Sleep disturbance is common among children with sickle cell disease (SCD) and is related to neurocognitive difficulties. However, research on sleep disturbances and related variables among adults with SCD is extremely limited. The present study examined the relationship between sleep, executive functioning, and emotional functioning among 62 adults (29 females; M age = 32 years, SD = 7.79) with SCD preparing to undergo a stem cell transplant. Participants were administered a neurocognitive evaluation that included objective and subjective measures of executive functioning, and they completed PROMIS self-report measures of anxiety, depression, and pain intensity. Results showed that about 17% of participants endorsed clinically significant sleep disruptions, while 16.1% and 8% endorsed clinically significant symptoms of anxiety and depression, respectively. Sleep disturbance in these adults was not significantly correlated with objective or subjective measures of executive functioning. Moreover, anxiety, but not depression, was a significant mediator between self-reported sleep difficulties and both objective and subjective measures of executive functioning while controlling for pain intensity. Future research on sleep interventions will be essential for ameliorating the effects of sleep disturbance on executive functioning and anxiety among adults with SCD.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The data included in the study is not publicaly available according to the NIH Publishing Agreement.
Prevention, Centers for Disease Control and (2018) Data & statistics on sickle cell disease. https://www.cdc.gov/ncbddd/sicklecell/data.html. Accessed 14 Dec 2019
Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, Klug PP (1994) Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med 330(23):1639–1644
Bartolucci P, Lionnet F (2014) Chronic complications of sickle cell disease. Rev Prat 64(8):1120–1126
Adegbola M (2015) Sleep quality, pain and self-efficacy among community-dwelling adults with sickle cell disease. J Natl Black Nurses Assoc 26(1):15–21
Moscou-Jackson G, Finan PH, Campbell CM, Smyth JM, Haythornthwaite JA (2015) The effect of sleep continuity on pain in adults with sickle cell disease. J Pain 16(6):587–593
Daniel LC, Grant M, Kothare SV, Dampier C, Barakat LP (2010) Sleep patterns in pediatric sickle cell disease. Pediatr Blood Cancer 55(3):501–507
Hollocks MJ, Kok TB, Kirkham FJ, Gavlak J, Inusa BP, DeBaun MR, de Haan M (2012) Nocturnal oxygen desaturation and disordered sleep as a potential factor in executive dysfunction in sickle cell anemia. J Int Neuropsychol Soc 18(1):168–173
Sharma S, Efird JT, Knupp C, Kadali R, Liles D, Shiue K, Boettger P, Quan SF (2015) Sleep disorders in adult sickle cell patients. J Clin Sleep Med 11(3):219–223
Rosen CL, Debaun MR, Strunk RC, Redline S, Seicean S, Craven DI, Gavlak JCD, Wilkey O, Inusa B, Roberts I, Goodpaster RL, Malow B, Rodeghier M, Kirkham FJ (2014) Obstructive sleep apnea and sickle cell anemia. Pediatrics 134(2):273–281
Downes M, et al., (2017) Parent reported sleep problems in preschool children with sickle cell anemia and controls in East London. Pediatr Blood Cancer 64(6)
Gileles-Hillel A, Kheirandish-Gozal L, Gozal D (2015) Hemoglobinopathies and sleep—the road less traveled. Sleep Med Rev 24:57–70
Graves JK, Jacob E (2014) Pain, coping, and sleep in children and adolescents with sickle cell disease. J Child Adolesc Psychiatr Nurs 27(3):109–120
Valrie CR, Bromberg MH, Palermo T, Schanberg LE (2013) A systematic review of sleep in pediatric pain populations. J Dev Behav Pediatr 34(2):120–128
Wallen GR, Minniti CP, Krumlauf M, Eckes E, Allen D, Oguhebe A, Seamon C, Darbari DS, Hildesheim M, Yang L, Schulden JD, Kato GJ, Taylor VI JG (2014) Sleep disturbance, depression and pain in adults with sickle cell disease. BMC Psychiatry 14:207
