bluuebunny/crossref_metadata_2025 huggingface dataset:
0814 A New Diagnostic Tool for Isolated REM Sleep Behavior Disorder: Automated 3D Video Analysis of Lower Limb Movements During REM Sleep
Authors: Stefani A
Published: May 2020

Introduction

The differentiation of isolated REM sleep behavior disorder (iRBD) or its prodromal phase (prodromal RBD, pRBD) from other disorders with motor activity during sleep is critical for identifying α-synucleinopathy in an early stage. Currently, definite RBD diagnosis requires video-polysomnography (vPSG). Aim of this study was to evaluate automated 3D video analysis of leg movements during REM sleep as objective diagnostic tool for iRBD.

Methods

A total of 122 participants (40 iRBD, 18 pRBD, 64 with other disorders with motor activity during sleep) were recruited among patients undergoing vPSG at the Sleep Disorders Unit, Department of Neurology, Medical University of Innsbruck. 3D videos synchronous to vPSG were recorded. Lower limb movements rate, duration, extent and intensity were computed using a newly developed software.

Results

The analyzed 3D movement features were significantly increased in subjects with iRBD compared to pRBD and other disorders with motor activity during sleep. Minor leg jerks with a duration <2 seconds discriminated with the highest accuracy (90.4%) iRBD from other motor activity during sleep. Automatic 3D analysis did not differentiate between pRBD and other disorders with motor activity during sleep.

Conclusion

Automated 3D video analysis of leg movements during REM sleep is a promising diagnostic tool for identifying subjects with iRBD in a sleep laboratory population and is able to distinguish iRBD from subjects with other motor activities during sleep. For future application as a screening, further studies should investigate usefulness of this tool when no information about sleep stages from vPSG is available.

Support

This study was funded by the Austrian Science Fund (FWF), Project KLI 677-B31.
0826 Gender Differences in Sleep Knowledge of Community-Dwelling Older Adults
Authors: Baldwin C M , Link D G , Coon D W , Quan S F
Published: May 2020

Introduction

This work compares sleep knowledge of community-dwelling older adult men and women.

Methods

Data were derived from a community-based sleep training program that assessed pre- and post-test knowledge of obstructive sleep apnea (OSA), Insomnia, short sleep duration (SSD), restless leg syndrome (RLS), circadian rhythm disorders (CRD), and drowsy driving (DD) on a 1 (none) to 5 (great deal of knowledge) Likert-like scale. Data were analyzed with frequencies for age, sex, and sources of sleep information, and ANOVA to determine gender differences using SPSS (V24) with significance set at p<.05.

Results

Participants (N=158; 68% women) were 56 years and older residing in a retirement community. Pre-test means±standard deviations showed women versus men had greater knowledge of Insomnia (3.5±1.3 vs. 2.9±1.0, p=.004) whereas men showed more knowledge of DD (3.2±1.1 vs. 2.6±1.3, p=.01). A trend was noted for women to have greater knowledge of SSD (3.6±1.2 vs. 3.2±1.0, p=.05). Post-test ANOVA showed a further increase in Insomnia knowledge for women versus men (4.4±0.8 vs. 4.1±0.7, p=.04); however, overall pre/post-test scores for each of the sleep disorders across men and women increased significantly at the p<.001 level. Notably, more women to men reported accessing various resources for sleep information: newspapers/magazines (46:7), friends/family (29:9), the internet (25:11), TV (37:7), and physicians/nurses (45:20).

Conclusion

Findings indicate, prior to sleep training, women have greater knowledge of insomnia and short sleep duration, while men have more knowledge of drowsy driving. Women’s greater understanding of insomnia persists even after sleep training; however, pre- to post-test scores for both sexes across sleep disorders show significant learning outcomes. One possible reason for women’s greater knowledge of insomnia and short sleep could be their greater likelihood to access information on health and healthy lifestyle factors, including sleep, as well as their greater health care utilization.

Support

N/A
0831 Hot Flashes and Insomnia Throughout the Life Span of Women from the Episono Cohort
Authors: Hachul H , Castro L S , Bezerra A G , Poyares D , Andersen M L , Bittencourt L , Tufik S
Published: May 2020

Introduction

Hormonal changes may trigger sleep disturbances in women. Insomnia affects one in every three-to-four of them, most likely during pre to post menopause, and especially in association with hot flashes. Thus, the present study aimed to investigate the occurrence of hot flashes among women with and without insomnia and on different reproductive stages.

Methods

Sampling procedure was a three-stage clustering of the population of Sao Paulo, Brazil according to gender, age (20-80 years), and socio-economic status. A total of 574 women were interviewed, underwent polysomnographic recording (PSG), and had fasting-blood samples collected. Hormone levels and a gynecological questionnaire were used to classify reproductive stages. Premenopausal women were classified either in the follicular, luteal, or periovulatory stage or as anovulatory or under hormonal contraceptives; whereas those menopausal were classified in perimenopause or in early or late stages. Individuals reporting frequent and persistent insomnia symptoms accompanied by relevant daytime impairment were classified with insomnia syndrome. Objective insomnia was defined by increased sleep onset latency and/or awake after sleep onset, decreasing sleep duration.

