bluuebunny/crossref_metadata_2025 huggingface dataset:
0728 The Effects of Yoga on Sleep Quality in Menopausal Women: A Systematic Review and Meta-analysis
Authors: Segsarnviriya Charnsiri , Sugkraroek Pansak , Saokaew Surasak , Chirakalwasan Naricha , Charakorn Natamon
Published: April 2024

Introduction

Sleep disturbance is a common complaint in menopausal women, which could be a consequence of several factors, including reproductive hormonal changes and menopausal symptoms. Previous studies identified the benefits of yoga in alleviating menopausal symptoms. We conducted a systematic review and meta-analysis of menopausal women to assess the effect of yoga on sleep quality and menopausal symptoms.

Methods

PubMed, Scopus, Ovid, the Cochrane Library, and Google Scholar were searched through July 2023. Randomized controlled trials (RCTs) evaluating the effects of yoga in menopausal women, which reported quantitative data on sleep quality and menopausal symptoms, were included. The study protocol was registered on PROSPERO (CRD 42023464468).

Results

Thirteen RCTs (1,649 patients) were eligible for the meta-analysis. The meta-analysis of six RCTs (591 patients) did not demonstrate a statistically significant difference in the total score of the Pittsburgh Sleep Quality Index (mean difference -1.39; 95% CI (-3.69, 0.92); P = 0.24). On the contrary, the meta-analysis of eight RCTs (1,065 patients) revealed a significant improvement in the total score of the Menopausal Rating Scale (MRS) (mean difference -7.10; 95% CI (-11.27, -2.93); P = 0.0008). There were significant differences in the subscale of each symptom comprising the somato-vegetative, psychological, and urogenital subscales (somato-vegetative subscale: mean difference -2.64; 95% CI (-4.93, -0.35); P = 0.02, psychological subscale: mean difference -3.43; 95% CI (-5.76, -1.11); P = 0.004, and urogenital subscale: mean difference -1,25; 95% CI (-2.30, -0.21); P = 0.02).

Conclusion

The pooled results did not demonstrate the significant benefits of yoga on sleep quality in menopausal women. Conversely, the remarkable advantages of yoga in relieving menopausal symptoms were illustrated. To further explain the benefit of yoga on sleep quality in menopausal women, additional longer-duration yoga training or longer-term studies would be required.

Support (if any)
0729 The Influence of Sexual Orientation and Socio-Demographics on Sleep After a Depressive Episode
Authors: Kim Jeffrey , He Michelle , Gunturu Sasidhar , Shahawy Omar El
Published: April 2024

Introduction

Our study addresses the gap in understanding sleep health among adults with depressive episodes, where sleep disturbances are common. We primarily investigate sleep disorder prevalence among sexual and gender minorities (SGM), while also examining the influence of sociodemographic factors in this context.

Methods

Our study analyzes data from the 2020-2021 National Survey on Drug Use and Health (NSDUH). The initial sample was 90,927, with an analytical sample of 15,244 after restricting the analyses to people experiencing depressive episodes. All estimates were weighted to account for the multistage sampling design. Descriptive statistics were used to estimate the prevalence of all variables of interest, including tobacco and nicotine use, age, gender, ethnicity/race, income group, marital status, education, and the year of data collection. Then, to examine these relationships in a multivariable manner, we computed generalized linear models (using Poisson and log-link) to estimate adjusted prevalence ratios for each covariate.

Results

Among participants with a history of depressive episodes, the majority identified as female (61.3%) and non-Hispanic White (71.3%). An estimated 82.3% of these individuals reported sleep difficulties in their lifetime. Within this subset, an estimated 4.63% (95% CI: 4.01-5.33) identified themselves as gay/lesbian, and an estimated 14.1% (95% CI: 13.0-15.2) as bisexual. Compared to heterosexuals, gay/lesbian individuals had 1.06 times the prevalence of sleep difficulties (p = 0.038), and bisexual individuals also had 1.06 times the prevalence of sleep difficulties (p = 0.009). Individuals who had completed a college degree or higher had 0.89 times lower prevalence of sleep difficulties compared to those who had not completed high school (p < 0.001). Finally, Hispanics had a 1.05 higher prevalence of sleep difficulties compared to non-Hispanic Whites (p = 0.015).

Conclusion

The study reveals significant disparities in sleep quality among different subgroups of individuals with depressive episodes. Gay/lesbian or bisexual individuals exhibit higher rates of sleep difficulties compared to their heterosexual counterparts. Furthermore, significant correlations were found between sleep difficulties and factors like ethnicity and educational attainment, suggesting a complex interplay of socio-demographic elements. These insights highlight the need for therapeutic strategies in mental health care that are cognizant of sexual orientation, educational background, and ethnicity.

Support (if any)
0739 Does Benzodiazepine Receptor Agonist Use, Insomnia, and OSA Explain Variation in Cognitive Performance?
Authors: Ann Lydia , Mitchell Michael , Alessi Cathy , Martin Jennifer , Dzierzewski Joseph , Josephson Karen , Naeem Saadia , Der-Mcleod Erin , Ghadimi Sara , Zeidler Michelle , Badr M Safwan , Moore Alison , Fung Constance H
Published: April 2024

Introduction

Older adults have multiple risk factors for cognitive impairment including insomnia, benzodiazepine receptor agonist (BZRA) use, and obstructive sleep apnea (OSA). Simultaneously addressing all risk factors is ideal but impractical. Clarifying the relative contribution of each risk factor could help prioritize strategies to reduce risk of cognitive impairment. We sought to quantify the effects of sleep risk factors on cognitive performance above and beyond other common risk factors for cognitive impairment.

