Open Access Research article

Sleep disturbance, depression and pain in adults with sickle cell disease

Gwenyth R Wallen1, Caterina P Minniti2, Michael Krumlauf1, Ellen Eckes1, Darlene Allen2, Anna Oguhebe2, Cassie Seamon2, Deepika S Darbari23, Mariana Hildesheim2, Li Yang1, Jeffrey D Schulden4, Gregory J Kato2 and James G Taylor VI2*

Author Affiliations

1 National Institutes of Health, Clinical Center, Bethesda, MD, USA

2 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

3 Center for Cancer and Blood Diseases, Children’s National Medical Center, Washington, DC, USA

4 Division of Epidemiology, Services, and Prevention Research, National Institute of Drug Abuse, National Institutes of Health, Bethesda, MD, USA

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BMC Psychiatry 2014, 14:207  doi:10.1186/1471-244X-14-207

Published: 21 July 2014



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.


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.


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).


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.

Trial registration identifier: NCT00011648.

Sickle cell disease; Sleep disturbance; Depression; Chronic pain; Patient reported outcomes; Bethesda sickle cell cohort study