Results

The final sample included 550 women, representing 53% of the EPISONO cohort (n=1,042). Hot flashes were reported by 9% of the premenopausal women (n=339) and by 42% of the menopausal. Complaints were more frequent among women in perimenopause (67%) and those in use of hormonal therapy (60%), and it tended to decrease in later stages (33%); whereas before menopause, hot flashes were especially reported by anovulatory women (26%), while significantly less by those using contraceptives (6%). Hot flashes were associated with a 2-fold increase in insomnia symptoms and while it predicted objective sleep alterations among premenopausal women, they did not after menopause, when alterations in sleep were better explained by an effect of aging.

Conclusion

Our current findings suggest that hot flashes are associated with irregular menstrual cycles among premenopausal women, and particularly with early stages of menopause, predicting both subjective and objective sleep alterations.

Support

This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001.
0848 The Relationship Between Sleep Disturbance & Sleep Hygiene In Japanese Pregnant Women
Authors: Asaka y , Morioka A
Published: May 2020

Introduction

Pregnant women are more likely to develop sleep disorders due to poor sleep quality. Sleep hygiene has been reported as a method for dealing with sleep disorders. However, studies on the relationship between sleep hygiene and sleep disorders in Japanese pregnant women remain insufficient. This study aimed to clarify the actual state of sleep disorders during pregnancy and the relationship between sleep disorders and sleep hygiene.

Methods

A cross-sectional study was conducted on 147 Japanese pregnant women. We used the Japanese versions of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (JESS) for evaluation of sleep. We used 32 items of habitual behavior important for sleep improvement for evaluation of sleep hygiene; these items were self-selected.

Results

The average PSQIG scores of women in their first, second, and third trimesters were 5.6 ± 4.3, 5.4 ± 2.4, and 6.6 ± 2.8, respectively; 22.2%, 46.4%, and 62.2% of women in their first, second, and third trimesters, respectively, exceeded the cut-off score. The average JESS scores were 12.2 ± 4.5, 9.9 ± 4.1, and 10.0 ± 4.6 for first, second, and third trimester women, respectively; 55.6%, 35.7%, and 41.9% of first, second, and third trimester women, respectively, slept excessively during the day (JESS score≥11). Following factor analysis, sleep hygiene was categorized into four factors: ”thinking positively,” ”adding rhythm to the day,” “avoiding going out and caffeine before bedtime,” and “avoiding eye irritation.” Pregnant women who “added rhythm to their day” had lower PSQI scores, and sleep hygiene was not related to JESS scores in the multiple regression analysis of sleep hygiene and sleep disorders.

Conclusion

Sleep disorders in pregnancy are related to habitual behavior such as being active during the day, eating and sleeping regularly, and basking in the sunlight every morning.

Support
0851 Sleep Disturbance But Not Sleep Duration Is Associated With Perceived Stress And Self-esteem In Postpartum Women
Authors: Wang X , Kishma E E , Sparks J R , Liu J , Castleberry L A , Cook J W , Youngstedt S D
Published: May 2020

Introduction

Healthy sleep is known to contribute to psychosocial well-being. Pregnancy and postpartum could have profound influences on women’s psychosocial well-being related to physiological changes and interrupted sleep due to caring for the infant. The purpose of this study was to determine the associations between self-reported sleep characteristics and psychosocial well-being.

Methods

Forty-seven women who delivered a singleton infant after ≥ 37 weeks of gestation were interviewed at 6-8 weeks, 4 months, and 6 months after delivery. The Pittsburgh Sleep Quality Index (PSQI) was used to obtain sleep duration, sleep disturbance, and the global PSQI score, and the Epworth Sleepiness Scale total score was used to assess daytime sleepiness. The Edinburgh Postnatal Depression Scale, Perceived Stress Scale, and Rosenberg Self-Esteem Scale were used to assess psychosocial well-being, and a summary score of each instrument was calculated.

Results

The self-reported nightly sleep duration decreased over time (535 ± 95, 505 ± 78, 488 ± 66 minutes, respectively at each timepoint, mean ± SD, p = 0.007). Other sleep characteristics did not change. There were also no significant changes over time in the scores of depressive symptoms, stress, or self-esteem. At 6-8 weeks postpartum, sleep disturbance was associated with stress (r = 0.32, p = 0.026) and self-esteem (r = -0.38, p = 0.008) so that women who had greater sleep disturbances perceived greater stress and lower self-esteem. These associations did not exist 4 months or 6 months after delivery. Sleep duration, global PSQI score, and sleepiness were not associated with any of the psychosocial measures.

Conclusion

Sleep disturbance is an important correlate of psychosocial well-being in early postpartum. The decreased sleep duration likely indicates recovering from pregnancy and delivery, and adapting to routine lifestyle.

Support

National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R21MD012740
0854 Exploration Of Sleep Health Among Middle-aged And Older Adults
Authors: Lorenz R A , Auerbach S L , Li C , Chang Y
Published: May 2020

Introduction

Sleep health, a construct introduced to characterize the multidimensional attributes of sleep, has been explored in a variety of populations; however has not been adequately examined for middle-aged and older adults. As attributes of sleep may change with age, the dimensional structure of sleep health may differ in this population. This study aimed to validate a composite measure of sleep health among middle-aged and older adults using data from the Health and Retirement Survey (HRS).

