bluuebunny/crossref_metadata_2025 huggingface dataset:
0820 Meta-Analysis of the Association of Age and Actigraphy-Assessed Sleep Across the Lifespan
Authors: Bowman M A , Buysse D J , Marsland A L , Wright A G , Foust J , Mehra R , Srinivasan S , Kohli N , Carroll L , Jasper A , Hall M H
Published: May 2020

Introduction

Sleep quantity and continuity vary across the lifespan. Actigraphy is reliable, ecologically valid, and is the most widely-used behavioral measure of sleep in research and personal health monitoring. The extent to which age is associated with actigraphy-assessed sleep has not been evaluated across the lifespan. The aim of this meta-analysis was to evaluate the associations between age and actigraphy-assessed sleep in relatively healthy individuals.

Methods

A systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using “actigraphy” and “sleep” terms provided 7,079 titles/abstracts, which were screened to exclude studies of only individuals with mental health disorders, medical conditions, sleep disorders, or shift workers. We evaluated 1,379 full-text articles for reports on the association between age and actigraphy-assessed sleep duration, efficiency, timing, and/or regularity. Overall, 88 articles met these criteria (182 effect sizes; N=18,443). Four meta-analyses were conducted, examining sleep duration (k=86), sleep efficiency (k=58), bedtime (k=27), and wake-up time (k=11). There were insufficient numbers of studies (less than 5) to evaluate sleep midpoint or sleep regularity. We tested continent of the study, study design, actigraphy device type, and number of nights of data collection as moderators of meta-analytic associations.

Results

With increasing age, sleep duration was shorter (r = -0.13) and sleep efficiency was lower (r = -0.06). Bedtime was later with age for ages 6-21 (r = 0.31) and earlier for ages 22 and up (r = -0.65). Wake-up time was not associated with age for ages 6-21 (r = 0.20) but was earlier with increasing age for ages 22 and up (r = -0.71). The strength of these associations was modified by continent and study design, but not by type of actigraphy device or number of nights of data collection.

Conclusion

Weak associations between age and actigraphy-assessed duration and efficiency suggest that inadequate sleep quantity or poor sleep continuity should not be dismissed as typical consequences of aging. Large associations between age and sleep timing, despite a small literature, highlights a promising area for further study, particularly to determine the age at which sleep timing shifts from delaying to advancing.

Support

MAB was supported by T32 HL07560.
0843 Prospective Associations of Insomnia Symptoms With Health Services Use in Community-Dwelling Older Adults
Authors: Tzuang M , Owusu J T , Huang J , Sheehan O C , Rebok G W , Kasper J , Spira A P
Published: May 2020

Introduction

Limited research has examined links of insomnia with health services use, particularly using claims-based data. We investigated the association of insomnia symptoms with costly health services use, measured by Medicare claims, in a nationally representative sample of U.S. older adults.

Methods

Participants were 4,302 community-dwelling Medicare beneficiaries aged ≥65 years from Round 1 (2011) of the National Health and Aging Trends Study who had continuous fee-for-service Medicare coverage 1 year before and after the Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency >30 minutes, difficulty returning to sleep after early awakening) which we categorized as 0, 1, or 2 symptoms. Outcomes were linked Medicare claims occurring after Round 1 interviews: emergency department (ED) visits, all-cause hospitalizations, preventable hospitalizations, all-cause 30-day readmissions, home health care (all measured as yes/no); and number of hospitalizations and ED visits.

Results

Overall, 18.9% of participants were hospitalized, 29.3% visited the ED, 3.1% had a preventable hospitalization, 2.6% had a readmission, and 11.7% used home health care. After adjustment for demographics, compared to participants with no insomnia symptoms, those with 2 symptoms had a higher odds of ED visits (odds ratio (OR)=1.42, p<0.001), all-cause hospitalizations (OR=1.30, p<0.01), preventable hospitalizations (OR=1.83, p<0.05), 30-day readmissions (OR=1.73, p<0.05), and home health care use (OR=1.27, p<0.05). These associations did not hold, however, upon further adjustment for health characteristics (i.e., depressive/anxiety symptoms, medical comorbidities and BMI). After full adjustment, reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits (Incidence Rate Ratio=1.16, p<0.05).

Conclusion

Among older adults, a greater number of insomnia symptoms is associated with greater health services use. Insomnia symptoms may be a marker of, or exacerbate, health conditions. Targeting insomnia may lower health services use.

Support

National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”
0873 Obstructive Sleep Apnea Impacts Brain Development in Obese Children and Adolescents: An MRI Study
Authors: Sarzetto F , Naik T , Narang I , Kassner A
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is a breathing disorder characterized by episodes of nocturnal hypoxia and chronic systemic inflammation, affecting more than 50% of obese youths. Both obesity and OSA independently have a negative impact on brain structure and function, but their combined effect on the developing brain is unknown. The purpose of this study was to assess MRI measurements of cortical thickness (CT) in obese youths with various degrees of OSA severity. We hypothesized that CT is abnormal in obese adolescents with OSA.

Methods

55 obese subjects (26 females, 29 males, mean 14.3 ± 2.4 years) were included in the analysis. All subjects were assessed with polysomnography (PSG) to evaluate presence and severity of OSA. T1-weighted MPRAGE images were acquired using a 3T MRI scanner following PSG. CT was extracted using the CIVET 2.1.1 pipeline, and statistical analysis was performed on SurfStat to examine global and regional CT in relation to age using a general linear model.

