Impaired Patient-Reported Outcomes Predict Poor School Functioning and Daytime Sleepiness: the PROMIS Pediatric Asthma Study

OBJECTIVE: Poor asthma control in children is related to impaired patient-reported outcomes (PROs; eg, fatigue, depressive symptoms, anxiety), but less well studied is the effect of PROs on children's school performance and sleep outcomes. In this study we investigated whether the consistency status of PROs over time affected school functioning and daytime sleepiness in children with asthma. METHODS: Of the 238 children with asthma enrolled in the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Study, 169 children who provided survey data for all 4 time points were used in the analysis. The child's PROs, school functioning, and daytime sleepiness were measured 4 times within a 15-month period. PRO domains included asthma impact, pain interference, fatigue, depressive symptoms, anxiety, and mobility. Each child was classified as having poor/fair versus good PROs per meaningful cut points. The consistency status of each domain was classified as consistently poor/fair if poor/fair status was present for at least 3 time points; otherwise, the status was classified as consistently good. Seemingly unrelated regression was performed to test if consistently poor/fair PROs predicted impaired school functioning and daytime sleepiness at the fourth time point. RESULTS: Consistently poor/fair in all PRO domains was significantly associated with impaired school functioning and excessive daytime sleepiness (Ps <.01) after controlling for the influence of the child's age, sex, and race/ethnicity. CONCLUSIONS: Children with asthma with consistently poor/fair PROs are at risk of poor school functioning and daytime sleepiness. Developing child -friendly PRO assessment systems to track PROs can inform potential problems in the school setting.