bluuebunny/crossref_metadata_2025 huggingface dataset:
0878 Association of Obstructive Sleep Apnea with Internalizing Symptoms vs. Externalizing Behaviors in Adolescents with Attention Deficit Hyperactivity Disorder
Authors: Puzino K , Calhoun S L , He F , Toth S , Vgontzas A N , Liao D , Bixler E O , Fernandez-Mendoza J
Published: May 2020

Introduction

Attention deficit hyperactivity disorder (ADHD) in children has been associated with insomnia, obstructive sleep apnea (OSA), and abnormal periodic limb movements (PLMS). However, there is lack of data examining the contribution of OSA to ADHD-related internalizing symptoms and externalizing behaviors in adolescents.

Methods

We studied the Penn State Child Cohort, a random general population sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y, 53.9% male). All adolescents underwent a 9-hour PSG, clinical history and physical examination. ADHD was ascertained by a parent- or self-report of having been diagnosed with ADHD. OSA was defined as an apnea hypopnea index (AHI) of ≥2 events per hour of sleep, while a periodic limb movement index (PLMI) ≥5 events per hour of sleep was indicative of PLMS. Controls, OSA-alone, ADHD-alone and ADHD+OSA were identified. The Child or Adult Behavior Checklist were used to ascertain internalizing and externalizing behaviors. Multivariable-adjusted models controlled for sex, race, age, and body mass index (BMI) percentile.

Results

As compared to controls, adolescents with ADHD-alone or ADHD+OSA had significantly greater externalizing behaviors (p<0.001), inattention (p<0.001) and thought problems (p<0.001). While adolescents with ADHD-alone had higher internalizing symptoms (p=0.021), specifically withdrawn-depression (p<0.01), adolescents with ADHD+OSA had more somatic problems than controls (p=0.048). There were no statistically significant differences in behavioral outcomes between controls and adolescents with OSA-alone or between adolescents with ADHD-alone and ADHD+OSA.

Conclusion

Adolescents with comorbid ADHD and OSA do not present with worse behavioral outcomes than those with ADHD alone. Future studies should examine whether the progression of these adolescents into young adulthood differs in terms of their behavioral outcomes and development of mental health disorders.

Support

National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0882 Local Deformation Analysis of Lateral Cephalogram for Childhood OSA Classification
Authors: Yuen H M , Chan H L , Au C T , Chan K C , Lui L M , Li A M
Published: May 2020

Introduction

Craniofacial profile is one of the anatomical causes of obstructive sleep apnea (OSA). Cephalometry provides information on patients’ skeletal structures and soft tissues. Traditional cephalometric analysis focuses on linear distances, angles, ratios and area of specific variables. Its classification power is often disappointed. In this study, a novel approach to cephalometric analysis using local deformation information was carried out to assess its efficacy in OSA classification.

Methods

This study was a retrospective analysis based on 60 case-control pairs who were Chinese children recruited for sleep studies in the Prince of Wales Hospital, with accessible lateral cephalometry and polysomnography (PSG) data. Local deformation technique was adopted to derive 1215 deformations from 15 manual landmarking on each cephalogram. In addition, three linear distances (hyoid bone to mandibular plane, hyoid bone to posterior pharyngeal wall, and minimal distance between tongue base and posterior pharyngeal wall) were measured from each cephalogram. A total of 1218 information features were obtained per subject. Classification models were built with an equal ratio between OSA and non-OSA groups (defined by OAHI≥1 and OAHI<1 respectively). Forty pairs were used as training data and twenty pairs were used as testing data.

Results

Three model settings which used all 1218 cephalometric features, 800 features, and 500 features were tested. The accuracy for the three settings were 67.5% (sensitivity: 70%, specificity: 65%), 87.5% (sensitivity: 90%, specificity: 85%), and 92.5% (sensitivity: 95%, specificity: 90%) respectively. Apart from the three distances, the 500 topmost discriminative features were predominantly landmarks around the nasal cavity.

Conclusion

A new approach to cephalometric analysis using local deformation information can provide additional details on each cephalogram, hence, achieving better classification. The classification models using 500 features yielded the highest accuracy among the three settings. This setting could benefit most from the comprehensive comparison while avoiding overfitting.

Support

-
0892 Sleep Abnormalities in Cornelia De Lange Syndrome
Authors: Villalobos R , Villalobos A P , Villalobos R , Villarreal I A , Grimaldo D , Valencia J A
Published: May 2020

Introduction

Cornelia de lange is an autosomal dominant disorder (when associated with NIPBL, RAD21, or SMC3 genes) with an incidence of 1:10,000 to 1:50,000 live births, patients affected are known to have a wide variety of sleep disorders, those range from insomnia and abnormal circadian cycle to sleep disordered breathing and hypoventilation.

The exact etiology of increased risk of sleep-disordered breathing in patients affected is not fully understood. It is possible that some facial features in these patients expose them to a higher risk (micrognathia, high arched palate, and short neck). We wanted to analyze the sleep related problems in CDLS.

Methods

We included 3 patients with the disorder, age range from 15 months to 16 years old. All patients met criteria for CDLS diagnosis, all had intellectual disability and behavioral associated symptoms. The somnology evaluation included questionnaires of diurnal behavior and sleep focused logs. We performed nocturnal polysomnography in only 2 patients due to inability to tolerate the test in one case.

