bluuebunny/crossref_metadata_2025 huggingface dataset:
0799 Do Weighted Blankets Improve Sleep Among Children with a History of Trauma? A Randomized Controlled Crossover Trial
Authors: Vieira Alyssa , Cifre Anthony , Baker Carter , Myers Annika , Rech Megan , Kim Jinu , Crabb Katherine , Zhang Yuexin , Alfano Candice
Published: April 2024

Introduction

Sleep problems (e.g., trouble falling asleep, nighttime awakenings) are highly prevalent and persistent among children with a history of trauma/ maltreatment and elevate their risk for a range of deleterious outcomes. Weighted blankets have gained popularity in recent years as a potential non-pharmacological intervention for improving sleep in clinical populations of children, but their efficacy has not been examined among children with a history of trauma and/or maltreatment. Therefore, this study explores whether the use of a weighted blanket for sleep improves objective and subjective sleep outcomes among a group of children adopted from foster care (i.e., with a history of trauma/ maltreatment).

Methods

The current study used a randomized, within-subjects, crossover design where participants used a weighted blanket for two weeks and their usual blanket for two weeks in a counterbalanced order. Participants were N=30 children (63% female), ages 6 to 15 years (M = 9.7, SD = 2.9), adopted from foster care in Texas. Sleep outcomes were measured using actigraphy and subjective sleep diaries.

Results

Results indicated no meaningful differences in the type of blanket used in either actigraphy-based estimates of total sleep time (t(27) = 0.10, p = .91, d = 0.02), sleep onset latency (t(27) = 0.14512, p = .88, d = 0.03), or wake minutes after sleep onset (t(27) = -0.44, p = .65, d = -0.08), or subjective total sleep time (t(27) = 0.75, p = .45, d = 0.14), sleep onset latency (t(25) = 0.28, p = .78, d = 0.06), or sleep quality ratings (t(26) = 1.97, p = 0.06, d = 0.38). Period effects were also examined for each variable; however, results were all also non-significant with small effect sizes. Child age, biological sex, and timing of participation (school year versus summer months) did not impact outcomes.

Conclusion

While this study did not find significant differences in sleep outcomes based on type of blanket used, controlled studies using larger samples of children with a history of maltreatment are needed.

Support (if any)

We thank Luna Blankets (www.lunablanket.com) for donating the weighted blankets used in this study.
0800 Evaluation of the Sleep Profile in Children with Cri Du Chat Syndrome: A Pilot Study
Authors: Xavier Sandra , Moysés-Oliveira Mariana , Kloster Anna Karoliny , Balbueno Bianca , Tufik Sergio , Andersen Monica
Published: April 2024

Introduction

Cri du Chat (CDC) syndrome is a rare genetic condition caused by the deletion of the short arm of chromosome 5, and it affects 1:50,000 live births. It is characterized by global delay in neuropsychomotor development, frequent behavioral alterations, and complaints of sleep fragmentation. The prevalence of sleep problems in CDC syndrome varies from 12 to 64%. So far, it is not completely established whether there is a higher prevalence of sleep disorders in individuals with this syndrome compared to the 20-30% prevalence in neurotypical (NT) children.

Methods

This is a pilot study in which the Sleep Disturbance Scale for Children questionnaire was applied to parents (or caregivers) of 11 patients with CDC syndrome and 11 age-matched NT individuals (controls) to determine the profile of sleep quality in the cohort. In the CDC group, inclusion criteria involved the availability of the molecular array exam, confirming the diagnosis of CDC syndrome.

Results

Sixty eight percent of the sample was male, and the age of participants ranged from 2 to 31 years. Daytime sleepiness, difficulty in falling asleep again after waking up during the night and awakenings during the night were significantly more frequent in the CDC group (p=0.025, 0.0004 and 0.027, Chi-squared test, respectively). No significant differences between groups were observed in relation to total sleep time, sleep latency and bed resistance. Our preliminary data showed that wake after sleep onset is 2.5x more frequent in CDC patients than in NT.

Conclusion

Our pilot study showed that CDC group presented worse sleep parameters in comparison to NT controls. Awakenings during the night and the presence of daytime sleepiness in the CDC group may be a manifestation of non-restorative sleep in this population. Better documenting the prevalence and profile of sleep disorders in this syndrome will allow the improvement of the challenging behavioral issues frequently observed in this condition. The increase in the number of participants in this study will certainly deeper characterize the sleep disturbances in these patients. Further clinical trials will be critical to develop more individualized treatment strategies to individuals with CDC syndrome.

Support (if any)

AFIP, CNPq, FAPESP.
0801 The Relationship of Objectively Measured Sleep to Puberty in School-Age Children with Familial Autism
Authors: Davis Emma , Botteron Kelly , Dager Stephen , Hazlett Heather , Marrus Natasha , Munson Jeff , Pandey Juhi , Pruett John , Schultz Robert , John Tanya St , Zwaigenbaum Lonnie , Piven Joseph , Estes Annette
Published: April 2024

Introduction

The onset of puberty brings changes in sleep patterns in neurotypical school-aged children, shifting circadian timing and decreasing total sleep time. Sleep problems affect over 80% of school-aged autistic children. The predominant autism sleep phenotype involves longer sleep onset latency, night wakings, and early morning waking—defining features of insomnia. Research on the relationship of puberty to sleep problems, sleep duration, and sleep onset timing in autistic children is limited.

