bluuebunny/crossref_metadata_2025 huggingface dataset:
0790 Polysomnographic Insights into the ADHD and OSA Connection in Children
Authors: Lacki Olga , Slaven James , Bandyopadhyay Anuja
Published: April 2024

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is closely linked to sleep disorders, particularly obstructive sleep apnea (OSA), but their relationship remains poorly understood. Polysomnographic studies on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated versus non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA.

Methods

Medical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019-2022. ADHD diagnosis was determined by ICD code F90, and moderate to severe OSA was defined by apnea-hypopnea indices (AHI) ≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA-alone, children with ADHD-alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest.

Results

4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA-alone (29.8%), 333 with ADHD-alone (8.3%), and 111 with ADHD+OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD-alone. However, they exhibited significantly better sleep efficiency, a polysomnographic proxy for insomnia, than children with OSA-alone, and sleep efficiency did not significantly differ from the other groups. No significant difference in periodic limb movements (PLMs) was found across all groups. Children with ADHD+OSA had higher BMIs than those with OSA-alone and ADHD-alone. The above results held true even after correcting for stimulant usage.

Conclusion

The polysomnographic marker of sleep efficiency falls short in explaining the frequency of insomnia diagnoses in children with ADHD. Enhanced subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with ADHD+OSA, polysomnogram results do not reveal any unique sleep parameters that cannot be better explained by OSA alone. Those with ADHD+OSA exhibit higher BMIs than those with ADHD alone, underscoring the importance of screening for OSA in children with ADHD symptoms, especially those with above-average BMIs.

Support (if any)

Morris Green Physician-Scientist Development Program and Joyce Victoria McRobbie Pediatric Fellowship
0795 Quantifying Guideline Adherence: Sleep Testing in the Pediatric down Syndrome Population
Authors: Balog Matthew , Loghmanee Darius , Donskoy Innessa , Snow Ayelet
Published: April 2024

Introduction

Down Syndrome (DS) is the most common chromosomal disorder, occurring in 1 in every 700 births. Clinically reported symptoms of obstructive sleep apnea (OSA), such as snoring, have been shown to be unreliable for predicting the presence of OSA in the DS population. With the prevalence of OSA in this vulnerable population estimated between 50-79%, and the lack of guidance that the traditional symptoms provide in clinical decision making, the American Academy of Pediatrics (AAP) recommends all children with DS be screened for OSA with polysomnography (PSG) before their 4th birthday. Previous studies conducted shortly after the publishing of these guidelines showed suboptimal adherence. Both DS and OSA impact medical costs over time, with OSA leading to a doubling of medical expenses (cite) and DS increasing it twelve-fold. Early diagnosis and treatment of OSA in children with Down Syndrome is imperative to improving morbidity in this patient population and lowering overall healthcare cost and utilization.

Methods

In this retrospective chart review, an electronic medical record (EMR) query for all patients aged 3-8 years, with a diagnosis of DS, and who live in Illinois was performed. The query included if any sleep clinic or PSG orders were placed and when these orders were completed. The query yielded a convenience sample of 582 children.

Results

Only 26% (117) of the subjects had a sleep medicine clinic or PSG order in their chart with 21% (124) having completed a PSG, and 11% (62) completed a sleep medicine visit. Only 23% (111) of patients between 4-8 years old were compliant with AAP sleep testing guidelines.

Conclusion

There is opportunity to strengthen the process of screening DS patients for OSA. The low adherence to AAP guidelines shown in this, and previous studies, highlight the need for dedicated quality assurance and improvement programs aimed at closing this practice gap, especially within institutions who care for sizable Down Syndrome populations.

Support (if any)

none
0802 Adolescents’ In-game Purchase, Problem Gaming, Gambling Game Playing Associated with Poor Sleep Quality
Authors: Chang Fong-Ching , Chuang Wei-Chun
Published: April 2024

Introduction

Problem gaming and sleep deprivation among adolescents represent critical issues in public health. Online gaming frequently incorporates monetary features, like microtransactions, blurring the line between gaming and gambling. More than half of parents are worried that their children feel pressured to make in-game purchases (Ofcom, 2023). Research has shown an association between problem gaming and heightened psychological distress as well as reduced sleep quality in adolescents. In Taiwan, there has been a notable increase in online game and gambling game advertisements across both offline and online platforms in recent decades. This study aims to explore the relationships between adolescents' exposure to marketing, parental involvement, in-game purchases, problem gaming, engagement in gambling games, psychological distress, and sleep problems in Taiwan.

Methods

Data were gathered from a sample of 2595 seventh-grade students across 30 middle schools in both urban and rural areas of Taiwan. A self-administered questionnaire was conducted in 2020. A panel of 8 experts was invited to assess the content validity of the questionnaire. The questionnaires were distributed to students in their classrooms by trained interviewers. Approval was obtained from the Institutional Review Board at National Taiwan Normal University.