Results

Sleep clinical information was abnormal in all the cases. Overnight behavioral video evaluation was done. The behavioral abnormalities were evident in all subjects and severe in one.

Overnight polysomnography demonstrated a moderate to severe degree of OSA, delayed sleep onset suggestive of insomnia, sleep-wake transition disorder with elevated WASO time, and arousal disorder with elevated spontaneous arousal index. It is of interest the finding of sleep related hypoxemia with limited evidence of obstructive component in one patient.

Conclusion

The abnormalities in sleep are frequent in CDLS, there are wide and present in the sleep architecture and the sleep ventilation, sleep apnea syndromes are frequent but are not the only major sleep-related abnormalities. When CDLS is caused by mutations in the HDAC8 or SMC1A gene, the condition has an X-linked dominant pattern inheritance. Most cases result from new mutations in the HDAC8 or SMC1A gene and occur in people with no history of the condition in their family, likely our cases are related to this mode of transmission and potential different patters of sleep disruption are dependent on different genes involved.

Support

None
0896 Nutritional Status Improves Following The Implementation Of Positive Airway Pressure For The Treatment Of Obstructive Sleep Apnea In Youth With Down Syndrome
Authors: Arputhan A , Xanthopoulos M S , Tapia I E , Hernandez P , Kelly A
Published: May 2020

Introduction

In typically developing youth, increases in body mass index (BMI) and rates of obesity accompany treatment of obstructive sleep apnea syndrome (OSAS) with adenotonsillectomy regardless of baseline BMI and OSAS severity. Residual OSAS following adenotonsillectomy and overweight/obesity are common in Down syndrome (DS). We sought to examine the impact of positive airway pressure (PAP) on BMIZ in youth with DS and OSAS.

Methods

Baseline, 6, and 12 month height/length and weight as well as pre-PAP PSG data were abstracted from the Children’s Hospital of Philadelphia Sleep Center for patients with DS and OSAS initiated on PAP between 01/01/2014-07/11/01/2017 (N=73; Median age=6.6y IQR: 3.6-12.1; 52% White, 29% Black; 42% Male). BMIZ was calculated. Longitudinal mixed effects models adjusted for adherence from 0-6 months, baseline BMIZ, and baseline SpO2 nadir were used to evaluate change in BMIZ at months 6 and 12 and the impact of baseline BMIZ on trajectories.

Results

OAHI (median; IQR) at initiation was 15.9 (8.1-28.9) events/hour, SpO2 nadir was 83% (77-88), and BMIZ was 1.50 (0.94-2.34). No differences in BMIZ at 6 and 12 months compared to baseline BMIZ were found (p>0.2 for both). Baseline BMIZ was associated with BMIZ at 6- and 12 months (β-coefficient=0.99; p<0.0001); the increase in BMIZ at 12 mo (β-coefficient= 0.49, p=0.001) was offset with decreasing BMIZ (12mo*baseline BMIZ β-coefficient= -0.3; p<0.0001); such that lower BMIZ was associated with increases in BMIZ while higher BMIZ was associated with decreases in BMIZ.

Conclusion

Initiation of PAP has a beneficial impact on nutritional status in youth with DS and OSAS. In youth who are at the lower end of BMIZ, BMIZ increases to a healthier status following the initiation of PAP, and in youth who are at the higher side of BMIZ, BMIZ decreases to a healthier status. Prospective studies are needed to elaborate on these associations.

Support

None
0900 Obstructive Sleep Apnea Severity, Symptoms Of Attention Deficit Hyperactivity Disorder And Other Comorbid Psychiatric Disorders In Children And Adolescents: A Retrospective Data Analysis
Authors: Skoulos M , Sedky K , Bennett D
Published: May 2020

Introduction

Children and adolescents with obstructive sleep apnea (OSA) are often diagnosed with attention deficit hyperactivity disorder (ADHD). However, the connection between the severity of Apnea/Hypopnea Index (AHI) and ADHD is controversial with research evidence pointing in opposing directions.

Methods

A retrospective study was conducted in a pediatric sleep center at a university hospital setting to investigate the effect between AHI severity, ADHD and/or other comorbid psychiatric disorders. One hundred and thirty-eight participants between the age of 6 and 18 were examined in terms of AHI severity level and their correlation with scores from the Child Behavior Checklist (CBCL) using SPSS program.

Results

A negative correlation between AHI scores and Attention Problems for the entire group of participants was found. Additionally, female adolescents had positive correlations between AHI scores and several affective disorder variables from the CBCL, while male adolescents had negative correlations between AHI levels and several CBCL scores that are typically associated with ADHD and Anxiety disorders.

Conclusion

This study suggests a relationship between OSA severity and psychiatric conditions. However, this relationship can vary depending on age, gender and AHI severity. More research is required to understand this relationship.

Support

Chervin, R.D. How many children with ADHD have sleep apnea or periodic leg movements on polysomnography? Sleep. 2005: 28(9): 1041-1042.

Sedky K, Bennett DS, Carvalho KS. Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: A meta-analysis. Sleep Medicine Reviews. 2014; 18: 349-356
0911 Association Between Chromosomal Abnormality And Sleep Disordered Breathing Characteristics In Children With Prader Willi Syndrome
Authors: Gupta G , Veeravigrom M , Felt B , O’Brien L
Published: May 2020

Introduction

Prader-Willi Syndrome (PWS) is a genetic disorder caused by lack of expression of paternal genes from the chromosomal region 15 q11.2-q13. PWS is associated with excessive daytime sleepiness, sleep-disordered breathing (SDB), hypoventilation and circadian rhythm disturbance. Chromosomal deletion and uniparental disomy (UPD) are the two most common genetic etiologies of PWS. Differences in clinical features between these groups are recognized; however, limited literature exists regarding sleep characteristics.