Methods

Data from the 2014 Core survey of the HRS was used to create a composite measure of Sleep Health including sleep efficiency, duration, timing, satisfaction, and alertness. We standardized and averaged the original variables before transforming to T scores. Sleep Health T scores (ranging 0-100, higher scores indicating better sleep health) were examined using exploratory and confirmatory factor analysis (EFA; CFA).

Results

Our sample included 6,095 adults with mean age of 68 years (SD=10.1; range 50-99 years). The majority were female (59.7%), white (77%), with high school education (53.9%). Sleep Health T scores ranged from 27-61 (mean=50; SD=6.7). EFA identified one factor. Timing was removed due to low factor loading (<0.4). The revised four-dimension composite Sleep Health measure had acceptable reliability (Cronbach’s alpha 0.6). CFA showed a well-adjusted model (REMSA=0.097; NFI=0.964; RMR=0.035; GFI=0.990; AGFI=0.951).

Conclusion

These results suggest that the composite measure was valid for assessing sleep health among middle-aged and older adults. Limitations include the use of secondary data, as sleep health dimensions were based on variables not created specifically for our research question. Future research should further examine the role of sleep timing in overall sleep health among middle-aged and older adults.

Support

This study was supported by the University at Buffalo Clinical and Translational Science Institute (CTSI) funded by the National Institutes of Health (Lorenz, PI).
0858 Impact Of Actigraphic Sleep Measures On Ambulatory Cognitive Performance In A Community-Based Sample Of Older Adults
Authors: Buxton O M , Zhaoyang R , Jiao J L , Sliwinski M J , Derby C A
Published: May 2020

Introduction

Few longitudinal studies link objectively assessed sleep and cognition, especially day to day differences in sleep as they relate to daily cognitive performance in ecologically-valid, natural environments. We examine the associations of sleep (actigraphy) with ambulatory ecological momentary assessments (EMA) of cognitive performance.

Methods

Analyses involved 225 participants enrolled in The Einstein Aging Study, a community based longitudinal cohort of older adults free of dementia at enrollment (Mage=77.27 years; 33% males; 47% Caucasian, 39% African American, 13% Hispanic). We examined between-person associations between actigraphic sleep duration and wake after sleep onset (WASO) with mean and variability across the day in cognitive performance. Cognitive performance was assessed via validated, smartphone-based EMA over a mean of 18 days. Six assessments/day included Symbol Match (processing speed), Color Dot (working memory), and Color Shape (memory binding). Models controlled for age, gender, ethnicity, education (years), clinically assessed mild cognitive impairment, and learning effects. Actigraphy data was collected throughout the study period.

Results

Sleep duration had a significant effect on within-person variability on ambulatory cognition: Color Dot, Symbol Match, and Color Shape (all p’s <0.001). Older adults with longer mean nightly sleep duration exhibited more stable cognitive performance over time versus those with shorter sleep duration; sleep duration did not predict mean levels of daily cognitive performance. Person-level means of WASO (0.99±0.45 hours/night) predicted mean levels on cognitive tests, independent of sleep duration. Older adults with less WASO/night exhibited better cognitive performance. One half hour less nightly WASO predicted 175ms shorter Symbol Match response time (p=0.004), 1.5% lower Color Dot error proportion (p=0.048), 0.07 points higher Color Shape accuracy (p<0.001). Older adults with less WASO/night also had less within-person variations in Color Dot (p<0.001), Symbol Match (p<0.001) and Color Shape performance (p=0.01).

Conclusion

Ambulatory cognitive performance assessed using EMA was related to actigraphic sleep. Poor sleep health may be a target for prevention of early cognitive changes that may precede onset of cognitive impairment and AD.

Support

Research was supported by the National Institute on Aging (NIA) award numbers P01AG003949 and R01AG056538.
0865 Menstrual Regularity And Bleeding Associated With Sleep Duration, Sleep Quality, And Daytime Sleepiness In A Community Sample
Authors: Onyeonwu C , Nowakowski S , Hale L , Branas C , Barrett M , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Female menstrual health and its relationship to sleep duration, quality, fatigue and other factors is an understudied subject in the field of sleep and women’s health. Few studies examined sleep in relation to menstrual regularity and bleeding.

Methods

Data were obtained from N=579 women who have had a menstrual period in the past 12 months who participated in the Sleep and Health Activity, Diet, Environment, and Socialization (SHADES) study, a community-based sample of adults age 22-60 living in southeastern Pennsylvania. Participants were asked, “How regular is your period?” with response choices of “Very Regular,” “Mostly Regular,” “Fairly Regular,” and “Not Regular.” They were also asked, “How much bleeding do you usually experience during your period?” Responses were “Very Heavy,” “Medium,” “Light,” or “Very Light.” These were evaluated as ordinal outcomes. Sleep-related predictors included sleep duration (<=6h [Short], 7-8 [Normal], and >=9 [Long]), Insomnia Severity Index (ISI) score, Pittsburgh Sleep Quality Index (PSQI) score, Epworth Sleepiness Scale (ESS) score, and Fatigue Severity Scale (FSS) score. Covariates included age, education, income, race/ethnicity, and body mass index.

Results

Short sleep duration was associated with a greater likelihood of heavier bleeding (OR=1.46, p=0.026) and greater irregularity (OR=1.44, p=0.031), compared to Normal sleep. Higher PSQI score was associated with more irregularity (OR=1.05, p=0.022). FSS score was associated with both heavier bleeding (OR=1.02, p=0.003) and more irregularity (OR=1.02, p=0.008). Long sleep, ISI, and ESS were not associated with either outcome. A sleep duration by FSS score interaction was found for irregularity (p=0.1). Among Normal sleepers, FSS was associated with greater irregularity, but not among Short sleepers.