Results

The findings revealed that 94% of adolescents engaged in online gaming, with 38% making in-game purchases, 9% participating in online gambling games, and 32% reporting poor sleep quality. The multiple regression results showed that adolescents exposed to higher levels of gaming marketing, involved in in-game purchases, and experiencing lower levels of active parental mediation were more likely to have problem gaming. Furthermore, adolescents with increased exposure to gambling game marketing, influenced by advertising effects, involved in in-game purchases, and experiencing problem gaming, were more likely to engage in online gambling games and purchase tokens. Additionally, adolescents involved in in-game purchases, problem gaming, and playing online gambling games were more likely to experience higher psychological distress and poor sleep quality.

Conclusion

Adolescents' engagement in in-game purchases, problem gaming behaviors, and playing online gambling games has been linked to increased risks of psychological distress and poor sleep quality.

Support (if any)

This research was supported by a research grant from the Taiwan Ministry of Science and Technology.
0805 Melatonin Use Among Children in Foster Care: Associations with Sleep and Daytime Behavior
Authors: Baker Carter , Vieira Alyssa , Cifre Anthony , Wolfson Amy , Ripple Carol , McGlinchey Eleanor , Alfano Candice
Published: April 2024

Introduction

In recent years, melatonin use has risen steeply in children of all ages. It is also the most commonly recommended intervention for sleep problems among children in foster care (Alfano et al., 2022) despite a lack of evidence of its safety and efficacy for children with a history of maltreatment/trauma. This study therefore investigated and compared aspects of sleep and daytime emotional/behavioral problems among children in foster care who have and have not been administered melatonin.

Methods

Survey data from N=454 caregivers from across the U.S. who were currently fostering children between the ages of 4- and 11-years-old (M=6.39, SD=2.20) were examined (McGlinchey et al., 2023). Caregivers were recruited for an anonymous online survey via private Facebook groups for foster families. Questions included whether or not they had ever administered melatonin to the foster child, aspects of the child’s sleep, and emotional/behavioral problems. Children included in the sample were relatively diverse, with 17% Black/African American and 11% Hispanic children from 46 U.S. states.

Results

Forty-eight percent (48%; n = 221) of foster caregivers reported administering melatonin to their child currently or in the past. ANCOVAs controlling for level of foster care (i.e., children with special needs) revealed melatonin use was associated with poorer sleep quality, F(1, 423)=25.118, p<.001, partial η²=.056, and increased severity of daytime behavioral problems, F(1, 410)=21.843, p<.001, partial η²=.051, based on medium effects. However, melatonin use was not associated with child depressive, F(1, 441)=2.151, p=.143, partial η²=.005, or anxiety symptoms, F(1, 422)=1.198, p=.274, partial η²=.003.

Conclusion

Children in foster care who are taking/have taken melatonin are reported to have worse quality sleep and more daytime emotional/behavioral problems than children in foster care not taking melatonin, but not more depressive or anxiety symptoms. The extent to which greater daytime problems might be a result of poorer nighttime sleep remains to be understood. Although our study has limitations, it is one of the first to examine behavioral correlates of melatonin use among children in foster care.

Support (if any)
0810 Impact of Schooling on the Measurement of Multidimensional Sleep Health in Adolescence
Authors: Nyhuis Casandra , Lenker Kristina , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio
Published: April 2024

Introduction

Multidimensional Sleep Health (MSH) is an emerging concept in sleep and circadian science that aims to capture the 24-hour experience of sleep and identify individuals in the population with good sleep health. While schooling is one of the most important contextual variables impacting adolescent sleep, little is known about how it impacts the measurement of MSH. In the present study, we examined differences in adolescent MSH while they were either in-school or on-break.

Methods

We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample, with 63% of the sample (n=236) in-school when sleep data were collected. We used the MSH RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – to derive a composite score of sleep health using actigraphy and self-reports.

Results

Adolescents in-school had a marginally (p=0.07) higher MSH score (3.12±1.2) than those on-break (2.87±1.4). Adolescents on-break were more likely to have optimal alertness (37.8% vs 31.8%, p< 0.05) and duration (37.2% vs 61.5%, p< 0.05), but less likely to have optimal timing (30.8% vs 61.8%, p< 0.001) and efficiency (34.6% vs 50.9%, p< 0.001) compared to those assessed while in-school. The differences observed in the timing and duration domains were driven by on-break adolescents mean sleep midpoint being more than an hour later than those in-school (4:42 am vs 3:36 am, p< 0.001) and having a mean sleep efficiency slightly below the cut-off of 85% (84.3% vs 85.9%, p< 0.05).

Conclusion

Accounting for contextual factors in adolescents, specifically whether they are attending school or not, is important for the measurement of MSH. Future work should derive cut-offs for optimal sleep health specific to adolescents as well as potentially include other timing dimensions beyond average sleep midpoint, such as social jetlag.

Support (if any)

NIH Awards Number R01HL136587, UL1TR000127
0814 Light Regularity Associated with Cognitive Performance in Adolescents with ADHD
Authors: Lunsford-Avery Jessica , Krystal Andrew , Engelhard Matthew
Published: April 2024

Introduction

Regular light exposure may play a key role in cognitive performance via both direct (via arousal) and indirect (via circadian rhythm regulation) mechanisms. Adolescents with ADHD are at risk for both cognitive deficits and circadian dysregulation, including delayed and irregular sleep patterns, and light exposure has been proposed as a critical contributor to ADHD-related impairments via its influence on circadian rhythm regulation. However, whether light irregularity contributes to cognitive impairment in adolescents with ADHD, and whether such relationships are mediated by disrupted sleep patterns, is unknown.