Methods

The objective was to evaluate sleep characteristics of children with PWS between those with 15q11.2-q13 chromosomal deletion and those with other genetic etiologies. A retrospective chart review of in-laboratory polysomnograms (PSG) in children with PWS prior to growth hormone treatment was performed. The apnea hypopnea index (AHI), REM AHI, NREM AHI, Obstructive Apnea Index (OAI), Central Apnea Index (CAI), hypopnea index, arousal index, presence of hypoventilation, and positional AHI were assessed.

Results

Overall 33 PWS children were identified. Mean age was 5.9 ± 5.19 (range 1-16 years), 57% were male and 85% had SDB. Almost half (42%) had a 15q11.2-q13 chromosomal deletion. Of those without deletion, 30% had UPD. Sleep variables were similar in PWS with and without deletion: AHI (5.9±5.7 vs. 8.54±7.1; p=0.27), NREM AHI (3.3±4.6 vs. 6.2±6.3; p=0.16), CAI (1.1±1.5 vs. 1.9±3.8; p=0.43) SpO2 nadir 82.7±9.9% vs. 85.3±5.7%; p=0.36) and arousal index (10.3±7.8 vs. 15.4±7.8; p=0.09).

Conclusion

Sleep characteristics do not appear to clearly differ between genetic etiologies of PWS. Larger sample sizes are needed to support these findings.

Support
0926 Examining Sleep In Parents And Children With Behavioral Or Clinical Sleep Disturbances
Authors: Varma P , Jackson M L , Junge M , Conduit R
Published: May 2020

Introduction

Sleep problems, such as insomnia are frequently reported in children. These sleep disturbances have either a behavioral (e.g. difficulties initiating or maintaining sleep) or clinical etiology (e.g. autism, asthma and T1 diabetes). Unlike clinical populations, outcomes in parents of children with behavioral sleep problems are underexamined. This study aimed to examine sleep in parents and children with behavioral or clinical sleep disturbances.

Methods

290 parents (parents Mage = 35.9±5.2y, children Mage = 4.1± 2.3y) were recruited. Child’s sleep was reported using Child’s sleep habits questionnaire (CSHQ). Parent sleep was assessed using Pittsburgh sleep quality index (PSQI), Pre-sleep arousal scale (PSAS), and Glasgow sleep effort scale (GSES). A demographic question on the nature of child’s sleep disturbance was used to categorize parents into a) behavioral (n=206) or b) clinical group (n=84).

Results

Overall, 71% of parents and 67% of children had clinically significant sleep disturbance (PSQI ≥ 5 and CSHQ ≥ 41 respectively). Significant associations were observed between CSHQ and a) PSQI (r=0.47, p<.001), b) GSES (r=0.21, p<.001), and c) PSAS (r=0.46, p<.001). Step-wise regression reported that CSHQ was the strongest predictor of PSQI, accounting for 22% variance in scores (p<.001), followed by PSAS (7%). Independent groups t-tests found no differences in parents’ sleep quality (p=.06) and pre-sleep arousal (p=.38) between clinical and behavioral groups. However, 47% of parents in the clinical group took longer than 30 minutes to fall asleep, as opposed to 30% of parents in behavioral group (t(289)=-2.39, p=.01).

Conclusion

Parents report having poor sleep irrespective of the nature of child’s sleep difficulties. It is possible that parents in the clinical group may underreport their sleep problems due to increased attention towards child’s symptoms and diagnosis. Nevertheless, if any sleep related issues occur in children, the impact on parental sleep should be considered during assessment.

Support

N/A
0927 Variations in Sleep and Glucose in Adolescents with Type 1 Diabetes
Authors: Griggs S , Redeker N S , Jeon S , Grey M
Published: May 2020

Introduction

The association between short sleep duration and poorer glycemic control in adolescents ages 10-16 with type 1 diabetes (T1D) is well established. Researchers have used cross-sectional, between-subjects’ methods, with limited focus on the potential intraindividual variation among these variables. The purpose of this analysis was to examine the within person associations between glucose variability indices (J index, low/high blood glucose index, time in range) and sleep characteristics (bedtime, waketime, total sleep time, sleep efficiency, wake after sleep onset [WASO], awakenings, and sleep fragmentation index) in adolescents with T1D.

Methods

Adolescents monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and either their own continuous glucose monitor (CGM) or a provided blinded CGM. General linear mixed models (GLMM) were used to determine within-person and day level associations.

Results

The sample included 38 adolescents (M age 13.4±1.8; 37.8% male; M A1C 8.2±1.2%). Average glucose levels were controlled in all GLMMs. Adolescents had earlier waketimes on days when more time was spent in hypoglycemia <70mg/dL (β=-0.15, p<0.001). At the person level, adolescents had greater WASO with more % time spent in severe hypoglycemia <54mg/dL with more severe low blood glucose indices (β=0.35, p<0.01 and β=0.34, p<0.01 respectively). At the daily level, adolescents had greater WASO (β=0.20, p=0.01) and more awakenings (β=0.16, p=0.04) on the days they had more overall glucose variability (J index) and more severe high blood glucose indices (β=0.17, p=0.04), but were less likely to have more % time in hypoglycemia (β=-0.15, p=0.02).

