Patient-Reported Outcomes for Measuring Sleep Disturbance in Pediatric Atopic Dermatitis: cross sectional study of PROMIS Pediatric Sleep Measures and Actigraphy.

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Most children with atopic dermatitis(AD) suffer from sleep disturbance, but reliable and valid assessment tools are lacking.To test PROMIS (Patient Reported Outcomes Measurement Information System) sleep measures in pediatric AD and to develop an algorithm to screen, assess and intervene to reduce sleep disturbance.A cross-sectional study was conducted with AD children ages 5-17 years and one parent(n=61), who completed sleep, itch, and AD-specific questionnaires; clinicians assessed disease severity. All children wore actigraphy watches for 1-week-objective sleep assessment.PROMIS sleep disturbance parent-proxy-reliability was high (Cronbach's α=0.90) and differentiated among Patient Oriented Eczema Measure (POEM)-determined disease severity groups (mean±SD in mild vs. moderate vs. severe was 55.7±7.5 vs. 59.8±10.8 vs. 67.1±9.5, p<0.01). Sleep disturbance correlated with itch (Numerical Rating Scale/NRS, r=0.48), PROMIS sleep-related impairment (r=0.57), and worsened quality of life (Children's Dermatology Life Quality Index/CDLQI, r=0.58), all p<0.01. Positive report on POEM sleep disturbance question has high sensitivity (95%) for PROMIS parent-proxy-reported sleep disturbance (T-score ≥60). An algorithm for screening and intervening on sleep disturbance was proposed.This was a local sample.Sleep disturbance in pediatric AD should be screened using the POEM sleep question, with further assessment using the PROMIS sleep disturbance measure or objective sleep monitoring if needed.


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