bluuebunny/crossref_metadata_2025 huggingface dataset:
561 Association of 25-hydroxyvitamin D and obstructive sleep apnea in adolescent bariatric surgery patients
Authors: Kanney Michelle , Sisley Stephanie
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) is a frequent comorbidity found in children with obesity. However, body mass index (BMI) as a single indicator does not reliably predict the presence of disease. There are no screening tools available which effectively risk stratify pediatric patients to determine the necessity of referral for a sleep study. Recent studies show an association between Vitamin D and OSA in adults, however few studies have examined this potential association in children. In this study we investigate the association of Vitamin D and OSA in pediatric patients.

Methods

We retrospectively reviewed the medical records of adolescent participants referred to our institution’s bariatric program over a two-year period. Inclusion criteria included documentation in the medical record of an initial bariatric clinic assessment, overnight diagnostic polysomnography (PSG) and comprehensive laboratory testing which included serum analysis of lipid profile, hemoglobin A1C, fasting glucose, iron panel, liver function enzymes, and 25-hydroxyvitamin D (25(OH)D) plasma levels. The metabolic profiles and polysomnographic data of patients with and without OSA were compared.

Results

Sixty medical records were reviewed, of which 40 participants were identified that met our inclusion criteria. Participants were grouped according to OSA severity (negative 17%; mild 32%; moderate 32%; severe 12%). There was no significant difference in age, gender or BMI in those with and without OSA (mean age 16.8 ± 0.6 versus 16.2 ± 1.5 years, p=0.13; male gender 32% versus 38%; and BMI 50.5± 5.4 kg/m2 versus 50.17±11.9 kg/m2, p=0.89, respectively). Metabolic profiles for 25(OH)D levels inversely trended with OSA severity (no OSA 21.3± 6.6, mild 17.6± 6.4, moderate 19.5± 5.6, severe 13.25± 5.5, p=0.13). Participants with severe OSA had significantly lower 25(OH)D plasma levels compared to participants without OSA (13.25 ± 5.5 versus 21.3 ± 6.6 ng/ml, p <0.03).

Conclusion

Vitamin D levels inversely correlate with OSA severity in severely obese adolescent patients, and may severe as a useful biomarker in the detection of disease.

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565 Adherence to Auto-Titrating CPAP in Children with Trisomy 21 and Obstructive Sleep Apnea
Authors: Barber Lisa , Oheim Chelsea , Valenzuela Andrew , Tomkinson James , Rodden Gregory , Johnson Samantha , Williams Tina , Kang June-Ku Brian
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) is common in children with trisomy 21. The pathophysiology can be multifactorial and challenging to manage. Auto-titrating continuous positive airway pressure (autoCPAP) is an emerging tool for the treatment of pediatric OSA and few studies discuss adherence. This study compares autoCPAP adherence in children with and without trisomy 21 at our center. We hypothesized that autoCPAP adherence would not differ between the two groups.

Methods

A retrospective review of patients aged 0 to 18 years with a diagnosis of OSA as defined by the International Classification of Sleep Disorders Third Edition, and empirically prescribed autoCPAP between 2012 and 2020 was conducted. Patients without available polysomnography or adherence data were excluded. Data included patient demographics, baseline polysomnography characteristics, and autoCPAP usage. Adherence was defined as usage ≥ 4 hours/night on 70% of nights during a consecutive 30-day period as per the Centers for Medicare and Medicaid Services criteria. Descriptive statistics and non-parametric tests were utilized for analysis.

Results

There were 130 total patients included with a mean age of 12.5 years ± a standard deviation of 4.1 years. Seventeen children (13%) had trisomy 21. No statistically significant differences were observed between the trisomy 21 group (T21) and the non-trisomy 21 group (non-T21) with respect to the obstructive apnea hypopnea index (9.5 ± 11.2 in T21, 14.7 ± 22.3 in non-T21, p=0.61), or the oxygen saturation nadir (87.8% ± 4.2% in T21, 84.4% ± 10.8% in non-T21, p=0.57). The percentage of days used ≥ 4 hours in a 30-day period did not significantly differ (52.3% ± 42% in T21, and 49.5% ± 37.5% in non-T21, p=0.64). While 41% of T21 subsequently underwent a CPAP titration for a suboptimal response to autoCPAP (for reasons including intolerance, persistent snoring, or daytime sleepiness), this did not differ significantly from 23% in non-T21 (p=0.11).

Conclusion

Although limited by a small sample size, our data suggest that adherence to autoCPAP did not differ between the trisomy 21 and non-trisomy 21 groups of children with OSA. Empiric autoCPAP is a reasonable treatment option for children with OSA who are not surgical candidates, including those with trisomy 21.

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566 Persistent Sleep Apnea and Desaturation in Preterm Children at 18 Months of Age at High Altitude (2640 M)
Authors: Duenas-Meza Elida , Escamilla Maria , Rincon Laura , Parra Andrea , Bazurto-Zapata Maria , Restrepo Sonia , Torres Jorge Luis , Suarez Miguel , Rojas Arriana , Caparo Elizabeth , Gonzalez-Garcia Mauricio
Published: May 2021

Introduction

Children born at term who live at high altitude (HA) (≥ 2500 m) have different respiratory patterns from those that live at sea level. It is essential to determine these patterns in preterm children due to their high risk of Sleep Apnea-Hypopnea Syndrome (SAHS). The evolution of the apnea hypopnea index (AHI), desaturation index (ODI), and oxygen saturation (SpO2) is unknown in this group at HA. The objective was to characterize the respiratory patterns during sleep of preterm children living at HA and compare it with those of healthy children born at term.

