bluuebunny/crossref_metadata_2025 huggingface dataset:
0770 The Effect of In-Home Sleep Extension on Insulin Sensitivity for Habitually Short-Sleeping Adolescents
Authors: Simon Stacey , Cooper Emily , Brinton John , Bowen Anne , Cree-Green Melanie , Nadeau Kristen , Wright Kenneth
Published: May 2023

Introduction

The interplay of physiological and behavioral factors of adolescence that result in dramatically insufficient sleep may confer a notable cardiometabolic risk. Increasing sleep duration reverses the negative metabolic consequences of insufficient sleep in adults, but this has not been examined in youth. Thus, the current study aimed to evaluate the impact of in-home sleep extension on insulin sensitivity (Si) in habitually short-sleeping adolescents.

Methods

Twenty-six healthy adolescents obtaining ≤7h sleep on school nights (age=16.6±1.1, 69% female, 73% non-Hispanic White) completed a randomized crossover trial consisting of one week each of Typical Sleep (usual school schedule) and Sleep Extension (≥1h additional time in bed) during the academic year. Sleep was estimated via actigraphy, and an intravenous glucose tolerance test (IVGTT) measured Si following each condition. Spearman and Kendall correlations assessed associations and paired samples t-tests and Wilcoxon signed-rank tests examined change in variables from Typical Sleep to Sleep Extension.

Results

A significant association between sleep and insulin sensitivity was observed during Typical Sleep, with poorer Si associated with longer sleep onset latency (rho=-0.29, p=0.04), and greater variability in waketime (rho=-0.44, p=0.02) and sleep duration (rho=-0.43, p=0.03). During Sleep Extension, participants significantly increased sleep duration by 1.4±0.7h (Typical Sleep=5.59±0.82, Sleep Extension=6.95±0.83 h; p< 0.001) by shifting bedtimes to an earlier clock hour (Typical Sleep=00:34±01:12; Sleep Extension=23:10±00:57; p< 0.001). Si did not significantly change between conditions (p=0.52). However, a trend was observed for a decrease in fasting glucose during Sleep Extension compared to Typical Sleep (Typical Sleep=92.5±8.87; Sleep Extension=88.48±12.06 mg/dL; p=0.055).

Conclusion

Habitually short-sleeping adolescents were successful at increasing sleep duration during an in-home intervention, but Si did not change compared to Typical Sleep. Notably, sleep duration during Sleep Extension was still less than the 8-10 h of sleep per night recommended for adolescents. A sufficiently early bedtime that supports adequate sleep is a biological challenge for adolescents when wake times are fixed due to early school start times. Future research is recommended examining whether combining sleep extension with a circadian health intervention can have a larger impact on sleep and cardiometabolic outcomes in adolescents.

Support (if any)

NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1TR002535
0772 Associations of Sleep Duration and Maternal Postnatal Depression in Infants with Autistic Siblings
Authors: Foster Miranda , Bradshaw Jessica
Published: May 2023

Introduction

Evidence suggests sleep differences emerge in the first three years of life for autistic individuals (MacDuffie et al., 2020) and may be a possible endophenotype in unaffected siblings (Naeem et al., 2021). In neurotypical samples, postnatal depression has also emerged as a potential contributor to infant sleep challenges (Dias & Figueiredo, 2021). Questions remain on the associations between infant sleep duration, maternal postnatal depression, and family history of ASD as well as how these variables interact to predict future autistic traits.

Methods

Participants (N=74) were enrolled in a prospective longitudinal study on early autistic traits and included infants with an autistic sibling (n=33, EL) and with no familial history of ASD (n=41, LL). At 6 months, caregivers completed the Edinburgh Postnatal Depression Scale (EPDS) and a 24-hour retrospective sleep log. At 12 months, clinicians administered a standardized observation of autistic traits (SORF) the includes scores related to deficits in social communication (SCD) and restrictive and repetitive behaviors (RRBs).

Results

At 6 months, EL infants spent significantly more time asleep during the day than LL infants, (t(45)=2.89, p<.01). There were not significant differences in nighttime sleep duration or EPDS scores between groups. In examining the influence of self-ratings of maternal depression and likelihood status on sleep duration, the model was significant for daytime sleep (F(2, 36)=4.27, p=.02), but not nighttime sleep. Likelihood status, not EPDS score, predicted more hours spent asleep in the daytime. When assessing the role of status and sleep-related variables on future autistic traits, only decreased nighttime sleep duration at 6 months was related to greater RRBs at 12 months (F(3, 10)=15.26, p=.02), regardless of likelihood status.

Conclusion

The results of this study suggest that EL infants may sleep more in the daytime at 6 months. Reduced nighttime sleep at 6 months possibly signal future autistic traits, regardless of likelihood status. Future research should examine actigraphy data and its relationship to the etiology of ASD in larger samples.

