bluuebunny/crossref_metadata_2025 huggingface dataset:
0464 Patient perspectives on facilitators and barriers to engagement with digital CBT-I
Authors: Melikyan Diana , Santarossa Sara , Sagong Chaewon , Sultan Zain , Drake Christopher , Cheng Philip
Published: May 2022

Introduction

Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) is a highly effective self-guided mHealth treatment for insomnia; however, completion and adherence rates are poor, especially among marginalized individuals. The present study explored facilitators and barriers to engagement with dCBT-I.

Methods

Thematic analysis was conducted on qualitative data collected in those who engaged with dCBT-I. A total of 151 written feedback, 34 individual interviews, and 1 focus group of six racial minorities with low socioeconomic status (SES) was used. A combined inductive and deductive approach was utilized, where an initial codebook was developed but emergent codes were also included in the coding process. Consensus between four independent coders were achieved prior to thematic analysis.

Results

Thematic analysis revealed five themes: digital person to person component, type and extent of information, users’ sense of autonomy, app functionality, and importance of tailored content. Overall, users felt that the dCBT-I content was engaging (e.g., “easily understandable”, “well-paced”), and valued the accessibility of a digital treatment (e.g., “I greatly enjoyed the weekly sessions in the privacy of my own home”). Participants across demographic groups felt that the virtual therapist (i.e., “The Prof”) increased engagement (e.g., “The Prof was entertaining”, “The Prof has a great voice…educated and soothing without condescension”).Barriers to engagement, particularly in those with lower SES, included eHealth literacy (e.g., “I had issues filling out my sleep diary”) and a desire for more human contact (e.g., “I maybe would have liked more communication throughout, maybe just checking in once to see if things were okay”). There was strong consensus among non-completers that additional support would have prevented treatment dropout (e.g., “HELP button or someone you could’ve asked questions”). Others expressed concerns about the lack of tailoring to their specific circumstances (e.g., “this system does not take into consideration ‘physical’ causes of my sleep problems”).

Conclusion

Although dCBT-I has high accessibility and scalability, those with lower health literacy may experience lower self-efficacy and negative outcome expectancy as barriers to treatment engagement and completion. There is support that enhancing dCBT-I with personalized support and tailored content may improve treatment adherence and completion.

Support (If Any)

K23HL136188; R01HL159180
0466 Living Alone as a Predictor of Symptom Change During Cognitive Behavioral Therapy for Insomnia
Authors: Tutek Joshua , Gumport Nicole , Dietch Jessee , Tully Isabelle , Simpson Norah , Manber Rachel
Published: May 2022

Introduction

Interpersonal factors have implications for sleep quality. Research has begun to explore how such factors may play a role in cognitive behavioral therapy for insomnia (CBTI). This study investigated whether living alone predicts reductions in insomnia severity and sleep-related daytime impairment across the first two months of treatment in a trial of CBTI.

Methods

Participants were 224 middle-to-older-aged adults with insomnia (166 women, M age = 63.16) enrolled in the ongoing Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING). All study participants received CBTI, delivered either via a therapist or a validated software program. At baseline, participants indicated whether they lived alone or with at least one other person. The Insomnia Severity Index (ISI) and PROMIS Sleep-Related Impairment (SRI) short form were administered at baseline and two months after starting treatment. Mixed effects models assessed whether living alone predicted reduction in symptoms across the first two months of CBTI.

Results

Across the total sample, ISI scores decreased from baseline to two months (β=-3.52, SE=0.35, p<.001, 95% CI=-4.20, -2.84). Living alone was not associated with baseline ISI scores nor change in ISI score. A reduction in PROMIS SRI score was also observed in the total sample from baseline to two months (β=-4.18, SE=0.50, p<.001, 95% CI=-5.15, -3.21). Living alone was not associated with baseline SRI score, but it did predict reduction in SRI score (β=-3.23, SE=0.88, p=.001, 95% CI=1.31, 5.15). Participants living alone displayed less reduction in SRI compared to those living with at least one other person.

Conclusion

Participants undergoing CBTI who live alone experienced reduction in insomnia severity over the course of treatment, but they displayed less improvement in daytime sequalae of poor sleep compared to those living with others. Future studies should further explore how living status contributes to insomnia treatment response across both nighttime and daytime sleep symptomology. Regular engagement with others living in the home may be important for insomnia treatment to translate into perceived functional improvements during the day.

Support (If Any)

1R01AG057500
0469 The Apnea and Insomnia Research (AIR) Trial: An Interim Report
Authors: Edinger Jack , Manber Rachel , Simmons Bryan , Johnson Rachel , Horberg Roxane , Depew Ann , Abraibesh Aysha , Simpson Norah , Eldridge-Smith E Devon , Strand Matthew , Espie Colin , Kushida Clete , Tsai Sheila
Published: May 2022

Introduction

Many sleep apnea patients suffer from comorbid insomnia disorder. Although cognitive behavioral insomnia therapy (CBTI) has proven effective for insomnia among such patients, access to trained CBTI providers remains limited. The current study is testing a digital CBTI (dCBTI) among PAP-prescribed sleep apnea patients with comorbid insomnia.

