey of 105 patients aged 8 to 17 years with SCD using Patient-Reported Outcomes Measurement System (PROMIS) pain interference, sleep disturbance, and sleep-related impairment item banks.

They used the ultra-short Munich Chronotype Questionnaire (μMCTQ) to assess chronotype and social jetlag. Next, they analyzed the correlations between PROMIS measures, sleep patterns, and clinical variables.

According to the results, sleep-related impairment was more prominent in female participants than in male participants. Patients who visited the emergency department for pain at least once in the previous 12 months experienced greater sleep disturbance and sleep-related impairment than those who did not have such a visit.

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Moreover, the tests showed significant associations between pain interference and both sleep disturbance and sleep-related impairment. The average midsleep time, defined as a midpoint between sleep onset and wake-up time on the μMCTQ, was estimated at 4:14±1:44 am, while the average social jetlag (hh:mm), defined as the absolute difference between the midsleep time on weekends and school days, was estimated at 2:32±1:35.

“Interestingly, the average sleep duration in our study population was in the range of recommended sleep durations (8–10 hours) for school-going children and adolescents; the recommended sleep duration is not typically observed in healthy adolescents,” Padmanabhan and colleagues wrote.

One of the most frequent clinical complications of SCD is pain, which varies from mild to debilitating and is due to acute or chronic processes. Sleep disturbances are another prevalent complication in SCD, comprising sleep-disordered breathing with nocturnal hypoxemia, insomnia, and sleep fragmentation. Daytime consequences of sleep disturbances such as increased irritability, cognitive difficulties, daytime sleepiness, and fatigue represent sleep-related impairments.

“This study highlights the need to conduct longitudinal prospective studies to define directionality of pain and sleep in this population. If disordered sleep contributes to worse pain, behavioral clinical trials should be performed to examine the effect of sleep interventions on pain outcomes,” the study authors added.

Reference

Padmanabhan D, Tucker T, Murdaugh D, Ilonze C, Lebensburger J, Thomas SJ. The relationship between pain and sleep in pediatric sickle cell disease. Pediatr Blood Cancer. Published online January 11, 2023. doi:10.1002/pbc.30201