Dos Santos J, Gomes Neto M (2013) Sociodemographic aspects and quality of life of patients with sickle cell anemia. Rev Bras Hematol Hemoter 35:242–245
Hasan SP, Hashmi S, Alhassen M, Lawson W, Castro O (2003) Depression in sickle cell disease. J Natl Med Assoc 95(7):533–537
Simo SM, Siela D (2018) Use of a depression and sleep impairment treatment guideline to improve quality of life for patients with sickle cell disease. Int J Palliat Nurs 24(5):246–255
Brown WJ, Wilkerson AK, Boyd SJ, Dewey D, Mesa F, Bunnell BE (2018) A review of sleep disturbance in children and adolescents with anxiety. J Sleep Res 27(3):e12635
Gould CE, Spira AP, Liou-Johnson V, Cassidy-Eagle E, Kawai M, Mashal N, O’Hara R, Beaudreau SA (2018) Association of Anxiety Symptom Clusters with Sleep Quality and Daytime Sleepiness. J Gerontol B Psychol Sci Soc Sci 73(3):413–420
Press Y, Punchik B, Freud T (2018) The association between subjectively impaired sleep and symptoms of depression and anxiety in a frail elderly population. Aging Clin Exp Res 30(7):755–765
Perez E, Dzierzewski JM, Aiken-Morgan AT, McCrae CS, Buman MP, Giacobbi PR, Roberts BL, Marsiske M (2019) Anxiety and executive functions in mid-to-late life: the moderating role of sleep. Aging Ment Health:1–7
Bills SE, Katz T, McNeil J, Schatz J (2019) Does obstructive sleep apnea increase cognitive deficits in pediatric sickle cell disease? J Int Neuropsychol Soc 25(9):922–930
Cha DS, Carmona N, Cha RH, Zhou AJ, Subramaniapillai M, Mansur RB, Lee Y, Lee JH, Lee J, Almatham F, Alageel A, Rosenblat JD, Shekotikhina M, Rong C, Harrison J, McIntyre R (2019) Perceived sleep quality predicts cognitive function in adults with major depressive disorder independent of depression severity. Ann Clin Psychiatry 31(1):17–26
Lillis T et al (2018) Sleep disturbances and depression symptoms mediate relationship between pain and cognitive dysfunction in lupus. Am Coll Rheumatol 71:406–412
Aras YG, Tunç A, Güngen BD, Güngen AC, Aydemir Y, Demiyürek BE (2017) The effects of depression, anxiety and sleep disturbances on cognitive impairment in patients with chronic obstructive pulmonary disease. Cogn Neurodyn 11(6):565–571
de Almondes KM et al (2016) The relationship between sleep complaints, depression, and executive functions on older adults. Front Psychol 7:1547
Lee SH, Kang Y, Cho SJ (2017) Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality. J Headache Pain 18(1):77
Hughes AJ, Parmenter BA, Haselkorn JK, Lovera JF, Bourdette D, Boudreau E, Cameron MH, Turner AP (2017) Sleep and its associations with perceived and objective cognitive impairment in individuals with multiple sclerosis. J Sleep Res 26(4):428–435
Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, DeVellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R (2010) The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol 63(11):1179–1194
Roth RM, Isquith PK, Gioia GA (2005) BRIEF-A: behavioral rating inventory of executive function—adult version, Psychological Assessment Resources, Lutz
Delis D, Kaplan E, Kramer J (2001) Delis-Kaplan Executive Function System Examiner’s Manual. The Psychological Corporation, San Antonio
Corp I (2019) IBM SPSS Statistics for Macintosh, Version 26.0. IBM Corp, Armonk
Hayes A (2013) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford, New York
Field A, (2013) Discovering statistics using IBM SPSS Statistics. 4th ed. Sage
Levenson JL, McClish DK, Dahman BA, Bovbjerg VE, de A. Citero V, Penberthy LT, Aisiku IP, Roberts JD, Roseff SD, Smith WR (2008) Depression and anxiety in adults with sickle cell disease: the PiSCES project. Psychosom Med 70(2):192–196