Methods

232 school-aged children (age 6-13 years; Male n=142, Female n=90) participated in a sleep study through the longitudinal, multisite Infant Brain Imaging Study (IBIS) network. Participants were ascertained at 6-months-old for having an older autistic sibling (high-likelihood; HL) or no family history of autism (lower-likelihood; LL). The HL group included 47 diagnosed with autism (HL+), 104 without autism (HL-), and an LL comparison group of 81. The participants with actigraphy were categorized as Pre-puberty (n=89) or In-puberty (n=38) based on Tanner Staging. Measures include sleep problems (Children's Sleep Habits Questionnaire, CSHQ), sleep duration and sleep onset time (via 10 days actigraphy and sleep diary).

Results

Sleep problems were significantly increased in the HL+ group compared to HL- and LL groups (CSHQ; p< 0.01; χ2=23.736). Sleep onset times were later for the In-Puberty versus Pre-Puberty HL- group by 52.2 minutes (Kruskal-Wallis; p=0.01), and later, but not statistically significant, for the HL+ group by 43.2 minutes and LL group by 6.6 minutes. Sleep duration was lower, but not statistically significant, for the In-Puberty versus Pre-Puberty HL+ group by 36.6 minutes and HL- group by 37.2 minutes, and higher for the LL group by 3 minutes (ns).

Conclusion

Overall, parent-reported sleep problems were increased in school-age HL autistic children compared with HL- and LL children. Objective measures revealed In-Puberty HL+ and HL- had notably later sleep onset times and decreased sleep duration compared with Pre-Puberty. However, only HL- sleep onset time was significantly later. This pattern suggests sleep characteristics could be associated with familial autism and puberty. Future studies with a larger sample are needed to further evaluate the effect of puberty on sleep in autism.

Support (if any)

R01 HD101578
0808 Nighttime Distribution of Periodic Limb Movements of Sleep After Surgical OSA Treatment in Pediatric Population
Authors: Chang Audrey , Ignatiuk Daniel , Nakamura Aisaku , Hossain Md Monir , Simakajornboon Narong
Published: April 2024

Introduction

Increased periodic limb movements of sleep (PLMS) can occur in patients with sleep disordered breathing. Changes in PLMS following treatment for obstructive sleep apnea (OSA) are observed, but poorly understood. In adults, PLMS are typically seen in the first portion of the night whereas OSA events occur most frequently during the latter portion. To better understand the link between pediatric PLMS and OSA, we investigated whether nighttime distribution of pediatric PLMS could predict resolution of PLMS following surgical management of OSA.

Methods

A retrospective study was performed in children and adolescents aged 1-18-year-olds who had pre-operative PSG showing OSA (OAHI ≥1.5/hr) and significant PLMS (PLM index [PLMI] ≥5/hr) before undergoing surgical treatment for OSA and subsequent post-operative PSG. The cohort was divided into 2 groups based on post-operative PSGs; (1) sustained PLMS with PLMI index >5/hr post-operatively and (2) resolved PLMS with PLM index < 5/hr postoperatively. PLMS distribution was qualified by calculating PLMI during each third of the night of pre-operative PSG. The age, PSG parameters and PLMS distribution were compared between patients with sustained PLMS and resolved PLMS.

Results

Twenty-seven subjects met the criteria for entry into analysis; 14 patients with sustained PLMS and 13 patients with resolved PLMS. Sustained PLMS had higher overall PLMI compared to resolved PLMS (15.13±8.02/hr vs. 9.77±5.88/hr, p=0.03). Sustained PLMS had a higher PLMI during the first third of the night on pre-operative PSG compared to resolved PLMS (15.99±10.37/hr vs. 6.05±8.02/hr, p=0.01). There were no significant differences in PLMS in the middle and last thirds of the night, BMI, age (6.37±4.20 vs. 5.07±4.10 years) at sleep study, AHI, or OAHI (8.11 vs. 6.04).

Conclusion

Children with PLMS that resolved after surgical treatment for OSA have less frequent PLMS in the early part of the night and a lower overall PLMI compared to children with sustained PLMS. This suggests that PLMS occurring in the first third of the night are independent of sleep disordered breathing and are likely associated with other conditions such as sleep related movement disorders. The distribution of PLMS may help prioritize children with OSA and PLMS who require further evaluation of RLS/PLMD post-operatively.

Support (if any)
0809 Circadian Phase Delays from School Nights to Weekends and Relates to Sleep Characteristics in High School Students
Authors: Hasler Brant , Oryshkewych Nina , Buysse Daniel , Clairmont Kaylyn , Clark Duncan , Guo Kathryn , Siegle Greg , Wallace Meredith
Published: April 2024

Introduction

Developmental shifts towards later sleep/circadian timing during adolescence are often at odds with early school start times, resulting in circadian misalignment and sleep restriction, as well as stark differences between sleep timing/duration on school nights versus weekends. While the sleep aspects of this mismatch have been well-characterized, limited objective data addresses within-person changes in circadian phase across the week. In a sample of high school students, this project aimed to (1) characterize within-person changes in circadian phase from school nights to weekend nights, and (2) examine whether later circadian phase relates to other sleep/circadian characteristics across the full week.