Methods

We used clinical trial baseline data from outpatients taking a BZRA hypnotic. In four nested regression analyses, we modeled predictors of Mini-Mental State Examination (MMSE), Trail Making Test (TMT) A, TMT B, and Digit Symbol Substitution Test (DSST). Base Models included age, sex, ethnicity, race, education, vascular risk, depression, traumatic brain injury, and alcohol use. Nested models were: Model 2 = base model + Insomnia Severity Index score (ISI); Model 3 = Model 2 + BZRA hypnotic use; Model 4 = Model 3 + OSA risk; and Model 5 = Model 4 + OSA-BZRA interaction term. We compared changes in R-squared values and used F-tests to examine the fit of nested models.

Results

Of 348 participants (mean age 68.8), 313 were included for MMSE (m=28.2), 298 for TMT-A (m=48.2 seconds), 287 for TMT-B (m=130.2 seconds), and 285 for DSST (m=8.0) analyses. Mean ISI was 14.2 (SD 6.6). Mean 7-day BZRA total dose was 29.5 diazepam equivalents milligrams (SD 31.4). 44% were high-risk for OSA. Base Model R-squared was 0.139 (MMSE), 0.241 (TMT-A), 0.229 (TMT-B), and 0.189 (DSST). Change in R-square from Model 1 to Model 5 was 0.003 (MMSE), 0.005 (TMT-A), 0.010 (TMT-B), and 0.001 (DSST), with p-values >.145 for F-tests comparing changes in R-squared. Change in R-squared for Models 2 to 3, 3 to 4, and 4 to 5 were not statistically significant.

Conclusion

Although our base models account for more than 13% of the variation in cognitive performance, sleep variables did not significantly explain additional variation in cognitive performance. These results suggest that in older adults using BZRAs, interventions targeting common risk factors should be prioritized to address cognitive impairment.

Support (if any)

VAIIR 17-234, NIAR01AG057929, UL1TR001881
0740 Does XX or XY Mark the Spot: Sex-specific Analysis of Polysomnographic Sleep and Cognition in Older Adults
Authors: Curtis Ashley , Costa Amy , Musich Madison , Rzeppa Chloe , McCrae Christina
Published: April 2024

Introduction

Poor sleep health is a proposed risk factor for Alzheimer’s disease (AD). Despite known sex differences in AD prevalence (higher in women), whether sex impacts associations between objective sleep parameters and specific cognitive functions remains underexplored. Such investigations are warranted and will provide information regarding potential sex-specific targets for early intervention and/or markers of AD risk. This study tested whether sex moderates associations between polysomnographic assessed sleep and cognition in older adults.

Methods

Older adults (Mage=68.2±5.5; 44 women/29 men) completed overnight polysomnography (Sleep Profiler) and cognitive tasks [NIH Toolbox: Pattern Comparison (processing speed), Oral Symbol Digit Test (attention and processing speed), List Sorting (working memory), Auditory Verbal Memory Task (episodic memory), Flanker (inhibition), Dimensional Change Card Sort (cognitive flexibility)]. Multiple regressions examined whether sleep metrics (sleep onset latency, wake time after sleep onset, sleep efficiency, total sleep time), macro-architecture (%N1-N3, %REM) or micro-architecture (sleep spindle duration and index) interacted with biological sex in associations with cognition, controlling for age, education and apnea-hypopnea index.

Results

Sleep onset latency (R-squared=.06, p=.03) and sleep spindle duration (R-squared=.05, p=.05) interacted with sex in their associations with cognitive flexibility. Specifically, in women (not men), longer sleep onset latency (B=-.01, SE=.002, p=.03) and longer spindle duration (B=-.08, SE=.03, p = .005) were associated with worse cognitive flexibility.

Conclusion

The link between polysomnographic sleep and cognitive flexibility in older adults may be sex dependent. Sleep onset latency cognitive (rumination/worry) and neural (physiological arousal/pre-frontal activation) mechanisms may interact with female sex-steroid alterations (post-menopausal drops in circulating estrogen and progesterone) and exacerbate its negative impact on cognitive flexibility. We also speculate that longer sleep spindle duration in the presence of dysfunctional cognitive flexibility may reflect compensatory thalamo-prefrontal cortical regulation (greater need for nighttime cognitive/cortical arousal reduction) that is further influenced by prefrontal sex-steroid mechanisms. Longitudinal studies in larger samples of cognitively healthy and impaired older adults are needed to further understand whether polysomnographic sleep metrics represent sex-specific markers of future cognitive decline.

Support (if any)

This research was made possible by awards (PI:Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.
0747 Tired and Lonely: An Exploration of Insomnia Symptoms and Loneliness Across the Adult Lifespan
Authors: Boyle Julia , Nielson Spencer , Dzierzewski Joseph
Published: April 2024

Introduction

Prior research has identified associations between poor sleep and loneliness; however, this research predominantly focused on a limited age range within adult populations. Very few studies have explored associations between insomnia symptoms (e.g., sleep disturbances, daytime dysfunction) and loneliness and how age might influence these associations across the adult lifespan. As such, the present study evaluated the association between insomnia symptoms and loneliness across the adult lifespan.

