bluuebunny/crossref_metadata_2025 huggingface dataset:
0778 Functional thalamo-cortical connectivity relates to sleep-onset problems in early infancy
Authors: Chiem Emily , Wagner Lauren , Ceballos Joshua , Dapretto Mirella
Published: May 2023

Introduction

Healthy sleep patterns are crucial for proper brain development in infancy. However, little is known about the relationship between early sleep disturbances and functional brain connectivity. The thalamus plays a critical role in the regulation of sleep and wakefulness, and undergoes rapid growth in the first year. Therefore, we examined how early thalamic connectivity relates to sleep-onset problems during the first 6 months of life.

Methods

All data were collected as part of the Baby Connectome Project (1U01MH110274). Forty-six infants (between 3-5 months old) underwent resting-state fMRI scans during natural sleep. The fMRI data were preprocessed and analyzed using FSL, and the bilateral thalamus was used in seed-based analyses. The Infant Behavior Questionnaire (IBQ) was used to create a measure of sleep initiation. Five IBQ items (21-25) were reverse-scored and averaged to generate the Infant Sleep-Onset Problems (ISOP) score, with higher scores indicating longer sleep latencies. ISOP scores across 3-6 months were used as regressors in whole-brain analyses.

Results

Preliminary results suggest a positive correlation between ISOP scores and connectivity between the thalamus and precuneus, such that greater sleep-onset problems were associated with stronger connectivity between the thalamus and precuneus. In contrast, there was a negative correlation between ISOP scores and connectivity between the thalamus and anterior cingulate cortex, such that fewer sleep-onset problems were associated with stronger connectivity between the thalamus and anterior cingulate cortex.

Conclusion

Our findings suggest that stronger thalamic connectivity with the precuneus, a region involved in the perception and integration of information, is related to greater sleep initiation difficulties. In contrast, stronger connectivity between the thalamus and anterior cingulate cortex, a region involved in attention allocation and emotional regulation, is associated with less sleep initiation problems. While these results are preliminary, they indicate that early sleep problems are associated with altered development of functional thalamo-cortical networks.

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0779 Impact of 8-h Time Limited Eating on Sleep in Adolescents with Obesity
Authors: Jayakumar Archana , Vidmar Alaina , Gillett Emily , Wei Choo Phei
Published: May 2023

Introduction

Time-based interventions, such as time-limited eating (TLE), have become a promising dietary strategy in adults with obesity. TLE involves shortening the daily eating window to a pre-specified number of hours and fasting for the remaining hours of the day without altering diet quality. No study to date has examined the impact of TLE on sleep quality in adolescents with obesity.

Methods

We conducted a secondary analysis of a 12-week pilot study that compared TLE (8-h eating window/16-h fasting window) to a prolonged window (12-h eating window/12-h fasting window) in adolescents with obesity (ages 14 to19, 72% female, 74% Hispanic). All youth completed the Pittsburgh Sleep Quality Index (PSQI) at baseline (n = 42), weeks 4 (n = 43), and 12 (n = 42). The seven component PSQI score, develops a global score that ranges from 0 to 21, where higher scores indicates worse sleep. Glycemic profiles were captured via continuous glucose monitors (CGM) worn for the duration of the study. Mixed effects generalized linear model in log scale and ordinal logistic regression models were utilized to (a) examine the change in PSQI total score and (b) assess the association between glycemic variability and PSQI total score overtime by intervention arm.

Results

Across all youth included in this analysis (n = 43), there was improvement in PSQI total score at week 12 compared to baseline that was marginally significant after adjusting for multiple testing (% change = -19.60, 95%CI = -31.83 to -5.18, p = 0.057). The median PSQI score for the TLE group (n = 29) was 6 at week 0 (5 to10) and 5 at week 12 (2.5 to 7), suggesting sleep quality improved. The changes in PSQI total score, sleep ratio, and sleep onset score over the course of study were not statistically different between groups (p > 0.05). There was no significant association between glycemic variability and PSQI score between the groups.

Conclusion

Findings from this secondary analysis indicate that TLE does not negatively alter sleep quality or duration in adolescents with obesity. The potential effects of TLE on sleep should be further investigated in larger randomized trials.

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0782 Sleep and Its Disturbance in Parents of Children and Adolescents with Epilepsy: A Systematic Review and Meta-Analysis
Authors: Tsai Shao-Yu , Tsai Han-Yi , Lin Ying-Ying , Chen Su-Ru , Kuo Shu-Yu , Lou Meei-Fang
Published: May 2023

Introduction

Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in parents of children and adolescents with epilepsy is lacking. A greater understanding of the characteristics of sleep patterns and sleep problems in parents of children with epilepsy is needed because when the sleep of the parents is compromised, the parents’ ability to provide quality care for the child may be hampered. The purpose of this systematic review and meta-analysis was to synthesize published studies examining sleep and its disturbance in parents of children and adolescents with epilepsy.

Methods

Five electronic databases, PubMed, Medline, Embase, PsychINFO, and CINAHL, were systematically searched from inception to September 2021. Studies examining parents or caregivers of pediatric patients aged < 18 years with epilepsy using a quantitative measure of sleep duration, sleep quality, or sleep disturbance were included. Available data were pooled using random-effects or fixed-effects models on the basis of heterogeneity between studies.