Methods

Patients enrolled in this trial complete baseline measures and are randomized to dCBTI or sleep hygiene (CTRL). After 8 weeks, all patients are reassessed. Patients in the dCBTI arm who reach remission by this time point are offered no additional insomnia treatment, whereas those who do not achieve insomnia remission are randomly assigned either another 8 weeks of dCBTI or a therapist delivered CBTI (TCBTI). All groups are reassessed at the end of this second 8-week treatment phase and then again at 3- and 6-month follow-ups. This report considers changes in scores on the Insomnia Severity Index (ISI) from baseline to the end of the second 8-week treatment, as well as insomnia remission (ISI < 8) and responder rates (> 8 point decline on the ISI) of dCBTI and TCBTI relative to the CTRL. The sample for this report included the first 305 participants (mean age = 56.5±12.5 yrs.; 57.1% females).

Results

Both dCBTI and TCBTI recipients showed greater (p = .0001) and comparable reductions in ISI scores from baseline to the end of the second 8-week treatment phase than did those in the CTRL group. Average ISI score improvements moved dCBTI and TCBTI recipients from moderately severe to mild insomnia symptoms. Significant group differences were noted for both the responder (X2 (2) =19.29, p < 0.0001) and remission rates (X2 (2) =13.89, p = 0.001). Responder rates for those participants switched to TCBTI (50%) were noteably higher than those continued with dCBTI (30.5%) and those in the CTRL group (19.2%); but remission rates were comparable (30.5% vs. 29.2%) and sigificantly higher than the rates shown by the CTRL group (19.2%).

Conclusion

The dCBTI tested compares well with TCBTI for reducing insomnia symptoms and achieving insomnia remission in those with insomnia and sleep apnea, but insomnia responder rates may be improved by switching patients to TCBTI.

Support (If Any)

Funding support from the National Heart, Lung and Blood Institute, Grant # 1R01HL130559-01A1.
0476 A Mobile App-Based Behavioral Intervention for Insomnia Among College Students
Authors: Floyd Veronica , Vargas Ivan
Published: May 2022

Introduction

Nearly 60% of college students suffer from poor sleep quality and 7.7% of students meet criteria for a sleep disorder (Schlarb et al., 2017). The most common of these sleep disorders is insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the frontline treatment for insomnia. The time and cost of CBT-I, however, has limited overall treatment uptake, especially among individuals with less severe symptom profiles or who are otherwise relatively healthy (e.g., college students). The goal of this study is to pilot-test a mobile application version of CBT-I (i.e., CBT-I Coach) to evaluate its effectiveness in treating insomnia symptoms among college students. The testing will also demonstrate the feasibility of using a CBT-I app for insomnia symptom treatment.

Methods

The study uses a between- and within-subjects design to assess biweekly variations in insomnia symptom severity among college students over a period of 8 weeks. Participants are randomized into the intervention group or a wait-list control group (where they were asked to initiate the intervention after a four-week delay). Participants in both groups are asked to use the CBT-I Coach app daily for 4 weeks. Every two weeks, online surveys are completed to assess sleepiness (via the Epworth Sleepiness Scale) and the insomnia symptom severity (via the Insomnia Severity Index).

Results

While data collection is ongoing, to-date we have collected data from 17 participants. The mean baseline ISI score was 15.3. Of the 17 participants that completed the baseline, 65% (n=11) filled out the 4-week online survey. The mean ISI score at the 4-week follow-up was 12.7. Ten participants (or 59% of those that completed the baseline) completed the eight-week follow-up survey. Data collection is scheduled to be completed in April 2022, and a full summary of the results will be presented at the APSS conference in Charlotte.

Conclusion

An effective app-based version of CBT-I has the potential to increase the accessibility of behavioral interventions for sleep to populations that are often missed by healthcare providers. Making CBT-I more available to college students and young adults may also decrease the onset of more chronic forms of insomnia.

Support (If Any)

N/A
0477 Comparison of a Non-Contact Sleep Monitoring Device with Wrist Actigraphy in a Sample of Individuals with Chronic Insomnia
Authors: Teeter Naomi , Skeiky Lillian , Gottlieb Elie , Raymann Roy , Buchwald Dedra , Watson Nathaniel , Van Dongen Hans , Hansen Devon , Finlay Myles , Peterson Mary
Published: May 2022

Introduction

Non-contact devices (NCDs) have been developed to measure sleep longitudinally and unobtrusively in the naturalistic home setting. We compared longitudinal measurements from a wrist actigraph (Actiwatch-2, Philips Respironics) and from a NCD (SleepScore Max, SleepScore Labs) in a sample of adults with insomnia

Methods

N=71 adults (ages 39.0±13.0y; 50 women) who met ICSD-3 criteria for chronic insomnia and were otherwise healthy participated in an at-home sleep monitoring study. Participants continuously wore the actigraph for one week, then used the NCD to record only nightly sleep periods for the next 8 weeks. Week-by-week within-subject averages and standard deviations (SDs) over days were assessed for five major sleep parameters: total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), time in bed (TIB), and sleep efficiency (SE). These sleep parameters were analyzed with mixed-effects ANOVA comparing week one (actigraphy) to the next 8 weeks (NCD), and correlations between the first week (actigraphy) and second week (NCD) were calculated.