Support (if any)

Funded by K23-MH120476, R21-DC071252, and T32GM081740.
0774 Characterization of sleep spindles and sleep architecture in adolescents with functional abdominal pain
Authors: Zyniewicz Olivia , Parikh Riya , Santucci Neha , Dye Thomas
Published: May 2023

Introduction

Functional abdominal pain disorder (FAPD) is a common disorder in adolescents with an estimated prevalence of 13.5 % worldwide. It is characterized by nearly-continuous or recurrent pain localized in the abdomen but poorly related to gut function. A greater incidence of sleep disorders has been described in pediatric populations with FAPD, but no studies have characterized differences in sleep continuity and quality that may be experienced by this population. This study examines differences in sleep spindles experienced by adolescents with FAPD due to the role of sleep spindles in sleep stabilization as it relates to pain.

Methods

Subjects ages 11-18 years with FAPD and age/gender matched controls were recruited and underwent prospective polysomnography (PSG). PSGs were conducted according to AASM accredited standards, scored by a registered PSG technician, and interpreted by a boarded sleep physician. Using only artifact free epochs, sleep spindles were identified and characterized using the YASA python package / A7 algorithm with selections confirmed against gold standard (manual scoring). Comparisons of FAPD and control groups were performed using t-test or Wilcoxon rank sum tests for normal and non-normally distributed data, respectively. The PSG scorers and those preforming spindle analysis were blinded to control vs study group throughout the study.

Results

The study included 21 adolescents with FAPD and 20 controls. When compared to controls, the FAPD group had an elevated arousal index (FAPD: 10.08/hr ±4.89/hr, control: 7.32/hr ±3.61/hr, p = 0.046) and a lower percentage of NREM 3 sleep (FAPD: 20.13% ±5.47%, control: 24.77% ±6.94%, p = 0.023). During NREM 2 sleep, the FAPD group had significantly greater spindle density over frontal head regions than controls (FAPD: 2.80/min ±1.39/min, control: 1.86/min ±1.35/min, p = 0.040).

Conclusion

This study demonstrated that adolescents with FAPD have greater sleep spindle density, higher arousal indices, and lower proportions of slow wave sleep when compared to their peers. This may reflect an underlying difference in physiology which predisposes one to FAPD, or alternatively, may be secondary to pain symptoms themselves. Further investigation is warranted.

Support (if any)

This research is supported by the Cincinnati Children’s Research Foundation.
0777 Feasibility and Acceptability of Personalized Sleep Health Education as Part of Bed Provision for Families Living in Poverty
Authors: Carson Mikayla , Dunnewald Maja , Lamanna Erin , Fay Kate , Kyck Fiona , Mindell Jodi , Williamson Ariel
Published: May 2023

Introduction

Socioeconomic sleep health disparities begin in childhood but there are few feasible and scalable community-based approaches to promote pediatric sleep health. This study aimed to determine community provider and family acceptability of community provider-delivered sleep health education.

Methods

Forty-four families (90% mothers) of children ages 8-12 years (Mage=9.9; 64% girls; 64% African American/Black; 23% Hispanic/Latinx) participating in an intervention condition of a randomized trial completed two personalized, telephone-based sleep health education sessions with a community provider. This intervention and the providers were part of a non-profit bed provision program for children without beds and living at or below 100% of the US poverty level. Data on feasibility from the community providers and treatment acceptability from the families were collected.

Results

Thirty-eight families (86%) completed both intervention sessions. The first session (n=38) averaged 15 minutes (SD=4 mins), while the second session (n=36) averaged 8 minutes (SD = 2.5 mins). Community providers indicated that the sleep health education delivery was feasible to implement, citing the easy integration into their typical program workflow (e.g., session 1 occurred during calls to schedule bed deliveries) as a key determinant of future sustainability. Providers also highlighted many positive experiences, noting that the sleep health discussions helped them to get to know program participants better. In terms of intervention acceptability, 87% of families agreed/strongly agreed that “overall, [they had] a positive reaction to these strategies,” and 81% agreed/strongly agreed that “[they] found these strategies to be an acceptable way of helping [their] child sleep.” In addition, 87% agreed/strongly agreed they would use the sleep strategies if they wanted to change their child sleep habits in the future, 84% liked the strategies they learned, 84% believed the strategies were effective, and 90% reported the strategies were likely to result in permanent sleep improvements.

Conclusion

Overall, a community provider-delivered sleep health education was highly feasible for providers, with strong intervention retention and excellent caregiver acceptability ratings. Training community providers to deliver sleep health education is a promising strategy for disseminating evidence-based sleep health information on a larger scale and promoting pediatric sleep health equity.

Support (if any)

American Academy of Sleep Medicine Foundation
0780 Iron Sucrose Infusions for Pediatric Sleep Related Movement Disorders
Authors: Rashid Iqbal , Bseikri Mustafa
Published: May 2023

Introduction

Sleep related movement disorders (SRMD) such as restless leg syndrome (RLS), periodic limb movement disorder (PLMD), and restless sleep disorder (RSD) are common diagnoses among children referred to pediatric sleep clinics, particularly among children with neurodevelopmental disorders such as ASD. These disorders have been associated with low iron status, and evidence demonstrates clinical response to iron supplementation. Oral iron supplementation is often used as a first step in management, although some children do not manifest an adequate response in serum ferritin levels, or do not tolerate oral iron due to side effects or taste. For these children, iron infusions may be an attractive therapeutic strategy.