Conclusion

Glucose variability was positively associated with poor sleep (e.g., WASO and awakenings) in adolescents with T1D both at the daily and intraindividual level. Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person associations between habitual short sleep duration and glucose variability.

Support

NINR T32NR0008346 & P20NR014126, Medtronic MiniMed provided CGMs at a discounted rate for the study.
0933 Preschoolers Sleep Explains Parent Cognitions and Parenting Behaviors
Authors: Raymond N S , Bérubé A , Mercier K , Forest G
Published: May 2020

Introduction

Children sleep is influenced by biological and socio-environmental factors. The contribution of various bedtime practices on child sleep is now well established. Emerging literature now seeks to understand the influence of more general parenting practices on child sleep. Thus, the current study examined how perceived children needs and parenting behaviors are associated with children sleep.

Methods

In a first study, 88 mothers (children 2-71 months) recruited during community activities completed the Child’s Sleep Habit Questionnaire, as well as a questionnaire regarding child needs (CN) and parents response to those needs (RN). Multiple linear regression analyses examined child sleep associations first to CN and then to RN, controlled by the child developmental score. Following this first study, 12 vulnerable mothers (children 39-68 months) participated in a child sleep intervention specifically developed for vulnerable families. The same measures were administered and Wilcoxon t-tests were calculated to compared pre and post intervention scores.

Results

Daytime sleepiness (β=.26, p=.008), sleep anxiety (β=.29, p=.007) and children cognitive development (β=-.32, p=.008) explained 31,6% of CN variance. Daytime sleepiness (β=.26, p=.03), and bedtime routine (β=-.68, p=.00), explained 20,8% of RN variance. Following the child sleep intervention, no change in CN were obtained, but a significant improvement in RN was found (Mpre=5.28 ± 1.60, Mpost=4.33 ± .65, p=.045).

Conclusion

Results suggest that parents perceived more needs in their child when they present higher daytime sleepiness, higher sleep anxiety and cognitive developmental difficulties. On the other hand, parents have more difficulty responding to their child needs when they see sleepiness in their child or struggle with bedtime routine. A child sleep intervention does not seem to change the perception of child needs but have a positive impact on the parent response to those needs.

Support
0939 Anxiety Symptoms Moderate the Effects of Sleep Loss on Children’s Emotions
Authors: Alfano C A , Bower J , Harvey A , Beidel D , Sharp C , Palmer C A
Published: May 2020

Introduction

An abundance of cross-sectional research links inadequate sleep with poor emotional health, but experimental studies in children are rare. Further, the impact of sleep loss is not uniform across individuals, and pre-existing anxiety might potentiate the effects of poor sleep on children’s emotional functioning.

Methods

N=53 children (mean age 9.0 years; 56% female) completed multi-modal, emotional assessments in the lab when rested and after two nights of sleep restriction (7h and 6h in bed, respectively). Sleep was monitored with polysomnography and actigraphy. Subjective reports of affect and arousal, psychophysiological reactivity, and objective emotional expression were examined during two emotional processing tasks, including one where children were asked to suppress their emotional responses.

Results

After sleep restriction, deleterious alterations were observed in children’s affect and their emotional reactivity, expression, and regulation. These effects were primarily limited to positive emotional stimuli. The presence of anxiety symptoms moderated most of the alterations in emotional processing observed after sleep restriction.

Conclusion

Results suggest inadequate sleep preferentially impacts positive compared to negative emotion in pre-pubertal children and that pre-existing anxiety symptoms amplify these effects. Implications for children’s everyday socio-emotional lives and long-term affective risk are highlighted.

Support

NIMH grant #R21MH099351
0940 Adolescent Sleep Quantity, Parenting Permissiveness, and Sugary Beverage Consumption
Authors: Rubens S L , Thai C L
Published: May 2020

Introduction

Research suggests that poor sleep is associated with sugary beverage consumption (SBC), however, little is known about contextual factors that may play a role in this association. This study examined the association between sleep quantity and SBC while accounting for parenting permissiveness among a national sample of adolescents.

Methods

Participants included 1542 adolescents (Mean age = 14.47, SD=1.60) participating in the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating survey, a web-based survey administered in 2014. Multivariable regression models were used to examine associations between sleep quantity (<8 hrs, 8-10hrs, >10hrs) and frequency of sugary beverage consumption in the past week (soda, energy drinks, sports drinks; not at all to 3+ times/day) while controlling for parenting permissiveness and sociodemographic factors (age, sex, parent education level, race).

Results

Approximately 58% (n = 1075) of participants reported receiving the recommended 8-10 hours of sleep, while 35% (n = 646) reported receiving less than this recommended amount and 7% (n = 138) reported sleeping more than the recommended amount of time. Findings from multiple regression models indicated that, when accounting for parenting permissiveness and sociodemographic factors, adolescents who slept the recommended number of hours (8-10) reported less frequent consumption of soda (β = -.18, p = .02) and energy drinks (β = -.12, p = .003) compared to those who slept less than 8 hours. Sleep quantity was not associated with frequency of sports drink consumption in unadjusted and adjusted models (p > .05).