Methods

Sample included 115 high school students (mean age 17.3, 55.7% female, 88.7% White) reporting at least one “standard drink” of alcohol in their lifetime. Participants completed baseline self-report measures, wrist actigraphy for 8 days, and two overnight visits (Thursday and Sunday) for salivary melatonin sample collection. The Munich Chronotype Questionnaire assessed chronotype and social jetlag. Actigraphy measures included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and midsleep timing. Circadian phase was calculated as the dim light melatonin onset (DLMO; 4 pg/ml threshold). Actigraphy and DLMO measures were separately calculated for school nights, weekends, and overall (mean). Linear regression was used to examine associations, covarying for sex, race, and SES.

Results

Circadian phase (DLMO) was systematically later on Sunday (mean 37+/-41 minutes later; d=0.68, p< 0.00). Later school night DLMO was associated with longer SOL (b=0.05,p=0.002), shorter WASO (b=-0.03,p=0.018), and shorter TST (b=-0.18,p=0.001) on school nights, as well as later chronotype (b=-1.72,p< 0.0001). Later weekend DLMO was associated with longer TST (b=0.22,p=0.042) on weekends. Later DLMO (school night, weekend, overall) was associated with larger weekday-weekend differences in actigraphic TST (p’s< 0.001) and more social jetlag (p’s< 0.03).

Conclusion

Circadian phase shows systematic within-person differences across school nights and weekends, broadly paralleling social jetlag based on sleep timing. While later circadian phase was associated with later chronotype, as well as more difficulty falling asleep and less sleep on school nights, this was specific to circadian phase assessed on school nights. Future studies should consider day-of-week of circadian assessments.

Support (if any)

R01AA025626(Hasler)
0811 Multidimensional Sleep Health and Its Association with Cardiometabolic Health in Adolescence
Authors: Nyhuis Casandra , Lenker Kristina , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio
Published: April 2024

Introduction

Multidimensional sleep health (MSH) aims to promote physical and mental well-being and capture the 24-hour experience of sleep by using measures of nighttime sleep and daytime functioning. We have previously updated the existing adolescent MSH model to incorporate objective and subjective measures and, in the present study, we examine its utility in identifying associations between MSH and Metabolic Syndrome (MetS), a cluster of five established risk factors of cardiovascular disease.

Methods

We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. We used the RU-SATED framework–regularity, satisfaction, alertness, timing, efficiency, and duration–to derive an MSH score using actigraphy and self-reports. A continuous MetS score was calculated as the sum of sex-and-age adjusted z-scores of waist circumference (WC), mean arterial blood pressure (MAP), homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides, and HDL.

Results

Overall, better MSH was not significantly associated with lower cMetS (β=-0.07, p=0.22); however, it was significantly associated with lower WC (β=-0.12, p< 0.05). When we examined each MSH dimension and its association with each component of cMetS, good sleep timing was significantly associated with lower WC (β=-0.13, p< 0.05) and higher HDL (β=0.11, p< 0.05) and good sleep efficiency was associated with lower cMetS (β=-0.11, p< 0.05) and lower MAP (β=-0.11, p< 0.05). When we examined each dimension continuously, we found that higher ratings of excessive daytime sleepiness were associated with higher cMetS (r=0.12, p< 0.05) and WC (r=0.11, p< 0.05), more morningness was associated with lower fasting triglycerides (r=-0.10, p< 0.05), later sleep midpoint was associated with lower HDL (r=-0.13, p< 0.05), and longer sleep duration was associated with lower MAP (r=-0.12, p< 0.05) and HOMA-IR (r=-0.11, p< 0.05).

Conclusion

Better sleep health is significantly associated with central obesity, the key driver of MetS. Additionally, our analyses demonstrate that specific dimensions of MSH may contribute differently to cardiometabolic health in adolescence.

Support (if any)

NIH Awards Number R01HL136587, UL1TR000127
0812 Modelling the Impact of Reallocating Sleep and Physical Activity on Anxiety and Depression Symptoms in Adolescents
Authors: Davidson Jordan , Wingerson Matthew , Creasy Seth , Cooper Emily , Brinton John , Bowen Anne , Hawkins Stephen , Cree Melanie , Nadeau Kristen , Melanson Edward , Wright Kenneth , Simon Stacey
Published: April 2024

Introduction

Insufficient sleep and sedentary behavior, both associated with increased anxiety and depression symptoms, are highly prevalent in US adolescents. Our lab previously found that extending adolescents’ sleep duration decreased sedentary behavior (SB). However, the impact of replacing time spent in unhealthy behaviors (e.g., SB) with healthy behaviors (e.g., sleep, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA]) on mental health is unknown. Therefore, we aimed to understand the impact of replacing SB and time-in-bed (TIB) with LPA and MVPA on anxiety and depression symptoms in habitually short-sleeping adolescents using isotemporal modeling.

Methods

Baseline data from a study of habitually short-sleeping (≤7 hours on school nights) and physically inactive (< 3h MVPA/week) adolescents ages 14-19 years were analyzed. During one week of home monitoring, thigh-worn accelerometry assessed SB, LPA, and MVPA; wrist-worn actigraphy estimated TIB. Participants completed PROMIS Anxiety and Depressive Symptoms scales. Isotemporal substitution modeling, which uses cross-sectional data to predict the effect of reallocating time spent in one activity with an equal amount of time spent on another, was used to estimate the effect of movement behavior reallocation on mental health symptoms.