Conclusion

There is a relationship between short sleep and heavier and irregular menses. These findings have implications for treating sleep problems among women. Also, mechanisms of these associations should be explored further.

Support

Dr. Grandner is supported by R01MD011600

The SHADES study was funded by R21ES022931
0870 Medicare 4% Desaturation Criteria Lead To Significant Underdiagnosis Of Gestational Obstructive Sleep Apnea
Authors: Bazalakova M , Rice L , Wiedmer A , Mourey H , Antony K
Published: May 2020

Introduction

Use of 4% criteria in non-pregnant populations significantly underestimates obstructive sleep apnea (OSA) prevalence and severity (Budhiraja et al, JCSM 2019). Women are significantly more likely than men to not meet Medicare 4% diagnostic criteria for OSA (Khalid et al, Sleep Vol 42 supplement, 2019). We investigated how use of 4% desaturation criteria affects the diagnosis of gestational sleep apnea (gOSA) in pregnancies complicated by obesity.

Methods

We retrospectively reviewed respiratory event index (REI) and pregnancy outcomes in 56 pregnancies with prepregnancy BMI>30 kg/m2, where home sleep apnea tests (HSATs, Alice PDx) were scored using both 4% and 3% criteria.

Results

33 out of 56 HSATs met 4% diagnostic criteria for OSA (REI4% > 5/hr). In 4 out of 33 cases (12%), use of 3% rather than 4% criteria changed the REI from 5-15/hr to the 15-30/hr range. An additional 11 studies were negative for gOSA by 4% criteria (REI4% < 5/hr), but met diagnostic criteria for gOSA by 3% criteria (REI4% > 5/hr). All 11 cases were in the “mild” category of REI 5-15/hr. Thus prevalence of gOSA was 58.9% by 4% but 78.6% by 3% diagnostic criteria. In an ongoing analysis of pregnancy outcomes in the two groups, the gestational age at delivery was lowest in the 4%gOSA group (35.9 weeks), but similar and no longer in the preterm range in the 3%gOSA and no gOSA (REI3%<5/hr) groups (38.7 and 38.3 weeks respectively). However the average baby weight at delivery was lower in the 3%gOSA compared to no gOSA group (3061g and 3580g respectively), suggestive of a potential pathophysiological significance of gOSA defined by <4% desaturation.

Conclusion

The use of 4% desaturation criteria leads to underestimation and missed diagnoses of gOSA complicating pregnancy. As the pathophysiological mechanisms of gOSA have not yet been elucidated, and are likely to differ from those of non-pregnant women and, certainly, men, examination of associated pregnancy morbidity is merited in gOSA defined by 4% versus 3% criteria.

Support

None.
0877 Impact of Sleep-Disordered Breathing on Quality of Life in Pediatric Cystic Fibrosis
Authors: Shakkottai A , Nasr S Z , O’Brien L M , Chervin R D
Published: May 2020

Introduction

The frequency of sleep-disordered breathing (SDB) may be high among children with cystic fibrosis (CF), a life-shortening, genetic disease that affects 1/3400 Caucasian live-births. Yet, the potential impact of SDB on their quality of life has not been well-studied.

Methods

The Pediatric Sleep Questionnaire Sleep-Related Breathing Disorders (PSQ-SRBD) Scale, a well-validated SDB screening tool, and two validated quality-of-life questionnaires, the Pediatric Quality of Life Inventory (PedsQL™) and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were administered to children 6-17 years of age with CF consecutively during a 2-week period during routine pulmonary clinic visits.

Results

Twenty-two children with CF and their parents completed the questionnaires. Mean age of the participants was 11.6±3.8(sd) years. Mean body mass index (BMI) percentile was 54.8±27.1%. Mean forced expiratory volume in 1 second percent predicted (FEV1 PPD) was 86.6±22.5%. Five subjects (23%) showed high risk for SDB (PSQ-SRBD Scores > 0.33). Seven additional subjects had PSQ-SRBD Scores of 0.3. Mean BMI percentile was higher among subjects with vs. without positive PSQ-SRBD Scores (66% vs. 42% respectively, p=0.03). The groups did not differ with regards to FEV1. Pearson/Spearman correlation identified negative associations between PSQ-SRBD Scores and functioning in multiple parent PedsQL domains: physical (R=-0.45, p=0.03), social (R=-0.53, p=0.01), school (R=-0.56, p=0.008); two child PedsQL domains: physical (R=-0.41, p=0.06), school (R=-0.41, p=0.06); multiple parent CFQ-R domains: physical (R=-0.44, p=0.08), respiratory (R=-0.45, p=0.07), emotional (R=-0.54, p=0.02), school (R=-0.70, p=0.002); and one child CFQ-R domain: physical (R=-0.51, p=0.01). None of these domains were associated with FEV1.

Conclusion

Children with CF may have SDB symptoms independent of the extent of lung dysfunction. Although the current cross-sectional data cannot prove a causal effect, they raise the possibility that the SDB itself may have adverse impact on physical, emotional, social, and school functioning.

