Patient-reported outcomes for measuring sleep disturbance in pediatric atopic dermatitis: Cross-sectional study of the Patient Reported Outcomes Measurement Information System pediatric sleep measures and actigraphy

J Am Acad Dermatol. 2023 Feb;88(2):348-356. doi: 10.1016/j.jaad.2020.05.138. Epub 2020 Jun 3.


Background: Most children with atopic dermatitis (AD) experience sleep disturbance, but reliable and valid assessment tools are lacking.

Objectives: To test the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in pediatric AD and to develop an algorithm to screen, assess, and intervene to reduce sleep disturbance.

Methods: A cross-sectional study was conducted with children with AD ages 5 to 17 years and 1 parent (n = 61), who completed sleep, itch, and AD-specific questionnaires; clinicians assessed disease severity. All children wore actigraphy watches for a 1-week objective sleep assessment.

Results: PROMIS sleep disturbance parent proxy reliability was high (Cronbach α = 0.90) and was differentiated among Patient-Oriented Eczema Measure (POEM)-determined disease severity groups (mean ± standard deviation in mild vs moderate vs severe was 55.7 ± 7.5 vs 59.8 ± 10.8 vs 67.1 ± 9.5; P < .01). Sleep disturbance correlated with itch (numeric rating scale, r = 0.48), PROMIS sleep-related impairment (r = 0.57), and worsened quality of life (Children's Dermatology Life Quality Index, r = 0.58), with all P values less than .01. Positive report on the 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.

Limitations: This was a local sample.

Conclusions: 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.

Keywords: actigraphy; atopic dermatitis; child; eczema; patient-reported outcome measures; quality of life; self-report; sleep; surveys and questionnaires.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Actigraphy
  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Dermatitis, Atopic* / complications
  • Dermatitis, Atopic* / diagnosis
  • Humans
  • Information Systems
  • Patient Reported Outcome Measures
  • Pruritus / diagnosis
  • Pruritus / etiology
  • Quality of Life
  • Reproducibility of Results
  • Severity of Illness Index
  • Sleep
  • Sleep Wake Disorders* / diagnosis
  • Sleep Wake Disorders* / etiology