Results

Eleven observational studies with a total of 934 parents of children and adolescents with epilepsy were reviewed. The pooled nocturnal sleep duration was only 5.93 hours (95% CI: 4.64 to 7.21 hours). Overall sleep quality as estimated by the bias-adjusted pooled Pittsburgh Sleep Quality Index total score was 6.65 (95% CI: 5.98 to 7.33). Parents of children with epilepsy had significantly higher Pittsburgh Sleep Quality Index total scores in comparison to parents of healthy children (differences in means: 1.84, 95% CI: 1.29 to 2.39). The pooled estimated prevalence of parental sleep disturbances was 58.1% (95% CI: 45.7% to 69.6%).

Conclusion

Our findings demonstrate a high prevalence of sleep disturbances with poor sleep quality and substantial reductions in sleep time in parents of children and adolescents with epilepsy. Healthcare professionals in pediatric neurology clinics should initiate screening of sleep disturbances in parents and refer parents to a sleep specialist when necessary.

Support (if any)

This work was supported by Ministry of Science and Technology, Taiwan, MOST 110-2628-B-002-039.
0785 Sleep Habits and Sleep Hygiene Practices of South African Primary School-Aged Children: An Exploratory Study
Authors: Wood Tanya , Rampf Nadine
Published: May 2023

Introduction

Insufficient sleep adversely affects the physiological and psychological well-being of children and their families. Reports indicate that children's sleep health is declining; however, comparable data on the South African pediatric population is lacking. To this end, the current study aimed to explore the sleep quality and sleep hygiene practices of South African primary school-aged children.

Methods

The current study was exploratory and employed convenience sampling. Parents/legal guardians of South African children (6 – 11 years) attending primary school were recruited through social media platforms and asked to complete an online survey. The survey captured basic biographical information on their child's sleep habits (Children’s Sleep Health Questionnaire, CSHQ) and sleep hygiene practices (Children’s Sleep Hygiene Scale, CSHS). Survey responses were collected from May–August 2022.

Results

Of the 448 responses, 208 were included in the data analysis. Responses were received from eight South African provinces; the highest response was from the Western Cape (38.5%), followed by Gauteng (30.3%). The mean age of the study population was 8.0 ± 1.7 years (mean ± SD) and 51% were female. Of the children surveyed, 49.5% attended government schools. The mean parental report of sleep duration was 9.31 ± 0.45 hrs. The mean total sleep disturbance score based on the CSHQ was 47 ± 8.4, with 76% of children scoring greater than or equal to 41, indicating the presence of a possible sleep disturbance. The mean sleep hygiene index was 28.0 ± 3.4. Linear regression analysis revealed a significant correlation between total sleep disturbance and sleep hygiene scores (R2 = 0.32, p < 0.001); low sleep hygiene index scores were associated with a higher total sleep disturbance score. Multiple quantile regression models revealed that home-schooling and increased age were also significantly associated with sleep disturbance scores.

Conclusion

While the reported total sleep time for South African primary school-aged children was within the recommended range (9 – 11 hrs) for this age group, the overall presence of possible sleep disturbances was high, which could be attributed to poor sleep hygiene practices.

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0786 Sleep Problems and Associations with Mental Health Among Children Recently Adopted from Foster Care
Authors: Rusin Karolina , Cifre Anthony , Alfano Candice
Published: May 2023

Introduction

Trauma and early adversity are known to increase risk for both sleep and psychological disturbances, placing children who spend time in foster care at a higher risk for these problems than other populations of youth. Recent research has shown most children in foster care experience impairing sleep problems, but little is known of whether and how these problems relate to longer-term mental health. Thus, among a large sample of children recently adopted from foster care, we examined the prevalence of sleep-related problems when children were first placed in the foster home and their associations with current mental health problems.

Methods

N=234 parents of children, 4–11 years (M=5.94, SD=1.97) adopted from foster care in the U.S. within the past two years completed an online survey about their children’s sleep and mental health. Participants were recruited through private social media groups for foster, kinship, and/or adoptive caregivers. Parents were asked to report the specific types of sleep-related problems children exhibited at time of first arrival in home and completed validated measures of child anxiety and depressive symptoms regarding their child’s current functioning.

Results

After first arriving in the home, 82.9% of children were reported to experience at least one sleep-related problem. Further, 58.5% were reported to experience nighttime awakenings, 37.2% exhibited fear of the dark, and 32.1% had trouble sleeping alone. Approximately one quarter of children wet the bed (27.8%), struggled with staying in bed (27.8%), experienced nightmares (26.1%), and/or had night terrors (22.6%). Total number of sleep-related problems was significantly positively correlated with child age (r (234) = .30, p < .001), as well as current separation anxiety (r (234) = .16, p < .05), generalized anxiety (r (234) = .33, p < .001), and depressive symptoms (r(234) = .23, p < .001).

Conclusion

Our findings align with previous reports indicating high rates of sleep-related problems among youth in foster care and further suggest that these early problems may be a harbinger for mental health problems even after children achieve permanence. Findings call for greater attention toward sleep health among children in foster care and other alternative care settings.

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0791 The Association of Sleep with Developmental and Behavioral Factors in Premature Infants
Authors: Dunnewald Majalisa , Lamanna Erin , Williamson Ariel , Moore Melisa , Mindell Jodi
Published: May 2023

Introduction

Children with neurodevelopmental conditions often experience sleep problems. Whereas sleep is a predictor of behavioral outcomes in children, there is limited evidence regarding sleep as an indicator of neurodevelopmental concerns. This study examined the prevalence of sleep issues and neurodevelopmental conditions in children with a history of prematurity, as well as the role of sleep as a potential indicator for future developmental and behavioral concerns.