Methods

This online study surveyed adults across the lifespan (N=2297, Mage=44 years, 49% female) with the Insomnia Severity Index and the Gierveld Loneliness scale. Correlation and linear regression analyses were utilized to examine direct associations between insomnia symptoms, age, and loneliness. The Gierveld Loneliness total score and subscales (emotional and social loneliness) were used to investigate if aspects of loneliness were differentially associated with insomnia symptoms. Moderation analyses examined if the association between insomnia symptoms and loneliness differed by age. Each loneliness outcome (i.e.,total, emotional, and social) was included in a separate moderation model, with insomnia symptoms, age, and their interaction as predictors.

Results

Greater insomnia severity and older age were both significantly associated with higher loneliness total and subscale scores (all p’s<.05). Age significantly moderated the association between insomnia symptoms and total and emotional loneliness scores (b = -0.02, t = -2.30, p=.02; b = -0.002, t = -2.88, p=.004, respectively); but did not moderate the association between insomnia symptoms and social loneliness (b = -0.001, t = -1.25, p=.212). Specifically, the strength of the association between insomnia severity and loneliness differed by age, with older adults displaying weaker associations between insomnia symptoms and loneliness compared to younger ages.

Conclusion

Insomnia symptoms are associated with loneliness across the lifespan. However, age moderated this association such that in older age cohorts the link between insomnia symptoms and loneliness, while still significant, was weaker than in younger cohorts. Efforts aimed at reducing loneliness in older adults should incorporate components of evidence-based insomnia treatments. Given the cross-sectional nature of this study, future research is needed to determine if lower levels of loneliness might be protective against developing insomnia in older adulthood.

Support (if any)

NIA - K23AG049955 (PI: Dzierzewski).
0753 Relationship Between OSA and Sleep Biomarker Based Neurodegenerative Disorder Risk in a Clinical Cohort
Authors: Mazeika Gandis , Cho Yeilim , Anderson Jack , Levendowski Daniel , Walsh Christine , Lee-Iannotti Joyce , Tsuang Debby , Neylan Thomas , Lewis Simon , Louis Erik St
Published: April 2024

Introduction

In this pilot study, sleep biomarker-based neurodegenerative disorder (NDD) risk was assessed in a clinical cohort of patients diagnosed with varying severity of obstructive sleep apnea (OSA).

Methods

Consecutive in-home multi-night Sleep Profiler records from a community sleep clinic were screened for age >54 years old. Cases with comorbid restless leg syndrome, hypersomnia, missing apnea-hypopnea indexes (AHI), AHI< 5 or single-night recordings were excluded. The 67 remaining records were 40% female, ages 63 + 7.4 years and up to 84 years old. NDD risk was assigned using a machine-learning algorithm combining age and nine sleep biomarkers to assign group probabilities: for Alzheimer’s disease, Lewy Body disease, prodromal synucleinopathy and controls (CG). Sleep biomarkers included: time-REM, non-REM hypertonia, autonomic-activation index, spindle-duration, atypical-N3, time-supine, sleep-efficiency, relative-theta, and theta/alpha. Those with CG probability score >70% were classified as “Probably-normal”. Those with CG probability between 45 - 70% were classified as “Likely-normal”. Insomnia severity >14 and a PHQ 9 > 5 were used as cutoffs for clinical insomnia and depression. Mann-Whitney U-tests were used to evaluate group differences.

Results

This cohort had 37% mild, 34% moderate, and 29% severe OSA. Self-reported comorbid insomnia and depression were present in 43%. Seventy-three percent of patients were classified as “Probably-normal”, 16% “Likely-normal”, 11% “Likely-NDD” or “Probable-NDD”. The “Probably-normal” group was younger than the rest of the cohort (62 + 6.2 years vs. 68 + 8.6 years, p< 0.01). Of those classified as “Probably-normal” (n=49), OSA was mild in 16, moderate in 17 and severe in 16. Mean AHI trended higher in the “Probably-normal” group than in those with elevated NDD risk (29 + 23.9 vs. 19 + 13.6 events/h, p=0.085).

Conclusion

Approximately 89% of the clinical cohort was classified as “Probably-normal” or “Likely-normal”. NDD risk was age-dependent. Interactions between OSA severity and NDD risk were not apparent in these findings, possibly related to group-wide effects. NDD risk, as measured by this model, did not appear to be adversely biased by untreated OSA. These results suggest a need for longitudinal studies to compare NDD risk in untreated OSA versus controls without sleep disordered breathing.

Support (if any)

NIH grants R44AG050326, R44AG054256, RO1AG060477, R33AG064271, ULRR024150, and R34AG056639.
0756 Validity of Self-reported Sleep in the Cancer Prevention Study – 3
Authors: Donzella Sidney , Masters Matthew , Phipps Amanda , Patel Alpa , Zhong Charlie
Published: April 2024

Introduction

Self-reported sleep measures are widely used in epidemiology research and may be influenced by a variety of factors, potentially introducing measurement error. We examined the one-year test/re-test concordance and validity of survey-assessed sleep duration.