Methods

Forty-six adolescents aged 13-17 (54% female) completed a diagnostic interview, >5 days/nights of actigraphy, and a cognitive measure (Kaufman Brief Intelligence Test-Second Edition (KBIT-2): Verbal, Nonverbal, and Composite scores). Twenty were diagnosed with ADHD; 26 were healthy controls (HC). Partial Pearson correlations covarying for sex and age examined associations between the light regularity index (LRI: derived from actigraph-measured light exposure) and KBIT-2 performance in the full sample. We further explored whether LRI-cognition associations were specific to the ADHD group, and if so, whether such relationships were explained by shorter (total sleep time, TST), less regular (sleep regularity index, SRI), and delayed (sleep midpoint) sleep patterns.

Results

In the full sample, lower LRI correlated with poorer composite (r=.34, p=.03) and verbal (r=.42,p=.005), but not nonverbal (r=.08, p=.62), cognitive performance. Adolescents with ADHD displayed lower LRI than HC (β=-.31), and decreased LRI was related to lower SRI (r=.63) and later sleep midpoint (r=-.50) in this group (p’s<.05). In the ADHD group, LRI was associated with composite (r=.67) and verbal (r=.70) cognitive performance (p’s<.01), and these relationships remained significant in sensitivity analyses controlling for SRI, TST, and sleep midpoint (p’s<.05). Associations between LRI and cognition were non-significant in HC (p’s>.10).

Conclusion

Irregular light exposure is associated with cognitive deficits among adolescents with ADHD, which is not fully explained by disrupted actigraphy-measured sleep patterns. Future studies using additional behavioral and biological measures of circadian function (e.g., Dim Light Melatonin Onset) may elucidate the specific mechanisms by which light regularity supports cognitive performance among adolescents with ADHD and assess whether regularly-timed light exposure chronotherapy improves cognition in this population.

Support (if any)

K23MH108704, R34MH128440
0819 Cultural Adaptation and Preliminary Efficacy Testing of a Sleep Intervention (SIESTA) for Urban Latino Children
Authors: Koinis-Mitchell Daphne , Yeo Anna , Boergers Julie , Chavez Ligia , Canino Glorisa
Published: April 2024

Introduction

Latino children living in urban areas face disproportionate exposure to contextual and cultural stressors that can challenge optimal sleep. School Intervention to Enhance Latino Students’ Time Asleep (SIESTA) is a tailored intervention to improve sleep hygiene and duration in Latino middle school students in the U.S. and Puerto Rico.

Methods

Using Barrera and colleagues’ five stages of cultural adaptation, we identified intervention elements to retain, set refinement goals, and gathered information (literature review, focus groups/interviews, school feedback). Stage 2 involved expert review and integrating information from Stage 1. Stage 3 included an open trial to assess the content and acceptability of the adaptation. Stage 4 involved integration of feedback from the open trial. In Stage 5 (pilot RCT), Latino children (ages 11-13, n=34) and their caregivers were recruited from urban middle schools in Greater Providence and San Juan. Children were randomized to the SIESTA or control condition. SIESTA participants received a virtual group intervention (four sessions about sleep hygiene, duration, environment) and two caregiver-child sessions (sleep environment assessment, goal setting, feedback from daily sleep monitoring). Control participants received basic sleep and health education (equivalent contact time). All participants completed baseline, end-of-treatment (EOT), and 4-month follow-up assessments.

Results

We identified themes about sleep values and beliefs, urban stressors disrupting sleep (e.g., noise, crowding), and barriers to engagement. Each component was tailored based on experiences relevant to many urban Latino families. SIESTA participants reported high acceptability. Sleep duration measured via actigraphy increased by 13.3% (M=45min; d=0.16) in SIESTA participants vs. 7.2% (M=25min; d=0.14) in controls from baseline to EOT, p=.04. Differences were greater at 4-months (15% increase in SIESTA, 1% in controls). Caregiver- and child-reported sleep disturbances significantly decreased from baseline to EOT and to follow-up for SIESTA vs. controls (p’s<.04). Caregiver- and child-reported sleep hygiene improved significantly for SIESTA vs. controls from baseline to EOT and to follow-up (p’s<.05).

Conclusion

A rigorous, multi-method approach allowed for tailoring of an innovative intervention to address the sleep needs of urban Latino children. SIESTA shows potential to improve sleep duration and hygiene in this population. A large-scale RCT will evaluate effectiveness and implementation.

Support (if any)

1R34HL135073
0823 Associations Between Parental Anxiety, Psychological Distress, and Infant Sleep Difficulties
Authors: Narcisse Marie-Rachelle , Sharkey Katherine , Mason Gina , Barker David
Published: April 2024

Introduction

Insufficient sleep in infancy is linked with deleterious health outcomes, encompassing compromised brain development, learning, mental functioning, and emotional states. Whether parents' emotional symptoms influence infant sleep has not been examined at the national level comprehensively. To explore this question observationally, we investigated associations between parental emotional symptoms and disturbances in infant sleep patterns.