Results

Thirty-four adolescents completed study measures (age=16.0±1.2 years, 70% female, 88% Non-Hispanic White). Reallocating 1 hour/day of SB to an equal amount of LPA within the model was associated with a 4.5-point improved depression T-score (p=0.019) but no difference in anxiety symptoms (p>0.10). Neither replacing 1 hour/day of SB with TIB or MVPA nor replacing 1 hour/day of TIB with LPA or MVPA within the model were associated with changes in depression or anxiety symptoms (all p>0.10).

Conclusion

Replacing 1 hour/day of SB with LPA but not MVPA was associated with significantly lower depression symptoms in habitually short-sleeping, physically inactive adolescents. However, neither reallocation of SB to TIB nor of TIB with PA was associated with mental health symptoms. As this modeling analysis is cross-sectional in nature, further prospective research is needed to evaluate the impact of replacing SB with healthy behaviors, including meeting recommended sleep and PA guidelines, to determine impacts on adolescent wellbeing.

Support (if any)

NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; NIH CTSA UL1TR002535
0813 Sleep Duration Moderates the Association Between Bullying and Suicide Attempts Among U.S. Adolescents
Authors: Narcisse Marie-Rachelle , Barker David , Wolff Jennifer , Carskadon Mary
Published: April 2024

Introduction

Suicide is a major public health issue among adolescents in the United States, with rates having more than doubled over the past 15 years. Bullying is a significant risk factor for suicide attempts during adolescence, while sleep insufficiency is concurrently associated with both bullying and suicide attempts. Although joint presence of these exposures may interact to predict suicide attempts, research has not sufficiently investigated whether sleep duration might moderate the association between bullying and suicide attempts.

Methods

This study draws upon data from the 2021 Youth Risk Behavior Surveillance System, comprising a nationally representative sample of 17,134 participants. Multivariable logistic regression was used to evaluate the relationships among bullying (school/electronic), sleep duration, and past-year suicide attempts among adolescents aged 12-18. Covariates included sex, age, race/ethnicity, screen time, and poor mental health. All analyses accounted for complex survey sampling used by the YRBSS.

Results

15% and 16% of adolescents were bullied at school or electronically, respectively; 10.2% had made ≥ 1 suicide attempt during the past year; 77.3% did not adhere to sleep duration recommendations; and 29.3% reported poor mental health either “most of the time” or “always”. In adjusted models, adolescents who were bullied in school or electronically were three times as likely to attempt suicide vs. those who were not bullied (odds ratio (OR): 3.0, 95% CI:[2.4; 3.7]. Adolescents with ≤4 hours of sleep (10.7%) were twice (OR: 2.6, 95% CI:[1.5; 3.0]) as likely to attempt suicide. Sleep duration significantly moderated the association between bullying in schools and suicide attempts (F5,44=3.1;p=0.019), with those who were bullied showing a higher likelihood of suicide attempts with lower (≤4-6 h) or higher (8-10+h) sleep duration. Those reporting no bullying showed reduced likelihood of suicide attempts as sleep duration increased to 7 hours, and the likelihood remained constant with more hours of sleep. Sleep duration did not moderate this association for electronic bullying.

Conclusion

Bullying (school/electronic) and short sleep duration significantly increase the odds of reported suicide attempts in teenagers. Future research is needed to elucidate why sleep moderates suicide attempts differently among adolescents who are bullied vs. those who are not.

Support (if any)

COBRE Award Number P20GM139743
0815 A Machine Learning Approach to Identify Factors Associated with Adolescent Sleep Outcomes
Authors: Ricketts Emily , Kaplan Katherine , McMakin Dana , Patriarca Guadalupe , Mathew Gina , McGrew Tylor , Chang Anne-Marie , Hale Lauren
Published: April 2024

Introduction

Beyond natural physiological changes coinciding with puberty, several factors perpetuate poor sleep health in adolescents. However, there is limited research examining their relative importance. This investigation used two popular machine learning approaches to identify the relative significance of key factors associated with multiple sleep outcomes, including bedtime, sleep duration, and social jetlag, in a diverse sample of adolescents.

Methods

Participants were 3,381 adolescents from the age 15 wave (M=15.59, SD=0.76) of the Future of Families and Child Wellbeing Study. Sixty-eight factors spanning child- and parent-reported socio-demographics, neighborhood environment, sleep behaviors, activities, psychopathology, family, school, physical health, and dietary patterns, were identified through literature review and author consensus. Variables were entered into lasso penalized regression (LASSO) and random forest machine learning models for variable selection and establishing the order of factor importance. Self-reported social jetlag (sleep midpoint on weekend nights minus sleep midpoint on school nights) and weekday and weekend bedtime and time in bed were dependent variables.

Results

Factors overlapping between LASSO and random forest in their association with sleep outcomes are reported. Delinquent behavior, peer delinquency, consuming sweet drinks, parent removal of adolescent privileges, and smartphone use near bedtime were associated with greater social jetlag. Irregular bedtime routine, delinquent behavior, and peer delinquency were associated with later weekday bedtime. Consuming breakfast and joint (parent and child) and independent (child) decisions surrounding selecting shows and movies were associated with earlier weekday bedtimes. Delinquent behavior, peer delinquency, and difficulty falling asleep were associated with later weekend bedtimes, while joint (parent and child) and independent (child) decisions surrounding selecting shows and movies were associated with earlier weekend bedtimes. Consuming breakfast more days was associated with longer weekday time in bed, while irregular bedtime routine, peer delinquency, parent verbal aggression, difficulty falling asleep, and smartphone use near bedtime were associated with shorter weekday time in bed. Delinquent behavior was associated with shorter weekend time in bed.