Results

Based on PSG outcome, subjects were divided into 3 groups, no OSA (OAHI < 1.5 events/hr., n = 15), mild OSA (OAHI < 5, n = 14), and moderate/severe OSA (OAHI ≥ 5, n = 26). Cortical thickness analysis revealed a negative-trending correlation between global CT and age in no OSA (T = -0.49, P > 0.6), as seen in typical development. This correlation weakened in the presence of mild OSA (T = -0.20, P > 0.8) and became significantly positive in moderate/severe OSA (T = 3.87, P = 0.001), affecting several cortical areas.

Conclusion

These results indicate that brain development in obese adolescents with moderate/severe OSA significantly deviates from the typical trajectory of cortical thinning. This thickening could be due to exacerbated inflammation from the combined effect of both diseases, or a neurotrophic effect of leptin. More data is needed to validate these findings.

Support

None
0875 Interrelations Among Race, Socioeconomic Status, Sleep Duration Variability, and Neurobehavior in Children with Obstructive Sleep Apnea Syndrome
Authors: Williamson A A , Fan J , Xiao R , Tapia I E
Published: May 2020

Introduction

There are racial and socioeconomic status disparities in child obstructive sleep apnea syndrome (OSAS) and in sleep patterns, but research on sleep patterns in children with OSAS is limited. This project examined interrelations among race, socioeconomic status (SES), sleep duration variability, and neurobehavior in children with OSAS.

Methods

Baseline data were drawn from 464 children with OSAS (M age 7 years, SD 1.4 years; 49% male; 34% Black) participating in the Childhood Adenotonsillectomy Trial. Sleep duration variability was calculated as the coefficient of variation for 5-day sleep diaries. Linear regression was used to examine whether sleep duration variability was associated with child race (Black vs. non-black), SES (family income; maternal education; neighborhood distress index based on US Census data), z-scored body mass index, asthma, prematurity, and secondhand smoke exposure. We then examined whether sleep duration variability was associated with parent-and teacher-reported child neurobehavior including executive functioning (Behavior Rating Inventory of Executive Functioning) and inattention (Conners Rating Scale), adjusting for the variables included in the first regression analysis.

Results

Black race was correlated with increased sleep duration variability (p = .05), but this association was not significant in the adjusted regression model. Secondhand smoke exposure was significantly associated with sleep duration variability (p<.001). Greater sleep duration variability was significantly associated with increased parent-reported neurobehavioral impairments (p=.004 for executive functioning and for inattention), adjusting for race, SES, secondhand smoke exposure, and the other covariates. Sleep duration variability was not associated with teacher-rated child neurobehavior.

Conclusion

In children with OSAS, sleep duration variability is greater in those exposed to secondhand smoke and is linked to increased parent-rated child neurobehavioral impairments. Findings suggest that clinicians should screen for secondhand smoke exposure and that treatment of pediatric OSAS should include a focus on promoting healthy sleep patterns.

Support

Sleep Research Society Foundation and K23HD094905 (AAW).
0884 The Effect of Bariatric Surgery on Sleep Disordered Breathing in Adolescents and Young Adults
Authors: Koirala A
Published: May 2020

Introduction

Childhood obesity is the major risk factor sleep disordered breathing (SDB). Severely obese young people may require bariatric surgery for correction of obesity, if other methods of weight loss have failed. We aim to assess the effect of bariatric surgery on SDB, in adolescents and young adults.

Methods

We conducted a retrospective chart review study of patients who underwent bariatric surgery between January 1, 2006 and August 31, 2019 at Cincinnati Children’s Hospital. Only patients who had pre-operative and post-operative polysomnograms were included in the study.

Results

Twenty-seven children and young adults (female: 59.2%) met the criteria for entry into analysis. The mean age of subjects at the time of weight loss surgery was 17.9 years (range: 12.9 to 32.5). Majority of the patients underwent laparoscopic partial gastrectomy (85.2%) and the remaining underwent laparoscopic gastric bypass surgery (14.8%). The average duration of follow up for post study measurements after the surgery was 10.4 months (Range: 0.4 to 57.5). The median Body Mass Index (BMI) was significantly lower at post-surgery (49.9 kg/m2[IQR: 45.4-55.9][pre] vs 39.3 kg/m2[IQR: 33.9-46][post], P<0.001). The median obstructive AHI was significantly reduced at post-surgery (6.7/hr[IQR: 3.1-16.4][pre] vs 2.6/hr[IQR: 1.6-6][post], P= 0.03). Median heart rate (HR) during REM (79 bpm[IQR:67-90][pre] vs 67 bpm[IQR: 59.7-72][post], P<0.0001) and NREM (81 bpm[IQR:65-91][pre] vs 65 bpm[IQR: 58-73][post], P<0.0001) sleep were significantly lower at post-surgery. There was no statistically significant difference in sleep architecture (sleep latency, arousal index and percentage of REM, N1 and N3 sleep, P> 0.05) except N2 sleep (53.1% [IQR:47.7-57.3] [pre] vs 55.7% [IQR:51.4-63.7] [post], P= 0.03) which was significantly increased at post-surgery.