Methods

The Activity Validation Sub Study (AVSS) included 751 participants of the Cancer Prevention Study-3 study to further investigate rest/activity cycles. Sleep duration was collected using three

methods

survey, Daysimeter device, and sleep diary. Survey-assessed sleep duration was collected in categorical and continuous formats. Selected participants (n=170) were asked to wear a device for seven consecutive days for two non-consecutive quarters and recorded sleep duration in sleep diaries for each night. Of the 170 study participants assigned a device, participants were excluded from the current study due to incomplete AVSS survey data, implausible device data, reported working night shift, insufficient days of device wear or diary entries, or reported less than 3 hours or greater than 14 hours of sleep for any of the sleep measures. We calculated concordance of pre- and post-survey sleep duration for both survey question using Spearman correlation. We used the method of triads to estimate the validity coefficient (VC) between the three sleep duration measurements in the present study and the “true” latent sleep duration measure, and bootstrapped 95% confidence intervals (95% CI). This was done for both survey-assessed sleep duration measures.

Results

A total of 117 participants were included in the study (53% male). Test-retest correlation for the pre- and post-survey showed strong and moderate correlations for sleep duration collected continuously and categorically, respectively. The VC for survey-assessed continuous sleep duration and the latent sleep duration was 0.83 (95% CI 0.72, 0.90) for weekday and 0.62 (95% CI 0.42, 0.78) for weekend. Performance of the VC was slightly weaker for survey-assessed categorical sleep duration (weekday VC=0.60 95% CI 0.45, 0.73; weekend VC=0.44 95% CI 0.29,0.61).

Conclusion

Performance of survey-assessed sleep duration as compared to device and diary measures varies based on how the question is asked and/or the response structure.

Support (if any)

The American Cancer Society funds the CPS-3 cohort. This work was supported through an unrestricted research grant from Sleep Number Corporation.
0759 Insomnia with Reduced Sleep Is a Risk Factor for Global Cognitive Decline in Cognitively Unimpaired Older Adults
Authors: Carvalho Diego , Fought Angela , Kolla Bhanu , Louis Erik St , McCarter Stuart , Przybelski Scott , Machulda Mary , Boeve Bradley , Petersen Ronald , Jack Clifford , Graff-Radford Jonathan , Vemuri Prashanthi
Published: April 2024

Introduction

Meta-analytic studies support that insomnia is a risk factor for cognitive decline and dementia, but limited accounting of confounders reduces their validity. Further, it is unclear whether these associations are driven by specific insomnia phenotypes. In this study, we aimed to assess the relationship between insomnia and longitudinal global cognitive decline in community-dwelling older adults after considering self-reported sleep duration changes and other important characteristics.

Methods

From the Mayo Clinic Study of Aging (MCSA) cohort, we identified all (age>=50yo) cognitively unimpaired participants at baseline without comorbid neurological disease with at least two previous comprehensive neuropsychological evaluations. Participants with at least two occurrences of insomnia ICD diagnosis (by EMR and Rochester Epidemiological Project data) at least 30 days apart were classified as having insomnia, and those without any instance of diagnosis were considered negative for insomnia. Changes in sleep duration were assessed using the question #16 of BDI-2 and categorized in reduced sleep (yes/no). We fit mixed-effect regression models to assess whether insomnia was associated with standardized global cognitive scores, after adjusting for age, sex, education, APOEe4, composite cardiovascular and metabolic conditions scores, anxiety/depression, reduced sleep, OSA (ICD diagnosis), alcoholism (CAGE≥2), and pain (NSAIDs use). Number of cognitive assessments and time from baseline were included as both fixed and random effects. Multiple interactions (e.g. insomnia*reduced sleep) were included. A backward stepwise procedure maintaining the hierarchical principal for interactions was utilized to reach the most parsimonious models.

Results

3063 participants (50.24% males, aged 70±9.73 at baseline) were included. Insomnia alone was not associated with a decrease in global cognition, but when combined with subjective reduction in sleep duration at baseline it was associated with a -0.19 (95% CI: -0.32, -0.07; interaction p=0.01) reduction in global cognitive scores. This was equivalent to approximately 3 additional years of age or 6 cardiometabolic comorbidities at baseline. The effect size was greater than those associated with baseline cognition for having any APOE e4 allele (-0.12) and alcoholism (-0.15).

Conclusion

Insomnia with reduced sleep duration phenotype is a potentially modifiable risk factor for cognitive decline in older adults. Further studies with objective sleep measures are necessary for objective confirmation.

Support (if any)

NIA/NIH
0783 Quality Care of Pediatric Patients Utilizing Continuous Positive Airway Pressure for Obstructive Sleep Apnea
Authors: Castner Lauren , Grekowicz Megan , Samphere Suzanne , Walden Krista , Flint Korina , McKay Karen , Wade Thomas , Willis Rebecca , Malsch Thomasien , Bandla Hari
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is a sleep related breathing disorder affecting 1-5% of children across all age groups. If left untreated, there is a variety of adverse health effects. Adenotonsillectomy (AT) is a common treatment, however some benefit from the use of continuous positive airway pressure (CPAP) treatment. Due to significant improvements of symptoms when CPAP therapy is applied consistently, we aimed to assess our objective measurements of adherence to PAP therapy along with reduction in their signs and symptoms of OSA.

Methods

Utilizing the AASM Quality Measures, medical records from patients enrolled in the Children’s Wisconsin Positive Airway Program were reviewed from January 2019 until December 2019. Guidelines were created for the objective use of CPAP, frequency of documentation for adherence, and symptom assessment within a year of CPAP initiation. The structure of the work was performed with the four step Plan-Do-Study-Act cycle and occurred from January 2020 to December 2020.