Conclusion

Across both approaches, the most consistent findings draw attention to delinquent behavior, bedtime routine regularity, smartphone use, and difficulty falling asleep as targets to optimize adolescent sleep health. Findings have implications for clinical and policy recommendations.

Support (if any)
0816 Infant Bedtime and Bedtime Variability Are Independently Associated with Total Sleep Duration
Authors: Lucchini Maristella , Takur Shambhavi , Ordway Monica , Barnett Natalie
Published: April 2024

Introduction

Sleep-related behaviors in the realm of pediatrics encompass elements that facilitate sleep, such as a regular sleep schedule, following a bedtime routine, and positive parent-child interactions before bedtime. Several studies have shown a positive association between an early bedtime, consistent routines and parent-infant interaction promoting infant independence in falling asleep with longer sleep duration and less night awakenings. Nonetheless, few studies have investigated bedtime regularity. Thus, we examined the relationships among infants' bedtime, bedtime regularity, total sleep time, night awakenings and sleep latency in infants over the course of one month, utilizing subjective and objective sleep data

Methods

We recruited 253 infants 4-11 months old (mean 6.7±2months), 46% males. Parents completed surveys on socio-demographic information and the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Objective sleep measures including average bedtime (BT), total sleep time (TST), number of night awakenings (NA) and the standard deviation for bedtime (BTV), were collected for one month using Nanit auto-videosomography (mean 24±5.3nights). Linear and logistic regressions modeled the relationship between BT and BTV as predictors of objective metrics of TST and NA and sleep latency collected from the BISQ-R. Infant’s sex and age were included as covariates.

Results

Compared to a BTV of 15minutes or less, a BTV of 45minutes to 1 hour was associated with a TST shorter by 28.0±10.2minutes, and a BTV of more than 1hour to TST shorter by 33.5±11.8min. Compared to a BT before 7pm, later BT was associated with a shorter TST. Specifically, TST was 19.7±10 min (p=0.03) less when BT was between 7-8PM, 63.8±10.0 min (p< 0.001) less for BT at 8-9PM, and 126.4±12.7 min (p< 0.001) less when BT was after 9PM. NA were not associated with BT or BTV. BT was associated with sleep latency, with infants going to bed after 9pm being more likely to take more than 16 min to fall asleep compared to infants going to bed before 7pm (OR 9.9 CI 1.22-80.4,p=0.03).

Conclusion

Higher BTV and BT after 7PM were independently associated with shorter TST in infants. These results provide important information for clinical practice and further work should explore how to incorporate this information in sleep interventions.

Support (if any)
0817 Influencing Factors in the Decision-Making Process of U.S. Parents Regarding the Use of Melatonin for Children
Authors: Hartstein Lauren , Garrison Michelle , Lewin Daniel , Boergers Julie , Hiraki Brandon , Harsh John , LeBourgeois Monique
Published: April 2024

Introduction

Parents are increasingly turning to exogenous melatonin to help children sleep, despite a lack of experimental research examining its efficacy and the safety of long-term use. In the U.S., melatonin is classified as a dietary supplement and no prescription is needed to obtain it. Given recent surges in pediatric consumption, current data on the factors contributing to parents’ decisions to administer melatonin to their children are vital in order to understand perceptions and concerns surrounding its use.

Methods

Parents of 1039 U.S. children ages 1.0-13.9 years completed an online questionnaire on children’s development, sleep health, and melatonin use. Data on 212 children who either took melatonin in the past 30 days (N = 131) or at some point previously (N = 81) were included in the present analysis. Open-ended questions on why parents administered melatonin and why they stopped (if applicable) were categorized through thematic coding.

Results

Although nearly half of children who recently took melatonin had bedtime resistance (51.1%) or difficulty falling asleep (46.2%), 24.4% had no reported behavioral sleep problems. Parents’ most common reasons for giving melatonin were to help children fall asleep (49.3%) or wind down before bedtime (22.7%). Parents also reported administering it to adjust for changes to regular sleep routines (17.5%) or to shift circadian rhythms (11.4%). Parents frequently reported initiating melatonin on their own (50.0%), with less than half following the recommendation of a healthcare provider (48.1%). Parents often stopped giving melatonin when they felt their child didn’t need it anymore (32.0%). Fewer parents discontinued use due to negative side effects (9.3%) or concerns about health and safety (13.3%).

Conclusion

Parents reported giving their child melatonin for a variety of reasons related to sleep and circadian timing. Melatonin use was frequently initiated without the recommendation of a medical professional, which raises concerns about misinformation given the gaps in scientific research and variable quality of over-the-counter supplements. Greater research and wider dissemination of guidelines are needed to support parents in making informed decisions regarding their child’s melatonin use.

