bluuebunny/crossref_metadata_2025 huggingface dataset:
0473 The impact on treatment adherence of adding a bedpartner to CBT-I: preliminary findings from a randomised controlled trial (Project REST)
Authors: Drummond Sean , Jenkins Melissa , Mellor Alix , Norton Peter , Baucom Donald , Bei Bei
Published: May 2022

Introduction

Cognitive Behavioural Therapy for Insomnia (CBT-I) includes often difficult-to-implement behavioural change, and this can result in poor adherence to treatment recommendations. In other CBTs, adding a significant other to “individual” therapy increases adherence. Here, we report preliminary findings from a randomised controlled trial (RCT) of a newly developed partner-assisted CBT-I.

Methods

117 adults with DSM-5 Insomnia Disorder (age M±SD=47.9±15.3yrs; 73F) and their live-in partners participated in a single-blind parallel RCT. They were assigned 1:1:1 to 7wk individual CBT-I (Ind-CBTI), partner-assisted CBT-I (PA-CBTI), or sleep management control (CTRL) conditions. Participants completed daily sleep diary throughout the intervention. Adherence in CBT-I conditions was assessed for Sleep Restriction Therapy (deviation from bed and wake times, naps) and Stimulus Control Therapy (wake time-in-bed during daytime, overnight, and after final morning awakening). Intention-to-treat, mixed effects models examined differences in adherence for “Build” (initial phase to build sleep debt) and “Maintain” (starting the first week when sleep opportunity was titrated upwards) stages of therapy.

Results

All conditions showed significant increase in sleep efficiency (p<.001), with significantly faster increase in Ind-CBTI and PA-CBTI compared to CTRL (ps<.001). Sleep Restriction Therapy: Build stage (vs Maintain) had greater adherence to prescribed wake time (p=.045); Condition by Stage interaction (p=.010) showed PA-CBTI (vs Ind-CBTI) adhered better in avoiding naps during Build (vs Maintain). Stimulus Control Therapy: PA-CBTI (vs Ind-CBTI) adhered better to avoiding daytime wake time-in-bed (p=.017), especially during Build (interaction p=.071); Condition by Stage interaction (p=.017) showed PA-CBTI (vs Ind-CBTI) adhered better to avoiding overnight wake time-in-bed during Maintain (vs Build). Both conditions had better adherence to avoiding daytime and wake time-in-bed after final awakening during Maintain (vs Build) Stage (ps<.001).

Conclusion

Adherence to CBT-I includes multiple indicators showing distinct features as the intervention progresses across different stages. Aspects of adherence appear modifiable, and adding bedpartners to CBT-I improved adherence to specific aspects of the intervention (i.e., avoiding naps, daytime wake time-in-bed, overnight wake time-in-bed). The Build and Maintain stages of treatment appear to be associated with better adherence to different aspects of the intervention (Sleep Restriction Therapy and Stimulus Control Therapy, respectively).

Support (If Any)

NHMRC grant APP1105458 (SPAD,DHB,PJN), APP1140299 (BB)Trial registration: ACTRN12616000586415
0474 Three-arm randomised controlled trial of Cognitive Behavioural Therapy for Insomnia, a responsive bassinet, and sleep hygiene for preventing postpartum insomnia: Preliminary findings on maternal insomnia and sleep outcomes (Study for Mother-Infant Sleep)
Authors: Quin Nina , Tikotzky Liat , Astbury Laura , Stafford Lesley , Fisher Jane , Wiley Joshua , Bei Bei
Published: May 2022

Introduction

Insomnia symptoms are common during the perinatal period and are linked to adverse parent/infant outcomes. This single-blind 3-arm randomised controlled trial examined how two interventions targeting different mechanisms prevent postpartum insomnia compared to sleep hygiene control. Trial registration: ACTRN12619001166167.

Methods

Participants were nulliparous females 26-32 weeks gestation with self-reported insomnia symptoms (Insomnia Severity Index [ISI] scores ≥ 8). Participants were randomized 1:1:1 to: (a) a responsive bassinet designed to support infant sleep until 6 months postpartum (RB), (b) therapist-assisted cognitive behavioural therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (c) a sleep hygiene booklet (control condition; CTRL). Outcomes were assessed at baseline (T1), 35-36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3-T5). The primary outcome is ISI scores averaged T3-T5. Secondary outcomes are PROMIS Sleep Disturbance (SDI), Sleep-Related Impairment (SRI), and self-report total sleep time (TST). We report preliminary results on T1-T4 as T5 is ongoing. Multiple regression analyses controlling for baseline outcomes examined group differences at post-baseline timepoints.

Results

127 participants were randomised (age M±SD=32.62±3.49; RB = 44, CBT-I = 42, CTRL = 41), and 118 (92.9%) completed T4. Compared to CTRL, CBT-I had lower ISI, SDI, and SRI at T2, T3, and T4 (all p<.05 except p=.07 and .06 for ISI at T3 and T4; Cohen’s d ranges 0.39-0.99); differences in TST were non-significant at all timepoints (all p>.25). The RB condition had significantly longer TST at T4 (40.10 min longer, p=.008, d=.63) compared to CTRL, but these two conditions did not differ significantly on any other measures across all timepoints (p>.22).

Conclusion

Preliminary findings suggest CBT-I was efficacious in preventing insomnia symptoms and reducing sleep disturbance and sleep-related impairment, but did not increase maternal sleep duration postpartum. Conversely, a responsive bassinet designed to support infant sleep meaningfully increased maternal sleep duration at 6 months postpartum but did not prevent insomnia symptoms. These initial findings suggest that perinatal sleep complaints are a multifactorial problem that likely require multi-component interventions targeting different causes and mechanisms.