Methods

We conducted a cross-sectional study in Bogotá, Colombia (altitude: 2640 m). We included 302 children, 127 were preterm with an average of gestational age of 31weeks (SD: 2.9) and an average weight at birth of 1600 g (SD: 594) and 175 healthy full-term infants. Three groups were defined according to age: Group I: 3–4 months, Group II: 6–7 months,, Group III: 10–18 months. All children underwent nocturnal polysomnogram to evaluate their respiratory variables: AHI, average and minimum SpO2, ODI, and T90 during sleep and analyzed the data according to the parameters of the American Academy of Sleep Medicine

Results

302 polysomnograms were performed, 54.3% were girls and were distributed by groups as follows: Group I:105 patients (34.8%), 16 preterm, Group II: 107 patients (35.4%), 46 preterm and Group III: 90 patients (29.8%), 65 preterm. We observed higher respiratory parameters within each age strata in premature infants compared to children born at term. Preterm infants had higher ODI, AHI, obstructive apnea hypopnea index (O-AHI), and Central Apnea hypopnea index (C-AHI). Although the effect decreases over time, we found a significant difference in the first age group. There was a high persistence index in children with a history of preterm birth living at high altitude. We also found a significant decrease in AHI, ODI across time in healthy and preterm children p<0.01

Conclusion

Premature children living at HA persist with higher ODI and AHI compared to children of similar ages born at term. The high desaturation index indicates the presence of intermittent hypoxia that persists in these children over time

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571 Evaluating Need for Follow up Polysomnograms after Adenotonsillectomy in children
Authors: Rao Harish
Published: May 2021

Introduction

Most children with Obstructive sleep apnea (OSA) undergo repeat polysomnogram (PSG) following adenotonsillectomy (T & A). Repeat PSG is often performed regardless of presence of symptoms of sleep disordered breathing after T & A. PSG data performed before and after T & A performed at our institution over past 2 years were reviewed. Data was collected on patient characteristics such as age, sex, BMI, comorbidities and AHI on pre-T & A study. Data was then analyzed looking at patient characteristics that can help predict significant OSA (AHI >5) in post T & A study.

Methods

Retrospective review of 50 consecutive PSGs before and after T & A performed at our institution over past 2 years was performed. Data was collected on age, sex, Obstructive AHI, BMI, O2 nadir and comorbidities to identify patient characteristics to predict significant OSA (AHI>5) in the post T & A study.

Results

Age range of our cohort was 2–16 years. Average age and BMI of our cohort was 5.8 years (median 5 years) and 16.6 respectively. 8 patients had significant OSA (AHI>5) in the after T & A study. AHI (>20) and increased BMI z-score at baseline was highly predictive of significant OSA (AHI>5) in the after T & A study.

Conclusion

Based on our data, follow up PSG is warranted if AHI is >20/hour on baseline diagnostic PSG. Similarly, high BMI z-score at baseline study is also highly predictive of significant OSA (AHI>5) in the post T & A study. Most children with associated comorbidities with mild (AHI 2–5 hour), moderate (AHI 5–10/hour) and lower end of severe OSA (AHI 10–20/hour) do not need repeat PSG after T & A unless symptoms of sleep disordered breathing are present. We are analyzing larger PSG database to identify other patient characteristics that may signal need for follow up PSG. As PSGs are expensive and time consuming, follow up PSGs should be performed only if clinical suspicion for residual OSA is high to optimize resource utilization.

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578 Sleep Attitudes and Beliefs in Children with Juvenile Idiopathic Arthritis and Their Caregivers
Authors: Zhai Shumenghui , Ward Teresa , Palermo Tonya , Ringold Sarah
Published: May 2021

Introduction

Sleep deficiency is highly comorbid in children with juvenile idiopathic arthritis (JIA), affecting approximately 40% of children. In this study, we examined children’s and parents’ beliefs and attitudes about sleep, their self-efficacy, and self-regulation in sleep-related behaviors and managing JIA, and if these factors were associated with their self-report and actigraphic sleep patterns.

Methods

The sample included 44 children with JIA (22 girls; mean age 10.5±1.8) and their parents. Dyads completed the Dysfunctional Beliefs and Attitudes about Sleep Scale and Self-Efficacy Scale. Children completed the Index of self-regulation. Parents completed the Pittsburgh Sleep Quality Index and PROMIS sleep-disturbance. Children wore an actiwatch and completed electronic sleep diaries for ten days. Scored actigraphy variables included children’s total sleep time (TST), wake time after sleep onset (WASO), sleep efficiency (SE, %); sleep diaries included the variables of children’s time in bed (TIB). Parents’ self-reported variables included sleep-disturbances and sleep quality (SQ).

Results

Children’s mean TST was 7.7 hours (±0.7), mean SE of 77%, and mean WASO of 1.1 hours (±0.4). After adjusting for child sex and age, children’s beliefs and attitudes towards sleep (BAS) were positively correlated with their self-efficacy in carrying out sleep-related behaviors (r=.6, p<.0001). Parents’ BAS were positively correlated with child self-efficacy in sleep (r=.4, p<.05) and TIB (r=.4, p<.001). Children’s self-regulation was positively correlated with parents’ SQ (r=.4, p<.05). In the first regression model, parents’ self-efficacy in managing their child’s JIA and parents’ sleep disturbances explained 25% of the variance of children’s TST, (F(4,35)=2.8, p=.039). Both parents’ self-efficacy and sleep disturbances were significant predictors of children’s TST. In the second regression model, children’s self-regulation, self-efficacy, and parents’ sleep disturbances explained 32% of the variance of parents’ self-reported SQ, (F (3,39)= 6.12, p=.002).

