Robyn Stremler and Jordana McMurray in Sim Lab

Sleep disturbances in youth with cystic fibrosis and the impact on their mental health

16 March 2023

Camille Goncalves and Jordana McMurray. Photo by Horst Herget

According to Robyn Stremler, professor at the Lawrence Bloomberg Faculty of Nursing, asking about someone’s sleep habits can be a less stigmatizing way of probing a patient’s mental health. Their response often leads to important discussions around stress, insomnia, and a range of issues that could be impacting a patient’s quality of life.

“There is considerable research showing that missing out on sleep increases your risk of developing anxiety or depressive symptoms,” says Stremler who is also an adjunct scientist at SickKids Hospital. “When we set out to understand sleep and sleep disturbances in certain populations, we are also looking at ways in which interventions might improve sleep to have a positive impact on a patient’s life.”

In an upcoming study Jordana McMurray, a PhD student at Bloomberg Nursing under the supervision of Professor Stremler, will be using actigraphy, a wearable device worn on the wrist, to measure sleep in adolescents and young adults with cystic fibrosis (CF) and its subsequent impact on their mental health.

CF is the most common life-limiting genetic illness in Canadian youth and is caused by a mutation in the gene responsible for coding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. Lack of this protein affects many systems in the body but most significantly affects the lungs and gastrointestinal tract where loss of CFTR function results in the production of thick mucus secretions.

“Improving our understanding of what sleep is like for those with CF, and including reasons for sleep disturbance, will give us a better sense of whether early interventions to improve sleep are needed” says McMurray, whose background as an RN, is in pediatric respiratory medicine also at SickKids Hospital.

The study which has received funding from the Canadian Lung Association and Cystic Fibrosis Canada, will compare those with CF to a healthy control group and will also examine relationships between sleep disturbance and symptoms of anxiety and depression in adolescents and young adults with CF.

To assess sleep and wakefulness, McMurray will use an actigraph device, similar to commercial style smart watches, which contains an accelerometer and can determine how often the participant moves while sleeping. A specialized computer program will then use an algorithm to assess minute by minute when sleep is taking place.

Robyn Stremler and Jordana McMurray in Sim Lab

“One of the great benefits of using actigraphy, is that the device can be worn for longer periods of time, and we can capture typical or usual sleep as it occurs daily compared to what might be assessed in a sleep lab,” says McMurray.

In addition to this captured data, participants will also be provided with a number of self-reported questionnaires on sleep and symptoms of anxiety and depression. Interviews with CF participants will feature prominently to incorporate their voices and obtain a nuanced understanding of sleep in this population.

In her clinical work as an RN, McMurray had witnessed a stark contrast in the sleep patterns of her pediatric CF patients, compared to patients with other respiratory disorders. This difference spurred her to consider exploring sleep in CF patients as part of her doctoral work.

An earlier systematic review conducted by McMurray in 2021, found evidence of objectively measured sleep disturbance and poor self or parent-reported sleep quality in adolescent CF patients. The review also found 13 factors associated with poor sleep, including an association with poor mental health.

McMurray points out that “sleep and mental health are inextricably intertwined, and we do not often pay enough attention to this relationship.”

“Patients with CF are facing a life-limiting and serious illness, so their sleep is very often overlooked,” adds Stremler. “However, Jordana’s research may provide evidence that earlier interventions in this group could help with their mental health and overall quality of life.”

Read more about Professor Stremler and Jordana McMurray’s research in our 2020-2022 Research Report