PROMIS SD, SRI: Validated Tools for Assessing Sleep in Adults With AD

sleep itch
sleep itch
PROMIS SD and SRI 8-item bank short forms demonstrate sufficient validity and feasibility to be used as assessment tools for burden of sleep in adults with atopic dermatitis.

The Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbances (SD) and sleep-related impairment (SRI) demonstrated good construct validity, internal consistency, feasibility, and responsiveness to investigate sleep in adult patients with atopic dermatitis (AD). The study results were published in the British Journal of Dermatology.

In adults with AD, sleep disturbance is typical. Although PROMIS SD and SRI are validated questionnaires to assess sleep in adults, their measurement properties in adults with AD remains unclear.

Consequently, the researchers investigated the measurement properties of PROMIS SD and SRI 8-item short-forms in adults with AD in a prospective, dermatology practice–based study of men and women (≥18 years) using questionnaires and evaluation by a dermatologist. The study enrolled 420 patients with 805 encounters, including 271 (64.5%) women, 245 (58.3%) Caucasians/whites, with a mean ± standard deviation age of 45.2±17.3 years. Spearman correlations were used to establish convergent construct validity of PROMIS SD and SRI. Feasibility was assessed by completion rates and time to completion for PROMIS SD and SRI.

The study results demonstrated that PROMIS SD and SRI had moderate correlations (r=0.67) and weak-moderate correlations with Patient‐Oriented Eczema Measure (rho=0.43/0.39) and average (rho=0.31/0.30) and worst numerical rating scale for itch (rho=0.32/0.30), Eczema Area and Severity Index (rho=0.41/0.31), and Scoring AD (SCORAD) (rho=0.44/0.30) (Spearman correlations, P <.0001). Both PROMIS SD and SRI established significant and stepwise increases for each level of frequency of sleep disturbance, self-reported global AD severity, and severe itch. In addition, both displayed good internal consistency (Cronbach’s alpha=0.84, 0.91, respectively). Changes from baseline in PROMIS SD and SRI were weakly to moderately correlated, and there were no floor or ceiling effects observed. All respondents completed all items in PROMIS SD and SRI, and the median completion time was 2 minutes.

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Limitations of the study include that it was a single-center study design, test-retest reliability or content validity was not examined, PSQI was not concurrently administered during the study, and objective assessments such as actigraphy or polysomnography was not used to compare PROMIS SD and SRI.

The researchers concluded that “the PROMIS SD and SRI 8-item short forms have good construct validity, internal consistency, and responsiveness to be used in clinical practice in adults with AD.” They suggest that these instruments can be “incorporated into the assessment of AD patients to improve the assessment and management of AD.”

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Lei D, Yousaf M, Janmohamed R, et al. Validation of patient-reported outcomes information system sleep disturbance and sleep-related impairment in adults with atopic dermatitis [published online February 4, 2020]. Br J Dermatol. doi: org/10.1111/bjd.18920