Methods

We performed a retrospective chart review of children referred for iron infusion between January 2021 to November 2022 at Kaiser Permanente Northern California Pediatric Sleep Clinics. Children carried a diagnosis of RLS, PLMD, or RSD. Iron sucrose was used, with a target dose of 6-7mg/kg, with a maximum dose of 200mg per infusion. We reviewed the number of infusions, pre- and post-infusion ferritin levels, and clinical response based on clinic notes and/or secure message communication after infusion.

Results

A total of 11 children were identified who received at least one iron infusion. Mean age at time of first infusion was 7.2 (4.5) years, 63.6% were male, and 45.5% were diagnosed with ASD. The most common diagnosis was PLMD (54.5%), followed by RLS (27.3%), and RSD (18.2%). Mean infusion dose of iron sucrose was 130.5mg (41.6) and children received an average of 2.0 (1.1) infusions. Mean ferritin prior to infusion was 30.1 (20.1) and 62.6ng/mL (41.1) post infusion. Based on chart review, 63.6% of families reported symptomatic improvement following iron infusions. No children were reported to have worsening of sleep or significant side effects following iron sucrose infusion.

Conclusion

Iron infusions are an effective strategy for management of sleep related movement disorders who are recalcitrant to oral iron. This can be an especially attractive therapeutic option in children with neurodevelopmental disorders such as ASD. Further research exploring optimal dosing and formulation of iron is warranted.

Support (if any)
0781 Relationship between Bedtime Routines with Sleep, Development, and Parenting Stress in Toddlers
Authors: Lam Joey , Salih Zainab , Carson Mikayla , Dunnewald Maja , Waisfeld Agostina , Randazzo Isabel , Heere Megan , Williamson Ariel , Mindell Jodi
Published: May 2023

Introduction

Institution of a nightly bedtime routine is a key component of sleep health and is likely to foster positive early childhood development. The current study investigated the longitudinal and concurrent relationships between a bedtime routine and sleep, social-emotional development, and parenting stress in toddlers living in lower income homes and/or neighborhoods.

Methods

Caregivers of 78 toddlers (56.4% female; M=12.87 mos; 67.9% Black; 73.1% WIC) reported on their child’s bedtime routine at their 12-month well-child visit. At their child’s 15- and 24-month well visit, caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R SF), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Parenting Stress Index (PSI-SF). Results were considered significant at p<.05.

Results

Toddlers with a consistent bedtime routine (5+ nights per week) at 12 months had significantly earlier bedtimes (20:54 vs 21:24) and waketimes (7:21 vs 8:48) at 24 months compared to those without a consistent routine. At 15 months, a more frequent bedtime routine was associated with fewer concurrent social-emotional problems (r = -.32) and decreased bedtime difficulty (r = -.34). At 24 months, toddlers with a consistent bedtime routine (33.3%) were less likely to exhibit concurrent BITSEA social-emotional competency concerns (66.7%). Caregivers also reported better nighttime sleep in toddlers with a consistent routine at 24 months. Additionally, caregivers whose child had a consistent routine at 15 and 24 months perceived their child as less difficult (PSI) at 24 months. However, no associations emerged between bedtime routine frequency and consistency at 12, 15, and 24 months with ASQ communication and personal-social concerns.

Conclusion

Bedtime routine frequency and consistency in toddlers was associated with better caregiver-perceived sleep, social-emotional development, and lower parental stress regarding their child being perceived as difficult, but not communication and personal-social concerns. A bedtime routine may be a cost-effective strategy to promote toddlers’ sleep, overall development, and family’s functioning.

Support (if any)

This study was partially funded by the Simms/Mann Institute
0783 Sleep Continuity and Quality in Adolescents with Functional Abdominal Pain
Authors: Parikh Riya , Zyniewicz Olivia , Santucci Neha , Dye Thomas
Published: May 2023

Introduction

Functional Abdominal Pain Disorders (FAPD), in which chronic abdominal pain occurs independently of organic pathology, are common in adolescents. FAPD can lead to significant impairment in daytime function and may overlap with sleep disorders. Though several studies have explored the nature of sleep disturbances experienced by adolescents with FAPD, none have characterized differences in sleep architecture in this population.

Methods

Adolescents (age 11-18 years) with FAPD and age/gender-matched controls were prospectively recruited to undergo polysomnography (PSG). PSG was performed according to AASM guidelines, scored by a registered sleep technologist, and interpreted by a board-certified sleep physician. The first four hours of artifact-free NREM sleep were analyzed using fast Fourier transformation with Welch tapered windows of 1024 samples (and 50% overlap) averaged over 30-second epochs. Total power was calculated for very low (0.3 – 1 Hz), delta (1 – 4 Hz), theta (4 – 8 Hz), and alpha (8-12 Hz) frequencies. Comparisons between groups were made using Wilcoxon rank sum tests or t-tests for non-normal and normal data, respectively.

Results

A total of 41 subjects were recruited (FAPD n=21, control n=20). The FAPD group had a greater arousal index and a lower percentage of NREM 3 sleep when compared to the control group (FAPD arousals: mean=10.08/min ± 4.89 min, control arousals mean=7.31/min ± 3.61/min, p = 0.046), FAPD NREM 3: mean=20.13% ± 5.47%, control NREM 3: mean=24.77% ± 6.94%, p =0.023). Delta power was significantly lower in the FAPD group compared to controls (FAPD Delta mean=488.67 µV2 ± 282.82 µV2, control Delta mean=1193.14 µV2 ± 663.89 µV2, p < 0.001).