Methods

This study utilized data from the National Health Interview Survey encompassing 447 mothers and 304 fathers and their infants (0-1 year; n=751) to examine associations among maternal and paternal anxiety, psychological distress, and infant sleep disturbances. Parents used the Baby Pediatric Symptom Checklist to report their infant sleep symptoms (troubles falling asleep: "Is it hard to put your child to sleep?” and staying asleep: "Does your child have trouble staying asleep?", with responses “not at all” (N), “somewhat” (S), “very much” (V). Predictors included maternal and paternal anxiety levels, gauged by frequency of feelings of worry, nervousness, or anxiety. Psychological distress was measured using the Kessler-6 scale. Multi-group generalized structural equation modeling was employed. Covariates were: age, sex, race/ethnicity (parent/infant), marital status, education, employment, nativity, poverty level, number of children and adults in household, and chronic health conditions (parent).

Results

Endorsement rates for trouble falling asleep were: N=79.6%, S=17.6%, and V=3.4%, and for trouble staying asleep: N=84.5%, S=13.4%, and V=2.1%. Compared with mothers who never experienced anxiety, mothers who reported anxiety a few times a year or weekly were 3.0 and 4.0 times as likely to report their infant having trouble falling asleep. Mothers experiencing anxiety a few times a year, monthly, or weekly, were 3.5, 5.0, and 5.2 times as likely to report their infant having trouble staying asleep. These associations were not evident among fathers. No associations were identified between maternal or paternal psychological distress and difficulties in infant sleep initiation or maintenance.

Conclusion

Results from this study align with previous clinical research showing differential associations between infant sleep and maternal and paternal mental health symptoms. Future work is needed to better understand why these differences exist in anxiety and to elucidate why psychological distress was not linked with infant sleep.

Support (if any)

COBRE Award P20GM139743
0827 Sleep-related Impairment and Cognitive Function Among Hispanic and Non-Hispanic Children in Rhode Island
Authors: Romero-Ramos Yaideliz , Acevedo Aliana Rodriguez , Katz Abby , Evans Gabrielle , Johnson Azia , Kemball-Cook William , Maxwell Zoe , Nwanaji-Enwerem Ugoji , Story Diane , Ury Brooke , Yang Jue , Cheol-Shin Jong , Barker David , McGeary John , Dunsiger Shira , Grigsby-Toussaint Diana
Published: April 2024

Introduction

Racially minoritized groups disproportionately experience poor sleep health profiles that increase the risk of long-term cognitive decline. Notably, disparities in sleep health are observed in childhood, where unfavorable sleep-wake patterns have been linked to cognitive impairments such as deficits in memory and attention. Nonetheless, limited studies exist examining sleep-related impairment on cognitive function among racially minoritized children in the United States. We aim to explore the association between sleep-related impairment (e.g., perception of waking alertness, sleepiness, and function) and cognitive function among a diverse sample of Rhode Island children.

Methods

A sample of elementary school children in grades 1-3 was taken from the ongoing Project Greenspace, Sleep, and Mental Health (G-SPACE) study in Rhode Island. Sleep-related impairment and cognitive function were assessed using PROMIS® Parent Proxy Scales. Multiple linear regression models were used to estimate associations between sleep-related impairment and cognitive function in the aggregate sample and then stratified by ethnicity (i.e., Hispanic and non-Hispanic) while controlling for actigraphy-derived sleep duration, age, gender, and income.

Results

The final sample (N=76) included 43 (57%) non-Hispanic and 33 (43%) Hispanic children. Seventy-four percent of the non-Hispanic children identified as White. Girls accounted for 60% (N=46) of the sample, with 26 (34%) and 20 (26%) being non-Hispanic and Hispanic females, respectively. The mean ages were 7.58 (SD=1.03) and 7.66 (SD=0.89) for non-Hispanic and Hispanic children. Adjusted analysis showed a negative association between sleep-related impairment and cognitive function in non-Hispanic children (β= - 0.52, 95% CI= -0.84, -0.21, p< 0.01), but no significant association was found in the Hispanic subgroup (β= - 0.06, 95% CI= -0.60, -0.47, p= 0.82).

Conclusion

Our findings suggest a negative relationship between sleep-related impairment and cognitive function among non-Hispanic children. However, no significant association was observed among Hispanics, suggesting ethnicity may serve as a moderator of the association between sleep-related impairment and cognitive performance. Limitations include a small sample size and less diversity in the Hispanic subgroup. Future analyses will include a larger and more diverse sample size and other factors, including sleep-related breathing disorders, and access to greenspace.

Support (if any)

Project G-SPACE is supported by the NIH/NIMHD (R01MD016241) and NIGMS 5P20GM139743.
0830 Polysomnography Differences in Children with and Without Hypertension in the Absence of OSA
Authors: Rani Seema , Cohen Alexandra , Martinez Diana , Exarchakis Alyssa , Harper Christine , Strang Abigail , Baker-Smith Carissa , Chidekel Aaron
Published: April 2024

Introduction

There is growing evidence linking hypertension and sleep disturbances in adults, even in the absence of OSA. Even though hypertension is associated with OSA in children, there is a lack of data on influence of the non-respiratory parameters of sleep on hypertension. The objective of this study is to compare respiratory and non-respiratory sleep parameters in children with and without hypertension, among those without OSA based on PSG.

