Member's paper - Kidney Health Education and Research Group

Abstract

VALIDATION OF THE PROMIS COMPUTER ADAPTIVE TESTING (CAT) SLEEP DISTURBANCE ITEM BANK IN KIDNEY TRANSPLANT RECIPIENTS

Hussain, J., Chawla, G., Ullah, N., Rafiqzad, H., Bartlett, S.J., Li, M., Howell, D., Peipert, J.D., Novak, M., Mucsi, I.

2019

American Transplant Congress

Full Abstract
Purpose: To assess the reliability and validity of the PROMIS Sleep Disturbance Item Bank using the Insomnia Severity Index as the primary legacy instrument in KTRs. Methods: A cross-sectional, sample of stable adult KTRs completed the PROMIS CAT Sleep Disturbance (SD) Item Bank, the Insomnia Severity Index (ISI), General Anxiety Disorder (GAD7), and Kidney Disease Quality of Life-36 (KDQoL-36) questionnaires on an electronic data capture platform. Sociodemographic and clinical data were collected from medical records. Construct validity was assessed using Spearman’s rho and known-group comparisons. Cut-off PROMIS CAT SD score to identify potentially clinically significant sleep problems was defined by Youden’s J Index in receiver-operating curve (ROC) analysis. Measurement agreement was assessed using Cohen’s kappa, test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Results: Mean(SD) age of 164 KTRs was 55(13) years, 56% were male, 59% were Caucasian, and 9% had moderate/severe sleep problems based on ISI cutoff of 15. PROMIS CAT SD was strongly correlated with ISI (rho=0.741, p<0.001). In known group comparisons, PROMIS CAT SD scores were marginally higher in patients with eGFR (in mL/min/1.73m2) >60 compared to <45 (52(8) vs 49(7), p=0.06). PROMIS CAT SD scores were higher in the first vs third tertile of KDQoL SF-12 Mental Composite scores (54(8) vs 46(8), p<0.001). KTRs with GAD scores >10 vs ≤10 also had higher scores on PROMIS CAT SD (58(6) vs 50(8), p<0.001). A cutoff of 60 for the PROMIS CAT SD score showed good discrimination when the ISI score 15 was considered to define clinically significant sleep problems with area under ROC curve of 0.908 (95% CI: (0.832, 0.983)). PROMIS CAT Sleep Disturbance showed good agreement with ISI (kappa=0.622) and excellent test-retest reliability (ICC = 0.777). Conclusions: These data contribute new evidence of the reliability and validity of PROMIS CAT Sleep Disturbance measure in KTRs and support its use in research and care.

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