Support (If Any)

National Health and Medical Research Council, Department of Education and Training.
0479 Prescribing Patterns for Hypnotic Medication Among Adults Seeking CBTI Treatment: A Preliminary Report from the RESTING Study
Authors: Simpson Norah , Kim Jane , Tully Isabelle , Dietch Jessee , Tutek Joshua , Gumport Niki , Palaniappan Latha , Rosas Lisa , Zulman Donna , Manber Rachel
Published: May 2022

Introduction

Use of prescription hypnotic medications is common among adults with chronic insomnia; however, little is known about prescribing patterns for hypnotic medication in middle-to-older age adults with insomnia disorder who seek to engage in cognitive behavioral therapy for insomnia (CBTI).

Methods

Participants were 235 adults aged 50 or older with insomnia disorder (mean age 63.1y [SD 7.7y], 73.6% women) enrolled in the ongoing Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING). At screening, participants provided information about prescribed medications for sleep, insomnia severity (Insomnia Severity Index), daytime sleepiness (Epworth Sleepiness Scale), chronotype (Composite Morningness Questionnaire), depression (Geriatric Depression Scale) and physical and mental health (PROMIS Global-10, Physical and Mental Health Subscales).

Results

Of the 235 participants, 95 (40.4%) reported taking at least one medication prescribed to improve sleep. 26.5% were prescribed multiple medications (polypharmacy). Non-benzodiazepine receptor agonists (non-BzRAs) were the most common (prescribed to 51.6% of medication-using sample), followed by benzodiazepines (Bzs; 35.8%) and trazodone (20.0%). 25.2% of participants took a variety of other prescription medications at lower frequencies.Comparing patient characteristics for patients prescribed non-BzRAs, Bzs, and trazodone monotherapies, as well as polypharmacy, there were no significant differences in age, gender, insomnia severity or any other clinical characteristics, outside of modest associations within the PROMIS physical health scale (F[3,81]=2.78, p=.046); participants prescribed trazodone as monotherapy had significantly higher scores (better physical functioning) than participants prescribed non-BzRAs. Bzs were more likely to be prescribed as part of polypharmacy (52.9% of patients prescribed Bz) in the total medication using sample compared to those taking non-BzRAs (34.7%) or trazodone (36.8%; p<.001).

Conclusion

In this study, a high percentage of adults with insomnia seeking CBTI were also taking medications prescribed for sleep, including medications that are associated with increased risk (benzodiazepines, polypharmacy) or are not FDA-approved for insomnia (trazodone). Increasing prescriber knowledge about CBTI may promote adherence to the American Geriatric Society Beers Criteria for potentially inappropriate medication use in older adults. More research on how prescription patterns may differ among provider specialties could help target educational efforts to increase utilization of CBTI.

Support (If Any)

1R01AG057500
0480 Reduction in health care-related costs after initiation of treatment with a prescription digital therapeutic for chronic insomnia: two-year follow up analysis of health care claims data
Authors: Forma Felicia , Knight Tyler , Thorndike Francis , Xiong Ray , Baik Rebecca , Maricich Yuri , Velez Fulton , Malone Daniel
Published: May 2022

Introduction

The objective of this study was to evaluate the effectiveness of the first FDA-authorized prescription digital therapeutic (PDT) for adults with chronic insomnia that delivers evidence-based treatment (Somryst, previously called SHUTi). FDA considers PDTs to be prescription-only neurobehavioral devices that provide a computerized version of condition-specific behavioral therapy as an adjunct to clinician supervised outpatient treatment.

Methods

A pre/post multi-payer analysis of claims data was conducted, comparing two-year pre- and post-index healthcare resource utilization (HCRU) in an all-comer population of patients with self-identified sleep problems across the United States who activated the PDT between February 1, 2012 and December 31, 2018 (Index). HCRU categories assessed were: hospitalizations, treat-and-release emergency department (ED) visits, ambulatory surgical center (ASC) visits, hospital outpatient department (HOPD) visits, office visits, number of sleep medication prescriptions, and associated health care costs. Costs were estimated by multiplying HCRU by published average costs for each medical resource.

Results

252 patients initiating the PDT were analyzed (mean age 54.2 years, 57.5% female). Compared to the pre-index period, post-index events were reduced for ED (-56.2%; P=0.001), hospitalizations (-20.9%; P=0.4), sleep medication use (-8.9%; P=0. 0.377), HOPD (-8.3%; P=0.522), and ASC (-6.7%; P=0.695). Post-index events were slightly increased for office visits (+0.7%; P=0.891). Total estimated two-year cost savings associated with the reduced rates of all services except office visits was $494,634, or $1,963 per patient.

Conclusion

In a real-world cohort of patients with self-identified sleep problems, treatment with a PDT delivering digital CBT-I was associated with clinically meaningful net reductions in health-related services and associated costs.

Support (If Any)

This analysis was funded by Pear Therapeutics, Inc.
0484 Trouble Sleeping Predicts Future Decreased Quality of Life in Young Children with Fontan Circulation
Authors: Combs Daniel , Partha Meghana , Hsu Chiu-Hsieh , Edgin Jamie , Seckeler Michael , Klewer Scott , Parthasarathy Sairam , Cooper David
Published: May 2022

Introduction

Children with congenital heart disease who undergo a Fontan procedure are at higher risk of reduced health-related quality of life (HR-QOL) compared to age-matched peers. We have previously shown that current sleep disturbances are associated with decreased HR-QOL, but there is no existing longitudinal data on the relationship between sleep disturbance and HR-QOL in children with Fontan circulation.