Conclusion

While effect sizes are small, findings suggest that sleep quantity is associated with caffeinated sugary beverage consumption above and beyond parental permissiveness. Given the public health concerns of SBC, examining the influence of developmentally appropriate sleep interventions on SBCs in adolescents is essential.

Support

n/a
0946 Parent-Perceived Sleep Problems Associated with Common Medical Issues During Infancy
Authors: Mindell J A , Leichman E S , Williamson A A , Gould R A , Hiscock H , Quach J
Published: May 2020

Introduction

Sleep problems are highly prevalent during infancy. However, little research has been conducted on associations between these sleep issues and common medical concerns in early development. Thus, the purpose of this study was to assess the prevalence of parent-perceived sleep problems in infants with common medical problems.

Methods

Participants were 5,097 children from the Longitudinal Study of Australian Children—Birth Cohort. Caregiver-reported child sleep problems and medical concerns were assessed at ages 0-1 year. Chi-square analyses were used to examine associations between the presence of a parent-perceived sleep problem and medical concerns.

Results

Wheezing (29.6%), eczema (14.9%), and food/digestive allergies (5.0%) were the most commonly identified medical concerns. In addition, 17.1% of caregivers reported a moderate/severe child sleep problem. Infants who had a moderate to severe parent-identified sleep problem experienced higher rates of overall medical care/needs, wheezing, eczema, food/digestive allergies (p<.001), ear infections (p<.05), and other illnesses (p<.01) than those infants without a sleep problem. No differences were observed with regard to hearing problems, vision problems, developmental delay, diarrhea/colitis, anemia, or other (non-ear) infections. Furthermore, parents reported higher rates of sleep problems for infants with medical problems (20.0-37.5%) than for infants without medical problems (16-17%), especially related to needing medical care (sleep problems = 27%), food/digestive allergies (27%), eczema (23%), and wheezing (20%), p=.001.

Conclusion

Overall, common medical issues during infancy, including food/digestive allergies, eczema, and wheezing, are associated with greater parent-endorsed child sleep problems. Primary care providers should assess for and address sleep problems when treating common medical concerns during infancy.

Support

This project was partially supported by Johnson and Johnson Consumer Health (JAM, ESL, and RAG) and NIH K23HD094905 (AAW).
0951 Sleep Stabilization Patterns Define Pediatric CNS Hypersomnia Conditions
Authors: Maski K P , Colclasure A , Little E , Steinhart E , Scammell T , Navidi W , Diniz Behn C
Published: May 2020

Introduction

Narcolepsy type 1 (NT1) is caused by loss of hypocretins, neuropeptides that promote consolidated nocturnal sleep and sustain daytime wakefulness. In mouse models of NT1, sleep in the light period is characterized by more brief wake bouts, fewer long wake bouts, and longer REM sleep bouts. It is unknown if this sleep pattern is present in NT1 patients and whether it can distinguish NT1 sleep from other CNS hypersomnia conditions [narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH)].

Methods

Participants (6-18 years of age, drug -naïve or drug free) had diagnostic PSG/MSLT testing at Boston Children’s Hospital between 2009-2018. PSG records were rescored blinded to diagnosis. We calculated Kaplan Meier survival curves for nocturnal wake and sleep stages extracted from the nocturnal PSGs. To adjust for differences in survival related to age, sex, and race, we used Cox proportional hazards models. In total, we performed survival analysis and compared wake/sleep stages for 4 groups: NT1 (n=46), NT2 (n=12), IH (n=18) and subjective sleepy controls (n=48).

Results

NT1 patients had worse survival of wake bouts compared to controls (p<0.001). In addition, NT1 patients had decreased survival of both NREM 2 and REM sleep bouts compared to all groups (all p<0.001), and, the survival of REM sleep bouts decreased with age (p=0.006). Compared to controls, NREM 2 bouts survived longer in IH patients and whereas NREM 1 bouts survived longer in the NT2 group (p’s<0.006). There were no group effects for NREM 3, but survival of NREM 3 was less in the older IH patients compared to older controls (p<0.02).

Conclusion

Pediatric NT1 patients have unique sleep fragmentation characterized by unstable wake, NREM 2 and REM bouts. Though less severe as NT1, NT2 patients sustain lighter sleep. In contrast, IH patients show overly stable NREM stage 2 sleep and plausibly this contributes to their characteristic sleep inertia. Further research is needed to determine if sleep stability patterns can be used to diagnose CNS hypersomnia conditions and differentiate treatment responsiveness.

Support

K23 National Institutes of Health (NINDS, K23 NS104267-01A1) and Investigator Initiated Research grants from Jazz Pharmaceuticals, Inc. (Dr. Maski)
0954 Sleep of Gifted Children Using Actigraphy
Authors: Bastien L , Théoret R , Godbout R
Published: May 2020

Introduction

Intellectual giftedness is characterized by an intellectual development superior to peers (QI > 120) while emotional and relational development corresponds to the age norms. Anecdotal reports from parents suggest that they sleep poorly compared to typically developing (TD) peers. We measured sleep of gifted children using actigraphy.

Methods

Thirteen gifted children (10 boys, mean age = 10.58, SD = 2.11) were studied. Giftedness was identified using Renzulli’s three-factor definition of giftedness conceptualise in terms of above-average ability and high levels of task commitment (refined or focused form of motivation), and creativity. Sleep was measured with actigraphy for two weeks and compared to normative data from TD children using T-tests.