Results

Significant differences for actigraphy versus NCD were found for the weekly averages of SOL and WASO (F>25.8, p<0.001). The NCD measured longer average SOL (M±SEM=25.0±1.5min) than actigraphy (12.6±2.0min) and less average WASO (40.5±2.7min) than actigraphy (51.1±3.2min). Further, significant differences were found for the weekly within-subject SDs of TST and WASO (F>7.52, p<0.01). The NCD measured greater SD for TST (71.6±2.8min) than actigraphy (60.0±4.7min) and greater SD for WASO (25.0±1.4min) than actigraphy (19.2±2.2min). Actigraphy and NCD weekly averages were positively correlated for TST, WASO, TIB, and SE (p<0.001), but not SOL (r=0.03, p=0.80). Similarly, weekly within-subject SDs were positively correlated for TST, WASO, TIB, and SE (p≤0.05), but not SOL (r=–0.03, p=0.81).

Conclusion

Actigraphy and NCD were not used simultaneously, precluding a direct comparison between these measurement modalities. Nonetheless, in this ecologically valid context, significant differences were only found for the weekly averages of SOL and WASO and for the weekly within-subject variability of SOL and TST, with significant correlations between the devices for all variables except SOL. Although actigraphy tends to underestimate SOL, NCD validation against polysomnography in chronic insomnia is warranted.

Support (If Any)

NIH grant KL2TR002317; research devices provided by SleepScore Labs.
0481 Effectiveness of a digital therapeutic compared to medications and cognitive behavioral therapy for treating chronic insomnia in adults
Authors: Forma Felicia , Pratiwadi Ramya , El-Moustaid Fadoua , Smith Nathaniel , Velez Fulton
Published: May 2022

Introduction

Limitations on the availability of guideline-recommended cognitive behavioral therapy for insomnia (CBT-I) constrain its use and create an unmet need for innovative ways to expand access. Digital therapeutics offer a potential solution. This study compared a digital intervention, traditional face-to-face CBT-I, and prescription medications for insomnia.

Methods

Of 184 articles identified in a systematic literature review, 13 studies reported ISI mean change from baseline data: 1 using the digital therapeutic (DT) SHUTi (now known as the prescription digital therapeutic Somryst), 1 on the medication eszopiclone, and 11 on traditional CBT. A Bayesian network meta-analysis (NMA) was performed on the mean change from baseline and the proportion of remitters using the insomnia severity index (ISI) endpoint with follow-up timepoints between 6-12 weeks. Mean change in ISI score from baseline was analyzed as a continuous endpoint while comparisons of the proportion of remitters was performed using odds ratios. The analysis used a random-effects model for the base case analysis. A surface under the cumulative ranking curve (SUCRA) analysis was performed to rank the treatments on each endpoint.

Results

Only the DT and CBT-I were significantly different than placebo. The DT had the greatest mean change from baseline in ISI from placebo (-5.77 points, 95% Credible Interval (CrI) [-8.53, -3.07]), followed by CBT-I (-4.3 points, 95% CrI [-6.32, -2.39]). In the SUCRA analysis, the DT had the highest probability (56%) of being the most effective treatment based on ISI mean change from baseline. 8 studies reported the proportion of ISI remitters. Only the DT showed a statistically significant difference in remission vs. placebo, and the DT had the highest odds ratio for remission vs. placebo (OR 12.33; 95%CrI [2.28, 155.91]). The DT had the highest probability (64%), of being the most effective treatment for inducing remission using ISI definitions.

Conclusion

The DT in this study was projected to be the most effective therapy on both mean change in ISI and ISI remission within 6-12 weeks of treatment start vs. either traditional CBT-I or medications.

Support (If Any)

This analysis was funded by Pear Therapeutics, Inc.
0488 Trajectories of Insomnia Symptoms since Childhood Associated with Treatment of Internalizing Disorders in Adulthood
Authors: Singh Rupsha , Lenker Kristina , Calhoun Susan , Ricci Anna , Liao Jason , He Fan , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio
Published: May 2022

Introduction

Internalizing disorders (ID) are the most common form of psychopathology, with a large proportion of individuals seeking treatment in young adulthood. Childhood insomnia symptoms, i.e., difficulties initiating or maintaining sleep (DIMS), have been shown to be associated with ID, however, little is known about the developmental trajectories of insomnia symptoms and their associated risk of receiving pharmacotherapy for ID. The present study examined the longitudinal association between trajectories of childhood insomnia symptoms and risk of receiving treatment for ID in young adulthood.

Methods

We analyzed data from the Penn State Child Cohort, a population-based sample of 505 children (Mdn=9y), who were followed-up 8 years later as adolescents (Mdn=16y) and 15 years later as young adults (Mdn=24y). Insomnia symptoms were defined as parent-reported (childhood) or self-reported (adolescence and young adulthood) moderate-to-severe DIMS. The trajectories of insomnia symptoms across the three time-points were identified as never, remitted, waxing-and-waning, incident and persistent. The presence of ID was defined as a self-report of a diagnosis of mood and/or anxiety disorders, whether they had received treatment or not and whether treatment consisted of prescription psychotropic medication (i.e., antidepressants, anxiolytics). Logistic regression models were adjusted for sex, race/ethnicity, age, and any childhood or adolescent history of a psychiatric diagnosis or psychotropic medication use.

Results

Persistent (OR=3.0) and incident (OR=3.3) trajectories, but not waxing-and-waning (OR=1.1) or remitted (OR=0.8) trajectories, were associated with increased odds of ID that did not receive treatment in adulthood. Additionally, the odds of receiving treatment for ID with prescription psychotropic medication in adulthood were increased in those with persistent (OR=3.4), incident (OR=3.5) and waxing-and-waning (OR=2.1) trajectories, but not in those with a remitted trajectory (OR=0.7).