Support (if any)

Eunice Kennedy Shriver National Institute of Child Health & Human Development (F32-HD103390; R01-HD087707)
0818 Room-sharing and Bed-sharing: Reasons, Beliefs, and Sleep in Mothers and Toddlers from Mexican American Families
Authors: Meltzer Lisa , Williamson Ariel , Tschann Jeanne , Ringwood Haley , Martinez Suzanna , Barron Ileana , Marraudino Elena , Thompson Darcy
Published: April 2024

Introduction

Sleep is essential for development, yet best practices in pediatric sleep are based on studies of primarily non-Latino White families, where rates of room-sharing, bed-sharing, and feeding to sleep are relatively low in toddlers. This ongoing study characterizes room-sharing and bed-sharing reasons, beliefs, practices, and sleep among mothers and toddlers in Mexican American families.

Methods

51 Mexican American mothers (19-43 years; mean education 12.3 + 3.2 years) of toddlers (77% boys; 12-15 months) completed surveys in Spanish (67%) or English. Mothers and toddlers wore an actigraph for 7 nights. Surveys included Bed-sharing and Room-sharing Beliefs (poor parent sleep, poor child sleep, child dependent on parent for sleep, parent preference to have child nearby) and the Brief Infant Sleep Questionnaire (sleep ecology, room-sharing reasons, sleep-related practices).

Results

Room-sharing was common (88%), with room-sharing reasons including parental preference to have child nearby (PREF, 53%), space/logistics (SPACE, 33%), and child needing parent to sleep (NEED, 13%). All NEED mothers reported bed-sharing with their toddler, with 50% of PREF and 47% of SPACE mothers reporting bed-sharing. SPACE mothers agreed that bed-sharing contributed to poor parent and child sleep more than PREF or NEED mothers (medium effect size). PREF mothers disagreed that bed-sharing made a child depend on parent for sleep more than the other groups (large effect size). Toddlers falling asleep at bedtime while feeding was common among all room-sharing mothers (SPACE=67%, PREF=88%, NEED=100%), although higher in bed-sharing families (96% vs. 65% own bed). Parent sleep timing (midpoint) was delayed 48 minutes for SPACE mothers vs. NEED mothers, while child sleep timing was 30 minutes delayed in bed-sharing toddlers and 54 minutes delayed in toddlers who fell asleep feeding. Toddlers who fell asleep feeding had a 35 minute longer sleep opportunity, but a 33 minute shorter sleep duration than non-feeding toddlers.

Conclusion

Early findings from our ongoing study of sleep in mothers and toddlers from Mexican American families suggest sleep ecology beliefs and practices differ from findings in U.S. non-Latino White families. Findings highlight the importance of cultural and ecological sensitivity when designing interventions to reduce sleep disparities and improve overall toddler health.

Support (if any)

R01HL163859
0822 The 3-30-300 Rule for Green Space Exposure and Sleep in 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

In 2015, the United Nations identified a target of “universal access to safe, inclusive and accessible, green and public spaces “to be implemented by 2030. However, few guidelines exist to equitably increase access to the health-promoting qualities of high-quality green space. Recently, the “3-30-300” rule was introduced as a benchmark to ensure universal access to green space. This study aimed to use the 3-30-300 benchmark for green space exposure, to determine whether these metrics are associated with sleep phenotypes in elementary school children.

Methods

Elementary school children 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. The 3-30-300 rule was applied to their residential address. ‘3’ was quantified using the Green View Index (GVI), derived from the panoramic street view from Google. ‘30’ refers to a minimum 30% tree canopy within a 200m buffer of the home;‘300’ is based on home distance to ≥50m² greenspace within 300m. The association between the mean greenspace measurements and sleep measures, Total Sleep Time (TST, hours), Sleep Efficiency (SEF), and Wake After Sleep Onset (WASO, minutes) was analyzed using T-tests.

Results

There is no statistically significant difference between viewing more than three trees versus less (TST mean 9.19 vs 8.95, SEF mean 88.5% vs 87.9%, and WASO mean: 37.8 vs. 39.6); having ≥ 30% tree canopy versus less ( TST mean: 9.16 vs 9.01, SEF mean 88.1% vs 88.2%, and WASO mean: 38.4 vs 39 ); and having 50m2 greenspace within 300m versus without (TST mean: 8.94 vs 9.18, SEF mean 88.3% vs 88.2%, and WASO mean: 38.5 vs 38.8).

Conclusion

Participants that met the benchmarks for the 3-30-300 rule did not have better sleep measures compared to those that did not. Due to the multifactorial nature of sleep, this benchmark may not capture the contextually relevant locations that may influence sleep health profiles among children.

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
0828 Investigation of Sleep Disturbances in Pediatric Patients with Septo-Optic Dysplasia
Authors: McCarty Grae , Danieli Hana , Karakas Cemal , Singer Emily
Published: April 2024

Introduction

Septo-optic dysplasia (SOD) is a heterogenous neurodevelopmental condition diagnosed based on the presence of two or more of the following findings: optic nerve hypoplasia, absence of the septum pellucidum, dysgenesis of the corpus callosum, and pituitary hormone abnormalities. Sleep disturbances in SOD are common, however, they have not been well characterized. This study aims to investigate and characterize sleep disturbances in SOD.

Methods

We used the Slicer-Dicer tool to identify pediatric patients (< 21 years) from EPIC with a diagnosis of SOD (ICD Q04.4) who had encounters between July 2013 and July 2023 at Norton Children’s Hospital, KY, USA.