Results

Initial review included 62 unique patients started on CPAP during 2019. 61 patients (98%) had appropriate documentation of adherence and 53 patients (89%) with follow up, appreciated a reduction of OSA signs and symptoms. Processes included standardization of electronic medical record templates, respiratory therapist assessment prior to and during clinic visits, and scheduling of appointments when CPAP therapy was recommended. Results remained consistent despite changes during the COVID-19 pandemic and shifts to telehealth visits. 44 patients (100%) had appropriate documentation of adherence prior to their first clinic visit with 40 patients (93%) having a reduction in symptoms by the first clinic visit.

Conclusion

The development of systems to ensure appropriate usage of CPAP allow for reliable assessments of use and improvements. EMR templates can document CPAP adherence, and reassess symptoms, regardless of visit location or staffing model shifts. We had an initial note template and then developed an auto-populated hyperlink that could be used in telephone and clinic encounters for adherence. With standardization and awareness, we ensured patients were receiving optimal care and treatments were adjusted when challenges were apparent.

Support (if any)

Internal funding provided by the Children’s Wisconsin Department of Pediatrics
0803 Insomnia, Mood, and Quality of Life in Children and Young Adults with Congenital Heart Disease
Authors: Maxfield Kate , Melcher Lauren , Bottrill Kenneth , Provencio-Dean Natalie , Hoyer Andrew , Seckeler Michael , Klewer Scott , Edgin Jamie , Combs Daniel
Published: April 2024

Introduction

While mortality rates have decreased in patients with congenital heart disease (CHD), numerous comorbidities associated with CHD persist, including decreased health-related quality of life (HRQOL), depressed mood, and sleep problems. Insomnia is known to worsen mood and HRQOL in children without CHD, therefore we examined the relationship between insomnia, mood and HRQOL.

Methods

We recruited 38 individuals with CHD between the ages of 4-25 years and assessed insomnia, health-related quality of life, anxiety, and depression using the Pediatric Insomnia Severity Index (PISI), Pediatric Quality of Life Inventory (PedsQL), Screen for Child Anxiety Related Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC). T-tests were used to compare differences in HRQOL, anxiety, and depression in individuals with CHD with and without comorbid insomnia. Logistic regression was used to assess whether the presence of insomnia can predict increased odds of clinically significant anxiety or depression.

Results

Individuals with CHD and insomnia (PISI score ≥8) demonstrated significantly lower health-related quality of life, more depressive symptoms, and higher total anxiety compared to individuals with CHD without insomnia. Individuals with insomnia had a mean HRQOL score of 63.1 ± 15.6 vs 77.8 ± 18.9 in the group without insomnia (p=0.03). Individuals with insomnia had a mean total depression score on the CES-DC scale of 21.5 ± 14.6 vs 7.3 ± 5.6 for those without insomnia (p=0.009). Clinically significant depression in the insomnia group was 24 times greater (95% confidence interval [95% CI] 2.3-247.4, p=0.008) compared to those without insomnia. The mean total anxiety score for individuals with insomnia was 25.0 ±19.6 compared with 12.4 ± 10.3 in those without insomnia (p=0.03), and the odds of clinically significant anxiety in the insomnia group vs those without insomnia was 4.44 (95% CI 0.9-21.8, p=0.07).

Conclusion

Insomnia is associated with markedly worse HRQOL, depression and anxiety in individuals with CHD. Further study is needed to evaluate the role of insomnia recognition and treatment in order to improve HRQOL and mood in children and young adults with CHD.

Support (if any)

No support
0804 Acceptability and Patient-centered Outcomes for Infant Behavioral Sleep Intervention in Black Families
Authors: Ahmed Safia , Chung Alicia , McKenzie Lara , Whitlow Jazmyne , McAdams Rebecca , Roberts Kristin , Mindell Jodi , Honaker Sarah
Published: April 2024

Introduction

While the efficacy and acceptability of infant behavioral sleep intervention has been developed and tested in White families, less is known about how Black mothers understand and perceive behavioral sleep recommendations. The objective of the Sleep Guidance in Black Families with Infant Children (SLUMBER) study was to evaluate the perspectives of Black mothers with infants on the acceptability and cultural appropriateness of standard infant behavioral sleep recommendations. As part of this study, we examined maternal perspectives on participation in an infant behavioral sleep program and desired patient-centered outcomes.

Methods

Participants were recruited through Black parent groups on Facebook and WhatsApp, along with more general social media campaigns targeting individuals who identified as Black. Semi-structured interviews were conducted with Black mothers (n=18; 55.6% with a college degree) with an infant < 9 months (M=4.5, SD=2.8; 66.7% male). Interview transcripts were analyzed within the NVivo software using a grounded theory thematic descriptive approach.

Results

Many mothers (n=11, 61.1%) indicated a high interest level in participating in a sleep program. Facilitators to participation included addressing current problem areas with their infant’s sleep and social support. The most identified barrier to participation was potential poor alignment between program recommendations and personal values, particularly pertaining to the acceptability of approaches involving infant crying without immediate intervention. Desired program outcomes that mothers most frequently described included a more consistent or predictable sleep/wake pattern, their baby learning to sleep independently, and increased sleep consolidation.

Conclusion

Black mothers endorsed high interest in participating in an infant behavioral sleep program, although over one-third were not interested. Personal and cultural alignment with program recommendations is important to parents, supporting the need for culturally sensitive interventions, with particular attention to variability in perceived acceptability of approaches involving infant crying. Infant behavioral sleep intervention programs should focus on achieving patient-centered outcomes, such as schedule consistency and sleep consolidation.