Methods

Electronic health records of 57 young children (M = 31.9 gestational weeks, range = 23 to 40 weeks; 35.1% girls) presenting to a neonatal follow-up clinic were reviewed. Caregivers completed the Brief Infant Sleep Questionnaire (BISQ-R) between 6-16 corrected months (Mage = 11.6 mos) and then completed the Modified Checklist for Autism in Toddlers (M-CHAT) between 16-26 corrected months (Mage = 20.9 mos). Caregivers also completed the Survey of Wellbeing of Young Children (SWYC; n = 56; Mage = 20.9 mos) and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA; n = 32; Mage = 17.4 mos).

Results

Approximately one-quarter (26.3%) of subjects had a caregiver-perceived child sleep problem at ages 6-16 corrected months. A total of 40.4% of children had clinically significant autism concerns on the M-CHAT and 67.9% had clinically significant concerns on the SWYC. Subsequent caregiver ratings showed that 25.0% of children exhibited challenging behaviors and 34.4% lower social-emotional competency on the BITSEA. Children who demonstrated clinically significant autism risk on the M-CHAT were more likely to have a prior caregiver-identified child sleep problem. Those who later failed the M-CHAT also had increased night waking frequency (2.43 vs 1.82 wakings) earlier in development. Logistic regression indicated that caregiver-identified sleep problems significantly predicted subsequent challenging behaviors on the BITSEA but not later neurodevelopmental concerns on the SWYC or social-emotional competencies on the BITSEA.

Conclusion

These pilot data suggest that a caregiver-identified child sleep problem at age 6-16 months corrected is linked to more frequent challenging child behaviors in toddlerhood (16-26 corrected months). Caregiver-identified child sleep problems and more night wakings also predicted later neurodevelopmental concerns. Sleep problems in premature infants may thus be an early indication of later behavioral and neurodevelopmental issues.

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0792 TigerCHAT: A School-Based Health Education Program Promoting Wellness and Sleep Health in a Rural Community
Authors: Feeley Christine , Gibson-Young Linda
Published: May 2023

Introduction

There is increasing awareness of the importance of sleep for overall health and wellness in children. However, many children are still not getting the recommended hours of sleep necessary for optimal school functioning. The purpose of this project is to describe a school-based health education program (TigerCHAT) and identify common barriers to sleep in 10-11 year old students.

Methods

TigerCHAT is a school-based health education program for children K-6th grades. It focuses on 45-minute sessions addressing various health topics, including sleep. Data are collected after parental consent approved. It was implemented in a rural elementary school in Alabama in the fall of 2018. Eighty-two nursing students over 10 weeks led small groups of students in brief educational modules, including one on sleep, during their scheduled gym period. Before education began, 5th and 6th grade students (10-11 years old) filled out a 22 question “What Keeps Me From Sleeping Well” Questionnaire modified for children from the Sleep Environment Inventory that asked students to circle yes/no/NA.

Results

Frequencies and percentages were run on the data to determine common reasons for disrupted sleep. Children ages 10-11 years in 5th and 6th grade (n=363, 47% female, 53% male, 45.3% Black, 50.8% White, 0.4% Hispanic, 1.5% Asian or Pacific Islander, 68% classified as economically disadvantaged) in a rural elementary school filled out questionnaires. The most frequently cited reasons for not sleeping well included: Noise inside the house (55%, n=198); Room too hot or cold (50%, n=181); Phone calls or text messages during the night (49%, n=176); Needed to go to the bathroom (49%, n=177); The TV, radio, or computer was on (44%, n=160); and Worried about my family (41%, n=149).

Conclusion

Students in this sample overwhelmingly endorsed environmental disrupters as reasons for not sleeping well (temperature of room, presence of noise, phone/technology in room), rather than other stressors on the questionnaire (worry about grades, worry about friends) or physical factors (stomach ache). Environmental factors such as the use of phones and social media should be examined further in this population, as it may be a significant, and potentially modifiable, reason for poor sleep in school age children.

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0794 Effect of Surgical OSA Treatment on Periodic Limb Movements of Sleep in Pediatric Patients
Authors: Ignatiuk Daniel , Nakamura Aisaku , Hossain Md Monir , Simakajornboon Narong
Published: May 2023

Introduction

The relationship between obstructive sleep apnea (OSA) and periodic limb movements of sleep (PLMS) is not completely understood, especially among pediatric patients. Previous research describes varied changes in PLMS following OSA treatment, including increased, decreased, or unchanged PLMS frequency. This study aimed to evaluate the effect of surgical OSA treatment on the periodic limb movement index (PLMI) in pediatric patients with OSA and significant PLMS.

Methods

Retrospective chart review was performed to identify pediatric patients who had polysomnography demonstrating significant PLMS (PLMI ≥ 5/hour) and OSA (obstructive apnea-hypopnea index (OAHI) ≥ 1.5/hour) that was treated with upper airway surgery. Patients aged 1-18 years were included if significant PLMS was present on either pre-treatment or post-treatment polysomnograms between 1/1/2010 and 7/31/2022. Patients were evaluated for changes in PLMI and OAHI between a pre- and post-treatment polysomnogram, each obtained within 12 months of OSA treatment. Patients with inadequate sleep time (< 2 hours) were excluded. Data are reported as mean ± standard deviation and results from mixed effect linear models.