Support

NIH Training Grant (F32HL145915)
0887 Diaphragm Pacer Malfunctions Requiring Surgical Repair in CCHS Patients
Authors: Kiang J B , Kun S S , Shin C , McComb G J , Keens T G , Perez I A
Published: May 2020

Introduction

Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disorder that results in the loss of autonomic ventilatory control, and patients require ventilatory support during sleep or both sleep and wakefulness. One method of ventilatory support is diaphragm pacing (DP), where electrodes surgically placed on the phrenic nerve are connected to subcutaneously implanted receivers that communicate with external antennas and transmitter. There are limited data on the frequency of DP malfunctions that require surgical revision.

Methods

We reviewed the records of 24 CCHS patients ventilated by DP followed at CHLA from 1990-2019. Records were examined for demographics, PHOX2B mutation, pacing duration/day, date and type of malfunctions, age and time since implantation at malfunction occurrence, and repair success rate.

Results

All 24 patients had thoracoscopic electrode placement. 17/24 (71%) of patients used DP while asleep; 3/24 (13%) during wakefulness only. 4/24 (17%) were not currently using their pacers. 10/24 (42%) patients required at least one surgical intervention (Age at implantation 9 ± 4.6 (SD) years; age at malfunction 12.5 ± 7.4 years). The average time from pacer implantation to malfunction was 3.8 ± 3.5 years. Malfunctions included defective receivers (6), insulation leaks (1), defective electrodes (4), and hardware infection (1). Of 12 unique component repairs, 6/12 (50%) involved changing receivers, 1/12 (8%) involved repairing an insulation leak, 4/12 (33%) involved replacing the electrodes and receivers, and 1/12 (8%) involved hardware extraction. Of the 12 malfunctions, 10 (83%) had successful surgical revision. 2/12 (17%) repairs were not attempted. While awaiting surgical revision, patients were successfully ventilated by unilateral DP.

Conclusion

Nearly half of CCHS patients on DP experienced malfunctions within 11 years of implantation. The most common DP repair was receiver replacement. Patients who are waiting for repair often successfully ventilate while pacing unilaterally.

Support

None
0889 Utility of Pulse Wave Amplitude in Detecting Arousals in Children
Authors: Al-Shawwa B , Cruz J , Ehsan Z , Ingram D G
Published: May 2020

Introduction

Identifying and scoring arousals are crucial to score hypopneas and respiratory efforts related arousals (RERAs). At the same time, children’s sleep architecture appears to be more stable compared to adults which makes it more difficult to score arousals. Pulse wave amplitude (PWA) is a signal obtained from finger photoplethysmography which is directly and positively correlated to finger blood flow. It is also used as a marker for finger vasoconstriction reflected by decreased signal amplitude and as a surrogate for autonomic and cortical arousals. Our aim was to study the effect of scoring arousals based on PWA on scoring of respiratory events in pediatric patients.

Methods

Ten polysomnograms for patients between the ages of 5-15 years who had apnea-hypopnea indices between 1 and 3 events/hour were identified. Patients with syndromes were excluded. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify subcortical/autonomic arousals. Arousals were rescored based on this criteria and subsequently respiratory events were rescored. Paired t-tests were employed to compare PSG indices scored with or without PWA incorporation.

Results

The sample of 10 children included 2 females, and the average age was 9.8 +/-3.1 years. Overall, polysomnography revealed an average total sleep time of 464.1 +/-25 mins, sleep efficiency of 92% +/-4.2, sleep latency of 19.6 +/-17.0 mins, rapid eye movement (REM) latency 143 +/-66 mins, N1 3.9% +/-2.0, N2 50.3% +/-12.0, N3 28.2% +/-9.1, REM 16.7% +/-4.0, and wakefulness after sleep onset (WASO) 18.1 +/-7.5 mins. Including arousals from PWA changes, respiratory indices significantly increased including total AHI (2.3 +/-0.7 vs 5.7 +/-2.1, p<0.001), obstructive AHI (1.45 +/-0.7 vs 4.8 +/-1.8, p<0.001), and RDI (2.36 +/-0.7 vs 7.6 +/-2.0, p<0.001). Likewise, total arousal index was significantly higher (8.7 +/-2.3 vs 29.4 +/-6.5, p<0.001).

Conclusion

Pulse wave amplitude is a useful marker for arousals that are not otherwise easily identified in pediatric polysomnography. This in turn would lead to a more accurate scoring of respiratory events and severity assessment of sleep disordered breathing. This likely will have clinical and therapeutic implications.

Support

None
0902 The Use Of Auto-titrating Continuous Positive Airway Pressure (auto Cpap) For Obstructive Sleep Apnea In Children With Neurological Disorder
Authors: Platter L , Urbano G , Roberto L , Sudhakar R , Tablizo M
Published: May 2020

Introduction

Multiple studies have demonstrated the effectiveness of auto-titrating continuous positive airway pressure (auto CPAP) in the adult population, but there is limited literature on the use of auto CPAP in the pediatric population. Specifically, the use of auto CPAP in children with neurological disorder(s) has not been established. Thus, we conducted a study to review the use of auto CPAP in children ages 18 years old and younger with Obstructive Sleep Apnea Syndrome (OSAS) and associated neurological disorder to document its effectiveness, adverse events and outcomes of its use.