Conclusion

The findings suggest that self-efficacy, self-regulation, BAS in both children and parents were associated with better sleep health. Interventions that incorporate parent-child shared decision making about sleep-related knowledge, motivation, skills for setting/achieving goals, and problem-solving strategies are needed for families with children with JIA and sleep deficiency.

Support (if any)

This work was supported by the NIH/ /NINR (P30NR016585, R21NR01747).
580 Psychosocial Functioning Mediates Parental Depression and Sleep Behaviors in Children with Autism Spectrum Disorder
Authors: Hayse Braden , Stearns Melanie , Nair Neetu , Mazurek Micah , Takahashi Nicole , Muckerman Julie , McCrae Christina S
Published: May 2021

Introduction

Parents who have been diagnosed with depression often report that their children have poor sleep behaviors. This relationship may occur because the children of parents with depression are more likely experience poor psychosocial functioning, which can negatively impact their sleep. Children with Autism Spectrum Disorder (ASD) are particularly at risk for sleep difficulties, and it is important to better understand these relationships as scant to no research has been done which investigates parental depression, child psychosocial functioning, and child sleep among children with ASD. The current study examined whether parental perception of their child’s psychosocial functioning mediated the relationship between parental depression and their child’s sleep behaviors.

Methods

The sample (N=36) consisted of parents (81% female) reporting on their children aged 6–12 (M=8.56, SD = 1.86; 75% male). All children were diagnosed with ASD and had sleep complaints as reported by their parents. Children and their parents were recruited because they expressed interest in a behavioral treatment sleep study and these data come from the baseline data collection associated with that study. Measures included Sleep Behaviors factor from the Child Sleep Health Questionnaire (CSHQ), the Pediatric Symptom Checklist (PSC), and a question asking if the parent had been diagnosed with depression.

Results

Analyses were conducting using AMOS 27.0. Child psychosocial functioning significantly mediated (β = .12) the relation between parental depression and child sleep behavior. Parents who had been diagnosed with depression were more likely to report greater child psychosocial difficulties (β =.39, p = .01) and child psychosocial difficulties were associated with a greater likelihood of the child having worse sleep behavior (β =.32, p = .04). The direct effect between parental depression and child sleep behavior was not significant.

Conclusion

These results indicate that child psychosocial functioning may help to explain the connection between diagnosed parental depression and poor child sleep behavior among children with ASD. This suggests that psychosocial functioning may be an important aspect to target in sleep interventions, particularly for children with ASD.

Support (if any)

University of Missouri Research Board Grant (McCrae, PI); United States Department of Defense USAMRAA Autism Research Program (McCrae, PI; CTA AR190047).
584 Response to Intravenous Ferric Carboxymaltose in the Treatment of Childhood Restless Legs Syndrome/Periodic Limb Movement Disorder
Authors: Edlund Wendy , Kotagal Suresh
Published: May 2021

Introduction

Pediatric Restless Legs Syndrome (RLS)/Periodic Limb Movement Disorder (PLMD) are treatable disorders affecting quality of life. The first line therapy is oral iron, which may have gastrointestinal side effects or suboptimal absorption. Consequently, parenteral iron preparations are needed, but have been insufficiently studied in children. This study evaluates the response to intravenous ferric carboxymaltose (FCM) in pediatric RLS/PLMD.

Methods

We performed a retrospective chart review of children who received FCM between May 2018 and January 2019 for treating RLS/PLMD. Serum ferritin before and after the infusion were compared. Where possible, the Clinical Global Impressions of Improvement (CGI-I) was evaluated. Side effects documented in the charts were extracted. The median administered dose of FCM was 10.1 mg/kg (range 9.6–20.8) over 0.6 to2 hours.

Results

There were 27 patients, with mean age of 10.0 +/-4.2 years. 52% were female. 24 had RLS and 3 had PLMD. 20/27 (69.7%) had prior oral iron therapy; 4/20 (26.0%) experienced side effects. Adverse events from FCM infusion included procedure-related anxiety in 4/27, nausea in 1/27, infusion site pain in 2/27, and tachycardia in 1/27. One patient developed subcutaneous extravasation of iron with brownish skin discoloration and a resulting adjustment disorder. Three patients had phosphorus checked following infusion; all were normal. Serum ferritin was available both before and after the infusion for 17 patients. Mean serum ferritin prior to infusion was 27.2 +/-15.7 µg/L (range 6–58) and after the infusion it was 109.8 +/-49.34 µg/L (range 27–192). Mean ferritin increase was 82.6 +/-41.5 µg/L (range 14–160; p=0.0001). Post-infusion ferritin was over 50 µg/L for all but 2 of the subjects, with follow up ranging from 31–266 days (mean 120 days). A larger increase was seen at higher doses (p=0.01). Ferritin increase was not impacted by age, gender, symptom severity, PLMI or prior ferritin level. CGI-I was applied to 15 patients with sufficient follow-up documentation and showed improvement in 86%, with 79% much or very much improved.

Conclusion

The administration of FCM in children with RLS/PLMD is associated with a satisfactory rise in serum ferritin and modest symptomatic improvement.