Conclusion

This study demonstrates significant differences in sleep architecture of adolescents with FAPD compared to their peers. In particular, decreased proportions of NREM 3 sleep and lower Delta power are indicative of diminished slow wave sleep (SWS). Reductions in SWS may be indicative of common neurotransmitter pathways shared between sleep and chronic pain syndromes, or secondary to sleep disruption associated with pain. Further research is indicated.

Support (if any)

This research is supported by the Cincinnati Children’s Research Foundation and the Summer Medical Student Respiratory Research Fellowship program at Cincinnati Children’s.
0784 Sleep Disruptors on the Inpatient Pediatric Unit
Authors: Uribe Daniela , Rani Seema , Chidekel Aaron , Strang Abigail
Published: May 2023

Introduction

High quality sleep is crucial to health and development in children. Compared to healthy children, hospitalized children have a higher chance of experiencing disrupted and poor-quality sleep, which may thereby impede their recovery. There is lack of research around sleep disruptors in hospitalized children outside of the ICU setting.

Methods

This IRB approved, prospective, survey-based study was completed in 2022 and included children ages 8-17 years who were hospitalized □3 days on the inpatient (non-ICU) units at Nemours Children’s Hospital, Delaware. The study was comprised of four surveys: The Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD, higher scores= more sleepiness), Adolescent and Children’s Sleep Hygiene Scales based on age (ASHS and CSHS, Higher Scores= Better Sleep Hygiene), Consensus Sleep Diary, and the Nemours Sleep Disruptors Questionnaire (NSDQ) which evaluated contribution of various factors to sleep disruption. The EMR was reviewed for demographic and clinical information. Descriptive and comparative statistics were performed.

Results

Study participants (n=45) were 40% male, 57.8% white, with a mean age of 13.4 years. The mean number of nighttime awakenings was 2 (range=0-7). The average total sleep time was 8.2 hours (range=5-12). Vital signs were obtained between 10PM and 6AM for 87% of participants. On the administered surveys, participants scored: ESS-CHAD (M=8.6 SD=4.3), ASHS (M=2.9 SD=.8), CSHS (M=3.3 SD=.6). 54% of patients reported feeling like they needed more sleep. On the NSDQ, the most disruptive factors noted by patients (causing at least mild sleep disruption) were alarms on equipment (69%), vital signs (64%) and environmental noise (62%).

Conclusion

In this cohort of hospitalized children, sleep environment (specifically related to alarms, environmental noise, and vital signs) was a leading cause of sleep disruption. Further interventional studies are needed to examine the relationship between sleep quality and sleep-friendly hospital environments, with vital signs and physiologic monitoring as potential targets for intervention.

Support (if any)
0789 Sleep Spindle Density is Associated with Core Symptom Severity in Autism Spectrum Disorder
Authors: Ishii Toru , Kawai Makoto , Chick Christina , Cotto Isabelle , Hallmayer Joachim , O'hara Ruth
Published: May 2023

Introduction

Converging evidence suggests that dysregulation of thalamocortical interactions, mediated by the thalamic reticular nucleus (TRN), contributes to the expression of autism spectrum disorder (ASD). Risk genes for ASD have been found to affect the TRN early in development. Two hallmarks of NREM sleep –slow oscillations (SO) and sleep spindles– reflect TRN function and distinct thalamic/thalamocortical circuits. While studies demonstrate disrupted sleep quality that correlates with symptoms in children with ASD, studies of spindles in ASD have produced inconsistent findings. It is yet unclear if and how spindle properties are associated with ASD symptoms. Herein, based on studies implicating TRN-mediated thalamocortical dysregulation in ASD, we hypothesized that 1) sleep spindles are reduced in ASD; 2) spindle abnormalities correlate with worse clinical symptoms and cognition.

Methods

Forty participants with ASD (32 males, age: 11.8 ± 3.2; range 6-15) and 46 typically developing (TD) controls (32 males, age: 11.2 ± 2.3; range 6-15) participated in the study. All participants underwent ambulatory overnight polysomnography (PSG) for sleep assessment after systematic desensitization. The Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) were used to assess core behavioral symptoms.

Results

Spindle density was significantly lower in ASD compared to TD participants (ASD: 2.5 ± 2.0; TD: 3.0 ± 2.1; d= 0.45, p=0.01). In the ASD group, less spindle density was associated with more severe behavioral symptoms, as measured by the total ADOS score (R2=0.15, p=0.01) and the three main subscales of the ADI-R (reciprocal social interaction: R2=0.22, p=0.002; communication and language: R2=0.19, p=0.003; and restricted and repetitive, stereotyped interests and behaviors: R2=0.14, p=0.01).

Conclusion

Alterations in the maturational trajectory of spindles are related to the core symptoms of ASD individuals. The results have the potential to identify novel biomarkers that index distinct aspects of ASD pathophysiology and point to multiple neural mechanisms underlying disease heterogeneity. The study may contribute to producing novel evidence to elucidate the bidirectional relationship between sleep and ASD.