Methods

IRB approved retrospective chart review of patients ages 8-17 years, who underwent PSG at Nemours Children’s Hospital, DE, between January 2020 and May 2023. Data was collected on demographics, anthropometrics, comorbid medical conditions, and PSG findings from EMR. Hypertension was defined as an average systolic (SBP) and/or diastolic blood pressure (DBP) ≥ 95th percentile for gender, age, and height based on AAP Clinical Practice Guidelines. An average of 5 BP measurements from clinic visits within year prior to the date of the PSG were analyzed. Height percentiles were calculated using CDC guidelines. Descriptive and comparative statistics were performed to compare PSG findings between non-hypertensive and hypertensive youth.

Results

We collected data on 228 children. The cohort (n=228) was split into non-OSA and OSA groups based on PSG results. Among the non-OSA group (n=108), 22 individuals were categorized as hypertensive (20.3%). Mean age was 11.4 years and mean BMI z-score was 2.7 (1.83) among the hypertensive group and 12.6 years and 1.12 (2.04) respectively among the non-hypertensive group, with a significant difference in BMI z-score (p< 0.001). Respiratory and non-respiratory sleep parameters were similar, except average heart rate during sleep was significantly higher in the hypertensive group; 79.3 BPM (±11.34) vs 70.9 BPM (±10.07) for the non-hypertensive group (p = 0.002).

Conclusion

In children without OSA, there were no observed differences in respiratory or non-respiratory parameters between the hypertensive and non-hypertensive groups. Children in hypertensive group had a significantly higher BMI Z-score and average heart rate during sleep. This may suggest that obesity and sympathetic activation are important in the pathogenesis of pediatric hypertension even in the absence of detectable sleep disorders. Future studies with larger cohorts are necessary to further explore these relationships.

Support (if any)
0831 Grand Connections: Inter- and Intraindividual Sleep Between Grandparents Raising Grandchildren and Grandchildren
Authors: Stearns Melanie , McGovney Kevin , Meltzer Lisa , McHale James , Littlewood Kerry , Szalacha Laura , McCrae Christina
Published: April 2024

Introduction

Grandparents raising grandchildren (GRG) report greater global sleep problems and sleep disturbances than non-caregiving grandparents. Moreover, 70% of grandchildren being raised by their grandparents sleep shorter or longer than recommended. However, no studies examined the daily relationship (intraindividual) or average (interindividual) relationship between GRG/grandchild sleep. We examined daily and average GRG and grandchild sleep associations.

Methods

Co-residing GRG (N=24, Mage=58.41, 66.7% female; 63% primary grandchild caregiver) completed daily sleep diaries for themselves/their grandchildren (Mage=8.19, 33.4% female). Grandparent/grandchild variables included sleep onset latency-SOL, wake after sleep onset-WASO, and total sleep time-TST. Multi-level models (Rv4.2.2) examined grandchild and grandparent sleep associations, controlling for grandparent and grandchild age.

Results

Daily grandchild sleep was positively associated with daily grandparent sleep for SOL (t(276)=5.75, p<.001), WASO (t(276)=7.71, p<.001), and TST (t(276)=5.68, p<.001). Daily grandparent sleep was positively associated with daily grandchild sleep for SOL (t(276)=5.74, p<.001), WASO (t(276)=7.71, p<.001), and TST (t(276)=5.68, p<.001). Average grandchild sleep was positively associated with average grandparent sleep for SOL (t(23)=2.31, p=.030) and WASO, (t(23)=8.31, p<.001). Average grandparent sleep was positively associated with average grandchild sleep for SOL (t(23)=2.36, p=.027) and WASO (t(23)=8.26, p<.001).

Conclusion

Analyses suggest a bidirectional relationship between GRG and grandchild sleep. Because over half of all GRGs coparent children with one or more family members, family-level analyses may help clarify sleep associations. Given that grandparents in this study reported on both their own and the child's sleep, longitudinal/multi-method studies are needed to determine causality. It remains to be determined whether improving grandchild sleep may improve grandparent sleep (and vice versa), or if dyadic intervention is needed.

Support (if any)

Sleep Research Society Small Research Grant (Stearns, PI)
0832 Hypertension in Pediatric Patients Without Obstructive Sleep Apnea (OSA)
Authors: Exarchakis Alyssa , Cohen Alexandra , Harper Christine M , Strang Abigail , Chidekel Aaron , Baker-Smith Carissa , Rani Seema , Martinez Diana
Published: April 2024

Introduction

Studies show that sleep disturbances are associated with adult hypertension. The relationship between OSA and hypertension has been extensively studied, however, is understudied in pediatric patients without OSA. The aim of this study was to identify socioeconomic factors, social determinants, and medical co-morbidities associated with hypertension in pediatric patients without OSA based on polysomnography (PSG).