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587 Temporal Daily Relationships Between Sleep Deficiency and Pain in Youth with Systemic Lupus Erythematosus
Authors: Wi Dahee , Ward Teresa
Published: May 2021

Introduction

Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory autoimmune disorder characterized by recurrent episodes of pain and is more prevalent in youth of color. Although sleep deficiency (poor quality and an inadequate amount of sleep) and pain are interrelated, most of what is known about SLE pain and sleep rely on reports from adults. Less is known about these associations in youth with SLE, leaving a critical gap in care for this population. This study aims to describe the temporal daily relationships between sleep deficiency and pain in 11-to 18-year-old youth with SLE.

Methods

Twenty-three youth (n=21 girls, n=9 Hispanic) with SLE (mean age=14.7 □ 2.2) participated in the study. Youth wore actigraphy and completed electronic sleep diaries for consecutive 10 days. Actigraphic sleep variables (Total Sleep Time [TST], Sleep Efficiency [SE]) and self-reported Sleep Quality (diary SQ) were examined as predictors of next-day pain in the morning. Average daytime pain was examined as a predictor of nighttime sleep (both actigraphic and self-reported sleep variables). Pubertal stage and ethnicity (Hispanic vs. Non-Hispanic) were entered as covariates in all models.

Results

Of the sample, the mean TST was 7 □ 1.2 hours and the mean SE was 73.5 □ 9.2% as measured by actigraphy. On average, diary SQ negatively predicted next-day pain in the morning (p <.001). On average, pain negatively predicted TST (p <.05) and diary SQ (p <.001). The within-subject relationships between sleep and next-day pain were not significant. Daytime pain predicted neither actigraphic nor self-reported sleep quality.

Conclusion

Poor sleep is a modifiable behavior, and improving sleep quality may reduce pain intensity in youth with SLE. Although further study is needed, the findings suggest that sleep is a potential target for interventions to alleviate symptoms of pain in this population.

Support (if any)

This work was funded by NIH/NINR P30NR016585 (MPI: MMH, TMW), R21NR017471 (TMW); University of Washington, School of Nursing, Research and Intramural Funding (RIFP); Hester McLaws Nursing Scholarship.
589 Sleep features longitudinally associated with refractive errors in preschoolers
Authors: Rayapoullé Alexis , Gronfier Claude , Forhan Anne , Heude Barbara , Charles Marie-Aline , Plancoulaine Sabine
Published: May 2021

Introduction

Refractive errors are very common, in particular in children and adolescents, leading to global health issues, academic implications and economic costs. The process of emmetropization in child development is a multifactorial and active mechanism, and is yet to be fully understood. Light exposure and endogenous circadian rhythmicity are thought to have an important role in this process. They are also known to be both cause and consequence of various sleep habits. The study aims at investigating the role of sleep duration and timing in refractive error development of preschoolers.

Methods

Sleep duration and timing were assessed at age 2 and 5 years, and vision problems at age 5 through parental auto-questionnaires in 1,130 children from the EDEN birth-cohort. We performed both cross-sectional and longitudinal analyses using logistic regression models, before and after adjusting for age, sex, socio-economic status, nap duration, time spent outdoors and daily screen-time. We conducted multiple imputations to deal with missing data on covariates. The shape of the association was considered by splitting sleep duration into tertiles.

Results

At age 5 years, 20.4% of the children were prescribed glasses (2% for myopia, 11.9% for hyperopia and 6.8% for unknow reason). Children slept on average (SD) 11h05 (30 min) per night at age 2 and 10h49 (48 min) at age 5. Average bedtime and midsleep were 8.36 pm (30 min), 2.06 am (36 min), and 8.54 pm (30 min), 2.06 am (24 min) at age 2 and 5, respectively. In the raw longitudinal analysis, a U-shaped association was observed between nocturnal sleep duration at age 2 and eyeglass prescription at age 5: 2-years-old children sleeping 11h30 had a higher risk to have an eyeglass prescription by the age of 5. Later midsleep and bedtime at age 2 were associated with an increased risk of eyeglass prescription at age 5. All associations, except the one concerning bedtime, were barely changed after adjustment while becoming borderline significant.

Conclusion

Duration and timing of sleep at age 2 were associated with subsequent onset of refractive errors in preschoolers from a general population. Sleep and light hygiene might be targets for prevention.

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591 Sleep disturbances and executive function outcomes after critical care hospitalization in children with acquired brain injury
Authors: Williams Cydni , Lim Miranda , McEovy Cindy , Hall Trevor , Drury Kurt , Shea Steven
Published: May 2021

Introduction

Annually, over 60,000 children require critical care admission for acquired brain injury (ABI) in the US, and many face long-term cognitive morbidity. Over 50% of these children also develop sleep/wake disturbances (SWD). Given the importance of sleep to brain development and healing after injury, we hypothesized SWD in children after ABI would portend worse cognitive outcomes in domains of executive function.

Methods

We performed a prospective observational study of N=80 children aged 6–18 years with ABI evaluated 1–3 months after critical care hospitalization. SWD were evaluated using the Sleep Disturbances Scale for Children (SDSC). The primary outcome was the Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2) Global Executive Composite (GEC; an age and gender adjusted T-score). Secondary cognitive outcomes included age adjusted scaled scores (ss) from the Delis Kaplan Executive Function System (DKEFS), Wechsler Intelligence Scale for Children, 5th Edition (WISC-V), and Children’s Memory Scale (CMS). Relationships between the SDSC and cognitive measures were evaluated using Spearman correlation (rs). Multiple linear regression evaluated associations between SWD and GEC T-scores controlling for patient and ABI characteristics.