Methods

We analyzed data from the Pediatric Heart Network Single Ventricle Reconstruction follow up study to evaluate associations between parent-reported trouble sleeping with HR-QOL as measured by the child health questionnaire (CHQ, measured at age 6 years) as well as the Pediatric Quality of Life questionnaire (PedsQL, measured at baseline as well as age 4, 5 and 6 years) in children with Fontan circulation. Presence of trouble sleeping was assessed at baseline and quality of life was assessed at baseline (age 3 years old) and annually for 3 years. Analysis was performed using the Wilcoxon sum rank test.

Results

227 participants had data at baseline (age 3 years), and 196 participants completed HR-QOL measures at all time points. Parent-reported trouble sleeping was reported “often” or “almost always” in 11% of participants. Baseline trouble sleeping predicted decreased HR-QOL at all future time points, particularly psychosocial HR-QOL. Psychosocial HR-QOL as measured by the Peds QL was significantly lower at all time points in the group with trouble sleeping. At age 6 years, psychosocial HR-QOL remained significantly lower in the group with trouble sleeping at baseline on both the PedsQL (median score 78 [interquartile range 63, 90] vs 65 [58, 83], p=0.03) and the CHQ (median t-score 54 [47, 59] vs 47 [42, 53], p=0.002).

Conclusion

Trouble sleeping in children with Fontan circulation predicts future decreased HR-QOL. Better understanding of sleep problems is needed in children with Fontan circulation as sleep disorder treatment may lead to improved HR-QOL in this at-risk population.

Support (If Any)

Funding to DC from the American Heart Association and NIH-NHLBI. Single Ventricle Reconstruction study data obtained from the Pediatric Heart Network.
0487 Exploration of Sleep Problems and Medication Use for Youth Residing in Juvenile Justice Facilities
Authors: McGee Ryann , Foster Mea , Adornetti Julianna , Leask Lauren , Bayley Shania , Nogales Josephina Munoz , Woodard Kelsey , Carlucci Marianna , Crowley Stephanie , Wolfson Amy
Published: May 2022

Introduction

Insufficient and disordered sleep are common among developing adolescents and can result in poor health and behavioral consequences. Previous studies have examined sleep and adolescent criminal behavior; however, little is known about adolescent sleep difficulties or disorders while residing in juvenile detention and treatment facilities. The current study explores psychiatric and sleep disorder diagnoses and medication use of youth under the care of the Department of Juvenile Services (DJS).

Methods

Participants were recruited from 11 detention and treatment facilities across Maryland. Youth (N = 67) were 13-19 years old (M = 16.8, SD = 1.2) and 84% male and 16% female. Racial Backgrounds: 55% Black, 18% White, 14% Multiracial, and 12% Other. A Healthcare staff member from each facility completed an online medical questionnaire regarding each youth’s sleep history, medical diagnoses, and current medications.

Results

The most common youth diagnoses were Insomnia (N = 26), ADHD (N = 26), and Anxiety (N = 12) with 72% of youth having more than one psychiatric/sleep disorder diagnosis. The most frequently used medications were melatonin (N = 23), trazodone (N = 12), and quetiapine (N=7) and 58% were on more than one sleep/psychotropic medication. Healthcare staff ordered 25 behavioral sleep studies (e.g., DJS behavioral sleep studies consists of night resident staff tracking if youth is asleep/awake while making rounds), resulting in diagnoses of insomnia (N=9) and parasomnia (N=1). Youth with sleep studies were prescribed the following medications: trazodone (N = 5), melatonin (N = 3), other (e.g., methylphenidate, clonidine, N = 11).

Conclusion

These preliminary findings suggest that youth are experiencing poor sleep quality while residing in juvenile justice facilities; over a third of the youth are struggling with insomnia and are prescribed Melatonin. Further data analyses will provide a better understanding of the youths’ sleep problems and the effects on their overall health and well-being.

Support (If Any)

This research is made possible by the American Academy of Sleep Medicine (AASM) Foundation Award #22-CS-19 and Department of Juvenile Services’ supportive collaboration.
0492 FAmily Burden and KIDs' Sleep (FAB-KIDS); Pediatric Sleep Disorders Impact on Family: A retrospective study
Authors: Blaty Justin , Chen Maida
Published: May 2022

Introduction

Little is known about the far-reaching impacts of pediatric sleep difficulties on family function, though widely thought to be a common reason to seek care, few pediatric sleep centers have adequate support resources for families. Valid, reliable instruments, including the Revised Impact On Family Scale (RIOFS), exist which can be used to reflect the psychological and social impact chronic childhood illness have on family life. We aim to assess the relationship between impact on life related to pediatric sleep disorders.

Methods

Retrospective chart review. Data from medical records, sleep study reports, and RIOFS results were extracted from children undergoing clinically ordered polysomnography at a tertiary pediatric sleep center. IRB approval was obtained. Preliminary data from 91 children were analyzed with descriptive and correlational statistics. The RIOFS is a 15 item Likert scale questionnaire with possible scores of 15-60; higher scores equate higher family stress.