Methods

IRB-approved retrospective chart review of patients who underwent PSG at Nemours Children's Hospital, DE between January 2020 and July 2023. Eligibility criteria included children 8-17 years, completed PSG, and office visit blood pressure (BP) recordings. Anthropometrics, demographics, and socioeconomic, social determinants, and medical history obtained from EMR. Those without OSA based on PSG were divided into hypertensive and non-hypertensive groups. Hypertension was defined as the average (5 BP measurements from clinic visits within a year from PSG) systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) that is ≥95th percentile for gender, age, and height based on AAP Clinical Practice Guidelines. Height percentiles were calculated using CDC guidelines. Descriptive and comparative statistics were performed to compare the two groups. Data is reported as mean ± SD, non-hypertensive vs. hypertensive. Frequency of categorical data is reported in parentheses for the hypertensive group.

Results

Of the 228 patients, 108 did not meet criteria for OSA based on AHI>2 and were excluded from the analysis (47.3%). Of the 108 without OSA, 22 were hypertensive (20.3%). All 22 had SBP ≥95th percentile; two had both SBP and DBP ≥95th percentile. Significant differences between hypertensives and non-hypertensives were in race (p=0.037, higher frequency of blacks), parents in household (p=0.042, lower frequency in those with both parents in the household), diabetes (p= 0.047, higher frequency of type 2 diabetes), and mental illness (p=0.027, higher frequency of autism and mood disorders). Daytime HR (96.2 ±12.4 vs 87.1±12.2, p=0.003), and BMI (2.7± 2.0 vs 1.1±1.8, (p< 0.001) were both significantly higher in the hypertensive group.

Conclusion

In pediatric patients without OSA, there are multiple factors and co-morbidities associated with hypertension. Future larger studies are necessary to establish these associations and relationships in non-OSA patients.

Support (if any)
0833 Identifying Clinical Determinants of Obstructive Sleep Apnea in Children with Sickle Cell Disease
Authors: Larrain Diana , Jon Cindy , Ahlstrom Katie , Yadav Aravind
Published: April 2024

Introduction

Children with sickle cell disease (SCD) are at increased risk for obstructive sleep apnea (OSA). Guidelines recommend screening for OSA in this population based on clinical assessment. Several aspects of OSA in children with SCD remain poorly understood, such as clinical characteristics and the optimal approach for screening. Although polysomnography (PSG) proves valuable for diagnosing individuals who exhibit signs and symptoms of OSA, its cost-effectiveness as a screening tool for asymptomatic children with SCD remains uncertain. There is a need for an effective clinical screening approach for OSA in this population. The objective is to compare the clinical characteristics of children with SCD who had OSA (AHI >1) against those who did not on PSG.

Methods

All SCD patients aged 2 to 18 between March 2016 to May 2023 attending the Comprehensive Sickle Cell Center who underwent PSG were retrospectively compared with sleep apnea symptoms during clinic visits. Symptoms criteria were retrieved from clinical encounters for snoring, apnea, mouth breathing, gasping, enuresis in children older than ten, morning headache, hyperactivity, daytime sleepiness, and daytime naps.

Results

From 180 children with SCD who attended the clinic, 56 patients (31.1%) had a PSG performed, whereby 37.5% (n=21) were diagnosed with OSA, and 62.5% (n=35) did not have OSA. In children with OSA, 80.9% (n=17) reported snoring, 23% (n=5) mouth breathing, and 4.7% (n=1) witnessed apnea. From the group without OSA, 40% (n=14) had no symptoms, 42% (n=14) reported snoring, 20% (n=7) mouth breathing, 17.1% (n=6) reported taking naps, 14.2% (n=5) gasping. Despite being the most frequent symptom to occur in those with and without OSA, habitual snoring was significantly higher in the OSA group (p= 0.02). Conversely, in the absence of symptoms, patients were unlikely to have OSA (p=0.003).

Conclusion

In children with SCD, the absence of symptoms suggests OSA is not present; therefore, PSG may not be warranted. However, the presence of habitual snoring may be an indicator for OSA requiring PSG confirmation.

Support (if any)
0836 Similarities and Differences in Maternal and Paternal Bed-sharing Beliefs in Mexican American Couples with Toddlers
Authors: Munoz-Gauna Anthony , Meltzer Lisa , Fineman Melissa , Gallegos Maria Flores , Martinez Suzanna , Ringwood Haley , Tschann Jeanne , Williamson Ariel , Thompson Darcy
Published: April 2024

Introduction

Room-sharing, but not bed-sharing is recommended for safe sleep, and pediatric behavioral sleep interventions commonly recommend a separate child sleep space, even when room-sharing. However, bed-sharing is more common globally and across cultural groups than in U.S.-based non-Latino White families. Further, most research has focused on maternal beliefs about bed-sharing, with little consideration of paternal beliefs. This exploratory study describes similarities and differences in maternal and paternal beliefs about bed-sharing in Mexican American couples with toddlers.