Results

Sixty-five (81%) eligible children completed evaluation, and 48% had clinically significant SWD (total SDSC ≥39). Significant correlation (p<0.05) was found between the SDSC total score and worse GEC T-score (rs=0.60), and worse ss for CMS numbers forward (rs= -0.39), WISC-V coding (rs=-0.36), DKEFS number letter switching total time (rs=-0.38), and DKEFS category fluency (rs=-0.43). Presence of SWD was significantly associated with a full standard deviation worsening in the GEC T-score (β-coefficient= 10.2, 95% Confidence Interval=1.0–19.3) when controlling for age, race, gender, admission Glasgow Coma Scale, critical care intervention, and chronic comorbidities.

Conclusion

Children with ABI requiring critical care have high rates of SWD after discharge that are associated with significantly worse executive function outcomes in overall function (BRIEF-2 GEC) and direct objective assessments (DKEFS, WISC-V, CMS) evaluating aspects of executive functioning including attention, processing speed, cognitive flexibility, and working memory. SWD may serve as a modifiable target to improve cognitive outcomes in this vulnerable pediatric population.

Support (if any)

This work is supported by the National Heart Lung and Blood Institute (K23HL150229-01)
593 Odds of Receiving Sleep Diagnoses in Common Pediatric Chronic Medical Conditions
Authors: Munoz Tomas , Patel Palakkumar , Adavadkar Pranshu
Published: May 2021

Introduction

Sleep disorders (SD) are under-diagnosed in the general pediatric population. Children with chronic medical conditions (CMC) tend to have a higher prevalence rate of SD; however, the studies about the rates of diagnosis of SD are limited. We examined the odds of receiving SD diagnoses in children with various CMC and hypothesized that if this likelihood is established, screening tools can be developed to increase the rates of diagnoses and improve clinical outcomes.

Methods

Chi-square test and regression analysis were used to test the association between SD and CMC based on ICD-9 and -10 diagnosis codes retrieved from the Medicaid claims submitted for children (0 to 18 years) enrolled in the Centers for Medicare and Medicaid Services-funded Coordinated Health Care for Complex Kids (CHECK) project, at an urban, public tertiary care hospital. Children without a CMC were excluded.

Results

Among 16,609 children with CMC (mean [SD] age of 9.1 [5.3] years; 56.4% male; 77% with multiple CMC), 14.1% received a diagnosis of SD. Compared to the cohort without a particular CMC, children with attention deficit hyperactivity disorder (ADHD), obesity, developmental disorder, or asthma had following odds of receiving sleep diagnosis respectively (odds ratio (OR) [Confidence Interval]): insomnia (6.9 [5–9.5]; 2.4 [1.7–3.2]; 1.6 [1.2–2.3]; 0.7 [0.5–1]), circadian rhythm disorders (6.1[2.7–13.7]; 2.8 [1.3–2.6]; 3.0 [1.4–6.4]; 0.5* [0.2–1.1]), hypersomnia (2.9 [1.0–8.6]; 7.8 [3–20.2], 0.9* [0.3–2.6], 0.8* [0.3–2.2]), and sleep-related movement disorder (1.9* [0.9–4.3]; 4.4 [2.5–7.8]; 2.2 [1.2–3.9]; 0.6*[0.3–1.1]). (*=p value <0.05).

Conclusion

Odds of receiving sleep diagnoses vary across CMC. Among others, strong associations between obesity-hypersomnia and ADHD-insomnia were noted. This information may help clinicians implement appropriate screening interventions to improve early SD detection and management. Further studies to examine these associations are necessary.

Support (if any):
594 Sleep Trajectories Between the Age of 2 and 5 are Associated with Blood Cytokine Levels at Age 5 in the EDEN Birth-Cohort Study
Authors: Radmanish Masihullah , Khalfallah Olfa , Glaichenhaus Nicolas , Forhan Anne , Heude Barbara , Charles Marie-Aline , Davidovic Laetitia , Plancoulaine Sabine
Published: May 2021

Introduction

There is a reciprocal interaction between sleep and the immune system. Activation of the immune system changes the quality of sleep, and sleep regulates innate and adaptive immune responses. While these interactions have been studied in adults and adolescents, only a few studies have focused on school age children and none on preschoolers. Here, we have studied the association between night sleep trajectories between the age of 2 and 5 and serum levels of four cytokines in 5-year-old children.

Methods

A total of 687 children (44% girls) from the EDEN French birth cohort were included. Information on night sleep trajectories between 2 and 5 was available in all included individuals, as well as the levels of Tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, interferon gamma (IFN-gamma), and IL-10 in 5-year-old children. The associations between sleep trajectories and cytokines were assessed by multivariate linear regressions adjusted for socioeconomic, familial, maternal, perinatal and child factors.

Results

A shorter sleep duration trajectory (<10h/night, 4.5% of children) was associated with higher levels of IL-6 when compared to the reference trajectory (≈11h30/night, 37.4% of children). A longer sleep duration trajectory (≥11h3/night, 40.9% of children) was associated with higher levels of IL-10. A changing sleep duration trajectory (≥11h30/night followed by 10h30/night, 5.6% of children) was associated with increased levels of TNF-alpha. No statically significant association was observed between sleep duration trajectories and IFN-gamma.

Conclusion

This first longitudinal study in preschoolers demonstrates an association between sleep duration trajectories and blood levels of IL-6, IL-10 and TNF-alpha. While association does not imply causation, our results are compatible with an impact of sleep duration on low-grade inflammation in preschool children. Should our results be replicated in an independent study sample, it would pave the way for a better understanding of the interactions between sleep and the immune system.