Methods

A retrospective chart review was performed on patients 18 yo and younger diagnosed with OSAS and associated neurological disorder(s) who have good compliance with auto CPAP use. Good compliance was defined as >4 hours/night and >20/30 days of auto CPAP use. Compliance from the most recent 30 days was downloaded.

Results

5 children met our criteria for inclusion, with a mean age of 11 years (6-18 years old). All had initial baseline sleep studies performed without PAP titration polysomnography. Associated neurological disorders were cerebral palsy, Arnold Chiari Malformation, seizure disorder and intellectual disability. The average length of use of auto CPAP was 4 months. Auto CPAP was used on average of 24/30 nights, with a mean of 7.35 hours/night. The mean baseline obstructive apnea-hypopnea (OAHI) index was 42 (8.2-94.4). The mean AHI on a 30 day download report showed a mean decrease in AHI to 2.9 (0.5-5.2) while on auto CPAP. Review of patient charts did not reveal any adverse outcomes associated with the use of auto CPAP in these patients.

Conclusion

This study showed that auto CPAP significantly improved the AHI in pediatric patients treated for OSA with associated neurological disorder. There were no reported adverse outcomes. Further research is needed to establish the effectiveness and safety of auto CPAP use in the pediatric population, specifically those with neurological disorder. The use of auto CPAP will help decrease the wait time for treatment in children with OSA. These patients can use auto CPAP while waiting for a titration study and for long term use.

Support

none
0914 Sleep Disordered Breathing In Pediatric Patients Before And After Intrathecal Baclofen Therapy
Authors: Sobremonte-King M , Chen M , DelRosso L M
Published: May 2020

Introduction

Refractory spasticity in children is treated with intrathecal baclofen (ITB), which may worsen both central and obstructive breathing events. Sleep disordered breathing (SDB) is seldom investigated prior and/or subsequent to placement of ITB and there are currently no standardized protocols. This study aims to compare occurrence of SDB pre/post ITB placement.

Methods

Retrospective chart review revealed 104 patients started on ITB therapy from 2009-2019 and those who had pre and/or post ITB polysomnograms (PSG) were included. Medical history and PSG parameters were extracted. Comparison of paired results will occur using the Wilcoxon Signed Rank Sum Tests once collection is complete.

Results

Thirty-seven patients were identified having pre and/or post ITB PSGs. Results in mean ± SD show: age was 11 ± 4 years and 65% were male. Twenty-five pre ITB PSG had an oAHI of 4 ± 5 with 22/25 (88%) having SDB. There were 15/25 (60%) with mild OSA (oAHI >1 but < 5) and 7/25 (28%) with moderate-severe OSA (oAHI > 5/hr). CAI was 1 ± 2 and oxygen saturation nadir was 88 ± 9 %. Sixteen post ITB PSG had an oAHI of 8 ± 13 with 100% having SDB. There were 11/16 (69%) with mild OSA and 5/16 (31%) with moderate-severe OSA. CAI was 3 ± 7 and oxygen saturation nadir was 84 ± 8 %. Ten patients were initiated on non-invasive ventilation, one on supplemental oxygen and two had adenotonsillectomy.

Conclusion

Initial data shows high occurrence of SDB in patients pre and post ITB placement leading to medical or surgical intervention in 35%. Post ITB PSGs showed worsened oAHI and CAI and lower oxygen saturation nadir. Possible mechanisms include depression of central respiratory drive and decreased pulmonary reserves. This study may help stratify and address risks of ITB for those with refractory spasticity and SDB.

Support

None
0917 Designing a Wearable Technology-Based Sleep Intervention To Support Sleep Health Among Adolescents: Using a Participatory Design Approach
Authors: Beck A J , Duffett-Leger L , Raffin Bouchal S , Ferber R , Ward T
Published: May 2020

Introduction

Sleep problems during adolescence are increasingly common and have been associated with adverse physical and psychological health outcomes. Efforts to improve insufficient sleep among adolescents have resulted in increased sleep knowledge and temporary enhancements in sleep hygiene. Good sleep hygiene is established through the development of daily routines that support healthy sleep. Wearable technology offers a potential solution whereby adolescents can acquire and manage healthy sleep habits. In this study, we are co-designing with adolescents a prototype intervention using wearable technology to promote sustained improvements in their sleep hygiene.

Methods

Guided by participatory design approaches, the ongoing multi-phase mixed methods study is currently being conducted in a metropolitan area in western Canada. In phase 1, sleep data is being collected from a sample of 30 adolescent-parent dyads using wearable sensors (Actigraphy watches) and self-report sleep measures (questionnaires about sleep quality, hygiene, and beliefs and attitudes, as well as their general health) over a 10-day period. In phases 2 and 3, individual interviews and iterative user interface design sessions will be conducted with 25 adolescents.

Results

To date, thirteen adolescents-parent dyads (13-17 years, 9 females; 39-56 years, 11 females) have completed phase 1 of our study. Data analysis is currently being conducted to evaluate sleep onset/offset, total sleep time, wake after sleep onset, sleep efficiency, and sleep schedule differences between adolescents and their parents. Ten adolescents have completed individual interviews in phase 2 of the study. Preliminary qualitative data suggests that youth are aware of the importance of sleep to their overall health. However, they struggle with identifying credible information to act on from the various and sometimes conflicting sources (e.g. online, friends, family).