Results

Medical record review identified 198 patients. The average age was 5.3±3.8 years (range 1.1-16.9 years) at pre-treatment polysomnogram, including 129 (65.2%) male patients. Adenotonsillectomy was the most common OSA treatment (n=136). For the whole group, the OAHI decreased from 12.3±15.3 to 5.3±8.1/hour and the PLMI increased from 5.5±8.5 to 7.0±8.7/hour after treatment, for an average PLMI increase of 1.5/hour (SE=0.7, p=0.04). Sub-group analysis of patients with decreased OAHI following treatment (n=152) showed an average PLMI increase of 2.3/hour (SE=0.8, p=0.004), while patients with increased OAHI following treatment (n=44) did not show a significant change in PLMI. There were 74 patients (37.4%) who developed significant PLMS following treatment and 36 patients (18.2%) with significant PLMS before and after treatment.

Conclusion

Effective OSA treatment led to increased PLMI among a majority of children, highlighting the potential for unmasking of PLMS in some pediatric patients with OSA. Furthermore, over one third of patients developed polysomnographic criteria for significant PLMS after OSA management. This may suggest a sub-group of children with OSA who have a PLMD phenotype that may not become apparent until appropriate OSA treatment.

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0795 Implementation of the Pediatric Craniofacial Screening Tool for Sleep Disordered Breathing (PCSS): An Observational Pilot Study
Authors: Heckler Gillian , Gueye-Ndiaye Seyni , Owens Judith
Published: May 2023

Introduction

Pediatric sleep-disordered breathing (SDB) is highly prevalent and associated with craniofacial risk factors not routinely assessed. We developed the Pediatric Craniofacial Screening Tool for Sleep (PCSS) to assess which craniofacial risk factors are closely correlated with SDB symptoms in children.

Methods

Pilot study of children ages 5-12y recruited from eight dental sites across the country to participate in the PCSS screening by dental providers. The primary outcome was SDB measured by the validated PSQ-SRBD questionnaire (22 items, range 0-1, and >0.33 signifying increased SDB risk). The predictors included PCSS total score and individual items comprising of 21 craniofacial features. Neighborhood socioeconomic status (NSES) was characterized by using the Area Deprivation Index (ADI). Correlation and regression analyses modeled the association between PSQ-SRBD and total PCSS score. To assess inter-rater reliability, a subset of subjects had a second PCSS screen by a second dental provider.

Results

The sample included 97 children (94%-Non-Hispanic-White, 4% Hispanic, 2% other; 49%-female), with a mean age of 8.6±2.2. PSQ-SRBD scores were elevated in 20 (20.6%) participants. Three children were reported to overweight (on item specific question of PSQ-SRBD scale). Children with elevated PSQ-SRBD (>0.33) had lower NSES compared to children with PSQ-SRBD scores < 0.33. PSQ-SRBD was associated with total PCSS score (OR=1.17 CI[1.01-1.36], p=0.033) and individual features including, narrow vaulted palate (OR=3.22, CI[0.94-10.93], p=0.03), forward head posture (OR=3.13, CI[1.11, 9.30], p=0.03), tongue thrust (OR=7.04, CI[1.20, 47.67], p=0.03), tongue tie (OR=7.58, CI[1.88, 33.58], p=0.005) and heart-shaped tongue (OR=11.21, CI[1.81, 98.11], p=0.01) after adjustment with age, sex, race and ethnicity. The correlation between total PCSS score and PSQ-SRBD was low (R=0.39, p= < 0.01), however in subjects with at least one positive craniofacial feature, the correlation between significant PCSS features and PSQ-SRBD was moderate (R=0.54, p= < 0.01). There was high inter-rater reliability (kappa=0.75) in a subset of 53 subjects with second PCSS screens.

Conclusion

Multiple craniofacial features assessed during routine dental visits were associated with increased risk for pediatric SDB. This study points to the utility of a craniofacial scale to assess SDB risk in children. This pilot study will be expanded to include a more diverse patient population.

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0797 Correlation between Obstructive Sleep Apnea and Echocardiography Parameters in Infants and Preschool Children with Down Syndrome
Authors: Bandyopadhyay Anuja , Rao Harish , Chmiel Michael , Slaven James , Jalou Hasnaa
Published: May 2023

Introduction

Down syndrome (DS) is one of the most common genetic disorders caused by the Trisomy of chromosome 21. Children with DS secondary to the unique airway anatomy and hypotonia, are at risk for obstructive sleep apnea (OSA). Untreated OSA in children can lead to serious complications because of chronic hypoxia leading to Pulmonary hypertension (PHTN) and Cor pulmonale. An overnight polysomnogram (PSG), the gold standard for diagnosing OSA in children, should be performed within 4 years per American Academy of Pediatrics recommendations. However, OSA in DS has been observed at a much younger age.

Methods

In this single-center retrospective study, data was collected by reviewing the medical records and PSG REDCap database from 2019-2021. Patients with ICD code 10 diagnosis of DS between 0 to 4 years of age who underwent PSG and echocardiography were included. Our primary aim was to assess the severity of OSA in preschool children and describe echocardiogram parameters in DS patients with OSA. We hypothesized that there will be differences in polysomnogram parameters of DS children with and without PHTN.

Results

61 patients met the criteria for the study with the mean age being 11.3 months. 3 patients (5.4%) did not have OSA (apnea hypopnea index (AHI)< 1/hr), 11 patients (19.6%) had mild OSA (AHI 1-4.9/hr), 12 patients (21.4%) had moderate OSA (AHI 5-10/hr), 30 patients had severe OSA (AHI >10/hr). Five patients with missing AHI values were excluded for subsequent analyses. Echocardiogram parameters were compared using the described AHI cut offs to define severity of OSA. OSA was observed to be significantly higher in the group with elevated RV systolic pressure.