Conclusion

There was significant improvement in BMI and SDB after weight loss surgery in children and young adults. Interestingly, there was a decrease in heart rate during both REM and NREM sleep after surgery which may suggest a decrease in sympathetic activation due to improvement if SDB. The sleep architecture remained unchanged after surgery, except the percentage of N2 sleep.

Support

Cincinnati Children’s Hospital Research Foundation
0890 Sleep Disordered Breathing is Associated With Endothelial Dysfunction and Atherosclerosis in Young Adults: Preliminary Longitudinal Findings in the Penn State Child Cohort
Authors: Fernandez-Mendoza J , Gao Z , Brandt K , Houser L , Calhoun S L , He F , Liao J , Vgontzas A N , Liao D , Bixler E O
Published: May 2020

Introduction

Sleep disordered breathing (SDB) in middle-age is an established risk factor for cardiovascular disease. However, population-based studies supporting its cardiovascular contribution at earlier stages of development are lacking, particularly with long-term follow-ups.

Methods

The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) with in-lab polysomnography (PSG). To date, 425 have been followed-up another 7.4 years later during young adulthood (24.4±2.6y) via a standardized survey and 136 of them (55.1% female, 21.3% racial/ethnic minority) have undergone a repeat of their PSG to ascertain apnea/hypopnea index. Subjects (n=121) also underwent Doppler ultrasounds to assess flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT). Linear regression models stratified by body mass index in young adulthood.

Results

SDB was cross-sectionally associated with lower FMD (β=-0.239, p=0.008) and greater CIMT (β=0.330, p<0.001) in young adulthood. Longitudinally, childhood (n=121) and adolescence (n=90) SDB were significantly associated with CIMT (β=0.327, p<0.001 and β=0.286, p=0.006, respectively), but not with FMD (β=-0.158, p=0.08 and β=-0.101, p=0.35, respectively). These associations, particularly longitudinal ones between childhood and adolescence SDB with CIMT in young adulthood, were stronger in overweight than normal weight subjects (e.g., β=0.310, p=0.030 and β =0.089, p=0.582, respectively).

Conclusion

SDB and obesity appear to be synergistically associated with endothelial dysfunction and atherosclerosis in young adults from the general population. These data suggest that a childhood exposure to chronic SDB is associated with long-term atherosclerosis, while endothelial dysfunction may be a short-term outcome. This ongoing 16-year longitudinal study will test whether the natural history of SDB from childhood through adolescence into young adulthood shows differential trajectories for cardiovascular morbidity.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0891 Cardiovascular Control is Impaired in Children With Down Syndrome and Sleep Disordered Breathing
Authors: Horne R S , Sakthiakumaran A , Bassam A , Thacker J , Davey M J , Nixon G M
Published: May 2020

Introduction

Children with Down Syndrome (DS) are at increased risk for sleep disordered breathing (SDB). In typically developing (TD) children, SDB is associated with adverse cardiovascular effects including elevated heart rate and blood pressure and impaired autonomic control. The aim of this study was to compare the cardiovascular effects of SDB in children with DS to those of TD children with and without SDB.

Methods

44 children with DS (3-18 y) were age and gender matched with 44 TD children without SDB (TD-) and with TD children with matched severity of SDB (TD+). Height, weight and blood pressure were measured and BMI, systolic and diastolic z-scores calculated. Heart rate variability (HRV) was calculated for 2 min artefact free epochs overnight. Power spectral density for the low frequency (LF), high frequency (HF), total power (TP) and the LF/HF ratio (sympathovagal balance) were calculated. Data were compared between groups with Kruskal-Wallis one-way ANOVA.

Results

Wake heart rate, systolic and diastolic z-scores were not different between groups. LF/HF was higher in the DS group compared to both TD+ (p<0.05) and TD- (p<0.01) in wake and total sleep time. During total sleep HF power was lower in DS compared to TD+ (p<0.01). In N2 TP and HF were lower and LF/HF higher in DS compared to both TD+ (p<0.01) and TD- (p<0.05). In N3 HF was lower in DS compared to TD+ (p<0.05) and LF/HF was higher compared to both TD+ and TD- (p<0.001 for both) and in REM LF/HF was higher compared to TD+ (p<0.01).

Conclusion

In children with DS and SDB, autonomic cardiovascular control is impaired compared to TD children matched for SDB severity and to non-snoring TD children. Our findings demonstrate significantly reduced parasympathetic activity (reduced HF power) and increased sympathovagal balance, that may contribute to increased risk of cardiovascular disease later in life.

Support

This study was funded by the Jack Brockhoff Foundation.
0895 Pediatric Positive Pressure Therapy: Enhancing Education And Parent/guardian Confidence To Implement Therapy
Authors: Moore W R , Anderson S E , Burr L E , Clark P R , Peine N A , Sydejko D M , Wahl A M , Hale A M , Baughn J M
Published: May 2020

Introduction

Pediatric positive airway pressure (PAP) therapy can be challenging for children and their parent/guardian (PG). These challenges are complicated by the need to facilitate behavioral competency in the management of both device equipment and therapy.