Conclusion

Childhood-onset persistent insomnia symptoms as well as adult-onset incident insomnia symptoms are strong risk factors for receiving treatment for mood/anxiety disorders in adulthood, while childhood insomnia symptoms that fully remit over time are not. Treatment of insomnia in youth should be an essential target as to decrease the risk of developing severe forms of mood/anxiety disorders requiring psychotropic treatment in adulthood.

Support (If Any)

National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)
0496 Sleep and Behavior Problems in Children with Overweight and Obesity
Authors: Tsai Shao-Yu , Tung Yi-Ching , Huang Chuen-Min , Lee Chien-Chang
Published: May 2022

Introduction

Limited studies have examined sleep variability in children with overweight and obesity, nor do studies focused on its relation with behavior outcomes in this high risk pediatric population. The purpose of this study was to examine sleep duration and its variability in relation to behavior outcomes in school-age children with overweight and obesity.

Methods

Sleep in 246 children aged 6-9 years with overweight and obesity was assessed using actigraphy for 7 days and through the parent-report Children’s Sleep Habits Questionnaire (CSHQ). Children’s behaviors were assessed using parental responses on the Behavior Assessment for Children. Children were categorized into 4 groups based on the median split of the average daily sleep duration and its variability: sufficient-stable, sufficient-variable, insufficient-stable, and insufficient-variable. General linear model (GLM) analyses were performed with the 4 sleep groups as the primary predictor variable and child behavior outcomes as the dependent variable.

Results

Average daily sleep duration by actigraphy was 7.52 hours, with 84.6% of the children having clinically significant CSHQ sleep disturbance scores and 68.3% having a total behavior problem score in the clinical range. In the unadjusted and adjusted GLM analysis, children in the insufficient-stable sleep duration category had significantly higher emotion problem (p < 0.05), self-control problem (p < 0.01), and total behavior problem scores (p < 0.01) when compared with those in the sufficient-stable sleep duration (reference) category. Children in the insufficient-variable sleep duration category had significantly higher self-control problem scores when compared with those in the reference category (p < 0.05).

Conclusion

School-age children with overweight and obesity coexist with sleep and behavior problems, with those who have persistent short sleep at the greatest risk for the worst behavior outcomes.

Support (If Any)

This work was supported by Ministry of Science and Technology, Taiwan, MOST 107 - 2314 - B - 002 - 025 - MY3.
0499 Sleep and Neurocognition in Adolescents with ADHD: A Polysomnographic Study
Authors: Lunsford-Avery Jessica , Kollins Scott , Jackson Leah , Tominaga-Brown Noyuri , Thalasila Venkata Ramana , Krystal Andrew
Published: May 2022

Introduction

Sleep disturbances are common among adolescents with ADHD; however, few studies have characterized the nature of ADHD-related sleep problems using the gold-standard sleep measure, polysomnography (PSG), in adolescence. Additionally, although similar cognitive deficits are common across ADHD and sleep-disordered populations, the potential role of sleep in contributing to cognitive impairment in adolescent ADHD is unknown. This study investigates differences in PSG-measured sleep among adolescents with ADHD versus healthy controls without psychiatric disorders (HC) and associations with cognition.

Methods

Sixty-two adolescents aged 13-17 (31 ADHD, mean age=15.3, 50% female) completed a psychiatric evaluation and 3 nights of ambulatory PSG. Following the third night, participants completed the Cambridge Neuropsychological Test Automated Battery (CANTAB). Sleep variables were averaged over 3 nights. Linear regressions controlling for age and sex examined group differences in a range of traditional PSG and spectral EEG indices as well as relationships between PSG/spectral indices and cognition (two summary scores derived from CANTAB: response accuracy and response time) within the ADHD group.

Results

Adolescents with ADHD displayed reduced SWS% (F(3,51)=9.67, p=.003), increased N2% (F(3,51)=10.35, p=.002), increased relative sigma (F(3,47)=6.55, p=.01) and beta (F(3,47)=4.10, p<.05) power, and a trend toward reduced relative delta power (F(3,47)=2.95, p=.09) compared to HC. Within the ADHD group, greater REM% (r=.43), reduced N2% (r=-.55), greater relative delta power (r=.52), higher delta power peak (r=.56), steeper delta decline overnight (r=-.56), and reduced relative theta (r=-.53), beta (r=-.74), and gamma (r=-.67) power were associated with better response accuracy (p’s<.05). Greater relative delta (r=-.51), and reduced relative theta (r=.55) and beta (r=.63), power were associated with faster response times.

Conclusion

Although adolescents with ADHD did not differ from HC on traditional PSG measures (TST, WASO), they exhibited abnormalities in sleep stage distribution and non-REM EEG frequency spectral indices, including reduced SWS and low frequency power and increased stage 2 sleep and high frequency power overnight. Notably, similar parameters were associated with impaired cognition, suggesting sleep may contribute to cognitive deficits in ADHD. Future studies may clarify whether sleep plays a causal role in cognitive impairments in adolescent ADHD and if sleep treatments result in improved cognition in this population.