Conclusion

Although our study did not find any difference in PSG findings in young children with DS with and without PHTN, obstructive apnea index was significantly elevated in young children with elevated RV systolic pressure. OSA is a significant contributor to the development of PHTN in children with DS. Children with DS are at higher risk for PHTN due to their unique pulmonary vasculature. As PHTN is a significant comorbidity of DS, it is important to perform PSGs early during childhood to detect and treat OSA.

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0800 Pediatric PSG Flagging Etiologies and Impact on Clinical Timeline
Authors: Rani Seema , Schanz John , Gatta Victoria , Kolb August , Strang Abigail , Chidekel Aaron
Published: May 2023

Introduction

There is a paucity of literature regarding “flagged PSGs”, a term used to triage emergent PSGs for expedited scoring and reporting. Given the morbidity and multi organ-system dysfunction of untreated OSAS in children, it is extremely important to identify and treat expediently. The aim of this study was to review flagged PSGs at a tertiary level pediatric sleep center, including management and intervention timelines.

Methods

This is an IRB-approved retrospective chart review of flagged PSGs (N=266) over a three-year period (2019-2022) at a pediatric sleep center. PSGs were flagged based on laboratory protocols and provider discretion. Demographic, clinical, and PSG data were obtained from EMR.

Results

Patients with flagged studies were white (49.2%), non-Hispanic (87.2%), males (66.9%) with (mean ± SD) age (6.9 ± 6.0) years and BMI of (23.3 ± 11.6) kg/m2, respectively. Reasons for flagging studies were repetitive brief oxygen desaturations < 80% (46.6%), sustained desaturations < 85% (32.3%), sustained EtC02 >60mmHg (5.6%), or other concerning events (15.5%). Most common comorbidity was pulmonary (41.4%), followed by genetic (30.5%), cardiac (23.3%), and neuromuscular (11.7%). 23.3% children were obese. 30.1% had prior airway surgeries; most commonly being adenotonsillectomy (70.0%). Mean Apnea-hypopnea index was 47.2 ± 36.1 events/hr. 35% children had hypoxemia and 36.8 % had hypoventilation. Time duration from flagging study to finalized report, surgical, or medical intervention was 4.3 ± 6.0, 78.2 ± 105 and 26.6 ± 93.0 days, respectively. Medical (40.6%) and surgical (37.9%) intervention were similar in frequency; however, children < 8 were more likely to undergo surgery (p< 0.001). Most frequent surgical intervention was adenotonsillectomy (82.1%). Patients with AHI>30 had less time between PSG and surgical intervention (65.3 ± 96.7 days vs 112 ± 119 days, p=0.04).

Conclusion

Most frequent reason for flagging PSG was repetitive brief desaturations. Time to surgical intervention was longer than medical intervention; however, they occurred in similar frequency. Pandemic staffing shortages and PAP machine recalls impacted both interventions. Patients with higher disease severity experienced quicker scoring, report finalization, and surgical intervention. Future directions include establishing protocols between sleep laboratory and surgical teams, assess the impact of this and further streamline care.

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0802 Quantifying Screening Efficacy and Referral Patterns in Well Child Visits
Authors: Balog Matthew , Loghmanee Darius , Donskoy Innessa
Published: May 2023

Introduction

Sleep-disordered breathing (SDB) can have profound impacts on pediatric physical, psychological and behavioral health. However, proactive history taking is needed to identify the signs of SDB, such as snoring. The American Academy of Pediatrics (AAP) therefore recommends that primary care providers actively screen for snoring at routine health maintenance visits. This study aims to assess the use of a snoring screening tool in our institution’s Electronic Medical Record (EMR) well child visit templates and subsequent rate of screening for sleep disordered breathing during routine pediatric visits.

Methods

We queried our institution’s electronic medical record for all patients ages 0-17 years who were presenting for their Well Child Visit (WCV) from January 1, 2019 through September 30, 2022. The query yielded a convenience sample of 428,632 children. The question “does your child snore” was embedded into the WCV template for all primary care providers.

Results

Before the pandemic only 12.3% of WCVs (52,695 patients) had a completed screening question. The snoring prevalence was 6.4% (4,034 patients) with 15% (594 patients) of those who screened positive for snoring receiving a referral to ENT or sleep medicine (65% to ENT). During the COVID pandemic (2020-2021) the screening rate was 13.4%. The snoring prevalence was 5.2% with 19% being referred to ENT or sleep medicine. There was also an increase in screening during the COVID pandemic, but screening usage reverted to pre-COVID levels when pandemic restrictions eased in 2022.

Conclusion

The introduction of a snoring screening tool in generic WCV note templates did not significantly improve the rate of screening for sleep disordered breathing at routine pediatric visits. However, this embedded tool was used more often during the SARS-CoV2 pandemic, when many visits were performed using telemedicine. Our data collection also highlighted a high prevalence of snoring within our institution and a referral pattern that largely routes these children directly to Otolaryngology versus Pediatric Sleep Medicine. This makes it imperative to continue brainstorming ways to support primary providers' abilities to screen for SDB and empower them with management options.

Support (if any)

None
0806 Treatment of sleep disordered breathing improves quality of life in children with Down syndrome
Authors: Horne Rosemary , Shetty Marisha , Davey Margot , Walter Lisa , Nixon Gillian
Published: May 2023

Introduction

Children with Down syndrome (DS) are at increased risk of obstructive sleep disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. We examined the effects of treatment of SDB on sleep and daytime functioning in children with DS.

Methods

Children with DS and SDB (n=34) completed a baseline and follow-up study which included 7 days of actigraphy in conjunction with a parental sleep diary. Parents also completed a number of questionnaires assessing sleep, behaviour, daytime functioning and quality of life (QOL). All children had overnight polysomnography (PSG) at baseline and 24 had PSG at follow-up.

