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Feasibility and acceptability of self-directed, remote dim-light melatonin onset collection in pediatric patients
Nicole Tacugue1, Jessica J Love2,3,4, Jakob M Cherry2,5
1Laboratory for Digital Assessment, Research, and Treatment, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.
Insights
This study shows that at-home dim-light melatonin onset collections are accurate for measuring circadian rhythms in children with chronic pain. This novel approach improves accessibility for pediatric sleep research.
Area of Science:
- Pediatric Sleep Medicine
- Chronobiology
- Pain Management
Background:
- Sleep dysregulation is common in pediatric chronic pain, impacting outcomes.
- Current methods for measuring circadian rhythm (dim-light melatonin onset) are lab-based, limiting accessibility.
- Understanding circadian misalignment in pediatric pain is crucial.
Purpose of the Study:
- To investigate a novel, self-directed, at-home method for dim-light melatonin onset (DLMO) collection.
- To assess the feasibility, accuracy, and acceptability of this remote approach in pediatric populations.
- To explore potential for improved sleep intervention strategies in pediatric chronic pain.
Main Methods:
- A 3-week protocol involving pediatric chronic pain patients and healthy controls.
- Included sleep/activity tracking, sleep diaries, chronotype surveys, and self-directed home DLMO collections.
- Objective compliance measures and acceptability assessments were utilized.
Main Results:
- The study demonstrated the feasibility and accuracy of self-directed, remote DLMO collections in pediatric participants.
- Calculated DLMO times using two methods (Hockeystick, 3 pg/ml threshold) showed consistency.
- Average DLMO was 1 hour and 43 minutes earlier than self-reported sleep onset.
Conclusions:
- Self-directed, at-home DLMO collections are a viable and accurate method for pediatric populations.
- This approach enhances accessibility for circadian rhythm assessment in children.
- Optimized measurement of endogenous circadian phase can inform targeted sleep interventions for pediatric chronic pain.
Introduction:
Sleep dysregulation is highly prevalent in pediatric chronic pain conditions and associated with poorer clinical outcomes. Interactions between underlying circadian misalignments and pain in pediatric populations remain unclear. Dim-light melatonin onset collections conducted in external lab settings are standard for measuring circadian rhythmicity by examining fluctuations in melatonin levels. However, present limitations prevent us from capturing a typical night's sleep and minimize accessibility to broader populations due to geographic, financial, and temporal barriers. We investigated a novel approach in which participants complete collections in an entirely self-directed manner using an at-home diagnostic kit.
Methods:
Participants included pediatric patients with diagnosed chronic pain and healthy controls. The 3-week protocol involved sleep, activity, and light tracking, self-reported sleep diaries, a survey determining morningness-eveningness chronotypes, one self-directed home dim-light melatonin onset collection with objective compliance measures, and assessment of study protocol acceptability.
Results And Discussion:
In a sample of pediatric patients with diagnosed chronic pain (N = 6, Mage =14.5, SD = 2.74, 66.7% female) and a subset of healthy controls (N = 6, Mage =13.3, SD=2.73, 50% female), both the Hockeystick method and 3 pg/ml dim-light melatonin onset threshold were employed to calculate salivary dim-light melatonin onset times in 8 of the 12 participants. On average, dim-light melatonin onset times were 1 h and 43 min earlier than self-reported sleep onset times. Our results illustrate the feasibility and accuracy of self-directed, remote dim-light melatonin onset collections in pediatric populations. With supplementary research validating this optimized approach to measure endogenous circadian phase, more specific aspects of sleep can be targeted in pain intervention strategies to further optimize clinical outcomes in a greater population of pediatric patients.
