Internalizing symptoms mediate the relationship between sleep disordered breathing and pain symptoms in a pediatric hematology/oncology sample

Objective: To examine caregiver ratings of children’s internalizing symptoms as a potential mediator between sleep disordered breathing and pain symptoms. Caregiver depression/anxiety symptoms were further examined as a potential moderator of the mediation model. Methods: Participants were 96 caregivers (82% mothers) of children with cancer, sickle cell disease, or other hematological conditions (M age = 10.45 years; 46.9% female, 78.1% African American). Caregivers completed questionnaires on child patient symptoms during regular clinic visits. Results: As hypothesized, the effect of sleep on pain (β = 0.31) was reduced (β = 0.15) after accounting for child internalizing symptoms (β = 0.17, 95% confidence interval = 0.03 to 0.42). The indirect effect accounted for 54.8% of the total effect. However, caregiver depression/anxiety symptoms were not a significant moderator of this mediation model. Conclusions: Sleep may play an important role in the experience of pain in children with hematology/oncology conditions. A child’s mood may mediate this relationship.