Results

Of the 91 subjects, 44% were girls. Average age at time of study was 8.9 (+/-5.4) years. Study types were 85% PSG, 15% titration. Average BMI percentile was 74%. Mean RIOFS score =28 (+/-9.8, 15-60). Initial correlation of RIOFS total score to PSG metrics did not show a significant correlation between hypothesized factors such as oAHI and RIOFS score (r 0.009, CI [-0.163, 0.182], p=0.927) or Sleep Efficiency (r 0.054, CI [-0.152, 0.256], p=0.609). Preliminary review suggests that the specific question on fatigue has the strongest correlation with increased AHI (r -0.171, CI [-0.047, 0.005], p=0.11).

Conclusion

In a cohort of patients referred to pediatric sleep lab, mean RIOFS total score was 28. For reference, mean total score for children with Autism Spectrum Disorder =31; with rare metabolic disorders =36.5; at home with tracheostomy and ventilator =40. Our data and published comparisons suggest high levels of family stress in patients referred for sleep studies. Supporting families with clinical social work, psychologists, therapists is key to delivery of effective family-centered care models. With ongoing study, identifiable sleep factors which may predict the highest RIOFS score may be identified. Future research is needed to investigate the best delivery of these services to this high-risk population

Support (If Any)
0493 Daytime Sleepiness in Children with Asthma: Is it really the lungs?
Authors: Strang Abigail , Gao David , Rani Seema , Pasquale Frances , Covington Lauren , Patterson Freda , Chidekel Aaron
Published: May 2022

Introduction

Insufficient nocturnal sleep is the most common reason of excessive daytime sleepiness. Children with asthma are at increased risk for sleep disruption secondary to nocturnal respiratory symptoms and medication effects, as well as more common behavioral pediatric sleep challenges. Not yet clear is the relative contribution of asthma severity versus behavioral factors to daytime sleepiness in a sample of children (8-17 years) with asthma.

Methods

This survey-based study was conducted in the outpatient pulmonology clinic at Nemours Children’s Hospital, Delaware between 2018-2021. Children with asthma were eligible if they had a diagnosis of asthma, spoke English, and did not have a developmental disorder. Participants completed four surveys: Pediatric Daytime Sleepiness Scale (PDSS, higher scores=more sleepiness), Pediatric Quality of Life Inventory (PEDS-QL, higher scores=better quality of life), PROMIS Pediatric Anxiety short form (higher scores=more anxiety symptoms), and an investigator-designed survey assessing sleep-related technology use. Asthma factors (e.g., asthma severity, lung function [FEV1], number of prescribed asthma medications) were obtained from the electronic medical record. Descriptives and multiple regression analyses were conducted to identify asthma severity and behavioral predictors of daytime sleepiness, controlling for demographics.

Results

Study participants (N=100) were mean age 12.1 years [SD=2.6], 54% male, and 45% Black. Persistent asthma was common (87%), with a mean of 4.2 (SD=2.5) prescribed asthma medications, and mean FEV1 of 97% (SD=17.8). On behavioral surveys patients scored: PDSS (M=14.13; range=0-31; SD=6.7), PEDS-QL (M=77.38; range=15.6-100; SD=18.6), and PROMIS (M=14.92; range=8-35; SD=7.2). 74% reported cell phone usage within 1 hour of bedtime. Multiple regression models showed that an increased number of prescribed medications (beta=0.168, p=0.042), lower patient-reported quality of life (beta=-0.310, p=0.004), increased anxiety symptoms (beta=0.203, p=0.05) and bedtime cellphone use (beta=0.290, p=0.003) were significantly associated with daytime sleepiness in children with asthma.

Conclusion

A greater number of behavioral than asthma severity factors related to daytime sleepiness in children with asthma. Strategies to reduce anxiety and bedtime cellphone use may be plausible behavioral targets to improve sleep in children with asthma. Further research to examine these associations longitudinally, and in children with more severe asthma, is warranted.

Support (If Any)

None
0497 Associations between Sleep Problems and ADHD Symptoms in Early Childhood: A Longitudinal, Primary-Care Based Study
Authors: Davis Naomi , Lunsford-Avery Jessica , Compton Scott , Dawson Geraldine
Published: May 2022

Introduction

Sleep problems are common, impairing correlates of ADHD. These associations may emerge as early as toddlerhood, suggesting sleep-focused interventions in early development may improve ADHD-related outcomes. However, previous research has been limited by cross-sectional methodology and small, clinically-referred samples. Thus, relationships between sleep and ADHD symptoms over time and in non-clinical samples remain unknown. The current study evaluated concurrent and longitudinal relationships between sleep problems and ADHD symptoms in early childhood in a large, non-clinical sample.

Methods

Children were recruited from primary care clinics at an academic medical center and assessed at two time points: T1 (n=1806, mean age: 20 months) and T2 (n=646, mean age: 37 months). Sleep problems and ADHD symptoms were evaluated via the caregiver-reported Child Behavior Checklist (CBCL) Sleep and DSM-Oriented ADHD scales, respectively. At T2, caregivers also completed the ADHD Rating Scale (ADHD-RS), which includes inattention and hyperactive/impulsive subscales. Associations between sleep and ADHD were examined using Pearson correlations at each time point. Stability of and longitudinal relationships between sleep and ADHD symptoms were also examined.