Results

We identified 35 patients (M:F=12:23) with SOD. The mean age was 9.5 years (SD:4.5). Twenty-six patients described a sleep disturbance including snoring (n=5), insomnia (n=8), and frequent arousals (n=5). Of those, ten patients had previous polysomnography (PSG) at a mean age of 4.5 years (SD:3.3). For those who underwent PSG, the mean total sleep time was 381.3 minutes (SD:75.8); the median sleep latency was 14.0 minutes (SD:34.1); four patients had a prolonged sleep latency of > 20 minutes (IQR:5.1-70.9); the mean sleep efficiency was 70.7% (SD: 26.9); the median percentage of N1 sleep was 0.15 % (IQR:0-0.6), N2 42.9% (IQR:35.3-49.9), N3 38.1% (IQR: 25.1-43.4), REM 21.8% (IQR:16.1-28.2). Four patients had an elevated arousal index of > 10. The mean AHI was 8.2 (SD:11.6). No patients had central apnea or elevated periodic limb movements. Of the 35 patients, eight had obstructive sleep apnea and seven used medications, such as melatonin, to assist with sleep.

Conclusion

Patients with SOD have fragmented sleep and are at increased risk of obstructive sleep apnea. The presence of sleep disturbances in patients with SOD is likely multifactorial. Many patients with SOD have midline brain defects and midline areas that regulate sleep such as the suprachiasmatic nucleus (SCN) of the hypothalamus and the pineal gland may be impacted by their condition.

Support (if any)
0834 Bedtime and Naptime Routines: Associations with Newborn and Parental Sleep Outcomes
Authors: Mindell Jodi , Leichman Erin S , Mack M Catherine , Carson Mikayla
Published: April 2024

Introduction

A consistent bedtime routine is associated with better sleep and well-being in young children. However, little is known about the prevalence of bedtime and naptime routines in newborns, and their association with sleep outcomes in both the newborns and their parents.

Methods

Parents (67% mothers, 33% fathers) of 135 newborns (1-15wks; M=8.2wks) from the US and UK completed an online questionnaire addressing questions about sleep and routines in newborns, as well as measures of sleep in the parents (PROMIS sleep disturbance scale and sleep-related impairment scale).

Results

Overall, 62% (n=84) reported having a bedtime routine and 20% (n=27) a naptime routine for their newborn. Of these families, 50% started a bedtime routine before 4 weeks of age with 58% starting a naptime routine within the same time frame. Most parents who engaged in a bedtime routine indicated that they liked it (79%), it was easy (70%), it helped their newborn fall asleep (62%) and sleep for longer stretches overnight (54%). For those with naptime routines, approximately half liked them (54%) and reported they were easy (50%), but fewer thought they helped their newborn nap (35%). Most parents thought that sleep routines helped them bond with their newborn (88% bedtime, 69% naptime). Further, newborns with a bedtime routine had longer stretches of sleep (5.1h vs. 4.2h, p=.023), shorter total time awake during the night (128.6m vs. 175.7m, p=.002), and trended toward fewer night wakings (2.1 vs. 1.7, p=.070). Finally, parents who had bedtime routines for their newborn were less likely to experience sleep disturbances themselves, p=.017, but there were no differences in sleep-related impairment.

Conclusion

Over half of all newborns have a bedtime routine, but only 20% a naptime routine. However, these routines are liked by parents and associated with increased sleep consolidation in newborns and decreased sleep disturbances in parents. A simple recommendation of instituting sleep routines for newborns may result in improved sleep outcomes for newborns and their parents.

Support (if any)

Kenvue, Skillman, NJ, USA
0835 Impact of Daylight Saving Time Change on Parental Anxiety, Stress, and Infant Sleep Expectations
Authors: Thakur Shambhavi , Lucchini Maristella , Kahn Michal , Barnett Natalie
Published: April 2024

Introduction

Daylight Saving Time (DST) transitions can disrupt infant sleep routines, and lead to temporary sleep disturbances, potentially contributing to heightened stress levels for parents. This study examines the associations between DST-related stress, parental anxiety, and parental and infant sleep.

Methods

602 parents of infants aged 0-24 months (11.45±5.5) from the US were recruited,79% mothers. A week prior to the spring DST transition, parents completed the Pittsburgh Sleep Quality Index (PSQI) and the Edinburgh Postnatal Depression Scale-3A (EPDS-3A) to assess perinatal anxiety. Additionally, they reported concerns regarding the impact of the DST change on their child's sleep (How long do you think it will take your child to adjust to the new time? How stressed are you about the impact of daylight saving on your child's sleep?). Objective infant total sleep time (TST) was measured using Nanit autovideosomnography for 7 nights prior to the DST change. Logistic regression analysis was performed with anxiety as the predictor and stress and anticipation about DST as the outcomes. Furthermore, a Wilcoxon test compared the average sleep duration of infants and parents between the anxious and non-anxious groups. An EPDS-3A score ≥5 was considered anxious. Infant age was a covariate in all analyses.

Results

Parents experiencing anxiety before DST were 1.98 times more likely (CI 1.15-2.42) to report being stressed about the DST change (p< 0.001), and were 1.66 times more likely (CI 1.15-2.42) to anticipate >3 days adjustment period for their child following DST (p=0.007) than those who did not experience anxiety. There was no significant difference in TST between infants of anxious and non-anxious parents, but non-anxious parents slept for an average of 11 minutes longer than anxious parents (p=0.017).