Support (If Any)

K23MH108704
0500 Increased adherence to light therapy and psychosocial outcomes in adolescents and young adults with cancer
Authors: MacArthur Erin , Semko Joshua , Kamara Dana , Wang Fang , Pan Haitao , Brigden Jane , Pappo Alberto , Wilson Matthew , Crabtree Valerie
Published: May 2022

Introduction

Adolescent/young adult (AYA) oncology patients consistently report fatigue as one of the most distressing symptoms during treatment. Bright white light (BWL) has been demonstrated to improve the symptoms of cancer-related fatigue in adults, and our prior research demonstrated feasibility, acceptability, and preliminary efficacy of BWL in AYA with cancer. As part of the trial examining the feasibility and acceptability of BWL in AYA, we explored whether adherence affected patient outcomes in the BWL group.

Methods

Twenty-seven participants were randomized to receive BWL using LiteBook® (retrofitted with adherence monitors) for 30 minutes upon waking daily for eight weeks. Study team members met with patients weekly for the duration of the intervention to download adherence data from the monitors, administer questionnaires, and discuss barriers to adherence if necessary. Participants completed mood, quality of life, and fatigue measures at every other research visit (5 times over the duration of the study).

Results

Adherence was characterized by total number of days that participants used the light device while on study. Multivariate regression was used to examine the predictive relationship between adherence and patient outcomes. Adherence significantly predicted parent-reported physical functioning [β=1.45, p= 0.0079], emotional functioning [β=0.87, p=0.0137], and total health-related quality of life [β= 0.76, p= 0.0218]. Adherence did not predict any of the self-reported patient outcomes.

Conclusion

BWL is a promising treatment to improve cancer-related fatigue in AYA, and adherence is essential to treatment success. Although adherence did not predict any participant self-reported outcomes, participants with better adherence had improved parent-reported emotional and physical functioning and overall quality of life. Individually tailored interventions, including sleep hygiene psychoeducation and motivational interviewing, may be used to increase adherence to light therapy to improve patient outcomes. Measures to monitor and foster adherence should be included in future light therapy trials.

Support (If Any)

This research was funded and supported by ALSAC.
0501 Sleep pattern changes two years after participating in the Makos sleep study: The effect of extending total sleep time and weighted blankets on teenage swimmers performance
Authors: Zarrouf Lily
Published: May 2022

Introduction

The initial Makos study was conducted in 2019, studying the effect of extending total sleep time and the use of weighted blankets (ETST+WB) on teenage swimmers’ performance. In it, we found a significant improvement of 100-free style race time in teenage swimmers after ETST+WB. The aim of the current follow-up study is to evaluate the sleep pattern of the same swimmers after 2 years.

Methods

Using an open-label prospective approach, the study investigated swimmer’s event time changes, total sleep time, daytime sleepiness, and other sleep measures after 2 years of the initial changes during the first study. 8 healthy swimmers on the Makos swim team filled follow-up questionnaires and participated in a 100-yard freestyle race. Descriptive statistics, frequency distributions, and correlation using SPSS 14.

Results

Eight (6F; 2M) of the initial nine seasonal teen swimmers participated (age 13-17). Four swimmers reported headaches and one reported sore throat in the morning. Three (37.5%) reported feeling sleepy during the day and 3 reported falling asleep when riding in a car. Two reported leg movements during the night. In two years after the initial study, 100-free race time significantly improved (65.01*5.38 vs 59.32*5.43 p=0.003), but the positive effect of ETST+WB on recorded sleep time was lost and returned to baseline. There was a clear trend, but no significant difference in total sleep time among the 3 groups: (initial 8:45 *0:32; after ETST+WB 9:17*0:32; after 2 years 8:08*0:30).

Conclusion

The improvement of total sleep time with weighted blankets and encouragement during the initial study correlated with improvement of 100 free race time in seasonal teen swimmers. This improvement in total sleep time was lost and returned back to baseline after 2 years follow up.

Support (If Any)

The authors report no financial relationship with any company whose products are mentioned in this manuscript, or with companies of competing products. Participants will be able to keep SKY Grand activity trackers at the end of their participation.
0508 Maternal Perceptions of Naps in Young Children
Authors: Leichman Erin , Rotella Katie , Mindell Jodi
Published: May 2022

Introduction

Sleep in young children affects both family functioning and maternal mental health and well-being. However, little is known about parental perceptions about daytime sleep. Thus, the aims of this study were to determine maternal perceptions of (1) naps overall, and (2) how naps impact child and maternal functioning.

Methods

Mothers of 465 infants and toddlers (4-36mos; M=18.5mos) completed an online questionnaire addressing questions about maternal nap perceptions, as well as the Brief Infant Sleep Questionnaire–Revised (BISQ-R). Global nap perceptions were categorized as positive or negative. Perceived impact on mother and child was also assessed.

Results

Overall, 95% (n=440) reported that their child napped. The majority of mothers agreed that naps were important (98.2%). Over one third (38.9%) wanted to change something about their child’s naps and 28% reported that naps are a problem. Furthermore, the majority of mothers believed that naps were an important part of their child’s day (94.6%), and that when they nap well their child is in a better mood (97.3%), more easy-going (95.7%), has fewer tantrums (88.7%), and is a better listener (84.4%, toddlers). Fewer mothers reported that their child’s nap is frustrating (21.8%) or are more trouble than they are worth (4.1%). Just under half wished their child fell asleep faster/easier for naps (49.0%), and one third wished they napped longer (35.5%).Finally, the majority of mothers believe that their child’s naps are an important part of their own day (94.1%), improve their own mood (87.1%) and make them feel more calm (89.9%). When their children nap, mothers can nap themselves (51.0%), get more done in the house (91.5%), get more work done (87.4%), spend more time with others (77.9%), and spend more time doing things for themselves (79.5%).