Results

Compared to normative data from TD children, gifted children had a significantly shorter sleep latency (p < 0.001), longer sleep periods (p = 0.001), shorter total sleep time and more wake time after sleep onset (p = 0.03). These differences were present both on week nights and weekend nights except that total sleep time was shorter in gifted children only during weekends (p < 0.001).

Conclusion

These data suggest that gifted children sleep poorly, and more so upon weekends. Whether this correlates with daytime functioning remains to be determined.

Support

N/A
0958 The Prevalence of Depression in Children With Chronic Sleep and Respiratory Disorders
Authors: Thakkar N , Trivedi R , Greenberg P , Ramagopal M
Published: May 2020

Introduction

In 2017, 13.3% of US adolescents aged 12 to 17 had at least one major depressive episode (NIMH, 2019). The risk of depression is higher in children with sleep apnea, and children with depression or anxiety have a 1.2-1.8 times higher rate of asthma related ED visits. Therefore, the purpose of this study was to determine the prevalence of depression symptoms in children with chronic disorders. We hypothesized that subjects with sleep disorders would have a higher prevalence of positive depression scores than subjects with respiratory disease, and that the prevalence would be highest in subjects with both conditions.

Methods

The Patient Health Questionnaire-9 (PHQ-9) was administered to children between the ages of 12 and 18 to screen for depression as part of a pulmonary or sleep clinic visit. Each patient’s PHQ-9 results were scored as normal, mild, moderate, or severe for levels of depression severity. Additionally, a chart review was conducted to gather their demographic and clinical data.

Results

Of a total of 87 subjects,71 (81.6%) had a respiratory disorder and 40 (46.0%) subjects had a sleep disorder. Due to the amount of overlap of respiratory and sleep disorders amongst the subjects, depression severity rather than chronic disease was chosen as the primary outcome. Using multiple linear regression, when all other factors were held constant, the average depression score increased by 5.0 when patients had a combination of asthma and obstructive sleep apnea (p-value = 0.02) and also increased by 2.4 for subjects who were female (p-value = 0.01).

Conclusion

It is important to identify depression in children with chronic illness, as it can lead to higher healthcare utilization. Additionally, as mental health status may significantly impact health outcomes for patients with chronic disease, it would be beneficial to evaluate mental health in all pediatric patients with chronic disease. However, further research is needed to investigate these associations.

Support

None
0960 Perception of Sleep Importance in Children With Cystic Fibrosis
Authors: Reiling K , Patel A
Published: May 2020

Introduction

Children with cystic fibrosis (CF) are known to have poor sleep efficiency and increased nighttime awakenings secondary to factors such as nocturnal cough and time spent on therapies for airway clearance. Studies have shown that children with poor lung function have a higher Pediatric Daytime Sleepiness Score (PDSS). An increase in sleep disturbance has been associated with poorer perceived health in children with CF. There have been limited studies to date that report the perception of sleep importance in CF patients. We aim to characterize the perception of sleep importance in children with CF as measured through a self-reported questionnaire and identify barriers to sleep.

Methods

After IRB approval, subjects with CF aged 3-17 years were prospectively recruited from routine pulmonology clinic visits (n=28, 17 male). A questionnaire was provided consisting of 35 questions regarding sleep practices, perception of sleep importance, and PDSS. Recent pulmonary function tests (PFTs) were also collected.

Results

The mean PDSS was 11.3, with a range of 4 to 24. The questionnaire responses were as follows: 82% of participants reported sleep as “very important” overall, 92% reported sleep being “very important” for health, and 75% reported sleep being “very important” for lung function. In addition, 39% reported airway clearance as part of their nighttime routine and 89% reported utilizing electronic screens 2 hours prior to bed. The most frequent barriers to sleep identified were technology and bedtime resistance (14% each), and homework, excitability, and vest/airway treatments (11% each). 86% of participants had at least one symptom of disordered sleep.

Conclusion

Screening for sleep problems in the CF population may be beneficial and may contribute to improved quality of life. Further recruitment is ongoing.

Support
0967 Clinical Characteristics of Children With Sleep Problems and Comorbid Psychiatric Disorders
Authors: McIntyre E , Oles S K , Walsh K , Bandyopadhyay A
Published: May 2020

Introduction

Anxiety and Attention Deficit Hyperactive Disorder (ADHD) are common psychiatric comorbidities in children with sleep disorders. It is known that comorbid psychiatric disorders increase the risk of sleep problems. However, no study has compared the clinical characteristics of children presenting with sleep problems and various common psychiatric disorders.

Methods

Retrospective chart review of all children presenting to the sleep clinic for sleep problems between March 2016 to June 2017 was performed. Demographics, sleep intake patient questionnaires, polysomnograms and ICD-9/10 codes for comorbidities and sleep diagnoses were collected. In children with diagnoses of anxiety (ICD-9 300/ICD-10 F41) and ADHD (ICD-9 314/ICD-10 F90), demographics, presenting symptoms, Epworth sleepiness scores and prevalence of sleep comorbidities were compared. T-test (continuous) and Chi Square (categorical) were used. Unadjusted odds ratio was calculated for presenting symptoms and sleep comorbidities. P value of <0.05 was considered significant.