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596 Sleep Outcomes and Sleep-Related Behaviors in NICU Graduates
Authors: Burnham Alisa , Kucheruk Olena , Brown Emily , Mindell Jodi
Published: May 2021

Introduction

Previous studies of sleep patterns and problems in preterm infants and toddlers have yielded inconsistent results, with some studies noting differences on salient sleep parameters and others indicating similarities. Furthermore, little is known about any differences about sleep-related behaviors. Thus, the current aims of this study were to assess sleep patterns, problems, and sleep-related behaviors in young children born prematurely who were NICU graduates.

Methods

Caregivers of 262 children (53.4% boys; 35.9% Black, 40.5% White, 23.6% Other) being followed in a neonatal follow-up clinic at their corrected age one-year (10–16 months) or two-year (22–28 month) visit completed the Brief Infant Sleep Questionnaire-Revised SF (BISQ-R SF).

Results

At approximately one year of age, infants were going to bed at 8:36, taking 33 minutes to fall asleep, and waking .63 times per night for 19 minutes, for a total nighttime sleep duration of 8’01”. Similarly, at approximately two years of age, infants were going to bed at 8:16, taking 26.7 minutes to fall asleep, and waking .94 times per night for 16.3 minutes, for a total nighttime sleep duration of 8’26”. Sleep problems were reported by 18.1% and 19.6% of caregivers, respectively, with the majority indicating that their child slept well (78.5% and 76.5%) and minimal bedtime difficulties (13.6% and 14.6%). The majority of infants slept in their own crib (81%), with infants more likely to room share at 1-year compared to 2-year (49% vs 35%), and almost half falling asleep independently (43% and 46%).

Conclusion

Overall, sleep patterns and parent-perceived sleep problems (18–20%) in these NICU graduates were better than expected, and similar to normative data of similar age children (Sadeh et al., 2008). However, these infants/toddlers obtained less nighttime (8–8.5 hrs vs 10 hrs). Sleep education of parents of NICU graduates should not only focus on sleep behaviors, but also on ensuring sufficient sleep.

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601 Comparison of Sleep Parameters in Children with Achondroplasia and Trisomy 21
Authors: Gustave Jodi , Gaza Kaelyn , Marriner Jennifer , Rani Seema , Strang Abigail , Chidekel Aaron
Published: May 2021

Introduction

Children with achondroplasia and Trisomy 21 (T21) have increased incidence of sleep disturbances including sleep disordered breathing. Abnormal sleep architecture has been documented in children with T21. It is important to continue to analyze sleep parameters in both groups since poor sleep quality is associated with neurocognitive impairment.

Methods

Following IRB approval, we performed a retrospective chart review of patients at Nemours/A.I. duPont Hospital for Children in Wilmington, DE with achondroplasia and T21 who underwent an initial polysomnogram (PSG) between 2015 and 2020. We compared sleep architecture parameters between the groups including sleep efficiency, total sleep time (TST), sleep latency, arousal index and concentration of N3 and REM sleep.

Results

In patients with achondroplasia (n=49, mean age 5.8 months and 63.3% male), 12% reported restless sleep. PSG data revealed TST of 392 minutes, mean sleep efficiency of 82%, mean sleep latency of 9.4 min, mean arousal index of 40, 22% REM sleep and 32% N3 sleep. In the patients with T21 (n=32, mean age 17.8 months and 50% male), 59% reported restless sleep. PSG data revealed TST of 393 minutes, mean sleep efficiency of 82%, mean sleep latency of 14 minutes, arousal index of 35, 15% REM sleep and 40% N3 sleep. The differences in REM and N3 sleep between the two groups were statistically significant (p-values of 0.001 and 0.04, respectively), but the differences in arousal index, TST and sleep efficiency were not.

Conclusion

Our study showed that children with T21 subjectively noted more restless sleep compared to patients with achondroplasia although TST and sleep efficiency were similar. Patients with achondroplasia had a higher arousal index that was not statistically significant. Children with achondroplasia had a shorter sleep latency and more robust REM concentration, likely due to their younger age. There was a higher concentration of N3 sleep in patients with T21. This is likely due to the decrease in REM concentration. In conclusion, it is important to establish expected sleep parameters in patients with achondroplasia and T21 to maximize sleep quality and mitigate negative neurocognitive effects of poor sleep.

Support (if any):
603 Socioeconomic Status and Caregiver Perception of Young Children’s Sleep
Authors: Lupini Francesca , Williamson Ariel , Daniel Lauren , Mindell Jodi
Published: May 2021

Introduction

Socioeconomic status (SES) has been associated with variation in child sleep problems, but few studies have examined variation by SES in caregiver-reported early childhood sleep problems, patterns, and health behaviors. We hypothesized that, compared to higher-SES caregivers, lower-SES caregivers would report poorer sleep outcomes and sleep health behaviors, but lower rates of caregiver-perceived sleep problems.

Methods

A total of 309 caregivers (97% parents) of young children (M child age=3.59 years; 53.1% girls; 15% non-Hispanic/Latinx White, 57% non-Hispanic/Latinx Black, 20% Hispanic/Latinx White, 8% Hispanic/Latinx Black) completed the Brief Child Sleep Questionnaire. SES was measured via income level (lowest=$0-$20,000; middle= $20,001-$50,000; highest= $50,001 or greater).