Conclusion

Overall, the vast majority of mothers believe that their child’s naps are important for their child, as well as for themselves. However, one third report that their child’s nap is problematic, almost one half want to change something (e.g., that their child fell asleep faster/more easily and napped longer). Future studies are needed focusing on interventions for daytime sleep issues to improve both child and family functioning.

Support (If Any)

Johnson & Johnson Consumer Inc., Skillman, NJ, USA
0510 Parent and Child Perception of Sleep for Children with Sensory Processing Difficulties
Authors: Hartman Amy , Soehner Adriane , Smagula Stephen , McKendry Sarah , Bendixen Roxanna
Published: May 2022

Introduction

Roughly 5.3 million elementary children in the United States experience sensory processing (SP) difficulties, like sensitivity to touch and overstimulation with movement. These difficulties cause high levels of daytime stress and daytime dysfunction (e.g., difficulties with attention, academics, and emotional regulation). In typically developing children (without SP difficulties), high levels of daytime stress impact sleep; however, research has yet to explore sleep health in children with SP difficulties. Our study aims to use validated self- and parent-reported questionnaires to characterize differences in sleep health for children with and without SP difficulties.

Methods

Children (ages 6-10) with (n=22) and without (n=33) SP difficulties (per parent report; Autism and ADHD diagnosis excluded) were recruited for this convergent mixed-methods study. Sleep was assessed using validated self- and parent-report questionnaires, the Sleep Self-Report (SSR) and Children’s Sleep Habits Questionnaire (CSHQ), and through qualitative interviews with parents. Groups were compared using t-test and Mann-Whitney U tests, with significance set a priori at α=0.05. A rapid qualitative analysis produced themes and were integrated with the quantitative data.

Results

Parents of children with SP report significantly worse sleep quality on the CSHQ difficulties (MedianSP= 50.5, SDSP= 11.45) than parents of children without SP difficulties (MedianCON=43.0, SDCON=7.27, U= -2.92, p=.004). Children with SP deficits also report significantly worse sleep on the SSR (MSPD=42.18, SDSPD=8.26) compared to their peers (MCON=33.55, SDCON=6.71, t(53)= -4.26, p<.001). Qualitative themes highlight the higher prevalence of rigid, lengthy bedtime routines and adaptations within the sleep environment (e.g. specific pajamas, special bedding) to support sleep for children with SP difficulties. Parents of children with SP difficulties also report higher frequencies of an adult being in the room while the child falls asleep and co-sleeping in the middle of the night.

Conclusion

Parents and children both report poorer sleep in children with SP difficulties when compared to peers. Future studies should incorporate other sleep health measurement tools (e.g. actigraphy) to further understand areas to target for intervention.

Support (If Any)

Sensory Integration Education Network PhD Grant (PI: Hartman, 2021); University of Pittsburgh’s School of Health and Rehabilitation Science’s PhD Student Award (PI: Hartman, 2021).
0514 Risk Factors for Symptoms and Signs of Sleep Apnea Impacting Quality of Life in an Urban Pediatric Community-Based Sample
Authors: Gueye-Ndiaye Seyni , Hauptman Marissa , Yu Xinting , Rueschman Michael , Castro-Diehl Olga Cecilia , Owens Judith , Gold Diane , Adamkiewicz Gary , Phipatanakul Wanda , Redline Susan
Published: May 2022

Introduction

Pediatric obstructive sleep apnea (OSA) disproportionately affects children from minority groups and children living in disadvantaged neighborhoods, but the risk factors that drive this risk are not well understood. We investigated the relationship between minority race/ethnicity, household risk factors (smoking, socio-economic status [SES]), and neighborhood disadvantage with OSA-related quality of life (QOL) scores in participants in the Environmental Assessment of Sleep Youth (EASY) observational study.

Methods

Families of children 5-12 years old recruited from largely low-income Boston-area neighborhoods participated in an extensive in-home evaluation of OSA risk factors. OSA-related QOL was assessed with parent-reported OSA-18 questionnaire (values >37 indicative of negative impact of symptoms and signs of OSA on QOL). Secondhand smoking (SHS) was defined by parent-report of smoking in the home. Neighborhood disadvantage was characterized using geocoded addresses, calculating the Neighborhood Socioeconomic (NSES) index. We performed logistic regression with OSA-18 >37 as the dependent variable and age, gender, race/ethnicity, BMI, household smoking, household measures of SES and NSES index as independent variables.

Results

The sample included 256 children (40%-Hispanic ethnicity, 31%-Black, 20%-White, 9%-Other; 56% were female), with a mean age 9.1±1.9 and BMI percentile 69.9±29.8. 33% and 40% of children were from households with income <$25,000 and $25,000-$75,000, respectively, and 10% had SHS exposure. Mean NSES index was 47.9±15.4 (national average of 50). An elevated OSA-18 was reported for 35% of participants and significantly associated with Hispanic ethnicity and smoking exposure (OR=2.16, CI 1.01-4.62 and OR=2.71, CI 1.2-6.3) after adjusting for age, gender, and BMI percentile. Further adjustment for family income attenuated the association of OSA-18 with Hispanic ethnicity, but a significant association with household smoking persisted. NSES index and BMI percentile were not associated with OSA-18.