Methods

As part of a larger quality management project aimed to improve PG and patient satisfaction we developed a targeted education visit provided by registered nurses prior to PAP trial initiation. Principle aims were to measure satisfaction with education and increase PG confidence in ability to manage therapy. The nurse session included: education on Obstructive Sleep Apnea (OSA) and PAP therapy, development of plan for first month of therapy, concepts of desensitization, regular practice, discussion and identification of concerns (assessment of barriers to implementation). A survey was administered pre-intervention to assess PG confidence in ability to manage therapy. Post-intervention, PG rated the interventions impact on baseline confidence, as well as an assessment of satisfaction with the education and content. Descriptive statistics were utilized to summarize the Likert survey questions.

Results

A total of 21of 25 (84%) participants completed surveys. 100% of PG that responded was either extremely satisfied or very satisfied with the educational intervention. Prior to the intervention, 19% (N4) indicated little to no confidence, 19% (N4) indicated some confidence and 62% (N13) indicated being very confident. 62% (N13) of PG’s indicated the information covered was new to them, while 24% (N5) indicated some information was new and 14% (N3) indicated none of the information was new. Regardless of baseline confidence, 100% (N21) responded that the intervention further improved confidence to a great degree.

Conclusion

The nurse visit resulted in high satisfaction with care and education and impacted PG confidence in ability to implement treatment. Future studies are needed to determine the impact on patient compliance.

Support
0904 Rapid Eye Movement Related Obstructive Sleep Apnea In The Pediatric Population: Case Series And Considerations
Authors: Petitto L , Musso M
Published: May 2020

Introduction

Rapid Eye Movement (REM) related Obstructive Sleep Apnea (OSA) can impact sleep quality and result in negative clinical consequences. There are limited pediatric studies evaluating potential consequences, looking at optimal decision making, and discussing best treatment options. Aims: 1: Describe clinical impact and potential negative consequences; 2: Discuss treatment management of REM related OSA; 3: Evaluate clinical effectiveness of treatment.

Methods

Case series: Retrospective review of 22 pediatric patients with REM related OSA at a tertiary care center. Clinical analysis of implemented treatment modality vs. observation was reviewed. Symptomatic response to treatment modality vs. observation including alteration of quality of life was examined.

Results

REM related OSA lead to negative clinical daytime symptoms which warranted consideration and implementation of further treatment.

Conclusion

Treatment considerations for REM related OSA include tonsillectomy and adenoidectomy, positive airway pressure, medical management, and watchful waiting. Further research is necessary to increase knowledge of clinical impact of REM related OSA and treatment.

Support

N/A
0907 Implementation Of Pathway For Severe Obstructive Sleep Apnea Management In Children
Authors: Gehring S , Auricchio L , Kidwell S , Oppy K , Smallwood S , Kalra M
Published: May 2020

Introduction

Obstructive Sleep Apnea (OSA) is associated with neuro-cognitive, cardiovascular and metabolic morbidity in children. Adeno-tonsillectomy is the first line of treatment for OSA with PAP therapy and Oxygen supplementation being alternative therapeutic options in select cases. Severe Obstructive Sleep Apnea is a known risk factor for postoperative respiratory complications after adenotonsillectomy. Therefore, inpatient adenotonsillectomy with close monitoring is recommended for this group of children. Challenges to safe and timely care for this high risk group of children can be overcome with effective coordination of care between different locations and health care providers.

Methods

All children seeking treatment at Dayton Children’s Division of Sleep Medicine were managed through a pathway developed by a multi-disciplinary team involving sleep medicine, otolaryngology and clinical logistics. Severe OSA was defined as AHI ≥15 events/hr (children <2 year old), AHI ≥15 events/hr with three or more Oxygen desaturations <80% (children ≥2 to <6 years old), AHI ≥ 30 events/hr with three or more Oxygen desaturations <80% (Children ≥6 to 18 years old).

Results

A total of 78 children were diagnosed with severe OSA in 2019. All children were successfully triaged to appropriate therapeutic option (Adenonotonsillectomy, PAP, O2) within 24 hours of diagnosis. Urgent adenotonsillectomy was performed on the same day in 4 children and within 2 weeks on 12 children. There was no postoperative respiratory complication after urgent adenotonsillectomy. Thirteen children had adenotonsillectomy after 2 weeks. PAP therapy was started in 28 children (34%). Therapy was initiated on the same day in 10 children and the next day on one child. Oxygen supplementation was started in 21 children (27%).

Conclusion

A multidisciplinary collaborative approach can result in delivery of timely and safe care for severe OSA in children.

Support

NA
0961 Comparison of Clinical Characteristics of Children With Narcolepsy With and Without Sleep Related Movement Disorders
Authors: McIntyre E A , Oles S K , Bandyopadhyay A , Daftary A
Published: May 2020

Introduction

Narcolepsy is known to be associated with sleep related movement disorders (SRMD) including periodic limb movement and restless leg syndrome. However, there is paucity of data comparing the clinical characteristics of children with narcolepsy with and without SRMD.

Methods

Retrospective chart review of all children presenting to the sleep clinic for sleep problems between March 2016 to June 2017 was performed. Demographics, sleep intake patient questionnaires and ICD-10 codes for comorbidities and sleep diagnoses were collected. Children with diagnosis of narcolepsy (ICD-10 G47.4) were included in this study. Cohort was divided into 2 groups- with and without co-existing diagnoses of sleep related movement disorders (ICD-10 G47.6). Demographics, presenting symptoms, Epworth sleepiness scores and prevalence of sleep comorbidities were compared using T-test (continuous) and Chi square (categorical). Unadjusted odds ratio was calculated for demographics and presence of SRMD. P value of <0.05 was considered significant.