Support (if any)

Simons Foundation Autism Research Initiative grant (177986).
0793 Effect of Sleeping Position on Obstructive sleep apnea in Children Undergoing Polysomnography
Authors: Rao Harish
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) in children is characterized by partial or complete upper airway obstruction during sleep, associated with gas exchange abnormalities and disrupted sleep with well-recognized neurobehavioral, neurocognitive, cardiovascular consequences. Positional obstructive sleep apnea (POSA) is defined as a lower AHI (by 50%) in the non-supine position than in the supine position. POSA has been well described in adults, affecting about 55% of adults with OSA. This occurs because airway collapse is maximal in the supine position compared to lateral or prone positions in this subset of patients with significant reduction in airway dimension occurring antero-posteriorly compared to circumferential reduction in airway dimension. However, POSA has not been well studied in children.

Methods

In this single center retrospective study, data was collected from one hundred consecutive polysomnographic studies from children (6-18 years) with moderate and severe OSA. Mean age was 10.7 years with 50% males in our cohort. Regression analysis was performed to study the relationship of sleeping position with the following variables: Age, sex, BMI, neck circumference, AHI, and desaturation index (DI) in supine and non-supine positions.

Results

60% of the patients in our study had significantly lower (by 50%) AHI and DI in non-supine position. This effect was seen in both moderate and severe OSA, though the effect was higher with increasing AHI and BMI. The effect of sleeping position persisted even when corrected for time spent in each position.

Conclusion

Most of the children in our cohort showed significant reduction in OSA in non-supine sleeping position. Positional therapy (PT), being a low-cost and non-invasive intervention is a reasonable approach in patients who demonstrate differences in AHI, oxygenation, and ventilation. Identifying the OSA phenotype and the subset of OSA patients likely to benefit from non-supine position increases the success of PT. PT may be helpful in situations where adenotonsillectomy may not be indicated and CPAP may not be well tolerated, not desired by the patient, and/or not sufficient to improve OSA. We intend to perform further analysis to study the effect of position on gas exchange and identify the phenotype who may benefit from PT in a larger cohort.

Support (if any)
0796 Safety and efficacy of the combination of atomoxetine and oxybutynin for OSA treatment in children with Down Syndrome
Authors: Combs Daniel , Edgin Jamie , Hsu Chiu-Hsieh , Bottrill Kenneth , Van Vorce Hailey , Gerken Blake , Matloff Daniel , Rue Sicily La , Esparza Lucia , Parthasarathy Sairam
Published: May 2023

Introduction

Children with Down syndrome (DS) are at very high risk for obstructive sleep apnea (OSA), with a prevalence of OSA of 50-79%. Current OSA treatments for children with DS have limited effectiveness, as positive airway pressure therapy is poorly tolerated and adenotonsillectomy is not curative in most children with DS. The combination of atomoxetine and oxybutynin (ato-oxy) is a promising OSA treatment in adults. Ato-oxy has been shown to improve upper airway hypotonia, a key feature of OSA in children with DS, thus it may be particularly effective for OSA in children with DS.

Methods

We performed a randomized, double-blind, crossover pilot trial examining the short-term efficacy of ato-oxy in 15 children aged 6 to 17 years with DS and OSA. Participants received 4 weeks of low dose (0.5 mg/kg atomoxetine and 5 mg oxybutynin) as well as 4 weeks of high dose (1.2 mg/kg atomoxetine and 5 mg oxybutynin) in random order. Participants underwent polysomnography as well as parent-reported health-related quality of life assessment using the OSA-18 at baseline and at the end of each dosing period. The primary study endpoint was reduction in obstructive apnea-hypopnea index (oAHI) from baseline. Paired t-tests were used to compare baseline to low and high dose ato-oxy.

Results

15 participants qualified for randomization and 11 participants had complete data at all points. Baseline oAHI was 7.4 ± 3.7 (mean ± standard deviation), oAHI with low dose ato-oxy was 3.6 ± 3.3 (p=0.001 vs baseline) and oAHI with high dose ato-oxy was 3.9 ± 2.8 (p=0.003 vs baseline). There were no differences in sleep architecture or sleep efficiency between baseline and either dose of ato-oxy. OSA-18 total score was 51.5 ± 18.5 at baseline; improved to 44.6 ± 17.0 (p=0.09) at the end of 4-weeks of low dose ato-oxy; and improved to 45.5 ± 15.7 (p=0.37) at the end of high-dose ato-oxy therapy. The most common adverse effects were irritability and fatigue, and these were generally mild.

Conclusion

Ato-oxy is a promising treatment for OSA in children with DS.

Support (if any)

Funding provided by NIH (HL151254 and HD109777) as well as the Lumind-IDSC foundation.
0798 Frequency of Sleep Disordered Breathing and Comorbidities Among Pre-school Aged Children with Down Syndrome
Authors: Kolstad Tessa , Cho Yeilim , DelRosso Lourdes , Sobremonte-King Michelle
Published: May 2023

Introduction

Children with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). The American Academy of Pediatrics recommends a polysomnogram (PSG) in children with DS prior to the age of 4. Data describing PSG parameters in this age group is limited. The purpose of this study is to examine the frequency of SDB, gas exchange abnormalities and comorbidities in this patient population.