Results

Greater sleep problems were correlated with elevated CBCL ADHD at T1 (r=.40, p<.001) and T2 (r=.49, p<.001). At T2, greater sleep problems were also related to increased ADHD-RS scores (r=.44, p<.001), with similar relationships for inattention (r=.41) and hyperactivity/impulsivity (r=.43). Sleep problems (r=.51, p<.001) and CBCL ADHD (r=.52, p<.001) were moderately stable over time. Using the CBCL, partial correlations indicated that T1 sleep was associated with T2 ADHD after controlling for T1 ADHD (r=.11, p<.01); T1 ADHD was associated with T2 sleep problems after controlling for T1 sleep problems (r=.17, p<.001).

Conclusion

Sleep disturbances and ADHD symptoms were bi-directionally associated in a non-clinical sample of young children recruited in primary care. Results are consistent with conceptualization of ADHD as a 24-hour disorder and suggest that incorporating behavioral sleep techniques into empirically-based ADHD treatments may improve clinical outcomes for young children displaying ADHD symptoms. Future research may focus on 1) optimizing identification of toddlers and preschoolers at risk for sleep problems and ADHD and 2) developing interventions that can be delivered in primary care settings.

Support (If Any)

P50HD093074 , K23MH108704
0509 Behavioral Topography of Bedtime Resistance in Younger and Older Toddlers
Authors: Leichman Erin , Rotella Katie , Mindell Jodi
Published: May 2022

Introduction

Sleep issues in young children are common, however little is known about bedtime resistance across development in toddlers. Thus, the aims of this study were to (1) assess the prevalence of bedtime resistance in younger and older toddlers and (2) examine differences in behavioral topography across groups.

Methods

318 mothers of toddlers (12-36 mos; M =23.1 mos) completed an online questionnaire addressing bedtime resistance, as well as the Brief Infant Sleep Questionnaire–Revised (BISQ-R). The sample included both younger (n=162, 12-23mos) and older (n=156, 24-36mos) toddlers.

Results

Overall, 61.3% endorsed bedtime stalling/fighting/resisting, with no age difference (57.4% younger vs 65.4% older), p > .05. Bedtime resistance commonly occurred after lights out (60% of those who resisted). Resistance also occurred during the bedtime routine (55.9%) and with announcement of bedtime (36.9%). Older toddlers were more likely to resist at announcement of bedtime (51.0% vs. 21.5%, p< .001), with no other age differences for resistance timing. Of the 21 resistant behaviors assessed, younger toddlers were most likely to cry/tantrum (68.8% vs 48.0%) and climb (or attempt) out of the crib (28.0% vs 12.7%), p < .01. Older toddlers were more likely to engage in 16 behaviors, including these most common: wanting a snack/drink (19.4% vs. 57.8%), adult to hug/snuggle/lie down (23.7% vs 53.9%), more time doing a bedtime activity (19.4% vs 49.0%), or a specific item (19.4% vs. 46.1%), getting out of bed (25.8% vs 46.1%), or watching electronics (24.7% vs 42.2%), p < .01.

Conclusion

Most mothers (61%) reported that their toddler resisted in some way at bedtime. No differences in the prevalence of bedtime resistance were found between younger and older toddlers, however the behavioral presentation of resistance differed. Whereas younger toddlers were more likely to cry and attempt climbing out of the crib, older toddlers were more likely to make specific verbal requests and requesting specific activities. These differences likely stem from developing language, motor, and cognitive skills. Ways to help caregivers manage these common bedtime behaviors need to be age and developmentally-based, aligning with presenting behavioral difficulties.

Support (If Any)

Johnson & Johnson Consumer Inc., Skillman, NJ, USA
0516 Characterizing Sleep and Mood during COVID for Youth with Allergic Disease
Authors: Booster Genery , Jump Stephanie , Meltzer Lisa
Published: May 2022

Introduction

The COVID-19 pandemic significantly disrupted the daily lives of children and adolescents. This study aimed to characterize sleep and mood during COVID in youth with asthma and/or eczema at two times: shortly after the lifting of stay at home orders (Summer 2020 [T1]) and after youth returned to school (Winter 2021 [T2]).

Methods

Pediatric PROMIS measures (Sleep Disturbances, Sleep-Related Impairment, Anxiety, Depressive Symptoms) and the Pediatric Sleep Practices Questionnaire were administered through REDCap. Parents of younger children (YC, 5-7 years, n=16) completed proxy measures for their children, while older children (OC, 8-12 years, n=16) and adolescents (ADOL, 13-17 years, n=17) completed self-report measures.

Results

For YC, mean Sleep Disturbances T-scores significantly decreased between T1 and T2 (62.0 vs. 56.4, p=.02), with no significant changes in the other variables. For OC, there were no significant changes in mean T-scores for any of the outcomes. For ADOL, there was a significant increase in Sleep-Related Impairment between T1 and T2 (52.0 vs. 57.7, p=.003), as well as a significant increase in Depressive Symptoms (48.2 vs. 52.5, p=.04). At T1, technology use prior to bedtime was more common in ADOL (YC=37.5%, OC=37.5%, ADOL=88.2%). At T2, technology use was also more common in ADOL (YC=50.0%, OC=37.5%, ADOL=64.7%), with an increase in YC technology use and a decrease in ADOL technology use observed. Parental presence while falling asleep was greatest in YC at both time points, with no noted changes in any group across time (T1: YC=56.3%, OC=18.8%, ADOL=17.6%; T2: YC=50.0%, OC=25.0%, ADOL=11.8%).