Results

28 (F=14,50%) children with narcolepsy were included. 25% children were diagnosed with SRMD. Mean (SD) age of children with SRMD presenting to the sleep clinic was 11.14 (5.08) years while mean age (SD) of children without SRMD was 9.52 (3.87) years. Age and race of children with and without SRMD were not statistically different. There was an increased prevalence of females in the group with narcolepsy and SRMD compared to the group without SRMD (86%vs38%, p=0.029). Epworth sleepiness score was not statistically different between the 2 groups. Female gender increased the odds of SRMD in children with narcolepsy (OR:9.75, 0.98- 96.56).

Conclusion

Children with narcolepsy can present with comorbid sleep related movement disorder. Females were more likely to present with associated SRMD compared to males.

Support

None
0976 Temporal Associations Between Sleep And Suicidality In Ultra-high Risk Adolescents And College Students During An Intensive Longitudinal Study
Authors: Franzen P L , Merranko J , Zelazny J H , Hamilton J L , Sewell C , Goldstein T R
Published: May 2020

Introduction

Studies consistently demonstrate a link between subjective sleep disturbances and the continuum of suicidality, although this evidence primarily comes from retrospective, cross-sectional studies using limited items to assess sleep. Longitudinal assessment of well-defined and measured sleep/wake behaviors with high-risk individuals are needed to enhance the specificity of near-term suicide risk detection and render concrete targets for suicide prevention.

Methods

Participants (N=46) included ultra-high-risk adolescents (N=29 ages 12-18) and college students (N=17 ages 18-24). For up to 12 weeks, participants wore an actigraph to yield objective data on sleep/wake, and concurrently completed daily cellphone-based ratings of subjective sleep and suicidality. Generalized estimating equations were used to examine the association between sleep parameters (subjective and objective) and the odds of next-day suicidal outcomes (i.e., passive death wish [PDW], suicidal ideation, suicidal intent) controlling for age, gender, and depression severity.

Results

Significant quadratic relationships were observed between actigraphy-derived total sleep time (TST) and probability of next-day PDW (Z=3.7, p=0.0002), suicidal ideation (Z=2.1, p=0.04), and suicidal intent (Z=2.78, p=0.006), with increasing suicidality at low and high values of TST. Low sleep efficiency (<75%) was associated with increased odds of next-day PDW (OR=1.24, Z=2.07, p=0.038). Subjectively (sleep diary measures), low sleep quality (<50 on 100-point scale) was associated with increased odds of next-day suicidal ideation (OR=1.57, Z=3.42, p<0.001), and longer sleep onset latency (>20 minutes) with next-day suicidal intent (OR=3.00, Z=2.37, p=0.018).

Conclusion

Poor sleep health may signal increasing suicide risk, and are modifiable risk factors. We document a significant temporal association whereby objectively-derived short and long TST and low sleep efficiency, as well as subjective sleep quality and sleep onset latency, predicts next day’s suicidality. Further understanding of the temporal association between sleep and suicidality may hold promise to inform real-time monitoring and preventive strategies. Interventions targeting these factors may therefore help reduce suicidality in high-risk youth.

Support

American Foundation for Suicide Prevention; University of Pittsburgh Clinical and Translational Science Institute
0983 Sleep Associated With Executive Functioning Among Adolescents Across The Adhd Continuum
Authors: Lunsford-Avery J R , Krystal A D , Carskadon M A , Kollins S H
Published: May 2020

Introduction

Executive functioning (EF) deficits are a key feature of ADHD, and sleep disturbances may be an important contributor. Specifically, disturbed sleep is prevalent in ADHD and similar EF deficits are observed in ADHD and sleep disorders. Associations between disrupted sleep and EF in ADHD are poorly understood, particularly during adolescence. This study is among the first to examine relationships between sleep and EF using polysomnography (PSG) among adolescents across the ADHD symptom continuum.

Methods

In this ongoing study, 42 adolescents aged 13 to 17 (mean age = 14.86, 20 females) completed 3 nights of at-home PSG recording (total sleep time; TST) and self-reports of sleep quality, daytime sleepiness, and chronotype. Seventeen had ADHD and 25 were healthy controls (HC). Participants and parents also completed a measure of EF (BRIEF-2; global and behavioral, emotional, and cognitive subscales). Linear regressions controlling for age and sex evaluated associations between sleep and EF.

Results

Self-reported poorer sleep quality and greater daytime sleepiness and eveningness tendency (p’s<.05), but not TST, were associated with poorer self-reported global EF among adolescents. Shorter TST and greater eveningness were correlated with poorer parent-reported global EF (p’s<.05). Follow up analyses examine differential relationships between sleep and behavioral, emotional, and cognitive domains of EF and between ADHD and HC groups.

Conclusion

This study is among the first to examine relationships between sleep and EF across the ADHD continuum in an adolescent-specific sample using PSG. Objectively-measured TST as well as subjective measures of sleep were associated with poorer EF in adolescents across the ADHD continuum. Prevention/intervention strategies focused on sleep may support EF among adolescents, and future studies should examine this possibility. In addition, given variability in EF among individuals with ADHD, future studies should investigate whether sleep disturbances identify a phenotypic subgroup within ADHD at risk for EF deficits.