Support (if any)

This research is supported by The Center for Injury Research and Policy at Nationwide Children’s Hospital through Grant Number R49CE003074 from the Centers for Disease Control and Prevention. Dr. Chung's time is supported by the National Heart, Lung, and Blood Institute under award number 1K01HL169419-01.
0806 The Effect of a Sleep Promotion Program in Adolescents with Insufficient Sleep: A Randomized Controlled Trial
Authors: Wescott Delainey , Goldstein Tina , Wallace Meredith , Miller Elizabeth , Buysse Daniel , Harvey Allison , Rofey Dana , Levenson Jessica
Published: April 2024

Introduction

Adolescent sleep is compressed by early school start times and often competes with school, extracurricular, and social demands. Insufficient and mistimed weeknight sleep contributes to large shifts in weekend-weekday sleep-wake schedules, which may lead to adverse physical and mental health outcomes. The Sleep Promotion Program (SPP) is a brief, scalable, behavioral intervention that aims to increase sleep duration and regularity while building motivation and efficacy to change sleep behaviors. This secondary analysis tested whether the SPP changed actigraphy-assessed sleep.

Methods

Participants (ages 13-15) with insufficient and irregular sleep (N=44) were randomized to the SPP intervention (n=24) or waitlist control (n=20). The SPP included sleep psychoeducation and a face-to-face clinician session, relying on evidence-based strategies for promoting sleep within a motivational interviewing framework. Participants wore an ActiWatch during their baseline and follow-up which occurred after the intervention or the waitlist period. We hypothesized participants randomized to SPP would lengthen and stabilize sleep from baseline to follow-up compared to controls. We tested a group (intervention vs. waitlist) by time (baseline vs. follow-up) interaction on actigraphy-assessed sleep duration, timing, and regularity (weekend-weekday shift in timing) using multilevel models with a random intercept.

Results

We included 38 participants with at least 4 weekday nights and 1 weekend night of actigraphy (n=23 intervention, n=15 waitlist). The intervention group delayed their weeknight bedtimes (~45 minutes; b=0.69, SE=0.27, p=0.01), delayed their weeknight waketimes (~1 hour; b=0.68, SE=0.32, p=0.03), and simultaneously decreased the difference between weekend-weekday bedtimes (b=-1.1, SE=0.5, p=0.04) compared to controls (i.e., increased regularity). Weekend sleep timing and total sleep time did not change significantly.

Conclusion

The SPP intervention regularized weekend-weekday sleep timing in adolescents with insufficient and irregular sleep, likely driven by delaying weeknight sleep times. Given that this study was primarily conducted during the COVID-19 pandemic, when many participants reported delayed school start times, participants randomized to SPP were able to regularize their weekend-weekday sleep schedules while simultaneously adapting their weeknight sleep schedules to better fit their preferred timing. Regularizing sleep may be an attainable first step to improving sleep in adolescents. Future work will examine whether sleep regularization associates with mental health outcomes.

Support (if any)

K23HD087433, Pittsburgh CTSI
0807 Ferric Carboxymaltose versus Iron Sucrose for Pediatric Sleep-related Movement Disorders
Authors: Ingram David , Balfaqih Yaslam , Al-Shawwa Baha
Published: April 2024

Introduction

Intravenous (IV) ferric carboxymaltose (FCM) and iron sucrose have previously been reported as effective therapies for sleep-related movement disorders (SRMDs) in children. While FCM has a more robust ability to optimize iron stores, iron sucrose is sometimes required instead due to insurance coverage. In this study, we compared clinical and laboratory outcomes of children in our center who underwent either FCM or iron sucrose infusion for SRMDs.

Methods

This was a retrospective study of all children who underwent either IV FCM or iron sucrose infusion in our outpatient infusion center between 1/2023 and 12/2023. While FCM was initially requested for all children, iron sucrose was ordered instead if dictated by insurance coverage. Children were included if the infusion was ordered by a pediatric sleep physician for treatment of confirmed SRMD, there were baseline and follow-up ferritin results available, and there was follow-up clinical information regarding sleep symptoms.

Results

Overall, there were n=40 iron infusions (n=18 FCM and n=22 iron sucrose) that had follow-up clinical and laboratory data available for analysis. There were no significant differences in weight, age, sex, or baseline ferritin level between groups. Children who underwent FCM infusion had significantly higher follow-up ferritin levels compared with iron sucrose (117.9 +/-52.1 vs 69.7+/-38.8 ng/mL, p=0.002) despite longer time to follow-up lab draw (71.3+/- 40.5 vs 28.1+/-37.1 days, p=0.010). Clinical improvement in sleep was noted in children underwent FCM and iron sucrose (72.2% vs 63.6%, p=0.564). Repeated infusions were needed significantly more often with iron sucrose compared with FCM (27.3% vs 0.0%, p=0.024). Each group had 1 case of mild gastrointestinal symptoms during infusion, otherwise no significant infusion reactions were noted. There were no cases of significant hypophosphatemia noted following FCM infusion (mean=4.4+/-0.7, none < 2.0 mg/dL).

Conclusion

Intravenous iron therapy is a safe and effective treatment modality for pediatric SRMDs. FCM is superior to iron sucrose both in terms of improvement in ferritin level as well as decreased need for repeated infusions.

