REMOTE SALIVA SAMPLE COLLECTION FOR DIM LIGHT MELATONIN ONSET (DLMO) MEASUREMENT IN URBAN CHILDREN WITH ASTHMA DURING THE COVID-19 PANDEMIC

ABSTRACT

Introduction: The COVID-19 pandemic has challenged researchers to use remote data collection. Our project includes determining DLMO phase, requiring a family-friendly without face-to-face interaction. We describe here our protocol, experiences, lessons learned, and findings from the first 15 participants. Methods: Fifteen urban-dwelling children with moderate to severe persistent asthma [7 girls, ages 7 (n=1) to 10 years;and 8 boys, 8 or 9 years] and caregiver (CG) participated. CG tracked bedtimes and risetimes in daily diaries for 10-14 days;average bedtimes from 5 nights preceding saliva collection were used to determine timing for 10 half-hourly samples. CG and child were oriented and then watched a demo video. A spit-kit was delivered to the home the afternoon of the study. Kits included a small cooler bag with bottle of water, 10 numbered and 5 spare Salivette tubes (Starstedt, Germany), plastic bag, dark wraparound glasses with securing strap, and log sheet. Data collection began with a zoom call with staff, CG, and child to reiterate the instructions, answer questions, and observe the first sample. Thereafter, a staff member telephoned the caregiver every 30 minutes to prompt the next sample and query whether glasses had been kept on. CG placed kit outside the home for morning pick up. Samples were centrifuged and frozen (-20°) until sending to the assay lab (SolidPhase, Portland, ME) for melatonin radioimmunoassay (Alpco, Windham, NH). Results: DLMO phase was determined with a 4pg/ml threshold for 11 children. DLMO phases (mtime=2146±68 min) and average bedtimes (mtime=2040±88min) were positively correlated (r=.87). Challenges identified for missed DLMOs included one child supervised by a teenaged sibling (not CG);one child/CG identified as potentially uncooperative. The other two misses likely arose from low saliva quantity, inconsistencies with staff training, and inadequate description of requirements for wearing glasses. Procedure modifications included strategies tailored to families' needs, experiences, and home environment that can challenge adherence to protocol, greater emphasis on wearing glasses, and cartoon reminder card and scales added to kit. Subsequent samples were successful. Conclusion: Our approach was effective for determining DLMO phase in children using a remote approach with careful application of methods.