Support

This work was supported by NIMH K23 MH108704 (Dr. Lunsford-Avery)
0987 Characterizing Scratch And Limb Movements In Atopic Dermatitis During Sleep
Authors: Gillow G M , Robins C , Palomo R , Sheldon S S , Fishbein A B
Published: May 2020

Introduction

Children with atopic dermatitis (AD) experience significant sleep disruption due to nocturnal scratching. Our group has found distinct patterns of limb movements in contrast to control and PLMD patients. To expand on previous findings, our objective was to characterize timing and duration of scratch v. non-scratch movement in children with AD coincidentally undergoing polysomnography (PSG).

Methods

Retrospective chart review of PSG, video footage was synchronized with the EEG and limb electrode readings using a time/date generator and was then operationally classified as either scratching or non-scratching movement. Analysis of data was done using SPSS and groups were compared using an ANOVA.

Results

We analyzed four previously completed sleep studies in children with atopic dermatitis (1 female and 3 males), mean age years±SD 11.3±1.0, mean BMI±SD 21.9±7.1, mean AHI±SD 2.3±0.8. Average scratch duration was not significantly different by sleep stage, N1v.N2v.N3v.REM (mean scratch duration in seconds±SD= 9.0±1.5 v 6.3±3.2 v. 11.9±11.8 v. 6.3±7.3, respectively p=0.65). However, frequency of scratching events were more common during N2v.N1v.N3v.REM (mean scratching events±SD= 9.3±3.9 v 3.8±1.7 v. 4.3±4.3 v. 1.3±1.9, respectively p=0.02). Yet, given the duration of total time spent in sleep stages, minutes of scratching events occupied the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 3.9±0.9 v. 0.6±0.4 v. 0.4±0.2 v. 0.3±0.5, respectively, p<0.01). Interestingly, non-scratch related movements were not significantly different between sleep stages (p=0.2). However, non-scratch related movements trended to occupy the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 9.3±7.7 v. 2.1±1.6 v. 1.5±0.8 v. 1.9±1.4, respectively, p=0.05).

Conclusion

Our results suggest that scratching episodes in children with AD occur most commonly during N2 sleep, but occupy the largest % of N1 sleep. Future work will include comparing these limb movements to age and gender-matched allergic rhinitis patients.

Support

This study was unfunded.
0988 Interaction Of Race/Ethnicity And Adverse Childhood Experiences: Links To Subsequent Childhood Sleep Duration
Authors: Rojo-Wissar D M , Sosnowski D W , Jackson C L , Maher B S , Spira A P
Published: May 2020

Introduction

Adverse childhood experiences (ACEs) and sleep disturbances independently affect health and development across the lifespan. While burgeoning research suggests a link between ACEs and sleep health among adults, few studies have examined the association between ACEs and sleep in childhood or whether these associations vary by sex or race/ethnicity.

Methods

Using prospective data from 2,063 children (49% female; 20% Non-Hispanic [NH] White, 55% NH Black, 25% Hispanic/Latino) from the Fragile Families & Child Wellbeing Study, we used multiple linear regression analyses to examine associations between primary caregiver reports of child cumulative ACEs (i.e., physical abuse; emotional abuse; neglect; household dysfunction; possible range=0 to 10) at age 5 and primary caregiver reports of average sleep duration (minutes) at age 9. We used interaction terms to examine whether these associations varied by sex (reference group: males) or race/ethnicity (reference group: NH Whites). If significant, we used plots to visually investigate other potential between-groups differences (i.e. non-overlapping 95% CIs) and tested these statistically using linear combinations of estimator tests. If there were significant group differences, analyses were stratified by sex or race/ethnicity.

Results

Associations between ACEs and sleep duration significantly varied by race/ethnicity but not sex, such that the magnitude of the association was stronger in NH Whites compared to NH Blacks (p<.0001) and in Hispanics/Latinos compared to NH Blacks (p<.0001). In analyses stratified by race/ethnicity and adjusted for both sex and age 5 sleep duration, each unit increase in ACE score was associated with a 6.66 minute shorter sleep duration in NH Whites (B=-6.66, SD=2.10, p=0.002), a non-significant 2.20 minute shorter sleep duration in NH Blacks (B=-2.20, SD=1.52, p=0.148), and a 4.36 minute shorter sleep duration in Hispanics/Latinos (B=-4.36, SD=2.03, p=0.032).

Conclusion

We found that cumulative ACEs were associated with shorter sleep duration across race/ethnicity and more strongly related in NH White and Hispanic/Latino children. Prospective studies with subjective and objective sleep measures investigating multiple sleep parameters are needed that identify factors (e.g., cumulative disadvantage) that differentially affect associations across race/ethnicity and characterize health outcomes of ACEs and sleep duration.

Support

5T32MH014592-39, 5T32DA007292-27, Z1A ES103325-01
1000 Social Media Use And Actigraphic Measures Of Sleep Timing Among High-risk Adolescents
Authors: Hamilton J L , Goldstein T R , Sewall C , Zelazny J , Rode N , Gibbons B , Franzen P L
Published: May 2020

Introduction

Social media use is a risk factor for poor sleep among adolescents. It remains unclear whether social media use before bed impacts later sleep timing or whether youth turn to social media because of sleep problems, which impacts sleep timing. No study to date has examined this relationship using prospective designs and objective sleep measures among high-risk adolescents, who may be particularly vulnerable to social media use.

