Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study

Abstract

Study objectives: The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range.

Methods: Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline.

Results: Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001).

Conclusions: SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.

Keywords: asthma; bedtime routine; behavioral sleep intervention; school-age children; shared management; sleep disturbance; sleep hygiene.

Conflict of interest statement

All authors have seen and approved of this manuscript. This study was supported by University of Washington Center for Innovation in Sleep Self-Management Grant NIH/NINR P30 NR016585, National Center For Advancing Translational Sciences of the National Institutes of Health Award KL2 TR002317, and Health Resources and Services Administration of the US Department of Health and Human Services Grant T72MC00007 (University of Washington Pediatric Pulmonary Center). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the US Government. The authors report no conflicts of interest.

© 2020 American Academy of Sleep Medicine.

Figures

Figure 1. SKIP study protocol.

Figure 2. SKIP module progression.

SKIP sleep environment module exemplar: (A) goal setting; (B) anticipating barriers and problem solving; (C) goal selection summary and tips; (D) progress report on prior week’s goal.

Figure 3. SKIP study postintervention semistructured interview questions.

Figure 4. SKIP study flow.

Figure 5. SKIP intervention preliminary efficacy by outcome variable.

*P < .05; **P < .01; ***P < .001.