Results

15 children (44%) were treated. At baseline the treated group had more severe SDB at baseline compared to the untreated group: obstructive apnoea hypopnoea index (OAHI) 29.3 ± 38.2 events/h vs 3.3 ± 5.2 events/h (p< 0.01). Actigraphy showed no significant differences in total sleep time or sleep efficiency from baseline to follow up in either the treated or untreated group. Wake after sleep onset increased at follow-up in the untreated group (p< 0.01). The sleep disturbance (p< 0.01) and total problems (p< 0.05) scales on the OSA-18 and the SDB subscale on the Pediatric Sleep Problem Survey Instrument (p< 0.01) improved in the treated children. No changes were seen in any of the measures in the untreated children.

Conclusion

Treatment of SDB improves QOL, despite treatment having no demonstrable impacts on actigraphic sleep measures. In contrast despite having less severe SDB children who were untreated had no improvements in QOL and increased sleep disruption.

Support (if any)

Jerome Lejeune Foundation
0808 Comparison of Maxillary Transverse Dimension with Pediatric Obstructive Sleep Apnea Presence and Severity
Authors: Wright Lauren , Rasmussen Chad , Jewell Abby , Giri Subha , Christopher Viozzi , Baughn Julie , Sorensen Channing , Mara Kristin , Lloyd Robin
Published: May 2023

Introduction

Obstructive Sleep Apnea (OSA) in children and adolescents is commonly discussed amongst dental specialists. Physical attributes such as a high and narrow palate, dolichofacial appearance, and retrognathic mandible are reported to increase pediatric risk for OSA. Previous research states rapid maxillary expansion decreases AHI in children with OSA and may be an effective treatment option. Current literature does not report a consistent method of measuring a maxillary transverse deficiency nor does it report a numerical maxillary threshold deficiency that requires expansion in pediatric patients with OSA. Our aims are to compare two different orthodontic diagnostic methods for measuring the maxillary transverse dimension and to assess whether patients diagnosed with mild, moderate, or severe OSA have a numerical threshold for maxillary deficiency.

Methods

Participants were ages 7-17 years old (average 11.7 years) with no history of orthodontic treatment, craniofacial syndromes, craniosynostosis forms, or nasal abnormalities. Those with and without adenoids and tonsils were included. Participants presented to the Mayo Clinic Sleep Center for their polysomnogram. Their dentition was scanned, and a digital model was rendered. The maxillary transverse dimension was measured via two different methods: McNamara’s Analysis and Andrew’s Six Elements of Orofacial Harmony.

Results

There were 65 participants: 31 diagnosed with OSA (13 Mild, 4 Moderate, 5 Severe, and 9 Other) and 34 without (controls). Patients in the Other category were diagnosed based on clinical findings. No statistical difference was found between the maxillary transverse measurements of patients with versus without OSA or between the OSA categories. Patients with OSA were more likely to have permanent teeth (61.3% vs 32.4%, p=0.019), tonsils removed (54.8% vs 26.5%, p=0.020), and to have snored during the PSG (83.9% vs 55.9%, p=0.048).

Conclusion

Conclusions based on this pilot study should be interpreted carefully due to limited sample sizes. No statistically significant differences of the maxillary transverse dimension were found between those with and without OSA using either diagnostic method. No numerical maxillary deficiency threshold was found. Maxillary expansion should not be recommended based on OSA diagnosis alone. Referral to a dental specialist is recommended based on dental needs.

Support (if any)

Support was provided by Mayo Clinic CTSA grant UL1TR002377.
0814 Obstructive sleep apnea in asthmatic children: highly prevalent though no identifiable risk factors
Authors: Togeiro Sonia , Santos Cristiane , Tufik Sergio , Smith Anna , Moreira Gustavo
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) and Asthma often coexist. There is some evidence that adults with asthma are more prone to developing OSA than the general population, as well as OSA may impact asthma control. Different than adults, OSA prevalence is equal in boys and girls, while puberty has strong influence in asthma, especially in pubescent girls. The objectives of this study were to analyze the prevalence of OSA in boys and girls and the impact of asthma severity in OSA prevalence.

Methods

Asthmatic children attending a tertiary pediatric pulmonology clinic performed clinical evaluation, Pulmonary Function Test, and Home Sleep Apnea Test. OSA was defined as habitual snoring and one or more obstructive respiratory events (OREI) per hour of recording. Control and severity of Asthma were evaluated according to Global Initiative for Asthma and puberal stage using Tanner figures for boys and girls

Results

We studied 80 consecutive patients, 7 to 18 years-old, mean age 11.6 years (SD: 2.7), 51.3% female. According to BMI z-score, nutritional status was: 2 (2.5%) underweight, 63 eutrophic (79%), and 15 obese (18.5%). Puberty was present in 17 volunteers. Pulmonary Function Tests were obtained from 71 volunteers, 45% presented obstruction pattern. Home Sleep Apnea Tests were available from 76 volunteers, with mean OREI of 1.8 events/h. OSA occurred in 69 volunteers (91%), while 66% were mild, 21% moderate, and 4% severe. We did not find associations of obstructive sleep apnea with sex or asthma severity.

Conclusion

OSA was highly prevalent among these asthmatic children, but most were mild. Sex and asthma severity were not associated to OSA. Considering the interrelationship of both diseases, it is worth to keep in mind the possibility of OSA among children and teenagers with asthma.