Methods

This is a retrospective chart review of children ages 2-4 years with DS who underwent first PSG at Seattle Children’s Hospital from 2015-2021. Data collected included demographics, comorbidities and PSG parameters: obstructive apnea hypopnea index (oAHI), central apnea index (CAI), time spent with CO2 levels > 50 mmHg, percentage of time spent with saturations < 88% and saturation nadir. Data is presented by descriptive statistics and comparison by unpaired t test.

Results

A total of 154 children underwent PSG during the study period and 75 met the inclusion criteria. Mean age was 3.03 years (SD 0.805), 56% were male and 54.7% were caucasian. Comorbidities included (n, %): cardiac (43, 57.3%), dysphagia or aspiration (24, 32.0%), prematurity (17, 22.7%), pulmonary (16, 21.3%), immune dysfunction (2, 2.7%) and hypothyroidism (23, 30.7%). PSG parameter data collected included (mean, SD): obstructive AHI (7.9, 9.4) and central AHI (2.4, 2.4). 94.7% met criteria for pediatric OSA, 9.5% met criteria for central apnea, and 9.5% met criteria for hypoventilation. Only 1 child met criteria for hypoxemia. 60% had surgical intervention with 89% of these being adenotonsillectomy. There was no statistically significant difference in the frequency of OSA at different ages and no significant difference in OSA or CSA in children with or without hypothyroidism or dysphagia (p>0.05).

Conclusion

Children with DS ages 2-4 years have high frequency of OSA. The most commonly encountered comorbidities were cardiac and dysphagia. Among those with OSA, more than half underwent surgical intervention, highlighting the importance of early diagnosis. Our previously published work showed that in infants with DS, dysphagia is correlated with severity of OSA. However, this was not shown in this abstract suggesting a potential larger contribution of other factors, such as adenotonsillar hypertrophy.

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0801 Predictive value of heart rate variability on BP outcomes in OSA status – a 10yr longitudinal study
Authors: Guo Wei
Published: May 2023

Introduction

The apnoea/hypopnoea index (AHI) is commonly used as the indicator of OSA severity, but it cannot fully describe the illness severity, comorbidities, or treatment response. Heart rate variability (HRV) is a non-invasive way of detecting cardiac autonomic nervous system activity variations. It adds a new dimension to help understand the interplay between cardiac and nervous systems involvement in OSA. Aims: To explore the associations of HRV with OSA status in subjects from a longitudinal study where measurements were performed at 4-yr and 10-yr follow-up visits.

Methods

The cohort was established in 2003 to examine the prevalence of OSA in primary school children. During the 4-yr follow-up, HRV data in the time domain and frequency domain for 243 subjects when they were 10-17 years old were collected. Participants were invited to return for the 10-yr follow-up visit to undergo anthropometric measurements, overnight sleep study, and 24-hour ambulatory blood pressure (ABP) monitoring.

Results

Two hundred forty-three participants returned for the 10-yr follow-up. Participants who completed the HRV measurements at the 4-yr follow-up were included in this preliminary analysis. There were 122 participants (48.4% with OSA). Participants with OSA (AHI >=5 event/h) at the 10-yr follow-up had a higher high frequency (HF) norm, a kind of HRV parameter, at the 4-yr follow-up than those without OSA (40.5 ±22.1n.u.) vs (33.7 ±15.2n.u.) (P = 0.030).

Conclusion

HRV parameters combined with OAHI at 4yr likely partially explain SBP, and it can better predict SBP at 10yr than independent OAHI. HRV is prone to have an interaction effect, instead of a mediation effect, to help us predict SBP.

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0805 Targeting Sleep Disordered Breathing Screening During the SARS-CoV2 Pandemic: Parents or Providers?
Authors: Balog Matthew
Published: May 2023

Introduction

Sleep-disordered breathing (SDB) can significantly impact a child’s physical and psychological well-being. Primary care teams are strongly positioned to first note the signs of SBD and the American Academy of Pediatrics recommends routine screening for snoring at all well-child visits (WCV). However, the literature demonstrates low rates of application of this recommendation. This is likely multifactorial as noted by previous studies on the subject. This study aimed to assess if providing an electronic questionnaire to families ahead of the WCV would increase the snoring screening rate.

Methods

This quality improvement (QI) program consisted of a convenience sample (control n=504, program n=222) of 726 children, age 2-17 years presenting for their new or well-child-visit (WCV) over six weeks during the SARS-CoV2 pandemic. The Pediatric Sleep Questionnaire (PSQ) was delivered to parents via the electronic patient portal (EPP) 1-2 weeks before their child's appointment. The questionnaire was then auto imported into the physician's note at the time of the appointment.

Results

The QI program showed a lower overall SDB screening rate (16.7%) than the pre-program control (21%), however, 3 of 4 (75%) of the participating physicians saw an increase in SDB screening during the program. Statistical significance was seen in two physicians (X2 (1, N=262) = 27.150, p=.000, Phi = .332 and Fisher exact test p=.000, 2-tailed, Phi = .366.

Conclusion

The screening rate for snoring significantly increased among physicians when electronic questionnaires were provided to families prior to scheduled WCV. This is an early but promising pattern. The electronic patient portal can serve as an important asynchronous tool for providers to gather valuable information about the sleep quality of children in their practice, aligning with AAP goals and better supporting families.

