The Relationship of Sleep Disturbance and Disease-Related Factors on Neural and Neurocognitive Function in Youth Living with Sickle Cell Disease

Authors

• Tiffany DeVaughn Tucker, University of Alabama at Birmingham

Advisor(s)

Donna Murdaugh

Committee Member(s)

Ammar Aalishlash
Jeffrey Lebensburger
Justin Thomas
Kristi Guest
Sylvie Mrug

School

College of Arts and Sciences

Document Type

Dissertation

Department (new version)

Psychology

Date of Award

9-9-2024

Abstract

Youth living with sickle cell disease (SCD) often face neurocognitive challenges, regardless of accompanying neurological issues. SCD involves red blood cell deformation, leading to complications including chronic anemia, vaso-occlusion, and acute crises such as pain and overt stroke. While screening and intervention advancements have improved survival, enhancing functional capacity and quality of life (QoL) remains a targeted area of intervention. Disease-related factors, sleep disturbances, and social determinants significantly impact neurocognitive health in youth living with SCD. Deficits across all cognitive domains, including attention, working memory, and executive function (EF), are common, affecting academic achievement and QoL. Brain-related issues, such as overt stroke and silent cerebral infarcts, contribute to morbidity and mortality. Advanced neuroimaging techniques reveal brain volume variations and altered connectivity patterns across SCD genotypes despite the absence of overt stroke. However, comprehensive studies integrating SCD risk and protective factors are limited. Thus, the overarching goal of the current study was to explore, characterize, and identify the risk and protective factors associated with neurocognitive outcomes in youth living with SCD, utilizing a combination of neuroimaging and neurocognitive techniques. First, a retrospective chart review was proposed to assess the relationship between subjective sleep, objective sleep, and disease-related, sociodemographic, and socioeconomic factors. Participants (age ≤18) with objective sleep (n = 144) and subjective sleep (n = 160) measures were selected from existing databases in collaboration with the Children's of Alabama (CoA) Center for Childhood Cancer and Blood Disorders. Findings indicated that demographic, disease-related factors, emergency department visits, treatment adherence, and low socioeconomic status were linked to subjective sleep and objective (e.g., nocturnal oxygen levels and sleep arousals) disturbance in youth living with SCD. Next, we used a subgroup of participants (subjective sleep n = 33; objective sleep n = 42) with neurocognitive measures from the first study to assess the relationship between sleep and neurocognitive outcomes while accounting for impacting disease-related, sociodemographic, and socioeconomic factors. Subjective sleep-related impairments were linked to decreased cognitive flexibility and caregiver-rated EF. Objective sleep, including time spent under 90% oxygen saturation, was associated with decreased cognitive flexibility and processing speed. Finally, a second subgroup of participants who completed neuroimaging was explored to assess the relationship between subjective sleep, neurocognitive outcomes, and resting-state functional connectivity. Results indicated positive correlations in the executive control, salience, and dorsal attention networks related to cognitive flexibility, attention, and subjective sleep disturbance. In summary, the findings support growing research detailing disease-related risk and socioeconomic factors interfering with sleep, which can impact neurocognitive outcomes and present complex complications, including differences in brain network functional connectivity. Given that cognition, sleep, socioeconomic, and disease-related variables are significant risk factors for this population, it is vital that youth living with SCD have access to comprehensive medical care to monitor and provide targeted interventions to improve overall QoL.

ProQuest ID

https://proquest.com/docview/3101971120