Conclusion

High symptoms and signs of OSA impacting QOL were associated with Hispanic ethnicity, household smoking and SES in this diverse cohort of children living in urban and predominantly low-income communities. The study points to the need for strategies to reduce household smoking as one strategy for decreasing sleep health disparities, and the further need to understand other factors associated with low SES that increase risk for poor sleep health.

Support (If Any)

NIH-NHLBI/T32HL007901, R35HL1358181, P30ES000002, K24AI106822, R01Hl137192, K23ES031663
0519 Sleep Dysfunction in Rett Syndrome
Authors: Bricker Katelyn , Vaughn Bradley , Roth Heidi , Walker Nathan , Fan Zheng (Jane)
Published: May 2022

Introduction

Rett syndrome (RTT) is an X-linked neurodevelopmental disorder affecting females and is linked to mutations in the methyl-CpG-binding protein 2 (MeCP2) gene. Typical comorbidities in RTT include poor growth, feeding difficulties, hyperventilation and breath-holding, seizures, scoliosis, and disrupted sleep. A few studies indicate sleep disruption in patients with RTT yet there is minimal data on polysomnographic findings in this population. We reviewed our cohort of Rett syndrome patients who underwent polysomnography.

Methods

This retrospective case control of 10 RTT subjects (mean age, 11.19 years; ranged from 1 to 33 years) underwent standard polysomnography (PSG) recording. Subjects were compared to 10 age and gender matched controls with an AHI <5 and no chronic medical problems using a student paired t test. All studies were scored using the AASM criteria.

Results

We found our cohort to have increased N3% sleep, decreased N2%, and shorter sleep onset latency (p< 0.05). Trends of lower BMI, lower oxygen saturation, and shorter REM latency (p < 0.10 but > 0.05). Review of PSGs shows the slow wave have morphological of typical slow waves and not that of the slowing seen on wake EEG nor the epileptiform activity. 4 of the 10 PSGs are notable for frequent interictal epileptiform discharges. 2 of the 10 subjects had a central apnea index >5, 2 had an AHI >5 and 1 demonstrated hypoventilation. There were central apneas associated with hyperventilation during awake and sleep-awake transition.

Conclusion

Our cohort of RTT patients demonstrates differences in sleep architecture, manifested most notably by a high percentage of SWS. This population has high amplitude rhythmic slow (theta) activity on wake EEG, primarily in the frontal-central regions. This slowing was distinct from the epileptiform activity seen in 40% of our cohort. Central apnea also appeared in older patients and the very young. Larger population studies are needed for future research.

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0521 Prevalence and Characteristics of Sleep Disordered Breathing in 12-24 Month Old Children: A Single Center Study
Authors: SurVance Emilee , Nguyen Quang , Betz Kelly , El-Kersh Karim , Senthilvel Egambaram
Published: May 2022

Introduction

To evaluate the prevalence and characteristics of obstructive sleep apnea (OSA) in children with ages between 12 to 24 months.

Methods

This was a single center, retrospective study that included children with ages 12-24 months who were evaluated for suspected sleep disordered breathing and underwent a full overnight polysomnography in an academic sleep disorders center over a period of 7 years. An apnea hypopnea index (AHI) >1 was used to define OSA, >5 was used to define moderate OSA, and >10 was used to define severe OSA.

Results

A total of 232 children with ages between 12-24 months were included in this study. The majority (66.4%) were noted to be males, and 56.9% were Caucasian. Snoring (90.1%) and witnessed apnea (53.3%) were the most common presenting symptoms for sleep evaluation. History of prematurity (18.2%) and gastroesophageal reflux (20.2%) were common co-morbidities. OSA was diagnosed in about 79% of the children and it was categorized as mild in 53.5%, moderate in 16.4 % and severe in 30.1%, respectively. There were no statistically significant differences in total sleep time, sleep efficiency, or the stages among these groups. However, statistical significant differences among the groups were noted in median REM% (Q1-Q3) (normal 19.3 (15-22.2) vs. mild 22.2 (18-26.6) vs. moderate 23.1(16-28) vs. severe 21(15-24.6) p=0.013), median REM AHI (normal 1.6 (1-2.8) vs. mild 7.5 (5-10.8) vs. moderate19.4 (12-23.6) vs. severe 51.2 (37-73.4) p<0.001), median OAHI (normal 0.3 (0-0.5) vs. mild 1.1 (1-2.6) vs. moderate 5.5 (4-7.5) vs. severe 20.7 (13-31.9) p<0.001), median supine AHI (normal-0.3 (0.0.6) vs. mild 1.7 (1-3.4) vs. moderate 6.3 (3-8.1) vs. severe 24.3(12-40.4) p<0.001), median SaO2 nadir (normal 94 (90-96) vs. mild 89 (84-91) vs. moderate 86.5 (82-91) vs. severe 80 (73-84) p<0.001), median arousal index (normal 8.9 (7-11.8) vs. mild 11.3 (9-13.5) vs. moderate 13.2 (11-18.6) vs. severe 16.8 (14-23.6) p<0.0001). Surgical treatment was performed in 98 children (53.5% of the children diagnosed with OSA) of which 76 surgeries were adenotonsillectomy.

Conclusion

In children with ages 12-24 months with suspected sleep disordered breathing, OSA was diagnosed in 79% with moderate to severe OSA in 46.5%.