Methods

As a preliminary test of this relationship, 25 adolescents and young adults in an intensive outpatient program for depression and suicidality completed baseline measures of social media use and wore actiwatches for up to three months. Social media use included: 1) minutes of use within 2 hours of going to sleep, and 2) frequency of social media use due to difficulty falling or staying asleep. To examine social media as a predictor of sleep timing over the next month, actigraphic measures of sleep timing (i.e., onset) were used in the first month after baseline.

Results

Multilevel modeling indicated that higher levels of social media use in the 2 hours before bed (mean = 46.94 minutes) predicted later sleep timing (B = .02; SE = .01; p= .003). Similarly, higher frequency of social media use due to perceived sleep problems predicted later sleep timing (B = .22; SE = .11; p= .04). Models covaried for age, gender, and prior-day depressed mood. When simultaneously entered, only minutes of social media use in the 2 hours before bed significantly predicted later sleep timing.

Conclusion

Findings suggest that the relationship between social media use and sleep timing among adolescents with depression and suicidality may be driven by both social media use before bed and media use due to sleep problems. Research assessing objective social media use and daily relationships are needed to further disentangle this relationship.

Support

Jessica L Hamilton is supported by a T32 fellowship from NHLBI (HL082610; PI: Buysse). This research is supported by grants from the American Foundation for Suicide Prevention and University of Pittsburgh Clinical and Translational Science Institute.
1001 Intravenous Ferric Carboxymaltose For Restless Legs Syndrome In Children And Adolescents
Authors: DelRosso L M , Ferri R , Allen R P , Chen M L , Kotagal S , Picchietti D
Published: May 2020

Introduction

Substantial scientific evidence implicates brain iron deficiency in the pathophysiology of restless legs syndrome (RLS). Current clinical guidelines recommend oral and intravenous iron (IV) in the treatment of both adult and pediatric RLS but studies using ferric carboxymaltose (FCM) are lacking in children and adolescents.

Methods

Retrospective case series of children and adolescents with RLS treated with IV FCM who had serum ferritin levels <50 μg/L. Patients were offered a single dose of IV FCM, 15 mg/kg if weighting <50 kg or 750 mg if weighting >50 kg. Iron profile, serum ferritin, and severity assessment by the International Restless Legs Study Group severity scale (IRLS) were collected pre- and post-infusion. Clinical Global Impression Scale (CGI) was used instead of the IRLS for children. Phosphorus level and adverse effects were assessed post-infusion in all patients. Age and sex-matched children with RLS treated with oral iron supplementation (mean dosage 1.5±0.62 mg/kg/day) were included as a comparison group.

Results

Twenty-eight subjects (15 females, mean age 11.5 years, SD 4.23) and 24 controls were included. Baseline ferritin levels were not significantly different from those of controls but increased significantly from 13.9±7.02 to 112.9±12.00 μg/L after 8 weeks from infusion (p<0.000001), when they were also significantly higher than control values (34.2±21.64 μg/mL, p<0.000001). Transferrin saturation increased from 22.8±9.77% to 31.7±6.81% (p<0.0001), total iron binding capacity decreased from 366.7±51.32 to 302.0±37.83 μg/dL (p<0.0000035). RLS was reported to be resolved or improved in all children treated with IV iron (vs. 62.5% of controls) while none of them reported no change (vs. 37.5% of controls; Chi-square test 9.84, p<0.002). IRLS Score decreased in adolescents from 30.7±22.68 to 3.2±4.21 (p<0.000008) while CGI-I was “very much improved” in six children and “much improved” in four. Side effects were reported in 17.8% of patients treated IV and 20.8% controls (Chi-square 0.0169, p=0.897). FCM side effects included lightheadedness and gastrointestinal discomfort. Post IV phosphorus levels were normal in all participants.

Conclusion

This open-label, observational and retrospective study indicates that FCM IV infusion is an effective treatment for pediatric RLS with higher efficacy than oral iron supplementation.

Support
1002 Endorsement Of Sleep Problems Indexes Autism Severity In Children And Adolescents: Evidence From A Large Community Sample
Authors: Saletin J M , Koopman-Verhoeff M , Han G , Barker D H , Carskadon M A , Anders T F , Sheinkopf S J
Published: May 2020

Introduction

Individuals with autism spectrum disorder (ASD) often experience sleep problems. A reliance on case-control studies rather than dimensional samples limit our ability to understand how sleep problems distinguish diagnosis and severity of ASD. To address this need, we present preliminary findings from a large community sample of individuals with heterogeneous autism phenotypes.

Methods

All participants (≤ 21 years) were selected from the Rhode Island Consortium for Autism Research and Treatment (RI-CART) (final n= 977; 233F; 11.27±4.13 years), a public-private-academic registry of families in Rhode Island affected by ASD-like symptoms. Participants completed the Autism Diagnostic Observation Schedule, 2nd Edition to confirm the presence of diagnosable ASD. Each caretaker also completed dimensional measures of functional impairment: Social Responsiveness Scale, 2nd edition and the Vineland Adaptive Behavior Scale (2nd/3rd editions). Caretakers were asked whether the participant suffered current/past sleep problems: yes/no. All analyses are adjusted for age, sex, race, ethnicity, caregiver education, and scale-version (e.g., 2nd/3rd ed., where applicable).