Support (if any)

None.
0820 Challenges to Pediatric Patients Sleeping Well in the Hospital: Environmental and Practice Considerations
Authors: Fidler Andrea , Chang Ellen , Dandoy Christopher , Beebe Dean , Smith David , Dye Thomas , Wang YunZu Michele
Published: April 2024

Introduction

Pediatric oncology and bone marrow transplant (BMT) patients frequently experience poor sleep during their extended hospital stays due to various sleep disruptors. This study aimed to identify specific factors affecting the sleep of our hospitalized patients.

Methods

Hospitalized BMT / oncology patients aged ≥5 years old (n=25) and their parents completed a survey designed for this study, which involved describing the extent to which factors identified in prior studies / extant literature were barriers or facilitators to patient sleep. Over 5 consecutive days / nights, we measured the light that patients were exposed to and how frequently staff entered patient rooms during the night. Light intensity (lux) was collected via Condor ActTrust actigraphs installed at eye-level by the patient’s bed. Room entries were tracked via paper / pencil logs affixed to the door.

Results

Participants (median age of 11.2 years) most frequently endorsed barriers related to vital sign checks, room entries, loud sounds, bright lights, medical procedures, and pain. Top sleep facilitators included reducing light in the room, pain / sleep medications, and having family nearby. Average light exposure varied over the course of the day: morning (median = 2.34 lux, range = 0.09-22.17), daytime (median = 15.55 lux, range = 3.49-125.63), evening (median = 10.48 lux, range = 2.64-64.82), and overnight (median = 1.03 lux, range = 0.28-9.44). Staff-recorded room entries averaged 5 per night, with one patient experiencing 18 room entries in a single night.

Conclusion

Participants endorsed numerous barriers to getting good quality sleep while hospitalized. Based on both patient / family-report as well as objective measurements, it is evident that staff room entries and bright lights at night are not conducive to sleep. Light levels in patient rooms were routinely too dim during the day to optimally support circadian rhythm entrainment. Given that sleep plays a crucial role in health maintenance and recovery, hospitals should strive to reduce staff-related sleep disturbances where possible and optimize lighting in patient rooms. These efforts would create a more “sleep friendly” environment for both patients and their resident family members.

Support (if any)

AF is supported by an institutional training grant (National Institutes of Health T32DK063929).
0821 GPS-derived Green Space Exposure and Sleep Among Elementary School Children
Authors: Grigsby-Toussaint Diana , Yang Jue , Acevedo Aliana Rodriguez , Evans Gabrielle , Johnson Azia , Katz Abby , Kemball-Cook William , Nwanaji-Enwerem Ugoji , Romero-Ramos Yaideliz , Story Diane , Ury Brooke , Cheol-Shin Jong , Barker David , McGeary John , Dunsiger Shira
Published: April 2024

Introduction

Exposure to greenspace has been linked to improved well-being among children such as cognitive restoration and reduced stress. Greenspace is also associated with increased exposure to light, a zeitgeber of the circadian system. Studies examining the association between greenspace exposure and sleep, however, have been equivocal, largely due to methodology related to static measures of environmental context. We address this issue by using GPS-derived measures of greenspace that move beyond static residential contexts, and examine multiple measures of access to greenspace.

Methods

Schoolchildren in grades 1-3 in the ongoing Project Greenspace, Sleep, and Mental Health (G-SPACE) study in Rhode Island were recruited to wear a GPS and an accelerometer for seven days. GPS was used to identify stay points if participants spent 15 minutes in a space. We extracted and averaged Normalized Difference Vegetation Index (NDVI) values in 100m, 200m, 300m, 500m, and 1,000m circular buffers surrounding each participant's stay points to calculate greenspace exposure. Sleep measures were derived using actigraphy, and potential association with greenspace exposure was analyzed using a series of linear regression models.

Results

Forty-nine participants had 398 valid days of wear-time. On average, participants wore devices for 6.2 days (SD=1.72). The mean sleep values included: Time in Bed, 9.63 hours; Total Sleep Time, 9.17 hours; Sleep Efficiency, 88.78%, and Wake After Sleep Onset (WASO), 37 minutes). Both TIB (hours) (100m β:1.98, p=0.01; 200m β: 1.87, p=0.01; and 300m β: 1.65, p=0.05) and TST (hours) (100m β: 1.94, p=0.01; 200m β:1.67, p=0.01; and 300m β: 1.37, p=0.05) showed positive associations with mean NDVI across smaller buffer distances. However, associations between Sleep Efficiency, WASO and greenspace exposure were not significant.

Conclusion

GPS-derived greenspace exposures in close proximity to daily activities are associated with total sleep time among elementary school children, with the strength of the association diminishing with each widening radius from the stay point. Our results have implications for urban planning and greening of neighborhoods, but additional analyses are needed with larger sample sizes and control for sociodemographic factors.

Support (if any)

Project G-SPACE is supported by the National Institutes of Health/National Institute on Minority Health and Health Disparities (R01MD016241) and NIGMS 5P20GM139743
0824 The Association Between Sleeping Arrangements and Breastfeeding Duration
Authors: Hershon Malka , Ly Michelle , Laganière Christine , Pokhvisneva Irina , Gaudreau Hélène , Pennestri Marie-Hélène
Published: April 2024

Introduction

The World Health Organization recommends that infants be exclusively breastfed for at least the first 6 months of life, and then partially breastfed until 2 years of age and onward, if preferred. However, the choice to breastfeed an infant is influenced by cultural, biological, and social factors. For instance, factors which may promote breastfeeding include bedsharing, but the current literature requires more longitudinal examinations and follow-ups. The current project aims to investigate the associations between bedsharing at 6 months and the duration of breastfeeding.