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0525 The Effects of the COVID-19 Pandemic on Continuous Positive Airway Pressure (CPAP) Adherence in Pediatric Patients with Obstructive Sleep Apnea (OSA)
Authors: Cole Melissa , Mullen Lisa , Tiemeyer Karin , Gurbani Neepa , Huang Guixia , Hossain Md , Simakajornboon Narong
Published: May 2022

Introduction

CPAP Adherence in children with OSA is often sub-optimal and there is concern for worsening during the COVID-19 pandemic. Although telehealth has been used in sleep clinics during the pandemic, there is little known about telemedicine’s effectiveness in specialized care. The purpose of this study is to compare CPAP adherence and related outcome metrics in pediatric OSA patients seen before and during the COVID-19 pandemic and between those seen in person and by telemedicine.

Methods

This retrospective cohort consisted of patients who were diagnosed with OSA, prescribed CPAP, and were seen in a CPAP clinic between 1/1/2018 and 9/31/2021. CPAP adherence data and outcome metrics including the Epworth Sleepiness Scale (ESS), Michigan Sleep-disordered Breathing (PSQ) and Pediatric Quality of Life questionnaires (Ped-QOL) were collected. Only patients with one pre-pandemic and at least one post-pandemic visit were included. All variables were reported as mean± SD. Statistical comparison was performed using the mixed-effects model.

Results

147 patients met criteria with 353 total visits. 147 were before the pandemic (pre) and 206 were during the pandemic (post). Demographic data indicated 57% male, 82% white, and 63% 12 years and older. Post-pandemic visits consisted of 78% telemedicine. Comparison between pre and post pandemic data demonstrated no statistically significant differences in % CPAP usage>4hrs (71±31% [pre] vs 73±33% [post], p=0.95), ESS (6.4±5.5 [pre] vs 5.9±5.8 [post], p=0.27), or PSQ (0.38±0.22 [pre] vs 0.36±0.22 [post] p=0.90). However, there was a significant difference in Psychosocial Health domain of Ped-QOL (68.6±19.4 [pre] vs 74.5±17.9 [post], p=0.012). Comparison between telemedicine and in-person visits during the pandemic showed no differences in %CPAP usage>4hrs (73±31% [Tele] vs 73±37%, p=0.73), ESS, PSQ, or Ped-QOL.

Conclusion

In our cohort, children with OSA had no significant changes in CPAP adherence, sleepiness, or OSA symptoms during the COVID-19 pandemic. CPAP telehealth visits provided the same effectiveness as in-person visits, as evidenced by similar adherences and outcome metrics. Interestingly, patients reported higher psychosocial health during the pandemic despite no difference in CPAP adherence. Factors not related to OSA management may contribute to the improvement of quality of life in this population.

Support (If Any)

Cincinnati Children’s Research Fund
0526 Utility of polysomnography in tracheostomy decannulation process in children
Authors: Gurbani Neepa , Knollman Phillip , Heubi Christine , Huang Guixia , Hossain Md , Simakajornboon Narong
Published: May 2022

Introduction

Different approaches have been used to assess decannulation readiness including clinical observation with gradual tracheostomy downsizing, capping, and microlaryngoscopy and bronchoscopy. Polysomnograms with tracheostomy capping are being used at some centers prior to decannulation. We have previously shown that polysomnography is an important additional tool to predict successful decannulation. However, this study was based on a relatively small number of children. Thus the aim of this study is to review the polysomnographic features that predict decannulation outcomes in a large cohort of children with various conditions.

Methods

A retrospective chart review of polysomnography and medical records was performed for children 0-18 years of age preparing for tracheostomy decannulation from Feb. 2005 to June 2019 at Cincinnati Children’s Hospital Medical Center. Subjects with less than four hours of sleep time were excluded from the study.

Results

A total of 128 subjects were included in the study with 74 in the successful decannulation group (SD), 48 in the no decannulation group (ND) and 6 in the unsuccessful decannulation group. Underlying diagnosis included history of prematurity 41 (32%), genetic disorders 39 (30.5%), neurological disorders 17 (13.3%), airway abnormalities 108 (84.4%), and cardiac disease 24 (18.8%). Average age at the time of tracheostomy was 1.8±3.4 years and at decannulation was 5.7±3.6 years in the SD group. Favorable microlaryngoscopy/bronchoscopy (MLB) was significantly higher in SD group 73.8% vs. ND group 26.2% (p<0.001). Comparing polysomnographic respiratory sleep parameters showed significant differences between ND and SD groups for apnea hypopnea index (AHI)>10/h (88% [ND] vs. 12% [SD]; p<0.001) and obstructive apnea hypopnea index (OAHI)> 5/h (75.6% [ND] vs. 24.4% [SD]; p<0.001). Alveolar hypoventilation (CO2>50 for >25% of TST) was also significantly higher in the ND group (70.6%) vs. SD group (29.4%) (p<0.009).

Conclusion

In our large cohort of children undergoing decannulation, there were several differences in polysomnographic characteristics including AHI, obstructive AHI and CO2 parameters between those who were and were not successfully decannulated. In addition to unfavorable findings on airway evaluation, children who did not undergo decannulation were more likely to have moderate to severe degree of sleep disordered breathing and alveolar hypoventilation.

Support (If Any)

This study was supported by Cincinnati Children’s Hospital Research Fund.