Results

Endorsement of sleep problems distinguished ASD diagnosis: a confirmed diagnosis of ASD was associated with greater prevalence of sleep problems compared to ASD diagnosis (OR: 1.58; 95% CI: 1.05,2.38; p = .028). Across the sample, endorsement of sleep problems was associated with impairments in adaptive behavior (b = -4.73; 95% CI: -7.47,-2.00045; p = .001) and social responsiveness (b = 6.72; 95% CI: 3.27,10.16; p < .001).

Conclusion

These data from a heterogenous community sample provide evidence for a link of sleep to the phenomenology of ASD. While the search for better diagnostic indicators of ASD continues, we recommend that clinicians consider a brief assessment of sleep behaviors of patients with such neurodevelopmental conditions as autism.

Support

Simons Foundation Autism Research Initiative, Hassenfeld Child Health Innovation Institute at Brown University. K01MH109854 (JMS), NIGMS Advance CTR (JMS). KNAW Ter Meulen Grant (MEKV).
Disturbed nighttime sleep in children and adults with rhythmic movement disorder
Authors: Laganière Christine , Pennestri Marie-Hélène , Rassu Anna Laura , Barateau Lucie , Chenini Sofiène , Evangelista Elisa , Dauvilliers Yves , Lopez Régis
Published: May 2020

Study Objectives

Rhythmic movements (RMs) during sleep are frequent and often considered as benign in children. Disabling forms are diagnosed as RM disorder and may persist in adulthood. Whether RMs severely impact sleep architecture in patients with RM disorder remain unclear. We performed a case–control study to characterize the clinical and polysomnographic patterns of children and adults with a diagnosis of RM disorder in comparison to controls, and to assess the associations between the RMs and the sleep architecture.

Methods

All consecutive patients (n = 50; 27 children, 35 males) with RM disorder from a single sleep clinic (from 2006 to 2019) underwent a comprehensive clinical evaluation and a polysomnographic recording in comparison to 75 controls (42 children and 53 males).

Results

About 82% of children and adult patients had a complaint of disturbed nighttime sleep. Comorbid neurodevelopmental, affective or sleep disorders were found in 92% of patients. While RM sequences defined by video polysomnographic criteria were observed in 82% of patients (in wakefulness and in all sleep stages), no similar sequences were observed in controls. Patients had altered sleep continuity, with low sleep efficiency, increased wake time after sleep onset, and frequent periodic leg movements and apnea events. The severity of RMs was associated with disrupted nighttime sleep, even after controlling for comorbid motor and respiratory events.

Conclusions

RM disorder is a rare, highly comorbid and disabling condition both in children and adults with frequent disturbed nighttime sleep that may contribute to the burden of the disease.
Proposed Changes to the 2021 Residency Application Process in the Wake of COVID-19
Authors: Gabrielson Andrew T. , Kohn Jaden R. , Sparks Hayley T. , Clifton Marisa M. , Kohn Taylor P.
Published: May 2020

The COVID-19 pandemic has brought unique challenges to the delivery of undergraduate medical education, particularly for current third-year medical students who are preparing to apply to residency. In mid-March, medical schools suspended all clinical rotations for the remainder of the 2019–2020 academic year. As such, third-year medical students may not be able to complete sufficient clinical experiences to make important career choices before they have to submit their residency applications. While the decision to suspend clinical rotations was necessary to protect students, specialty organizations and residency programs must mitigate the deficits in students’ clinical education caused by the COVID-19 pandemic.

In this Perspective, the authors identify potential challenges for third-year medical students and advocate for solutions to improve the residency application process for students and programs. First, they propose delaying the date that programs can access applicant data through the Electronic Residency Application Service, thereby affording students more time to complete clinical experiences, solidify their specialty decision, and strengthen their residency application. Second, the authors recommend a restriction on the number of visiting rotations that students are expected to complete to allow for a more equitable distribution of these important experiences. Third, they suggest that program directors from each specialty agree on a maximum number of applications per applicant (based on historical data) to curb an upsurge in applications that may stem from the unique circumstances created by COVID-19 without causing applicants undue stress. Lastly, the authors advocate that residency programs develop infrastructure to conduct video-based interviews and engage students through virtual networking events.

Amidst the unique environment created by COVID-19, the authors urge governing bodies, specialty organizations, and residency programs to consider these recommendations to improve the efficiency and reduce the stress surrounding the 2021 Match.
Have Health Reforms in Brazil Reduced Inequities in Access to Cancer Screenings for Women?
Authors: Mullachery Pricila , Macinko James , Silver Diana
Published: May 2020

We measured asset-based and education-based inequity in utilization of 2 cancer screening tests, Pap tests and mammograms, using nationally representative surveys conducted in 2003, 2008, and 2013. Utilization of Pap tests (ages 25-59 years) and mammograms (ages 50-69 years) increased over time. Asset-based and education-based inequities declined significantly for both screening tests, particularly among women who reported a doctor visit in the previous year. This decline coincided with increases in the coverage of primary health care in Brazil. However, barriers persisted; in 2013, college-educated women were still 2.27 times more likely to have a mammogram than those who were illiterate.