Date of Award

Fall 2020

Document Type

Open Access Thesis



First Advisor

Jeffrey Schatz


Youth with sickle cell disease (SCD) are at increased risk for poor psychosocial and functional outcomes due, in part, to disease effects like vaso-occlusive pain crises, fatigue, and poor sleep quality (Brown, 2006). A growing body of literature has examined temporal associations between pain, sleep quality, and mood using daily diary studies (Valrie, Gil, Redding-Lallinger, & Daeschner, 2007a; Valrie et al., 2019). These studies help to identify how symptoms are prospectively related to each other, but they are often limited to small sample sizes and may lack generalizability. Additionally, despite ubiquitous reports of fatigue among sickle cell patients, few studies have examined this construct in youth with SCD. The present study aims to a) replicate findings from prior daily diary studies to increase our understanding of their generalizability and b) examine novel indicators of fatigue among youth with SCD. Daily diaries assessing positive and negative mood, pain severity, fatigue severity, sleep quality, and use of pain medications were collected for eight consecutive weeks among youth. Results indicated significant associations between increased same-day pain and poor prior-night sleep quality, and increased fatigue. Poor sleep quality predicted increases in next-day fatigue levels among youth and moderated the temporal relationship for pain impacting next-day fatigue. Opioid and non-opioid medication use did not significantly affect ratings of next-day fatigue. Overall, most findings from prior daily diary studies were replicated, while a few were not. Future research using larger samples should attempt to elucidate discrepancies in findings. Novel findings from this study supported that sleep quality plays an important role in predicting fatigue levels and modifies the prospective pain-fatigue relationship. As such, sleep quality may be an important target for intervention. Finally, pain medication use may not substantially contribute to prospective fatigue levels among youth, which decreases concerns about possible iatrogenic effects medication use on sleep quality.


© 2020, Julia D. Johnston