Conclusion

This study was limited by a small sample size, but provides some insights into the sleep and mood of children and adolescents with allergic disease during the first year of the COVID-19 pandemic. Although YC had fewer sleep disturbances at T2, there was an increase in technology use prior to bedtime. For ADOL, some of the changes in sleep, technology use, and depressive symptoms were likely due to the return to school at T2. Finally, it was notable that multiple OC and ADOL required parental presence to fall asleep. Additional research is needed to understand how the ongoing pandemic is impacting children and adolescents.

Support (If Any)
0522 Level II Home Sleep Apnea Testing Compared to In-Lab Polysomnography for the Evaluation of Obstructive Sleep Apnea in Youth with Down Syndrome
Authors: Cielo Christopher , Kelly Andrea , Ward Michelle , Falvo Jennifer , Arputhan Ahtish , Walega Rachel , Xanthopoulos Melissa , Tapia Ignacio
Published: May 2022

Introduction

In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA) diagnosis in children. However, cost, insufficient facilities, and disruption to families challenge PSG completion, particularly for youth with disabilities such as Down syndrome (DS) in whom OSA is common. By providing sleep architecture and arousal-associated hypopnea data, level II home sleep apnea testing (HSAT) with EEG has the potential to be accessible and accurate. We hypothesized that compared to PSG, HSAT would be accurate in detecting moderate-severe OSA in youth with DS and preferred by families.

Methods

Prospective comparative effectiveness study. Youth <18 years old with DS underwent in-laboratory PSG and level II HSAT at home. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored using AASM criteria blinded to PSG result, were compared to reference PSG. OSA was defined as obstructive apnea hypopnea index (OAHI) greater than 5 events per hour on either test.

Results

Thirty-five (17 female) youth aged [median (IQR)] 10.0 (6.1, 16.9) years completed testing. Total sleep time for HSAT was 7.9 (6.9, 8.9) hours versus 6.8 (5.9, 7.0) hours for PSG (p=0.002). PSG OAHI was 12.7/hr (5.3, 21.5). Twenty-six (74.3%) participants had OSA by PSG, 20 of whom were correctly identified by HSAT; one participant with OSA diagnosed by HSAT (OAHI=6.2/hr) was not identified by PSG (OAHI=3.9/hr). Accuracy of HSAT for identifying OSA was 80.0%, sensitivity 76.9%, and specificity 88.9% compared to PSG. Signal quality was good except for pulse oximetry, with median (IQR) adequate signal for 79.5% (57.5%, 86.3%) of the study. Compared to PSG, 83.3% of parents reported that youth had a more normal night’s sleep with HSAT, 70.0% of parents found HSAT easier, and 90.0% of youth preferred HSAT.

Conclusion

In youth with DS, HSAT has good accuracy for detecting moderate-severe OSA. Limitations may include night-to-night variability, differences in environment, or loss of oximetry signal. Youth slept more during HSAT than in-lab PSG and the majority of families preferred level II HSAT. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with DS.

Support (If Any)

NIH R21HD101003 (Tapia/Kelly)
0527 Reasons for Early Polysomnography Termination in Pediatric Patients with Sleep-Disordered Breathing
Authors: Luong Shan , Culp Marilyn , Caraballo Michelle , Wani Anna
Published: May 2022

Introduction

Many children with possible obstructive sleep apnea remain unidentified due to low referral rate. Out of the patients who successfully get referred, scheduled, and show up to their polysomnography (PSG), a proportion fail to complete the study. Our focus is to explore what factors can lead to early PSG termination in hopes of proactively identifying the at-risk groups and implementing strategies in the future to help bridge the gap between scheduled and completed studies.

Methods

The sleep lab at the Pediatric Sleep Center at UT Southwestern Medical Center includes 20 pediatric beds across two sites, with >4000 pediatric sleep studies run per year. We retrospectively reviewed all studies from January 1, 2017 through December 31, 2019 that were terminated before study completion. We investigated reasons for early termination in each case and gathered patient characteristics such as age, gender, presence of neurocognitive impairment, payor status to identify predictors of unsuccessful studies. We also looked at variability in time of year and testing sites in early study termination.

Results

From the data review of 138 patients, we identified the 3 main reasons for termination to be intolerance to equipment (n=65), acute illness (n=45), or refusal by parent (n=28). There was a greater proportion of patients who terminated due to illness, relative to the other two reasons, in the winter (p = 0.01 refusal by parent; p = 0.02 intolerance to equipment) and a lesser percentage in the summer (p = 0.003 refusal by parent; p < 0.001 intolerance to equipment). There was a greater proportion of subjects who were neurocognitively impaired that terminated due to intolerance to equipment relative to those that terminated due to illness (p = 0.002).

Conclusion

In our retrospective analysis of the three main reasons for early PSG termination, we did not notice any difference between location sites, age groups, or payor status. In the future, efforts to prevent underutilization of the lab should focus on illness screening especially in the summer and winter as well as development of tools to assess tolerance especially in the neurologically impaired.

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0530 A Study of Pediatric PAP Compliance in Longitudinal and Single-Visit Patients
Authors: Culp Marilyn , Luong Shan , Nguyen Emily , Wani Anna
Published: May 2022

Introduction

PAP compliance is difficult to attain and maintain, but important for treatment efficacy in obstructive sleep apnea. This study sought to identify patterns of compliance by age, stratified by gender and device type in patients who followed up only once after treatment initiation (single-visit patients) and those who were seen more than once (longitudinal patients).