Support (if any)

none
0811 Impact of Tonsillectomy and Adenoidectomy on Delta Power in Children with Obstructive Sleep Apnea
Authors: Naha Sowjanya , Kranthi Bhavana , Cohen David , Ner Zarah , Sahota Pradeep , Thakkar Mahesh
Published: May 2023

Introduction

Delta power is a known indicator of sleep drive and sleep pressure. Non-REM sleep delta power is increased in adults with sleep-disordered breathing, and lowered by treatment with continuous positive airway pressure (CPAP). Our purpose was to investigate the effect of tonsillectomy and adenoidectomy on delta power in children with sleep apnea. Here we report results from the pilot study phase of this project.

Methods

A retrospective study was performed using consecutive children between the age of 5 and 15 years presenting to our Sleep Disorders Clinic between October 2019 and October 2022 who underwent tonsillectomy and adenoidectomy for obstructive sleep apnea and for whom polysomnographic data was available from before and after the procedure. Spectral power density analysis was performed using polysomnography data to determine delta power.

Results

A total of 41 children were screened of whom appropriate polysomnography studies were available for 10 children. The mean delta power prior to surgery was 2687.8±1081, while the mean delta power after surgery was 1737.9±522.9. Paired t-test was performed and showed a significant and large (~65%) reduction in delta power (Cohen’s D 0.91; p=0.018).

Conclusion

Results of the pilot study showed a large and statistically significant reduction in delta power after tonsillectomy and adenoidectomy. This finding is consistent with the expected improvement in sleep pressure with correction of sleep apnea. Delta power represents a potent new metric to measure the biological efficacy and impact of surgery in children with sleep apnea.

Support (if any)

None
0813 Increasing accessibility of assessment of obstructive sleep apnea syndrome in youth with Down syndrome
Authors: Xanthopoulos Melissa , Arputhan Ahtish , Stefanovski Darko , Cielo Christopher , Kelly Andrea , Walega Rachel , Tapia Ignacio
Published: May 2023

Introduction

Because of the high risk for obstructive sleep apnea syndrome (OSAS) in youth with Down syndrome (DS), in-lab polysomnogram (PSG) is recommended by age 4-years and if symptom screening warrants. Unfortunately, screening for “traditional” OSAS symptoms has been considered unreliable DS. Further, while in-lab polysomnography (PSG) is the gold standard in assessment of OSAS, undergoing in-lab PSG is time and cost intensive and often stressful for youth with DS and their families. This study examined the relationship of sleep disturbance questionnaires with in-lab PSG and home sleep apnea testing (HSAT) in youth with DS.

Methods

As part of a larger study comparing PSG to HSAT in individuals with DS aged 6-25y, caregivers completed the parent-proxy Pediatric Promis Sleep Disturbance Measure (PPSDM) and Modified Epworth Sleepiness Scale (ESS). The relationships of the PPSDM and ESS and sleep study variables (total sleep time, oxygen desaturation nadir (SpO2 nadir), wake after sleep onset (WASO), sleep efficiency, obstructive hypopnea index (OAHI), and arousal index) were examined using Spearman correlation.

Results

Caregiver-completed questionnaires were available for 38 individuals with DS (18 males; mean age of 15.0±4.7, 84% White; 95% Non-Hispanic). PSG OAHI median [IQR] was 12.9[5.5-22.8] events per hour, SpO2 nadir 86.5[81-89] %, PPSDM 25[20-33], ESS 2.5[1-8]. The PPSDM was negatively correlated with PSG SpO2 nadir (r=-0.437; p=0.006) but with no additional HSAT or PSG variables. ESS was positively correlated with the obstructive apnea hypopnea index (OAHI) on both PSG (r=0.340, p=0.03) and HSAT (r=0.372; p=0.02) and negatively correlated with HSAT WASO (r=-0.369; p=0.02).

Conclusion

Given the limited availability of sleep specialists and labs equipped to complete PSG in individuals who may require increased attention, overnight pulse oximetry overnight coupled with ESS and caregiver completed sleep disturbance questionnaires may provide an initial, noninvasive, cost-effective method to screen for OSAS in individuals with DS. Considering that ESS correlated with OAHI, this questionnaire could be used to decide repeat PSG in youth with DS.

Support (if any)

This study was support by NICHHD grant R21HD101003 (PIs: Kelly and Tapia).
0815 Utilization of Telemedicine visits in a Pediatric Sleep Center and the Effect on PAP Adherence Rates
Authors: Scribner April , Spray Beverly , Willis Denise , Pruss Kristi , Jambhekar Supriya
Published: May 2023

Introduction

Although positive airway pressure (PAP) is an effective treatment for OSA, adherence is often suboptimal. Consistent follow up is needed to address barriers to adherence; however, in-person clinic attendance in our center has been low and was further reduced during the COVID-19 pandemic. Suboptimal adherence may result in cessation of reimbursement by insurance, leaving OSA untreated. Untreated OSA in children can lead to behavior and learning problems, impaired growth and cardiovascular complications. Due to the decrease in show rates, in-home telemedicine visits were offered in lieu of in-person visits.

