For patients with sickle cell disease (SCD), there is a connection between sleep disturbances and anxiety, according to study results reported in the Annals of Hematology.

Although previous studies suggest that sleep disturbances are common and related to neurocognitive difficulties with SCD, research is very limited. A team of investigators conducted a cross-sectional analysis to examine whether relationships exist between sleep difficulties and cognitive and/or emotional function among patients with SCD.

Assessments of 62 adults with SCD (29 women; 95.2% Black/African-American; median age, 32 years) were made using 3 measurement systems prior to the patients undergoing stem cell transplants. The Patient-Reported Outcomes Measurement Information System was used with an emphasis on metrics for pain intensity, sleep disturbance, and anxiety and depression. Executive function was evaluated using the Behavior Rating Inventory of Executive Functions – Adult and the Delis-Kaplan Executive Function System.

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Reportedly, 17.7% of patients had sleep disturbances that were clinically significant. Clinically significant anxiety was also reported in 16.1% of participants, while clinically significant depression was reported in 8% of participants.

Scores for sleep disturbance were linked to anxiety (P <.001) and to depression (P <.05), but not to the metrics used for executive function. Pain intensity was linked to anxiety and depression but not to sleep disturbance or executive function.

While a significant correlation was not found between sleep disturbances and executive functioning, anxiety did appear to be a mediator between sleep disturbances and executive functioning. Depression did not show such an effect.

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The study investigators noted that the study population consisted of patients expecting to undergo stem cell transplantation, implying a considerable level of morbidity in this population that may limit the applicability of this study’s results to the broader population of patients with SCD.

Even so, the researchers pointed out that many of the features examined in this study tend to occur in patients with SCD, and they indicated that the rate of sleep disturbance was lower in this study than was found in prior research.

“These findings demonstrate the significance of anxiety in understanding sleep and cognitive functioning among individuals with SCD,” concluded the investigators.


Rhodes A, Martin S, Wolters P, et al. Sleep disturbance in adults with sickle cell disease: relationships with executive and psychological functioning [published online May 27, 2020]. Ann Hematol. doi: 10.1007/s00277-020-04058-7