The Effect of Sleep Continuity on Pain in Adults With Sickle Cell Disease

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. Perspective: 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. (C) 2015 by the American Pain Society