Methods

Charts for approximately 10 months from 10/2018 to 7/2019 were retrospectively reviewed for 1177 patient visits, representing 521 patients with 246 single-visit and 275 longitudinal patients. Some longitudinal patients had visits dating back to 2002. Data analyzed included: age at visit versus compliance measured by percentage of days used and percentage of days used over 4 hours during their compliance period. Data was analyzed for single visit and longitudinal patients stratified by gender and device type. Age was categorized as 0 to 24 months, then years 3.0 to 5.9, 6.0 to 12.9, 13.0 to 18.9 and 19.0 to 21.9.

Results

Patient demographics: 47.2% single-visit, 52.8% longitudinal; 60% male; Approximately 80% between 6 and 18.9-years-old; 80.8% used CPAP. Statistically significant results:Seen for different age groups among females (p=0.012): Females 19 to 21.9-years-old had 45.8% lower compliance for percentage of days used over 4 hours compared to 3 to 18.9-years-old.Longitudinal patients showed 7.5% and 2.4% better compliance for percentage of days used (p=0.0006) and for days used over 4 hours (p=0.002), respectively, compared to single-visit patients after adjusting for sex and age group. Using a BPAP device was associated with 8.9% better compliance for use over 4 hours (p=0.002) compared to CPAP after adjusting for sex, age and visit groups. Longitudinal patients had 7.7% higher compliance for % days used over 4 hours compared to single visit patients (p=0.0016) after adjusting for sex, age group and device.

Conclusion

Statistically significant positive factors for compliance were longitudinal patients versus single-visit patients and those using BPAP.Among females, 19 to 21.9-year-olds were least compliant, otherwise no differences between age or gender were identified.

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0537 Symptom Improvement Reported with Some PAP Use in Non-adherent Pediatric Patients with OSA
Authors: Scribner April , White Jennifer , Pruss Kristi , Jambhekar Supriya , Spray Beverly
Published: May 2022

Introduction

Positive airway pressure (PAP) is commonly used in children to treat obstructive sleep apnea (OSA) when surgery is not an option or is ineffective1-3, but adherence is often poor. Observational studies suggest utilization of PAP improves symptoms, signs, and polysomnogram indices of OSA in at least 85% of children4-9. The Agency for Healthcare Research and Quality released the report “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea”10. Conclusions of this report determined that the published evidence reviewed does not support that PAP affects long term outcomes. No pediatric studies were included in this report. Objectives of this study were to determine if pediatric patients with OSA who are non-adherent to PAP therapy report an improvement in symptoms with some use of PAP.

Methods

A retrospective chart review was performed on patients with OSA on PAP seen in the pediatric sleep clinic. Patients were considered adherent to PAP if usage was longer than 4 hours/night for 70% of nights or more. Follow up visits occurred around 3 months, 6 months, 1 year, and 18 months-2 years. Adherence data and reported improvement in symptoms were documented at each visit, and demographical information was obtained.

Results

235 patients were included in the analysis (63.9% male, 32.3% female, 3.8% missing), with a mean age (SD) at PAP initiation of 12 years (4.5). The sample was predominately Caucasian (51.5%) or African American (38.3%), 85.9% were non-Hispanic, and 53.2% obese. The mean (SD) apnea-hypopnea index was 24.7(27.6)/hr. At first visit post-initiation, of the 138 patients that had adherence data available, 80.4% reported improvement in symptoms with PAP use. Of these patients, 55.86% were non-adherent but reported symptom improvement with some use of PAP. Visit 4 data was available for 74 patients. At visit 4, 91.9% reported improvement in symptoms. Of these, 48.53% were considered non-adherent but reported symptom improvement with some use of PAP.

Conclusion

Historically, PAP adherence in children has been relatively poor11. Utilizing PAP therapy to treat OSA may result in an improvement in symptoms when used in patients who are considered non-adherent to therapy.

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0547 RLS Patient Odyssey Survey II
Authors: Cinatl Christopher , Ondo William , Koo Brian , Dzienkowski Karla , Durmer Jeffrey , Phelps Charles , Winkelman John
Published: May 2022

Introduction

RLS affects 5%-10% of European and North American adults, with 2%-3% experiencing moderate to severe symptoms. RLS patients, often undiagnosed or improperly treated, experience significant depression in addition to loss of sleep.

Methods

ODYSSEY II, an online and in-print self-administered questionnaire (respondents primarily from the United States) included validated questions on RLS diagnosis and severity, associated medical conditions, RLS treatment responses, access to RLS care, and standardized PHQ-9 depression measures. RLS status was confirmed using the Cambridge-Hopkins Questionnaire. Analysis included linkage of PHQ-9 depression scores to EQ-5D Health-Related Quality-of-Life (HRQoL) scores using externally validated methods.

Results

Of 3,003 online or mail-in participants, 2,745 were RLS confirmed, 55% having severe symptoms (IRLS ≥ 21), 86% using medications and 73% reporting histories of dopaminergic augmentation (medication related worsening of symptoms).Of RLS-confirmed respondents, average PHQ-9 depression scores were 8.98 for women (US average 3.72) and 7.22 for men (US average 2.67). Among RLS patients, 29% of males and 40% of females (comparable US averages 11% and 6.5%) had PHQ-9 depression scores ≥ 10 (moderate, moderately severe or severe) a fourfold risk of important (≥ 10 score) depression. Suicidal ideation was reported by 15% of respondents (US average 4.0%). Associated EQ-5D scores show that 37% of all respondents had HRQoL scores below 50% of “full health.”Of six drug classes used to treat RLS, three drug classes had patient-reported efficacy above 60%, but all had patient-reported drawbacks, ranging from weaker efficacy for some patients (alpha-2-delta ligands) to augmentation (dopaminergics, almost three-quarters of patients) and difficulties in obtaining prescriptions (opioids) for others.Respondents reported decade-plus delays from time of symptom onset to diagnosis, and still may remain improperly diagnosed or inadequately treated. Respondents managed by RLSF certified providers reported better outcomes.