Conclusion

We anticipate that co-designing a wearable solution with adolescents will lead to a sleep intervention that is more relevant, persuasive, and useful in supporting their sleep health.

Support

This work is supported by the Sensor Technology in Monitoring Movement STiMM Program.
0920 Behavioral Profiles Associated with the Development of Insomnia Symptoms in Children with Known Mental Health Disorders
Authors: Bourchtein E , Calhoun S L , Puzino K , McQuillen A , He F , Vgontzas A N , Liao D , Bixler E O , Fernandez-Mendoza J
Published: May 2020

Introduction

Mental health disorders (MHD) are a known risk factor for the development of insomnia symptoms in youth. However, a number of children with MHD do not go on to develop insomnia symptoms later on in life. Little is known about possible childhood factors that exacerbate or mitigate the risk of developing adolescent insomnia symptoms (AIS) among children with MHD. The present study examined, in an at-risk group of children with MHD, the behavioral profiles associated with the development of AIS.

Methods

The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y), of whom 421 were followed up as adolescents (12-23y). Absence of childhood insomnia symptoms was ascertained by parent-reports (n=312), while presence of AIS in this subgroup was ascertained by self-reports (n=97). Presence of MHD was ascertained based on the clinical history and physical exam at baseline (n=52). The Pediatric Behavior Scale (PBS) assessed multiple parent-reported behavioral domains.

Results

Children with MHD at baseline had greater levels of difficulty across a variety of internalizing (e.g., anxiety, depression) and externalizing (e.g., impulsivity, hyperactivity) behavioral domains than those without MHD, regardless of whether they developed AIS. However, children with MHD who went on to develop AIS had significantly greater levels of aggressive (p<0.001) and oppositional (p=0.006) behaviors relative to children with MHD who did not develop AIS. In fact, these latter children did not differ from peers without any history of MHD or AIS on levels of aggressive (p=0.820) or oppositional (p=0.436) behaviors.

Conclusion

Children with MHD who present with normative aggressive and oppositional behaviors are less likely to develop AIS. Healthcare providers should consider providing preventative sleep interventions to youth with MHD who are exhibiting comorbid externalizing behaviors.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0922 Nightly Associations Between Pre-Bedtime Activity, Actigraphic Light, and Sleep in Children With ASD and Insomnia
Authors: McGovney K D , Curtis A F , Mazurek M , Chan W S , Deroche C B , Munoz M , Davenport M , Takamatsu S , Takahashi N , Muckerman J , McCann D , Sahota P , Mills B , McCrae C S
Published: May 2020

Introduction

Approximately two thirds of children with Autism Spectrum Disorder (ASD) suffer from chronic insomnia. Current behavioral interventions for insomnia in children with ASD use sleep hygiene guidelines to educate parents and their children regarding sleep promoting habits. However, the relationship between pre-bedtime physical activity/light and sleep is understudied in ASD. The current study examined daily associations between pre-bedtime actigraphically assessed activity/light levels and objective/subjective sleep outcomes in children with ASD and insomnia.

Methods

Thirty children (Mage=8.5 yrs, SD=1.78 yrs) with comorbid ASD and insomnia completed 14 days of actigraphy measuring ambient white light intensity and activity levels every 30 seconds. Validated sleep scoring algorithms (in Actiware V. 6.0.9) estimated objective sleep onset latency (SOL), total sleep time (TST), wake time after sleep onset (WASO), and average activity/light levels 30, 60, and 120 mins prior to bedtime. Additionally, average activity/light levels 120-240, and 240-360 mins prior to bedtime were computed. Children also completed 14 daily sleep diaries (with parental assistance) measuring subjective reports of the same sleep parameters. Associations between daily estimations of pre-bedtime activity levels, light, and nighttime objective and subjective sleep were examined through multilevel modelling. Bonferroni corrections were performed to account for multiple comparisons.

Results

After Bonferroni corrections (p<.025 significance level), greater activity within 30 minutes (B=0.0465, p=.0093) and 60 minutes (B=0.0681, p=.0005) of bedtime were associated with longer subjective SOL. Pre-bedtime light exposure was not a significant predictor of sleep outcomes.

Conclusion

Results suggest that in general, variations in daily pre-bedtime activity, but not light, are associated with worse nightly subjective SOL in children with ASD and insomnia. Findings support that sleep hygiene recommendations in children with ASD include avoidance of higher levels of pre-sleep physical activity. Prospective studies examining temporal causal relationships between pre-bedtime activity and sleep in ASD are warranted.

Support

Research was supported by a University of Missouri Research Board award (McCrae, PI; Mazurek, Co-PI). Data collected as part of clinical trial NCT02755051 Targeting Sleep in Kids with Autism Spectrum Disorder at the University of Missouri (PI: McCrae).
0928 Heart Rate Variability During Sleep in Children and Adolescents with Restless Sleep Disorder or Restless Legs Syndrome and Normal Controls
Authors: Ferri R , Bruni O , DelRosso L M
Published: May 2020

Introduction

Restless sleep disorder (RSD) has been recently characterized clinically and polysomnographically in children and differentiated from restless legs syndrome (RLS). Heart rate variability (HRV) is a reliable method to quantify autonomic changes during sleep. The aim of this study was to characterize HRV in children with RSD, RLS and normal controls, with the hypothesis that children with RSD have a shift toward sympathetic predominance during sleep.

