APNA 26th Annual Conference Session 2047: November 8, 2012

Transcription

1 Sleep Impairment and Insomnia in Adults Living with Sickle Cell Disease: A Retrospective Chart Review of Clinical and Psychological Indicators Kathrynn Thompson MS, RN, PMHCNS-BC Valerie Mann-Jiles DNP, ANP-BC The speaker/investigators have no conflict of interest to disclose Presentation Objectives 1. Describe the role of the Mental Health Clinical Nurse Specialist (CNS) in the integrated physical and mental health care of the adult sickle cell patient. 2. Identify the possible etiologies/contributing factors of sleep impairment in the adult sickle cell patient. 3. Discuss the implications for future research in sleep impairment in the adult sickle cell patient. 3 Thompson, Mann-Jiles 1

2 Mental Health CNS Role in Integrated Care of Adult Sickle Cell Patient Initial complete mental health assessment of each patient on team Identification of mental health problems Diagnosis of psychiatric illnesses Ongoing treatment and evaluation Coordination of mental health care with physical care 4 Primary Aims of Research 1. To examine clinical and psychological indicators related to impaired sleep in adults with sickle cell disease 2. To investigate impaired sleep in adult patients with different types of sickle cell disease 5 Theoretical Framework The Theory of Unpleasant Symptoms (TOUS) This theory allows for the presence of multiple symptoms that interact and/or are multiplicative Adapted for use in chronic illness Lenz, E.R., Gift, A., Pugh, L.C. & Milligan, R.A. (2013). Unpleasant symptoms. In Peterson, S.J. & Bredow, T.S. (Eds Eds), Middle Range Theories: Application to Nursing Research (3 rd. Ed). Philadelphia: Wolters-Kluwer/Lippincott, Wiliams & Wilkins, pp Thompson, Mann-Jiles 2

3 Identified Problem Clinical observations of adults with sickle cell disease revealed sleep disturbances, although the contributing factors to these symptoms are understudied. The effect of sleep disturbances on the management of sickle cell disease progression and other related medical conditions in this population is less clear. Limited research in the adult population Methods An IRB-approved retrospective chart review of adult patients with sickle cell disease (N=72) was conducted at a Midwest comprehensive cancer center to observe for clinical and psychological indicators linked to sleep disturbances, specifically sleeplessness and insomnia. Assessments in clinic were reviewed for documentation of psychological factors; use of specific pain medications, anxiolytics, antidepressants, and sedative/hypnotics. Study Criteria Inclusion 18 years of age or older Lives in the United States Ability to read, write and understand English Diagnosis of SCD Hgb SS, SC or S beta Thal Exclusion Less than 18 years of age Residing outside the United States Inability to read, write or speak English Diagnosis other than Hgb SS, SC or S beta Thal; example: trait 9 Thompson, Mann-Jiles 3

4 Statistical Analyses Descriptive statistics Medians, ranges, and percentages Chi-square analyses to determine differences Sample Demographics I N % Gender Female Male Race African American Hispanic Disease Type Sickle cell anemia Sickle C disease Sickle beta thal Age Range (20-29) 54.8 Discussion Findings from this retrospective chart review illustrated that adults with sickle cell disease (N=72) frequently experienced insomnia (47%) and sleep impairment (15%). Statistically significant relationships existed between pain scores and sleep impairment (p<0.00), insomnia and pain scores (p<0.00) and hours of sleep in the am (p<0.00) and pm (p<0.00) as related to pain scores. These findings suggest that pain may contribute to insomnia or interrupt sleep habits. Hours of sleep in the morning positively correlated to insomnia, suggesting that daytime sleeping habits are not conducive to successful nighttime sleep hygiene. Thompson, Mann-Jiles 4

5 Discussion The use of anxiolytics, antidepressants, and long-acting opioids, were negatively correlated to insomnia (p<0.00), (p<0.43), and (p<0.10) respectively. The statistically significant relationship suggest that a lessening of anxiety, may reduce the incidence of insomnia. Additionally, the use of long-acting opioids may provide improved pain control, thus allowing improved sleep. Limitations of the study Scope of research limited to one geographical facility which limits generalization to all SCD population Convenience, self-selected selected sample Contributions of the Study Increased understanding of the meaning of sleep disturbances for people living with SCD Contribution to the SCD sleep research by investigating the sleep disturbances in adult patients with SS, hemoglobin SC, or hemoglobin S Beta Thalassemia Thompson, Mann-Jiles 5

6 Implications for Practice Health care providers play a pivotal role in the assessment, screening, intervention and if needed, referral for patients with sleep impairment or disorders Affective assessment and management of impaired sleep is necessary for improved quality of life for this adult population and their families Recommendations for Future Research Larger sample sizes and a broader spectrum of SCD Further investigation is needed to understand the meaning of sleep impairment in adult patients with sickle cell disease with prospective controlled studies to examine the efficacy of interventions, specifically pain-related outcomes. Thank you for your attention Any Questions? Thompson, Mann-Jiles 6

7 REFERENCES Castro, M.M.C. & Daltro, C. (2009). Sleep patterns and symptoms of anxiety and depression in patients with chronic pain. Archives of Neuropsychiatry, 67(1); Davies, K.A., Macfarlane, G.J., Nicholl, B.I., Dickens, C., Morris, R., Ray, D. & McBeth, J. (2008). Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study. Rheumatology, 47: Fortier-Brochu, E. Beaulieu-Bonneau, S., Ivers, H., & Morin, C.M. (2010). Relations between sleep,f atigue and health related quality of life in individuals with insomnia. Journal of Psychosomatic Research, 69; Lenz, E.R., Gift, A., Pugh, L.C. & Milligan, R.A. (2013). Unpleasant symptoms. In Peterson, S.J. & Bredow, T.S. (Eds Eds), Middle Range Theories: Application to Nursing Research (3 rd. Ed). Philadelphia: Wolters-Kluwer/Lippincott, Williams & Wilkins, pp Levenson, J.L. (2008).Psychiatric issues in adults with sickle cell disease. Primary Psychiatry. 15 (5);45-49 Parish, J.M. (2009). Sleep-related problems in common medical conditions. Chest, 135: Turk, D.C. & Cohen, M.J.M. (2010). Sleep as a marker in the effective management of chronic osteoarthritis pain with opioid analgesics. Seminars in Arthritis and Rheumatism, 39 (6); U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). Morbidity and Mortality Weekly Report. Weekly Report, 60:8 19 Thompson, Mann-Jiles 7