Results

The prevalence of a caregiver-reported child sleep problem was similar across SES (17.6% of lowest SES group, 8.8% of middle, and 15.5% of highest, p>.05). However, ANCOVA models covarying for child race/ethnicity, age, caregiver age and education indicated sleep outcomes varied by SES. Caregivers in the lowest SES group reported significantly longer child sleep onset latency (SOL) than the middle or highest groups (p=.008), more frequent night wakings than those of middle SES (p=.009), and longer night waking duration than those of the highest SES, (p=.047). There were no significant differences by SES for child bedtime, total nighttime sleep, and total (24-hour) sleep duration. Logistic regression models with the same covariates showed no variation by SES for sleep behaviors, including caffeine consumption, presence of bedroom electronics, and bedtime resistance. Within each SES group, logistic regression models indicated that increased night wakings were uniquely associated with greater likelihood of endorsing a child sleep problem in the middle SES (p=.045) and highest SES groups (p=.040), but not in the lowest SES group.

Conclusion

Although caregiver-reported child sleep problems did not significantly differ across SES, lower-SES caregivers reported longer child sleep onset latency and increased number and duration of night wakings. Furthermore, night wakings were associated with perceived sleep problems, but only in middle and highest SES families. Clinicians should consider specific sleep parameters, such as SOL and night wakings, in addition to caregiver-reported child sleep problems when assessing and addressing child sleep problems, especially in lower-SES families.

Support (if any)

Funding: NIH K23HD094905 (AAW)
605 Sleep problems are associated with behavioral problems and decreased quality of life in children with Fontan circulation
Authors: Robertson Kirstin , Seckeler Michael , Klewer Scott , Hsu Chiu-Hsieh , Edgin Jamie , Provencio-Dean Natalie , Lopez Silvia , Parthasarathy Sairam , Combs Daniel
Published: May 2021

Introduction

Children with congenital heart disease who undergo a Fontan procedure are at higher risk of behavior and attention problems as well as reduced quality of life compared to age-matched peers. While sleep problems are associated with behavior and attention problems in children without Fontan circulation, this relationship has never been examined in children with Fontan circulation. We hypothesized that sleep problems in this population may increase the risk of behavior problems and also reduce health related quality of life (HRQOL).

Methods

We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent-reported diagnosis of a sleep problem with reported behavioral concerns and HRQOL as measured by the child health questionnaire (CHQ) in 558 children with Fontan circulation. Analysis was performed using logistic regression or Wilcoxon sum rank test, as appropriate, with Bonferroni correction for multiple comparisons.

Results

Parent-reported sleep problems were present in 10% of participants. Sleep problems were associated with a 4.6x higher risk of attention problems, 10.2x higher risk of anxiety problems, 3.9x higher risk of behavioral problems, 9.5x higher risk of depression, 5.0x higher risk of developmental delay, 6.9x higher risk of learning problems and 2.2x higher risk of speech problems (p=0.04 for speech problems, p<0.001 for all others). Parent report of a sleep problem was associated with decreased physical HRQOL (z-score -1.3 [interquartile range-2.2, -0.2] vs 0.0 [-0.8, 0.4], p<0.001) and psychosocial HRQOL (-0.9 [-1.9, 0.0] vs 0.0 [-0.8, 0.7], p<0.001) compared to children without a reported sleep problem. Report of a sleep problem was associated with significantly lower HRQOL across all subdomains of the CHQ (p<0.05 for all subdomains).

Conclusion

Children with Fontan circulation with sleep problems have an increased risk of behavioral and developmental problems as well as reduced HRQOL. Better understanding of sleep problems is needed in children with Fontan circulation, as sleep disorders may represent a reversible cause of behavioral problems and decreased HRQOL in this population.

Support (if any)

Funding to DC from the American Heart Association, University of Arizona Health Sciences Center, and NIH-NHLBI. Fontan study data obtained from the Pediatric Heart Network.
606 Incidence & Influence of Drug Screening in Children with Hypersomnolence During MSLT: Analysis of the Children’s Wisconsin Cohort
Authors: D’Andrea Lynn , Handa Arun , Amos Louella , Bandla Hariprasad , Castner Lauren , Grekowicz Megan , Graf Danielle , Kump Theresa , Pan Amy , Barbeau Jody
Published: May 2021

Introduction

The Multiple Sleep Latency Test (MSLT) is a validated test for evaluation of hypersomnolence in children and adults. AASM practice parameters recommend performing urine drug screens (UDS) in patients undergoing MSLT to identify substances that alter MSLT results. The study aims are to determine the incidence of positive UDS and their influence on MSLT variables in a cohort of children evaluated for hypersomnolence.

Methods

All children undergoing an MSLT in Children’s Wisconsin sleep laboratory over an 8-year period (11/1/2012 to 9/30/2020) were included in this retrospective chart review study. Clinical and demographic data, including UDS results were manually abstracted. Record validation conducted by random allocation. Data were summarized as median and IQR or n (%). Chi-square test or Fisher’s exact test were used to examine associations between categorical variables.