Methods

Polysomnographic recordings from thirty-two children who fulfilled RSD diagnostic criteria (19 boys and 13 girls), 32 children with RLS (20 boys and 12 girls) and 33 controls (17 boys and 16 girls) were included. Four ECG epochs were chosen, one for each stage, and were analyzed for automatic detection of R waves. Time domain and frequency domain HRV parameters were obtained and analyzed.

Results

Age and gender were not statistically different between groups. In terms of time domain only the standard deviation of the average RR interval during stage N3 was slightly but significantly higher in RSD than in RLS patients. In terms of frequency domains, the LF band and the LF/HF ratio were increased in RSD and the HF percentage was lower in RSD during sleep stages N3 and R. The LF band and the LF/HF ratio increased in RLS and the HF percentage was lower in RLS during stage W.

Conclusion

Children with RSD have increased sympathetic activation during sleep, particularly N3 and REM, compared to controls but, as expected, not during wakefulness. Differently, children with RLS have sympathetic activation during relaxed wakefulness preceding sleep and during sleep.

Support

Partial support by a grant of the Italian Ministry of Health RC n. 2751598 (R.F.)
0930 Prenatal Cannabis Use and Sleep Outcomes in Children 9-10 Years of Age in the Adolescence Brain Cognitive Development Study
Authors: Winiger E , Hewitt J
Published: May 2020

Introduction

The fetal brain is densely populated with CB1 receptors that increase in number throughout gestation and might be involved in sleep processes since they are found in many brain areas related to the regulation of the sleep-wake cycle. THC binds to CB1 receptors, possibly altering neurodevelopment and fetal cortical circuitry in the womb. Studies have found prenatal cannabis use is associated with early sleep factors from as early as few days after birth to 3 years of age, yet no studies have examined associations in later childhood.

Methods

We used data from the Adolescent Brain Cognitive Development (ABCD) study to determine whether maternal reports of cannabis use while pregnant were associated with child sleep outcomes (The Sleep Disturbance Scale for Children) among 11,875 children ages 9-10. Regression analyses accounted for the nested nature of families (twin and non-twin sibling) and were estimated controlling for potential covariates including daily tobacco and weekly alcohol use during pregnancy, mother’s education, combined household income, parental marital status, child sex, and child age.

Results

Amongst mothers in our sample, 6% endorsed using cannabis while pregnant. Prenatal cannabis use was associated with lower sleep duration, disorders of initiating and maintaining sleep, disorders of arousal, sleep wake disorders, disorders of excessive somnolence, and a summed sleep score (all b >0.09 and p < 0.04) but not with sleep latency, sleep breathing disorders, and sleep hyperhidrosis (all b <0.08 and p >0.09).

Conclusion

Prenatal cannabis use was associated with increased childhood sleep deficits including shorter sleep duration and higher endorsements of sleep disorder symptoms. This is the first report of prenatal cannabis use being associated with sleep in childhood as late as 9-10 years of age. Although causality is not established, the results suggest potential long-term effects of prenatal cannabis use on sleep and the need for abstinence from cannabis use while pregnant.

Support

T32 DA017637. The ABCD Study is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, U24DA041147, U01DA041093, and U01DA041025 (https:// abcdstudy.org/federal-partners.html).
0934 Ambulatory Blood Pressure Monitoring During Overnight Polysomnography in Children and Adolescents
Authors: DelRosso L M , Chan J , Ruth C , Arp M , Ferri R
Published: May 2020

Introduction

During NREM sleep, sympathetic nervous system input decreases and systolic blood pressure drops. Sleep disorders can alter this mechanism. Ambulatory blood pressure monitors (ABPM) are increasingly used in children and are superior to clinic blood pressure in predicting cardiovascular morbidity and mortality. We aim to assess the effect of ABPM use during a sleep study in children and adolescents.

Methods

Subjects were children ages 7-18 from Seattle Children’s Hospital who underwent a sleep study for evaluation of suspected obstructive sleep apnea. Excluded children with known hypertension or taking a medication that altered blood pressure. An ABPM was placed on the right arm during the overnight sleep study and programmed to record BP every hour. Studies from children without OSA were analyzed for all sleep parameters. Data was compared with a control of children who underwent PSG and did not wear the ABPM. BP measurement was recorded and the PSG was reviewed for sleep stage, arousal, or awakening.

Results

To date, we have 15 children with ABPM age mean 11.6, SD 2.9 and 35 controls age mean 10.97 and SD 3.1, age, sex and BMI did not vary between groups. None of the PSG parameters was statistically different between groups including total sleep time, sleep efficiency, arousal index or sleep stage distribution. An average of 10 BP readings was obtained per patient. 53% of BP readings in N1 resulted in awakenings, compared to 39% in N2, 5% in N3 and 14.8% in REM. Systolic, diastolic, heart rate and mean arterial pressure showed appropriate dipping during sleep with appropriate circadian increase at 4 AM. Pulse pressure remained the same.

Conclusion

We have demonstrated the feasibility of using ABPM during PSG in children. Although sleep macroarchitecture did not show any significant difference in sleep efficiency or arousal index, further evaluation of each ABPM insufflation during the sleep study showed a sleep stage specific, sleep disruption with awakenings more likely to occur during N1 or N2 and less likely to occur during N3 or REM sleep. There was normal dipping and as expected circadian variability in the values.

Support