Conclusion

ODYSSEY II documents that depression, suicidal thinking and HRQoL losses are very significant among many RLS patients. Respondents report troubling delays from symptom onset to correct diagnosis. Survey results demonstrate that RLS related symptoms are best improved when patients use RLSF certified providers. Improved education to both primary care providers and patients may also lead to better patient outcomes.

Support (If Any)

Arbor Pharmaceuticals
0565 Examining obstructive sleep apnea knowledge and attitudes of providers in southern West Virginia
Authors: Aryal Shubekchha , Salyer Rachel , Stansbury Robert
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) syndrome is a common but underdiagnosed clinical problem with multiple health implications. The rising prevalence of OSA has been linked to increasing obesity. Because the obesity rate of West Virginia (WV) is almost 40%, successful identification and treatment of OSA is essential to improving the health of WV communities. Our previous work demonstrated that OSA is ineffectively managed in our rural communities. This study aimed to evaluate OSA knowledge and attitudes of primary care providers (PCPs) practicing at Federally Qualified Health Centers (FQHC) serving rural communities with significant health disparity in southern WV.

Methods

We assessed OSA knowledge and attitudes of 14 PCPs in southern WV (n=6 physicians and 8 mid-level providers; 53.2 + 12.2 years of age; 78% female) practicing at FQHC. The OSA Knowledge and Attitudes (OSAKA) questionnaire assesses providers’ knowledge via 18 true-false statements and importance and attitude via five Likert. OSA attitudes are assessed via two items for importance of OSA and three items for confidence in identifying and treating OSA.

Results

No respondents answered the 18-knowledge portion with 100% accuracy (mean = 14.3). Mann Whitney U tests were then used to compare Physicians’ and mid-level providers’ years in practice and OSAKA responses. Knowledge scores in physicians (Mdn = 16) significantly differed from mid-level providers scores (Mdn = 13.5) in our sample (U = 5.5, p < 0.05, r = -0.66). OSAKA Importance and Confidence questions revealed that PCPs felt OSA identification was important, but were not confident in their ability to manage OSA.

Conclusion

Our results demonstrate that rural PCPs have fairly good knowledge of OSA in general but lack knowledge in specific domains. Interestingly, providers feel OSA is an important disease and were fairly knowledgeable with the disease, but lacked confidence to manage OSA. Further explanatory studies are warranted to more robustly examine these findings. Our prior work demonstrates sleep apnea is ineffectively managed in the region. Thus, targeted training and further engagement with rural providers may well address disparity in OSA management for Appalachian communities.

Support (If Any)

(NIH/NIGMS 5U54GM104942-03).
0577 Sleep Quality and Its Association with Inflammation Over Time in Patients Undergoing Radiation Therapy for Head and Neck Cancer
Authors: Ye Lichuan , Miller Andrew , Bruner Deborah , Paul Sudeshna , Felger Jennifer , Wommack Evanthia , Higgins Kristin , Shin Dong , Saba Nabil , Xiao Canhua
Published: May 2022

Introduction

Sleep disturbance is a prominent concern in patients with cancer with detrimental effect on health outcomes. Although inflammation has been proposed as a potential mechanism of sleep disturbance, there is a dearth of longitudinal data supporting the relationship between cancer-related sleep disturbance and inflammatory markers. The goal of this prospective longitudinal study was to examine the change in sleep quality and its association with inflammatory markers in patients undergoing radiation therapy for head and neck cancer.

Methods

A total of 176 patients who had head and neck cancer without distant metastases were assessed before, immediately after, and at 3 and 12 months after radiotherapy. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Peripheral blood inflammatory markers were measured using standard techniques at the same four assessment times. Generalized estimating equations with exchangeable within-subject correlation matrix were used to analyze repeated measures.

Results

The participants were mostly middle-aged White (79.5%) men (74.0%) who were married or living with significant others (70.0%) and received concurrent chemoradiotherapy (80.1%). Using the PSQI of 5 as the cut-off, 66.3% of the participants were poor sleepers at baseline, and this rate increased to 82.8% immediately after, then dropped to 56.8% at 3 months and 46.2% 12 months after therapy. Being single (p=0.007), taking antidepressants (p=0.020), and with feeding tube (p=0.01) were identified to be significantly associated with poor sleep quality over time. Controlling for relevant demographic and clinical factors, changes in sleep quality were associated with changes of circulating levels of two inflammatory markers, C-reactive protein (CRP) and interlukin-1 receptor antagonist (IL-1ra). Increased CRP and IL-1ra levels were associated with higher PSQI global scores (beta=0.826, p=0.007 for CRP; beta=1.412, p=0.050 for IL-1ra), indicating worse sleep quality.

Conclusion

Patients with head and neck cancer experienced poor sleep quality, especially immediately after treatment completion and in those who were single, depressed, or with feeding tube. Inflammation is associated with cancer-related sleep disturbance and both sleep and inflammation may be potential targets to promote health outcomes in patients with cancer.

Support (If Any)

The study was supported by NIH/NINR K99/R00NR014587, NIH/NINR R01NR015783, NIH/NCI P30CA138292.