Methods

Fourteen Mexican American couples (mothers [27-41 years, mean education 12.8 + 3.7 years] and fathers [27-45 years, mean education 11.1 + 3.4 years]) with toddlers (78.6% boys; 12-15 months) completed the 17-item Bed-sharing Beliefs measure in Spanish (50%) or English. Half of families reported bed-sharing with their toddler. Although data collection is ongoing, we describe dyadic concordance (dyads both agree or disagree) or discordance (one person agrees, the other disagrees) in the current sample.

Results

The most dyadic concordant responses were parent sleep/privacy items: “bed-sharing interferes with the parents privacy” (100% concordance: 93% agree), “bed-sharing makes the parents sleep poorly” (86% concordance: 64% agree), and “bed-sharing helps the parent sleep well” (79% concordance, 36% agree). Teaching the child to sleep independently items also had strong dyadic concordant responses: “bed-sharing makes the transition to their own bed harder” (79% concordance, 64% agree), “bed-sharing makes it harder for the child to sleep on their own” (79% concordance, 64% agree), and “bed-sharing makes the child dependent on the parent to sleep” (77% concordance, 62% agree). The greatest dyadic discordant responses were related to the child’s sleep quality: 62% discordance for both “bed-sharing keeps the child from sleeping comfortably” and “bed-sharing interferes with the child’s sleep.” No differences between bed-sharing and non-bedsharing dyads were found.

Conclusion

Early findings from our ongoing study of sleep beliefs in Mexican American families with toddlers suggest greater parental concordance about the impact of bed-sharing on parental privacy/sleep and toddlers learning to sleep independently, with discordant beliefs about the impact of bed-sharing on child sleep quality. Further exploration of dyadic parental beliefs about bed-sharing and the relationship with sleep location is needed in a larger sample.

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R01HL163859
0839 Parental Perspectives on the Effectiveness of a Sleep Intervention for Preschoolers: A Preliminary Assessment
Authors: Pétrin Rachel , Bérubé Annie , Pennestri Marie-Hélène , Touchette Evelyne , Forest Geneviève
Published: April 2024

Introduction

Healthy sleep is essential to a child's development, particularly during preschool. However, interventions that address sleep difficulties among children in this age group are scarce. This preliminary study explored parental perspectives on the effectiveness and barriers of a short sleep intervention for preschool children.

Methods

Twenty-nine families (either one or both parents) and their 3 to 5-year-olds participated in a two-hour sleep intervention and one-hour follow-up meeting to address children's sleep difficulties. Parents were taught about children’s optimal sleep habits. They were given tips on maintaining a consistent bedtime routine, managing their child's anxiety at bedtime and during the night, helping their child fall asleep independently, and reducing the occurrence of nightmares and night terrors. Parents were asked open-ended questions two months later to assess its success and barriers. Responses were analyzed using NVivo 14.23.2 to identify common themes.

Results

Numerous parents reported that their child's sleep improved in at least one aspect after the intervention. The most reported improvements were reduced nighttime awakenings, improved sleep independence, reduced sleep onset latency, a consistent sleep schedule and routine, and reduced conflicts at bedtime. More than half of parents noted that at least one aspect of their own sleep had improved, the most common being reduced sleep fragmentation. Almost all parents denoted other positive outcomes, such as better moods and reduced fatigue in children, increased patience, more personal time, improved mood and heightened energy levels in parents. A few parents indicated having a better relationship with their child. Sleep difficulties persisted in some children, such as trouble falling asleep, autonomous sleep and nighttime awakenings. Among parents who identified obstacles in implementing sleep strategies, conflicts at bedtime, changing sleep schedules, separation anxiety, and screens before bedtime were the most frequent.

Conclusion

Parents found the brief intervention effective and well-suited to their specific needs. Reducing children's sleep difficulties contributed to improving parents' sleep quality and the overall health and well-being of the family. This research highlights the need for tailored interventions that address preschoolers' sleep issues.

Support (if any)

This study was funded by the Social Sciences and Humanities Research Council of Canada (SSHRC).
0840 Center-based Childcare Attendance and Sleep in Children Under Six Years Old: A Systematic Review
Authors: O'Hagan Belinda , von Ash Tayla
Published: April 2024

Introduction

Many children within and outside of the United States spend a considerable amount of time in childcare settings during early childhood. The early childhood period is also marked with significant transitions in sleep, and many young children rely on a combination of daytime and nighttime sleep to meet their sleep needs. Thus, childcare settings may impact children’s sleep outcomes. The current systematic review aims to summarize findings of past research examining center-based childcare attendance and sleep outcomes.

Methods

We followed the steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Keywords related to sleep and childcare were entered into PubMed and PsycINFO on November 13, 2023, yielding 2,355 articles. Articles were reviewed using the following inclusion criteria: population included children ages 0-6 years old, intervention included formal center-based childcare attendance, control or comparison included between-subject (i.e., center-based childcare vs. no center-based childcare; half-day vs. full-day) and within-subject (i.e., weekdays vs. weekends) designs, outcomes included sleep duration and timing, and study designs included observational and experimental research. Methods were critically assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS).