Conclusion

This study demonstrates that parents experiencing anxiety exhibit higher stress levels and more negative expectations regarding their infants’ sleep during the DST transition than non-anxious parents. Moreover, anxious parents reported shorter sleep durations before the DST change compared to non-anxious parents. Notably, there was no significant difference in TST between infants of the non-anxious and anxious parent groups.

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0837 Associations Between Sleep Health, Diet Quality and Movement Behaviors in a Community Sample of Preschoolers
Authors: Covington Lauren , Brewer Benjamin , Alvarado Adriana Verdezoto , Cordova Angeni , Archer Emma , Ji Xiaopeng , Patterson Freda , Robson Shannon
Published: April 2024

Introduction

Lifelong sleep, diet and movement behaviors are formed during the preschool (age 3-5) years. Inadequate sleep health (i.e., short duration, late bedtimes, low quality) and poor diet quality are independently associated with physical inactivity and subsequent risk of obesity development. Not known is how sleep health and diet quality may interact in association with movement behaviors (moderate-to-vigorous physical activity [MVPA] and sedentary behavior [SB]) during this critical period of the life course. This study explored the interaction between diet quality and sleep health on movement behaviors in a community sample of preschoolers.

Methods

Preschoolers from families living in Delaware communities wore an Actigraph on their waist for up to one-week (average wear time=6 days) to measure sleep health, SB, and MVPA. Sleep health metrics included sleep duration (minutes), timing of sleep onset and offset (hours), and sleep efficiency (percentage of time in bed spent asleep). Parents completed 3-days of dietary records for their child, and Nutrition Data Systems for Research (NDS-R) software was used to analyze these dietary records. Healthy Eating Index 2015 (HEI-2015) scores were derived (higher scores=better diet quality). Generalized Linear Models utilizing GEEs quantified the associations between sleep health and diet quality on SB and MVPA; and the interaction between diet quality and sleep health was explored. Models adjusted for age, sex, race, parent education, and BMI.

Results

In a sample of 24 preschoolers (mean age=4.6 years, SD=0.78; 50% male, 63% White, non-Hispanic), there was a significant interaction between diet quality and sleep timing on movement behaviors. Having an HEI-score above the sample median of 61 was associated with less SB (p< 0.001), but having a late bedtime (p< 0.001) and late wake time (p=0.004) tempered this association. Similarly, having an HEI-score above the median was associated with more MVPA (p< 0.001), but having a late bedtime (p< 0.001) and late wake time (p=0.03) tempered this association.

Conclusion

Our findings underscore the interdependence of health behaviors in preschoolers. Future integrated interventions may consider targeting multiple behaviors, including sleep timing, diet and physical activity, to impede early childhood obesity development.

Support (if any)

2020 Center for Innovative Health Research Interdisciplinary GOLD Research Grant
0838 Sleep Hygiene in Mexican American Toddlers: Bedtime Screen Use and the Role of Maternal Beliefs and Self-efficacy
Authors: Thompson Darcy , Kaizer Laura , Schmiege Sarah , Clark Lauren , Cabrera Natasha , Ringwood Haley , Meltzer Lisa , Valdes Estefania Miramontes , Gorman Carol , Colunga Ariadna Juarez , Spacone Anne , Babiak Marko , Tschann Jeanne
Published: April 2024

Introduction

Good sleep hygiene includes restricting screen use in the hour before bedtime. Despite this, bedtime screen use starts for many in early childhood. To inform the design of interventions aiming to promote quality sleep, a better understanding of parental conceptualizations about their children’s bedtime screen use is needed. We evaluated whether maternal beliefs about bedtime screen use and self-efficacy to limit bedtime screen use are related to toddler screen use before bedtime in Mexican American families.

Methods

This study used data from a larger study enrolling Mexican American families with toddlers (15-26 months old) recruited from a federally qualified health system. Participants were asked how much they agreed that using a screen device before bed helps little children sleep better (belief) and how confident they were about limiting their toddler’s bedtime screen use (self-efficacy). Screen use before bedtime was measured via a 7-day diary completed by mothers, resulting in a count of nights the child used a screen device in the hour before bedtime. We used multiple regression to evaluate whether maternal beliefs and self-efficacy were associated with toddlers’ bedtime screen use, adjusting for child age, and maternal education and employment status.

Results

Participants (n=286) were on average 31.4 years old (SD=5.9) and 73% reported ≤ high school degree. Mean child age was 21.7 (SD=3.1) months. Over one-third (36%, n=103) of children used a screen device in the hour before bedtime at least 4 nights per week. Mothers’ stronger beliefs that screen use before bed helps with sleep (Incidence rate ratio (IRR)=1.22, 95% CI 1.06-1.41) and mothers’ lower self-efficacy to limit bedtime use (IRR=0.79, 95% CI 0.70-0.89) were associated with greater toddler bedtime screen use.

Conclusion

Maternal beliefs and self-efficacy regarding limiting screen use at bedtime should be considered in interventions addressing toddler sleep hygiene in this population.

Support (if any)

Research reported in this publication was supported by NIH/NINR (R01NR017605, PI: Thompson) and NIH/NCATS Colorado CTSA Grant Number UM1 TR004399. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.