Results

250 (F=145, 58%) children were evaluated. 71.2% children were diagnosed with anxiety and 28.8% diagnosed with ADHD. Mean age at presentation was 8.53 ± 4.2 years. Age, gender and race of children presenting with sleep problems and comorbid anxiety/ADHD were statistically similar. Children with anxiety spent less time in stage N3 sleep (25.2% ± 9.1 versus 28.6% ± 9.2) and had lower arousal indices (7.19 ± 3.8 versus 8.86 ± 5.5) compared to children with ADHD. Children with anxiety were more likely to present with chief complaint of “feeling tired or sleepy during the day” (OR:2.38, 1.32-4.37) and were more likely to have a diagnosis of hypersomnia (OR: 11.67, 3.19-42.75) versus children with ADHD.

Conclusion

Children with psychiatric comorbidities have distinct polysomnographic characteristics. Children with anxiety are more likely to present with daytime sleepiness and have a significantly higher prevalence of hypersomnia compared to children with ADHD.

Support

None
0971 Mother’s Parenting Style As A Moderator In The Relationship Between Temperament And Sleep Problems In Children With Obesity
Authors: Nam H , Kim J , Woo S , Park S , Lee H , Jang H , Park† K , Suh† S
Published: May 2020

Introduction

Based on past studies, a child’s temperament and parenting style greatly affect a child’s sleep. However, there are limited studies that have investigated how parenting styles and a child’s temperament interact and affect the child’s sleep in obese children. Thus, this study investigated parenting styles as a moderator in the relationship between temperament and sleep in obese children.

Methods

Seventy-seven obese children (male=66.2%, average BMI = 27.35±2.78) participated in the study. The mean age of the participants was 10.82(± 1.00) years. The primary caregiver (mother) of the participants completed the Junior Temperament and Character Inventory (J-TCI), and Parents as Social Context Questionnaire (K-PSCQ), and Children’s Sleep Habits Questionnaire (CSHQ). Among the different subscales, only Novelty Seeking (NS) and Reward Dependence (RD) were used for analysis among Junior Temperament and Character Inventory (J-TCI) components.

Results

In this sample, 66 children (85.7%) reported significant levels of sleep problems based on the CSHQ. Novelty seeking (NS) and reward dependence (RD) significantly predicted sleep problems (B=-.771, p<.05, B=-.683, p<.01). Additionally, mother’s negative parenting style moderated the relationship between NS and the child’s sleep problem [B=.03, 95% CI=.007, .049] and the relationship between RD and the child’s sleep problem [B=.031, 95% CI=.013, .049]. The more negative mother’s parenting style, the higher the child’s NS or RD scores had a negative effect on sleep.

Conclusion

The results of this study show that obese children experience high levels of sleep disturbance. Additionally, the mother’s negative parenting style moderated the relationship between temperament and sleep problems in obese children. The results suggest that sleep interventions for obese children should include the mother, especially in children with high novelty seeking and reward dependence.

Support

This work was supported by Korea Centers for Disease Control and Prevention & Korea National Research Institute of Health (2019020660E-00)
0989 Examining The Role Of Toddler Sleep Quality On Wake EEG And Language Ability
Authors: Page J , Walters R , Gould R , Wakschlag L , Norton E
Published: May 2020

Introduction

Sleep and the development of language are prominent concerns of many parents and until recently, many have examined these concerns tangentially. Children with developmental delays/disabilities have shown to have impaired sleep and poor sleep quality, and impairments or changes in sleep quality may play a prominent role in the acquisition of language and neuronal oscillatory patterns. This study examines the role of child sleep quality paired with a normed measure of language and wake electroencephalography (EEG). Examining the role of child sleep quality with language ability and wake EEG may provide nascent incremental utility to understanding the influences of sleep on healthy development.

Methods

Data from 109 toddlers (age range 24 to 30.5 m, M = 26.83 ± 1.58 m, 52% male) from the Brief Infant Sleep Questionnaire (BISQ), Mullen Scales of Early Learning (MSEL), and continuous EEG were collected and analyzed. EEG was recorded (32 electrode cap BioSemi) while toddlers sat in a booster seat and watched a silent video. Data were analyzed in RStudio and Matlab to examine toddler’s sleep quality (infant sleep and parent behaviors) and relations with the MSEL and EEG (controlling for child age and gender).

Results

Means and standard deviations appeared within expected limits based on the range of each variable. Toddlers with slow-developing language were associated with relatively poor sleep quality, explaining 9.75% of the variance. We find preliminary evidence to suggest a potential sleep disruption around the time when a child is undergoing a rapid expansion in their vocabulary (expressive language). Toddler’s sleep quality and language acquisition were also correlated with wake EEG (alpha and beta).

Conclusion

Sleep is regarded as an essential component supporting the myriad changes observed in early development. Sleep quality fundamentally influences healthy development across domains. Here, we showed child sleep quality is highly associated with toddler’s language ability, and wake EEG, providing new insights into the developing brain.

Support

National Institutes of Health R01DC016273, R01MH107652-03S1, and Johnson & Johnson Consumer Inc., Skillman, NJ, USA.
0995 Nightcap For School-nights: Association Between Milk Intake And Sleep Duration In First-graders
Authors: Chung A , Martinez S , Ursache A , Chang S , Huang Y , Jean-Louis G , Brotman L
Published: May 2020

Introduction

Insufficient sleep has been identified as an obesity risk factor due to mechanistic pathways contributing to higher carbohydrate intake, including in children. Dietary intake of macronutrients, such as fats and protein found in milk, may serve as a modifiable risk factor for adequate sleep. We hypothesize that milk intake among a sample of urban first-graders may be associated with sleep duration.