Support (if any)

AFIP (Associação Fundo de Incentivo à Pesquisa) and CNPq (Conselho Nacional de Pesquisas)
0819 Does Sleep Health Modify the Relationship Between Hypertensive Disorders of Pregnancy and Incident Cardiovascular Disease?
Authors: Jackson Chandra , Gaston Symielle , Louis Judette , Sandler Dale
Published: May 2023

Introduction

With pregnancy considered a cardiovascular “stress test”, adverse pregnancy outcomes (APOs), such as gestational hypertension, have been associated with higher risk of poor cardiometabolic health later in life. Sleep has been identified as a contributor to cardiometabolic health; however, few studies have considered how sleep may affect APO-associated cardiovascular disease risk.

Methods

To investigate sleep health during middle-to-older adulthood as a potential modifier of longitudinal associations between hypertensive disorders of pregnancy (HDP) and CVD incidence, we used data collected from 32,313 parous women (mean±SD age 55±8.9 years) without prior CVD in the Sister Study (enrollment: 2003-2009; n=1,407 Hispanic/Latina, n=2,411 non-Hispanic (NH)-Black, n=27,683 NH-White, and n=812 another race/ethnicity). Report of physician-diagnosed CVD or death from CVD (i.e., heart failure, myocardial infarction, stroke) was collected over follow-up until October 2020. At enrollment, participants reported a history of HDP (i.e., gestational hypertension, preeclampsia, eclampsia) and current sleep health characteristics (i.e., short (< 7 hours) habitual sleep duration, frequent napping, insomnia symptoms; all yes vs. no). Adjusting for sociodemographic, health behavior, and clinical characteristics, Cox proportional hazards regressions estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD among participants with vs. without history of HDP. Wald tests assessed HDP*sleep characteristics interactions.

Results

Overall, 11% of women reported a history of HDP, and prevalence varied by racial/ethnic group (14% among NH-Black and Latina, 12% another race/ethnicity, 11% NH-White). Poor sleep characteristics were prevalent and more frequent among participants with a history of HDP (e.g., insomnia symptoms: 46% vs. 43% [no HDP]). Over a mean±SD 12±3.0 years of follow-up, there were 1,658 new cases of CVD. After adjustment, the association between HDP and higher risk of CVD (HR=1.40 [95% CI:1.22-1.60]) did not differ between participants with poor vs. non-poor sleep (all p-interactions > 0.05; e.g., short sleep: HRyes=1.41 [1.11-1.79] and HRno=1.34 [1.13-1.59]).

Conclusion

Using subjective measures, poor sleep during middle-to-older age did not appear to exacerbate risk of CVD associated with HDP. Future studies that include multiple dimensions of objective sleep measured over the life course are warranted to better elucidate how sleep health among parous women may impact CVD risk.

Support (if any)

NIEHS (Z1AES103325[CLJ] and Z01ES044005 [DPS])
0820 Integrated Polysomnographic and Sleep Symptom-Based Cluster Subtypes Associated with Incident Atrial Fibrillation
Authors: Heinzinger Catherine , Lapin Brittany , Thompson Nicolas , Milinovich Alex , Foldvary-Schaefer Nancy , Van Wagoner David , Chung Mina , Mehra Reena
Published: May 2023

Introduction

While sleep disorders are implicated in atrial fibrillation (AF), the interplay and overlap of these disorders in AF risk remains unclear and a risk stratification challenge. Sleep-based clusters associated with AF can account for this complexity and translate to actionable approaches to identify at-risk patients. We hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF.

Methods

Cleveland Clinic patients (age>18) who underwent PSG 11/27/2004-12/30/2015 were retrospectively examined. Clusters were identified using latent class analysis of 23 symptoms (e.g. related to sleep disordered breathing (SDB), sleepiness, REM intrusion, NREM parasomnias), Epworth Sleepiness Scale (ESS) score, and 24 measures of SDB and sleep architecture from PSG reports. Outcome was 5-year incident AF. Cox-proportional hazards models were adjusted for age, sex, race, body mass index, cardiovascular disease and risk factors, tobacco use, chronic obstructive pulmonary disease, anti-arrhythmic medication use, and positive airway pressure use.

Results

The sample included 43,433 patients: age 51.8±14.5, 51.9% (n=22,548) male, 74.4% (n=32,313) White, 7.3% (n=3,151) with baseline AF, and 4.3% (n=1,875) developed 5-year incident AF. Five clusters were identified and ranked by strength of AF association: 1) Hypoxemic (n=3,245): highest %time SaO2< 90% (T90), 2) Apneas+Arousals (n=4,592): most witnessed apneas, highest apnea hypopnea index (AHI), highest arousal index, least hypopneas, 3) Short sleep+NREM (n=6,126): shortest sleep time, longest REM latency, lowest %REM, 4) Hypopneas (n=2,661): most hypopneas, 5) Long sleep+REM (n=26,809): longest sleep time, shortest REM latency, highest %REM. Compared to ‘Long sleep+REM’, ‘Hypoxemic’ had 47% higher AF risk (HR=1.47,95%CI=1.27-1.69), and ‘Hypopneas’ did not differ (HR=1.05,95%CI=0.86-1.28).

Conclusion

Of five clusters identified, the ‘Hypoxemic’ subtype conferred the strongest AF risk with the highest degree of hypoxemia (highest T90, lowest minimum and mean SaO2), maximum end-tidal CO2, heart rate, and ESS score. Consistent with prior evidence of hypoxemia as an AF driver and cardiovascular risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates risk in the clinical setting, providing potential value as a risk prediction tool. Future investigation should focus on external validation of these findings.

