All ETDs from UAB

Advisory Committee Chair

Marti Rice

Advisory Committee Members

Suzanne Ameringer

Andres Azuero

Gwendolyn Childs

Lisa Meltzer

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


ABSTRACT Introduction: Life expectancy is improving for those with sickle cell disease (SCD); however, with this improvement come increasing risks for long-term health complications. Early identification of health concerns could lead to improved long-term health outcomes. Two health concerns in school-age children with SCD are fatigue and blood pressure (BP). Previous research with other populations indicates perceived stress and sleep disturbance may influence outcomes of fatigue and BP. Further, cortisol, a stress hormone, may mediate the proposed relationships. Therefore, the purpose of the study was to determine effect sizes of relationships between fatigue, BP, perceived stress, and sleep disturbance in a convenience sample of children diagnosed with SCD. Additionally, examining the mediating role of cortisol between study variables was proposed. Method: A cross-sectional predictive design with convenience sampling was employed for this study. Recruitment occurred in two hematology clinics in the Southeastern U.S. Data collection occurred in one day during a scheduled appointment and included: a demographic questionnaire; Patient Reported Outcomes Measurement Information System Pediatric Fatigue Scale; Feel Bad Scale measuring child’s perceived stress; Child Reported Sleep Problems self-report measuring sleep disturbances; sleep diary data; blood pressure (oscillometric BP monitor), anthropometric measures; and salivary cortisol. Results: Thirty children, ages eight to fourteen-years-old, and their parent/guardian provided assent/consent for the study. Most children were HbSS type and female. Parents consisted of mostly mothers with diverse socioeconomic backgrounds. Analysis revealed clinically relevant (r > .2) effect sizes between perceived stress and fatigue (r = .72); perceived stress and cortisol (r = .25); sleep disturbance and fatigue (r = .75), DBP (r = .23), and cortisol (r = .24). Additionally, incident BP elevations were noted with 36.6% of participants having elevated systolic, and 6.6% elevated diastolic BP. Overall, 16.6% of participants had BP measurements in the elevated range, and 20% had BP measurements in stage 1 hypertensive range. Discussion: Incident BP elevations were apparent in this sample of children with SCD. Relationships between perceived stress and fatigue and sleep disturbances and fatigue and sleep disturbances and cortisol reached the level of clinical relevance. Findings support need for a larger, fully powered study. Keywords: sickle cell disease, perceived stress, sleep disturbance, fatigue, blood pressure, school-age children

Included in

Nursing Commons



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