Methods

The analysis included data from 294 mother-infant dyads (52 bedshared) from the Maternal Adversity, Vulnerability and Neurodevelopment cohort. Maternal reports of their infant’s sleep location were reported at 6 months of infancy. Infants who shared a bed with their mother were considered to bedshare, whereas those who slept in the same room as their mother, in their own room alone, or in their own room with someone else where not considered to bedshare. A retroactive measure of breastfeeding was given to mothers (until infants were 24 months), in which they were asked how old the infant was when they stopped breastfeeding. An independent samples t-test was conducted to compare breastfeeding duration between infants who bedshare and those who do not.

Results

Bedsharing infants were breastfed for a longer period (in months; M=12.87, SD=5.21) than infants who did not bedshare (M=10.64, SD=3.97; t(292)=-3.48, p=<.001).

Conclusion

These results show that infants who bedshare with their mother are likely to be breastfed for about 2 months more. These results provide support for the protective nature of bedsharing at 6 months on breastfeeding duration. Given these potential benefits, these results highlight the need for clear recommendations for parents to safely practice bed sharing if they are willing to use this sleeping arrangement.

Support (if any)

Malka Hershon holds a Canada Graduate Scholarship - Master’s program (SSHRC). Dr. Pennestri holds a Chercheur-Boursier Award from the Fonds de recherche du Québec – Santé and a William Dawson Award from McGill University.
0825 Sweet Dreams Are Made of This: Improving the Family Bond with Better Sleep for Children 6 Months to 6 Years Old
Authors: Vadasz-Chates Nataly , Chaung Matthew , Kaji Sanjay , Troester Matthew , Dorrity Renae
Published: April 2024

Introduction

This comprehensive review explores methods employed to improve pediatric sleep, emphasizing developmental trends, challenges, and health impacts. The narrative navigates through behavioral modification techniques, responsive parenting, and innovative digital therapeutic interventions, offering a holistic perspective on pediatric sleep dynamics. The primary objective is to evaluate the efficacy of responsive parenting techniques within the Batelle Sleep School program in improving pediatric sleep patterns and enhancing overall family well-being. This study aims to contribute evidence-based insights into the complex interplay between sleep quality, parenting styles, and child development.

Methods

The study involves a retrospective analysis of surveys from under 500 families with children aged six months to six years enrolled in the Batelle Sleep School program from October 2022 to March 2023. Quantitative and qualitative data will focus on sleep assessments, parental confidence, sleep latency, and awakening surveys. The intervention spans two weeks, during which parents follow the program's guidelines.

Results

Pre-program and post-program data will be analyzed to assess changes in sleep latency and the number of awakenings. Statistical methods, including paired t-tests, will be employed for quantitative analysis, while qualitative data will undergo thematic analysis to identify common themes related to family dynamics and program effectiveness.

Conclusion

This research aims to provide evidence-based recommendations for parents, healthcare professionals, and researchers by investigating the integration of responsive parenting techniques with a digital therapeutic in the context of the Batelle Sleep School program. Bridging the gap between pediatric sleep challenges and effective interventions, this study contributes to the evolving landscape of sleep medicine, recognizing the diverse needs of families and offering tailored solutions for improved pediatric sleep.

Support (if any)
0826 Sleep in Parents and Children with Overweight and Obesity
Authors: Tsai Shao-Yu , Tung Yi-Ching , Huang Chuen-Min , Gordon Christopher , Cayanan Elizabeth , Lee Chien-Chang
Published: April 2024

Introduction

Sleep is fundamental for overall health and well-being. Nevertheless, a substantial portion of school-age children, ranging from 30.0% to 43.7%, experience sleep disturbances as reported by their parents. Children who are overweight or obese have increased sleep disturbances than their normal-weight peers. Research on children and parent’s sleep shows that parental sleep and health characteristics may serve as a risk or protective factor for children's sleep. This study aims to investigate the sleep patterns of parents and their school-age children with overweight and obesity.

Methods

Children (6-9 years) with overweight and obesity wore a wrist-worn actigraph for 7 days. Children’s sleep disturbance was assessed using the parent-report Children's Sleep Habits Questionnaire (CSHQ). Parental subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with parental depressive symptoms measured using the Epidemiologic Studies-Depression Scale (CES-D). General linear models were used to examine the association between parental and child sleep.

Results

Overall, 246 children and parents participated in this study, with 208 (84.6%) children experiencing clinically significant sleep disturbances and 123 (50%) parents reporting poor sleep quality. Higher children's sleep disturbance scores significantly predicted poorer parental sleep quality (b = 0.11, p < .01). Poorer parental sleep quality was associated with more severe sleep disturbances in children (b = 0.46, p < .01). This association was unaffected by children’s actigraphic sleep (all p > .05) and remained significant after adjusting for parental depressive symptoms (b = 0.14, p < .01).

Conclusion

Sleep disturbances are prevalent in both parents and their school-age children who are overweight or obese, with a significant bi-directional association between the two. Healthcare professionals working in school settings should screen for sleep disturbances in parent-child dyads of children with overweight and obesity.

Support (if any)

This work was supported by the Ministry of Science and Technology, Taiwan, MOST 107-2314-B-002-025-MY3.