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The Impact of Eczema on Sleep Lisa J. Meltzer, Ph.D., CBSM National - - PowerPoint PPT Presentation
The Impact of Eczema on Sleep Lisa J. Meltzer, Ph.D., CBSM National - - PowerPoint PPT Presentation
The Impact of Eczema on Sleep Lisa J. Meltzer, Ph.D., CBSM National Jewish Health August 5, 2017 Conflict of Interest Disclosures Grant/Research Support NIH NEA Consultant Johnson and Johnson Royalties Co-author, Pediatric Sleep
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What is Sleep?
§ Sleep is a reversible behavioral state of perceptual disengagement from and relative insensitivity to the environment, usually characterized by typical behavioral concomitants § Sleep is not a passive state and is essential for health, daytime functioning, and well-being
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Sleep is NOT for slackers!
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Who Needs Sleep?
§ Everyone! § By the age of 18 years, ~40% of time spent sleeping § 25-40% of healthy children have sleep problem at some point in childhood
§ Up to 83% of children with eczema have sleep issue
§ In most cases, when children don’t sleep, parents don’t sleep
§ Parenting a child with eczema above and beyond typical parenting
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itchylittleworld.com
Sleep in Parents of Healthy Children vs. Sleep in Parents of Children w/Eczema
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“Itching in Their Sleep Every Hour”
0 1 2 3 4 5 6 7 8 9 Hours of Sleep
Growth hormone released, brain recovery, executive functioning Memory consolidation, learning
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“Itching Worst at Bedtime”
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Parent and Child Sleep (AD)
§ Sleep disruption most disruptive aspect of disease for families across studies
§ Previous studies used single item to assess parent sleep disturbance § Limited comparison with other populations
§ 243 parents of children ages 1-19 years
§ 120 patients in NJH day hospital program § 61 ventilator assisted children (Vent) § 63 healthy, typically developing children (Typ)
Camfferman et al. (2010) Sleep Med Reviews; Meltzer & Moore (2008) Journal of Pediatric Psychology; Meltzer & Booster (2016) Journal of Pediatric Psychology
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Reasons for Night Wakings
10 20 30 40 50 60 70 80 90 100 Caregiving Stress - Child's Health General Stress Percent of Parents with NW >1/week
AD Asthma AD+ Vent Typ
Χ2 = 5.8, n.s.
Meltzer & Booster (2017) Journal of Pediatric Psychology
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Moderate to Severe Insomnia
5 10 15 20 25 30 35 40 45
Percent of Parents Above Clinical Cutoff
Insomnia Severity Index >15
AD Asthma AD+ Vent Typ
X2 = 36.3, p < .001
Meltzer & Booster (2017) Journal of Pediatric Psychology
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Child Night Wakings
10 20 30 40 50 60 70 80 90 100
< 1/week 5-7 x week
Percent of Children
AD Asthma AD+ Vent Typ
Χ2 = 106.7, p < .001
Meltzer & Booster (2017) Journal of Pediatric Psychology
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Objective Data: Actigraphy
§ Ambulatory device that measures movement with an accelerometer
§ Movements are frequent and large while awake, but absent or small during sleep
§ Worn on wrist (or ankle) for multiple 24- hour periods in the natural environment § Activity counts translated into epochs § Algorithm used to determine if each epoch is “sleep” or “wake”
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Objective Data
Chang et al. (2014) Pediatrics
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HEIST: Healing Eczema and Improving Sleep Trial
§ To examine impact of treatment for moderate to severe AD on sleep duration and sleep quality for children and their parents § To examine whether sleep mediates the relationship between AD severity and functional outcomes in children and parents
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§ Up to 60 families who are treated at NJH
§ Children 6 months to 17 years and parents
§ Actigraphy one week prior to admission § Questionnaires at admission and discharge
§ Mood, QOL, child behavior, cognitive abilities
§ Actigraphy/questionnaires one month after discharge § Questionnaires three months after discharge
HEIST: Healing Eczema and Improving Sleep Trial
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§ 2 year old boy, pre-treatment
Sleep Opportunity 11.1 hours Sleep Duration 8.4 hours Sleep Efficiency 75%
HEIST: Healing Eczema and Improving Sleep Trial
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§ 2 year old boy, one-month post-treatment
Sleep Opportunity 11.1 à 10.6 hours Sleep Duration 8.4 à 9.2 hours Sleep Efficiency 75% à 86%
HEIST: Healing Eczema and Improving Sleep Trial
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§ Mother of 2 year old boy, pre-treatment
Sleep Opportunity 7.2 hours Sleep Duration 6.3 hours Sleep Efficiency 88%
HEIST: Healing Eczema and Improving Sleep Trial
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§ Mother of 2 year old boy, post-treatment
Sleep Opportunity 7.2 à 7.8 hours Sleep Duration 6.3 à 7.2 hours Sleep Efficiency 88 à 93%
HEIST: Healing Eczema and Improving Sleep Trial
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Summary
§ Sleep essential for health, development and well-being § Both child and parent sleep disrupted by eczema § Treatment of eczema results in improved sleep for the family
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