Methods

Cross-sectional analysis of parent reports of an adapted version of the Child Sleep Health Questionnaire (CSHQ) and Block Dietary Data Systems Food Frequency Questionnaire (FFQ) were analyzed among a sample of 837 Black children in Brooklyn, New York. Summary scores were created for milk type. Milk intake was classified by fat content: whole milk and 2% categorized as high-fat, and 1% and skim as low-fat. Independent t-test, correlations and regression analysis to identify associations between parent reports of child’s sleep duration and milk intake were conducted.

Results

On average, children were 7.3 + 0.6 years old and 52% female. Nearly 57% of parents were immigrants. Children’s mean BMI was 17.27, approximately at the 85th BMI percentile according to CDC index-for-age percentiles. On average, FFQ data reported children consumed high-fat milk 6 days a week. Linear variable regression analysis between high-fat milk intake and sufficient sleep were significant (β =, 0.090, p < 0.05). BMI was significantly associated with high-fat milk intake (β= 0.17, p<0.05). However, high-fat milk intake was not significantly associated with (in)sufficient sleep, after controlling for BMI, sex and age. No difference was reported between immigrant parents and U.S. born parents.

Conclusion

Plausibly, high-fat milk is contributing to satiety and longer sleep duration. Future studies should include more comprehensive measurement of milk consumption (i.e. time of day and volume) to consider possible effects on children’s sleep. Actigraphy measures and sleep diaries should also be considered.

Support

Bezos Grant and Community Service Plan grant.
1003 Sleep Spindle Abnormalities In Youth With Ptsd
Authors: Peterson B , Castelnovo A , Riedner B , Herringa R , Jones S
Published: May 2020

Introduction

Sleep disturbance is central to the phenomenology of PTSD across the lifespan with up to 90% of youth with PTSD reporting sleep disturbance. Subjective sleep dysfunction has also been linked to the development, maintenance and severity of the disorder. However, to date there have been no objective EEG assessments of sleep in youth with PTSD, and little is known about how the disease impacts specific sleep features.

Methods

Ten youth with PTSD (aged 14.5±3.2; CAPS-CA score 60.5±25.3) and ten age-and sex-matched typically developing youth (TD) (aged 14.7±3.2) completed two non-consecutive overnight high-density EEG (256-channel) polysomnography sleep studies. Prior to sleep on one night, participants performed an emotion processing task. Group differences in sleep macrostructure variables were assessed with two-way ANOVA, and group differences in all-night spectral density were assessed using unpaired t-tests. An automatic algorithm was used to detect spindle amplitude, duration, and density topographically. Statistical non-parametric mapping (SnPM) cluster testing was used to determine significantly different topographic differences between groups.

Results

No significant group differences were observed in sleep macrostructure variables. All-night spectral density analysis revealed increased power in PTSD youth relative to TD youth in the sigma band on both task and baseline nights. PTSD youth showed higher spindle duration, higher integrated spindle activity, and higher spindle amplitude globally both nights relative to TD youth. The increase in spindle duration achieved significance in a robust frontal cluster on both nights (43-channel cluster (p = .044) on baseline night, 66-channel cluster (p = .019) on task night).

Conclusion

Structural and functional abnormalities of the prefrontal cortex are a prominent feature of pediatric PTSD. The observed increase in spindle duration may represent another marker of impaired cortical function in youth with PTSD reflecting a failure of cortical inhibition of the thalamically-generated spindle rhythm.

Support

K08 MH100267 to RH, Wisconsin Institute for Sleep and Consciousness Pilot Award to SJ
The resistance and resilience of European beech seedlings to drought stress during the period of leaf development
Authors: Gebauer Roman , Plichta Roman , Urban Josef , Volařík Daniel , Hájíčková Martina
Published: May 2020

Spring drought is becoming a frequently occurring stress factor in temperate forests. However, the understanding of tree resistance and resilience to the spring drought remains insufficient. In this study, European beech (Fagus sylvatica L.) seedlings at the early stage of leaf development were moderately and severely drought stressed for 1 month and then subjected to a 2-week recovery period after rewatering. The study aimed to disentangle the complex relationships between leaf gas exchange, vascular anatomy, tree morphology and patterns of biomass allocation. Stomatal conductance decreased by 80 and 85% upon moderate and severe drought stress, respectively, which brought about a decline in net photosynthesis. However, drought did not affect the indices of slow chlorophyll fluorescence, indicating no permanent damage to the light part of the photosynthetic apparatus. Stem hydraulic conductivity decreased by more than 92% at both drought levels. Consequently, the cambial activity of stressed seedlings declined, which led to lower stem biomass, reduced tree ring width and a lower number of vessels in the current tree ring, these latter also with smaller dimensions. In contrast, the petiole structure was not affected, but at the cost of reduced leaf biomass. Root biomass was reduced only by severe drought. After rewatering, the recovery of gas exchange and regrowth of the current tree ring were observed, all delayed by several days and by lower magnitudes in severely stressed seedlings. The reduced stem hydraulic conductivity inhibited the recovery of gas exchange, but xylem function started to recover by regrowth and refilling of embolized vessels. Despite the damage to conductive xylem, no mortality occurred. These results suggest the low resistance but high resilience of European beech to spring drought. Nevertheless, beech resilience could be weakened if the period between drought events is short, as the recovery of severely stressed seedlings took longer than 14 days.