Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Sleep in Polyarticular Juvenile Idiopathic Arthritis: An Electronic Daily Diary Study.

Bromberg5,  Maggie H., Valrie4,  Cecelia R., Connelly1,  Mark, Anthony3,  Kelly K., Franks3,  Lindsey, Gil6,  Karen M., Schanberg2,  Laura E.

Children's Mercy Hospital and Clinics
Duke Univ Medical Center, Durham, NC
Duke University Medical Center, Durham, NC
East Carolina University
University of North Carolina at Chapel Hill, Carrboro, NC
University of North Carolina at Chapel Hill

Purpose:

In addition to joint pain and stiffness, children with arthritis may experience sleep problems. Recently, researchers have used electronic surveys to track symptom and behavior fluctuations, including sleep, in home settings. This study compares child- and parent- reported daily electronic surveys describing children's sleep quality.

Methods:

The sample consisted of 31 children with active polyarticular arthritis (27 girls; 80.7% Caucasian; mean age 12.7 years, 45% with moderate to severe disease severity) and their parents (87% mothers; mean age 41.7 years). As part of a larger study, all participants recorded symptoms on an electronic survey via a smartphone three times each day for one month, including ratings of child sleep each morning. Physicians completed disease severity ratings at baseline. Sleep quality was rated on an electronic visual analog scale with the anchors "Did not sleep well" and "Slept very well." Daily sleep quality reports were aggregated, descriptive statistics were performed on all sleep variables, and compliance rates were calculated. Dependent sample t-tests were used to compare average parent and child sleep quality ratings.

Results:

Children completed 65% and parents completed 72% of all possible electronic morning reports. Averaging all reports, children in the sample reported moderate to high sleep quality (m = 70.09, SD = 27.77). Parent ratings of child sleep quality were not significantly different (t =-0.59, p >.05). Children and parents' individual sleep quality entries spanned the full range of 0–100mm. Poor sleep quality (>1SD below the mean) was reported by children on 18% and parents on 25% of all morning reports. Self-reported sleep quality did not vary by gender (t=-1.58, p>.05). Neither child nor parent-reported average sleep quality scores correlated with physician-rated disease severity (r =.27, p >.05; r=.22, p >.05) or age (r =-.25, p >.05; r=-.18, p >.05). However, average self-reported pain (m = 28.6, SD =21.9) and self-reported sleep quality were significantly correlated (r =-.45, p <.05), as were parent-reported average pain (m = 28.42, SD = 20.66) and parent-reported average sleep quality (r =-.41, p <.05). Children reported sleeping 4–8 hours on 55.7% of nights and 8–10 hours on 33.4% of nights, and reported mild difficulty with sleep onset and few night wakenings.

Conclusions:

Parents and children completed comparable numbers of morning electronic diary surveys, suggesting that children can adequately complete independent entries using this new technology. Self- and parent- ratings of child sleep quality were similar, supporting the use of child self-reported sleep ratings in future studies. Children generally reported adequate sleep duration and few sleep disruptions during the night. Although disease and demographic variables were not related to sleep quality scores, pain intensity reports correlated to sleep quality. Despite adequate sleep quality on average, children reported experiencing poor sleep quality on 18% of morning reports, suggesting daily variability. Additional research is needed to identify factors effecting daily sleep quality and to determine the clinical impact of sleep quality variability.

To cite this abstract, please use the following information:
Bromberg, Maggie H., Valrie, Cecelia R., Connelly, Mark, Anthony, Kelly K., Franks, Lindsey, Gil, Karen M., et al; Sleep in Polyarticular Juvenile Idiopathic Arthritis: An Electronic Daily Diary Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1406
DOI: 10.1002/art.29172

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