Results

236 children completed an MSLT. The sample had a median age of 14.1 (IQR 10.5–16.2) years (50.9% female; 63.1% Caucasian). Narcolepsy I (“N1”; n=14; 5.9%), Narcolepsy II (“N2”; n=56; 23.7%), Idiopathic Hypersomnia (“IH”; n=39; 16.5%) were frequently diagnosed. Most children (97.9%) completed a UDS; 60.2% tested positive. Common substances found on UDS were caffeine (62.6%), OTC medications (40.3%), and prescription medications (33.8%), however nicotine (14.3%) and cannabis (5.8%) were also seen. Caffeine was commonly found in those diagnosed with N1 (70%), N2 (69.4%), and IH (54.2%). Fewer children diagnosed with narcolepsy were positive for prescription medications compared to those diagnosed with IH (21.7% versus 41.7%) although results did not reach significance (p=0.08). No child with N1 tested positive for prescription medications. ≥2 substances were found in 43.2% of positive drug screens. OTC medications and caffeine were most commonly co-occurring (23%); OTC analgesics being the most common OTC medication. No association between positivity for >2 substances and sleep diagnosis was found (p=0.5).

Conclusion

More than half of children undergoing an MSLT had a positive UDS for >1 substance. The impact of these substances on PSG/MSLT parameters (total sleep time, mean sleep onset latency, sleep onset REM periods) is under investigation through additional analysis. Based on the above data our findings support the AASM guidelines of children obtaining a UDS on the day of MSLT.

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607 Longer slow wave sleep and exacerbated core symptom severity in autism spectrum disorder
Authors: Buck Casey , Kawai Makoto , Hara Ruth O’ , Chick Christina , Anker Lauren , Schneider Logan
Published: May 2021

Introduction

Sleep disturbances in individuals with autism spectrum disorder (ASD) are common, yet previous studies have reported inconsistent findings on the associations between sleep architecture and core features of ASD. Our goal is to examine 1) the difference in sleep architecture, especially SWS, between children with ASD and typically developing controls (TD), 2) the association between SWS and core symptoms in ASD, and 3) the association of slow wave activity (SWA) spectral power and ASD symptoms.

Methods

We used ambulatory polysomnography (PSG) to record the sleep architecture in 61 children and adolescents (age 6 to 18) with ASD and 73 typically developing controls (TD) in their sleeping environment. We performed an analysis to examine 1) the difference in sleep architecture between ASD and TD, and 2) the association of SWS with core symptoms of ASD with the Autism Diagnostic Interview-Revised (ADI-R) and Repetitive Behavior Scale (RBS).

Results

Children and adolescents with ASD showed a higher SWS ratio and lower REM ratio than TD. Delta (1–4 Hz) relative power during total sleep was higher in ASD than TD. Further, a higher ratio of SWS predicted more severe behavioral symptoms as measured by the ADI-R and the Ritualized Behavior subscale of the RBS. Delta power did not show a significant association with core symptoms.

Conclusion

A higher ratio of SWS may reflect the neuronal immaturity specific to ASD in this age group. It may help us understand the underlying mechanism of the clinical symptoms in children with ASD.

Support (if any)

Support for this work was provided to Dr. O’Hara by a grant from the Simons Foundation Autism Research Initiative (SFARI). Dr. Kawai is supported by the National Institute on Aging of the National Institutes of Health K23AG053465, and his contribution to this manuscript was made possible by an award from the American Sleep Medicine Foundation (#157-BS-16), a foundation of the American Academy of Sleep Medicine, 2018 NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation, and Autism Working Group Award from Mosbacher Family Foundation. All authors gratefully acknowledge all participants and their families.
609 Comparing parental sleep goals for younger versus older toddlers
Authors: Mindell Jodi , Collins Meghan , Leichman Erin , Rotella Katie
Published: May 2021

Introduction

This study aimed to assess parental sleep goals, comparing younger (12-23.9-month-olds) and older toddlers (24-35.9-month-olds) in consideration of developmental differences.

Methods

Parents (98.0% mothers) of 401 toddlers (12–35 mos; M=22.49 mos; 49% male) in the US completed an online survey, including an abbreviated Brief Infant Sleep Questionnaire and a list of 58 desired areas of change (DACs). There were 230 one-year-olds (1yos; M=17.42mos) and 171 two-year-olds (2yos; M=29.30mos), with no difference in parent age between groups (M=34.41 years).

Results

25.7% reported a perceived sleep-problem, whereas 94.8% indicated at least one sleep-related DAC. Parents of one- and two-year-olds reported similar rates of DAC for overnight sleep (58% vs. 49%), morning sleep (55% vs. 52%), and naps (70% vs. 64%), p>.05. Parents of 2yos, however, reported bedtime as a DAC at a higher rate (59% vs. 79%), p<.001. Twenty-five percent of specific bedtime DACs (n=8) were endorsed by ≥10% of parents. Parents endorsed falling asleep without an adult (17% of 1yos vs. 22% of 2yos) and falling asleep without nursing (10% vs. 9%) at similar rates, p>.05. Parents of two-year-olds were more likely to endorse: getting through bedtime routine quickly/easily without stalling (10% vs. 30%,), earlier bedtime (10% vs. 24%), falling asleep faster at bedtime (24% vs. 10%), falling asleep without a pacifier (11% vs. 19%), falling asleep faster while alone (8% vs. 16%), and falling asleep without stalling/making requests (3% vs. 18%), p<.05.

Conclusion

The majority of parents of toddlers endorsed a sleep-related desired area of change, with two-thirds wanting to change something about bedtime and naps, and over half wanting to change something about overnight and morning sleep. Parents of older toddlers (2yos) were more likely to desire changes at bedtime than parents of younger toddlers (1yos), especially related to stalling and discontinuing pacifier use. As toddlers age, bedtime problems are more likely. Health care providers should be aware of developmental changes, such as increased language and assertions of independence, that seem to mostly affect bedtime when addressing sleep issues in toddlers.

Support (if any)

Johnson & Johnson Consumer Inc., Skillman, NJ, USA.