Results

Nine studies were included in the final data extraction process. Studies were conducted in five countries: Japan (n=5), United States (n=1), Malaysia (n=1), France (n=1), and Australia (n=1). Evidence indicated that center-based childcare attendance is associated with decreased sleep duration, though findings were mixed. Four studies found that attendance was associated with shorter nighttime sleep duration whereas one study found null association. Two studies found positive association between attendance and daytime sleep (i.e., weekends/weekdays, half/full day) whereas one study found a negative association when comparing childcare type (i.e., relative/non-relative). Two studies found no association between attendance and total sleep duration. Most studies reported nighttime sleep and did not use an objective measure of sleep. Classifications of childcare type varied, making comparisons across studies challenging.

Conclusion

More research is needed to examine how center-based childcare attendance may impact sleep outcomes in young children. Future research should use objective measures of sleep when possible and describe details about childcare consistently to facilitate comparison or generalization.

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0841 TigerCHAT: Sleep and Cellphone Access in Rural Elementary School Children
Authors: Feeley Christine , Gibson-Young Linda
Published: April 2024

Introduction

There is increasing awareness of the importance of sleep for health and wellness in children, and the impact technology has on sleep. However, many children are not getting the necessary sleep for optimal school functioning. The purpose of this project is to describe cellphone access, placement at night, and bedtime in 8–9-year-olds attending an elementary school in a rural area.

Methods

TigerCHAT is a school-based health education outreach program for children K-6th grades. It focuses on 45-minute sessions addressing various health topics, including sleep. Data are collected after IRB approval. In fall of 2022, nursing students led small groups of students in a sleep educational module during their gym period. Before education began, 50 3rd- grade students filled in a questionnaire regarding phone usage (do they have one, location during bedtime, bedtime and wake time).

Results

Frequencies, percentages, and ANOVA were run on the data to describe sleep and phone placement during the nighttime. Children ages 8-9 years (n = 50, 49% female, 51% male, 91.2% White, 8.4% Black, 46.4% classified as economically disadvantaged, 41% receive free or reduced lunch). Over half reported having a cellphone (n=31, 62% yes; n=19, 38% no). Of those with a cellphone, eleven (22%) reported having it under or by pillow, 11 (22%) reported having it on the bedside table, and 9 (18%) reported it not in their room at night. There was no significant difference in bedtime between those with a phone or without (F=.696, p=.402,) or where cellphone was located (in vs outside room) (F=1.55, p=.277). Children self-reported an average bedtime of 9:12pm (range 7:30pm-1am), and an average wake time of 5:15am (range 4:30am-6:30am), with an average total sleep time of 8.3 hours (range 4-10 hours).

Conclusion

The majority of students in this sample reported having access to a cellphone, and also reported having the cellphone close to them at night. While there was no significant difference in bedtime based on location or having a phone in this sample, it is still an important aspect of the sleep environment. Future studies should examine the significance of nighttime cellphone placement for school age and adolescent populations.

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0847 The Role of Pulse Wave Amplitude in Detecting Arousals in Children with Hypersomnia
Authors: Al-Shawwa Baha , Ingram David
Published: April 2024

Introduction

Changes in pulse wave amplitude (PWA) are a sensitive marker for both cortical and autonomic arousals, and are readily available in conventional polysomnogram recordings. The aim of the current study was to examine electrocortical versus PWA-based arousals in pediatric patients being evaluation for disorders of central hypersomnolence.

Methods

Polysomnograms for thirty consecutive patients who underwent multiple sleep latency test (MSLT) were identified. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify arousals. Arousals on overnight polysomnogram were rescored based on PWA drop. Patients were classified based on MSLT results into 3 groups: Narcolepsy group if mean sleep latency < 8 minutes and the presence of 2 or more sleep onset rapid eye movement periods (SOREMP); idiopathic hypersomnia (IH) group if mean sleep latency < 8 minutes and less than 2 SOREM periods; or normal if they did not meet criteria for narcolepsy or IH. Group differences in electrocortical arousal index (AI) vs PWA-based arousal index were examined via ANOVA.

Results

Out of the 30 patients included, there were 19 patients with normal MSLT, 7 patients with narcolepsy, and 4 patients with IH. There were no significant between-group differences for age, total sleep time (TST), sleep efficiency (SE), sleep latency (SL), REM latency, N1, N2, N3 or REM percentages, apnea hypopnea index (AHI), or periodic limb movement index (PLMI). There was were no significant differences between electrocortical AI in normal (9.4+/-4.4), IH (9.1/hr+/-4.9), and narcolepsy (10.6+/-6.6) groups (F(2,27)=[0.156], p=0.857). In contrast, there statistically significant between-group differences in PWA-based AI (F(2,27=[3.765], p=0.036). Post-hoc analysis demonstrated higher PWA-based AI in narcolepsy vs normal (24.2+/-10.4 vs 16.2+/-5.3, p=0.017), a trend for higher levels in IH vs normal (22.3+/-8.5 vs 16.2+/-5.3, p=0.131), and no difference between narcolepsy and hypersomnia groups (24.2+/-10.4 vs 22.3+/-8.5, p=0.674).

Conclusion

Pulse wave amplitude may hold promise as a scoring tool to help identify arousals and sleep disruption in patients with central disorders of hypersomnolence. Further studies are needed to verify these preliminary results and explore the utility of PWA-based AI in other sleep disorders.

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