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 Problems: A Clinician’s Guide to Behavioral Interventions

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

Sleep is NOT for slackers!

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

Sleep in Parents of Healthy Children vs. Sleep in Parents of Children w/Eczema itchylittleworld.com

“Itching in Their Sleep Every Hour” Memory consolidation, learning Growth hormone released, brain recovery, executive functioning 0 1 2 3 4 5 6 7 8 9 Hours of Sleep

“Itching Worst at Bedtime”

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

Reasons for Night Wakings AD Asthma AD+ Vent Typ 100 Χ 2 = 5.8, n.s. Percent of Parents with NW >1/week 90 80 70 60 50 40 30 20 10 0 Caregiving Stress - Child's Health General Stress Meltzer & Booster (2017) Journal of Pediatric Psychology

Moderate to Severe Insomnia AD Asthma AD+ Vent Typ 45 Percent of Parents Above Clinical Cutoff X 2 = 36.3, p < .001 40 35 30 25 20 15 10 5 0 Insomnia Severity Index >15 Meltzer & Booster (2017) Journal of Pediatric Psychology

Child Night Wakings AD Asthma AD+ Vent Typ 100 Χ 2 = 106.7, p < .001 90 80 Percent of Children 70 60 50 40 30 20 10 0 < 1/week 5-7 x week Meltzer & Booster (2017) Journal of Pediatric Psychology

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”

Objective Data Chang et al. (2014) Pediatrics

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

HEIST: Healing Eczema and Improving Sleep Trial § 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 § 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 § 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 § 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 § 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%

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

Thank You! Lisa J. Meltzer, Ph.D. National Jewish Health meltzerL@njhealth.org