Asnani MR, Fraser R, Lewis NA, Reid ME (2010) Depression and loneliness in Jamaicans with sickle cell disease. BMC Psychiatry 10:40
Laurence B, George D, Woods D (2006) Association between elevated depressive symptoms and clinical disease severity in African-American adults with sickle cell disease. J Natl Med Assoc 98(3):365–369
Brody DJ, Pratt LA, Hughes JP Prevalence of depression among adults aged 20 and over: United States, 2013-2016. NCHS Data Brief 2018(303):1–8
Gelonch O, Garolera M, Valls J, Rosselló L, Pifarré J (2016) Executive function in fibromyalgia: comparing subjective and objective measures. Compr Psychiatry 66:113–122
Vlagsma TT, Koerts J, Tucha O, Dijkstra HT, Duits AA, van Laar T, Spikman JM (2017) Objective versus subjective measures of executive functions: predictors of participation and quality of life in Parkinson disease? Arch Phys Med Rehabil 98(11):2181–2187
Fisher K, Laikin AM, Sharp KMH, Criddle CA, Palermo TM, Karlson CW (2018) Temporal relationship between daily pain and actigraphy sleep patterns in pediatric sickle cell disease. J Behav Med 41(3):416–422
Valrie CR, Kilpatrick RL, Alston K, Trout K, Redding-Lallinger R, Sisler I, Fuh B (2019) Investigating the sleep-pain relationship in youth with sickle cell utilizing mHealth technology. J Pediatr Psychol 44(3):323–332
Halphen I, Elie C, Brousse V, le Bourgeois M, Allali S, Bonnet D, de Montalembert M (2014) Severe nocturnal and postexercise hypoxia in children and adolescents with sickle cell disease. PLoS One 9(5):e97462
Uong EC, Boyd JH, DeBaun MR (2006) Daytime pulse oximeter measurements do not predict incidence of pain and acute chest syndrome episodes in sickle cell anemia. J Pediatr 149(5):707–709
Willen SM, Rodeghier M, Rosen CL, DeBaun MR (2018) Sleep disordered breathing does not predict acute severe pain episodes in children with sickle cell anemia. Am J Hematol 93(4):478–485
de la Vega R et al (2019) The role of sleep quality and fatigue on the benefits of an interdisciplinary treatment for adults with chronic pain. Pain Pract 19(4):354–362
Blake MJ, Snoep L, Raniti M, Schwartz O, Waloszek JM, Simmons JG, Murray G, Blake L, Landau ER, Dahl RE, Bootzin R, McMakin DL, Dudgeon P, Trinder J, Allen NB (2017) A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality. Behav Res Ther 99:147–156
Lengacher CA, Reich RR, Paterson CL, Jim HS, Ramesar S, Alinat CB, Budhrani PH, Farias JR, Shelton MM, Moscoso MS, Park JY, Kip KE (2015) The effects of mindfulness-based stress reduction on objective and subjective sleep parameters in women with breast cancer: a randomized controlled trial. Psychooncology 24(4):424–432
Gallegos AM, Moynihan J, Pigeon WR (2018) A secondary analysis of sleep quality changes in older adults from a randomized trial of an MBSR program. J Appl Gerontol 37(11):1327–1343
Carlson LE, Garland SN (2005) Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med 12(4):278–285
The authors are grateful to the patients who participated in this study. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
This work was funded, in part, by the NCI Center for Cancer Research IRP. This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the National Heart Lung and Blood Institute (Protocol Numbers: 09-H-0225, 03-H-0170, 14-H-0077, 17-H-0069).
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent for publication
Patients signed informed consent regarding publishing their data.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Rhodes, A., Martin, S., Wolters, P. et al. Sleep disturbance in adults with sickle cell disease: relationships with executive and psychological functioning. Ann Hematol 99, 2057–2064 (2020). https://doi.org/10.1007/s00277-020-04058-7
- Sickle cell disease
- Executive functioning