Support (if any)

Cleveland Clinic Neurological Institute Center for Outcomes Research & Evaluation Pilot Grant, Transformative Research Resource Development Award
0825 Association of Sleep Disturbance and Physical Functioning following Acute Hospitalization in Older Adults
Authors: Arentson-Lantz Emily , Deer Rachel , Kokonda Manasa , Meers Jessica , Carreon Samantha , Shetty Sharonya , Boyle Julia , Taffet George , Vahidy Farhaan , Agarwal Kathryn , Volpi Elena , Nowakowski Sara
Published: May 2023

Introduction

Three out of 10 older adults are admitted for acute care in U.S. hospitals where they are at risk for a rapid decline in physical function due to deconditioning. Identifying factors, such as sleep quality, that may be related to recovery of physical functioning is a key step in facilitating independence following hospital discharge. Thus, this study aimed to examine the association between sleep quality and functional recovery after an acute hospitalization in community dwelling older adults.

Methods

Participants (n=52; age 71.3 ± 6.8y, 75% female, 94.2% white), were recruited during an acute hospitalization. Participants completed sleep questionnaires including PROMIS Sleep-Related Impairment and Sleep Disturbance, as well as physical function testing and questionnaires, Short Physical Performance Battery (SPPB) and PROMIS Physical Function prior to hospital discharge (baseline) and at 4-weeks post-discharge (follow-up). Separate multivariate regression models were conducted to determine whether baseline sleep predicted physical functioning at follow-up as well as if pre-post hospital changes in sleep predicted pre-post changes in physical functioning.

Results

The PROMIS Sleep-Related Impairment score at baseline was inversely associated with SPPB Gait (0.02±0.009, p=0.04), SPPB Balance (0.02±0.008, p=0.02), SPPB Chair Stand (0.05±0.02, p=0.006) and Total SPPB (0.19±0.04, p<.0001) at follow-up. Similarly, baseline PROMIS Sleep Disturbance score was inversely associated with PROMIS Physical Function at follow-up (0.19±0.07, p=0.008). The change in PROMIS Sleep-Related Impairment was inversely associated with the change in Total SPPB (0.05±0.03, p=0.03), SPPB Balance (0.05±0.02, p=0.01) and PROMIS Physical Function (0.15±0.06, p=0.012) from baseline to follow-up. The change in PROMIS Sleep Disturbance was inversely correlated with the change in PROMIS Physical Function (0.11±0.05, p=0.04) from baseline to follow-up.

Conclusion

Together, these results demonstrated that self-reported sleep disturbance and daytime sleep-related impairments during and following hospitalization predicted physical functioning at 4-weeks post-discharge. Improving sleep during hospitalization may reduce hospital deconditioning and improve functional recovery.

Support (if any)

This work is supported by NIH Grant #s R01NR018342 (PI: Nowakowski), P30AG024832, UTMB Pepper OAIC, (PI: Volpi), UL1TR001439, (UTMB ITS); and the National Dairy Council (1229, PI: Volpi) Additional support was provided by the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0828 Greater sleep variability is associated with higher systemic inflammation in type 2 diabetes
Authors: Reutrakul Sirimon , McAnany J Jason , Park Jason , Pannain Silvana , Prasad Bharati , Chau Felix , Danielson Kirstie , Van Cauter Eve , Hanlon Erin
Published: May 2023

Introduction

Circadian misalignment increased systemic inflammation in sleep experiments and in those performing shift work. Milder degree of circadian misalignment such as day-to-day shift in sleep timing, i.e. sleep variability, was related to inflammation in population studies. Further, other sleep disturbances and glycemic control can contribute to inflammation. This pilot study explored if sleep variability was associated with inflammation in type 2 diabetes (T2D).

Methods

Subjects included 35 non-shift working T2D patients with and without diabetic retinopathy (DR) who were participating in a clinical study (NCT04547439). Sleep pattern was assessed by 14-day actigraphy, yielding sleep duration and efficiency. Standard deviation of sleep duration across the night was used to represent sleep variability. Sleep apnea severity was assessed by an overnight home monitor. Neuropathy pain, statin use, serum creatinine, low-density lipoprotein (LDL), HbA1C and by high-sensitivity c-reactive protein (hs-CRP) were collected. Spearman’s correlation analyses and multiple regression analysis (using natural-log transformed values) were performed to establish an independent association between sleep variability and hs-CRP.

Results

Mean (SD) age was 54.3 (6.4) years, 54.3% were female and 62.9% had DR. Median (interquartile range) of sleep variability was 69 (56,84) minutes. Median A1C was 7.5 (6.6, 8.7)% and hs-CRP was 2.4 (1.4, 4.6) mg/L. Higher hs-CRP was significantly associated with higher sleep variability (r=0.342, p=0.04), HbA1c (r=0.431, p=0.01) and LDL (r=0.379, p=0.03), but not with sleep duration, sleep efficiency, sleep apnea severity, DR status or other variables. Multiple regression analysis showed that higher sleep variability (B = 0.91, p=0.034) and higher HbA1c (B = 1.51, p=0.035), but not LDL, contributed to higher hs-CRP.

Conclusion

Higher sleep variability in non-shift working T2D patients was shown to be independently associated with higher systemic inflammation, conferring higher cardiovascular risk. This data supports the role of even a mild degree of circadian misalignment on systemic inflammation. Further investigations are needed to determine whether sleep intervention to increase sleep regularity can reduce systemic inflammation and improve cardiometabolic health.

Support (if any)

NEI R01EY029782 The University of Illinois Chicago Center for Clinical and Translational Science, which is supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002003.”