Methods

A retrospective chart review was performed for children with OSA seen in the pediatric sleep clinic from March 2020 and October 2022. Subjects were excluded from analysis if they did not transition to telemedicine. Telemedicine visits were conducted in the same manner as in-person visits. PAP usage after telemedicine was compared to in-person visits. Adherence was reported as percent of total usage and percent of usage greater than four hours (U>4h) per night.

Results

Three hundred nineteen charts were reviewed of whom the majority were male (69.9%). The median age (interquartile range) at PAP initiation was 12 years (7-15). Seventy eight subjects were included in the analysis. Mean U>4h and total usage decreased when subjects transitioned from in-person to telemedicine visits (4.18% ± 26.7, p=0.17 (3.08% ± 22.5, p=0.23), respectively. These differences were not significant. 36 subjects (46%) had < ± 5% change in total adherence, 23 (29%) had > 5% increase in total adherence, and 19 (24%) had > 5% decrease. When comparing change in U>4h, 29 (37%) subjects had < ± 5% change in adherence, 22 (28%) had > 5% decrease, and 27 (35%) had > 5% increase in adherence.

Conclusion

There were no statistically significant differences in adherence rates between telemedicine and in-person visits. Adherence improved in some children on transition from in-person to telemedicine visits. Utilization of in-home telemedicine visits may be a useful alternative for some children treated with PAP. Further studies are needed to determine which specific patient populations may benefit most from in-home telemedicine visits.

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0816 Actigraphy-Measured Sleep Timing and Risk of Breast Cancer in the UK Biobank
Authors: Freeman Joshua , Saint-Maurice Pedro , Watts Eleanor , Moore Steve , Shams-White Marissa , Wolff-Hughes Dana , Hong Hyokyoung , Loftfield Erikka , Matthews Charles
Published: May 2023

Introduction

Shift work leading to circadian disruption is associated with increased breast cancer risk, but it remains unclear whether typical sleep timing variation in the general population that may cause less extreme disruption is also associated with increased risk. Prior studies relied on sleep timing assessed using self-report, but research using actigraphy is limited. Our goal was to characterize the association between sleep timing and breast cancer risk using actigraphy-based measures.

Methods

Our sample included 43,109 women without a history of breast cancer in the UK Biobank cohort who wore Axivity-AX3 accelerometers over 7 days. We estimated sleep midpoints, the median of sleep onset and waking. Social jetlag was estimated as the absolute difference in average weekend and weekday sleep midpoints. We used multivariable Cox models to estimate hazards ratios (HRs) and 95% confidence intervals (CI), adjusting for age, body mass index, participant characteristics, socioeconomic status, physical activity, menopause, parity, and oral contraceptive use. We conducted a sensitivity analysis excluding shift workers to control for potential strong confounding from shift work.

Results

Over 6.2 years of follow-up, there were 683 incident breast cancer cases. Earlier and later sleep midpoints were not associated with breast cancer (Early, < 4:00AM HR:1.08 [95%CI: 0.89-1.32]; Later, ≥5:00AM HR:1.24 [0.86-1.81]; vs. Reference 4:00-4:59 AM). Per-hour increases in social jetlag were suggestively associated with greater breast cancer risk (HR:1.09 [0.96-1.24]), but significantly higher risk was only noted at the highest levels of social jetlag comparing ≥2 hours to < 1 hour (HR:1.58 [1.13-2.20]). Results were unchanged when excluding shift workers.

Conclusion

Higher levels of social jetlag among UK women appeared to be associated with elevated breast cancer risk, possibly due to circadian disruption. While our results suggest that minimizing variation between weekday and weekend sleep timing may be related to lower breast cancer risk, replication of our findings in future studies using actigraphy-based measures and larger case numbers is needed.

Support (if any)

Supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health.
0817 Associations between Sleep Health and Injuries among Adults in the US: Findings from the National Health Interview Survey
Authors: Locklear Clarence , Narcisse Marie-Rachelle , Seixas Azizi , Martin Chloe M , Moise Rhoda , Turner Arlener D , Blanc Judite , Rogers April , Jean-Louis Girardin
Published: May 2023

Introduction

In 2020, 55.4 million Americans sought medical attention due to nonfatal, preventable injuries. Injury-related death rate was 15.7% higher than in 2019. Poor sleep health is associated with increased risk of injuries (e.g., falls, sports, and motor vehicle-related injuries). This study examined the associations between sleep health and injuries among adults (≥18 years).

Methods

This study utilized the 2020 National Health Interview Survey (n=31,568). The primary outcome encompassed sustained bodily injuries in the past 3 months. Secondary outcomes were fall-related, sports-related, and motor vehicle (MV)-related injuries. Sleep health in the past month was measured via 1) sleep quantity: very short (≤ 4 hours), short (5-6 hours), healthy (7-8 hours), or long (≥9 hours); 2) sleep quality: trouble falling asleep and trouble staying asleep; 3) feeling well-rested upon waking-up; and 4) sleep medications. Response categories included never, some days, most days, or every day. Adjusted multivariable logistic regression was used to examine associations between injuries and these four domains of sleep health.

Results

Overall, 9.1% of respondents sustained an injury. Among injured adults, 47.4% had fall-related injuries, 29.1% had sport-related injuries, and 6% had a MV-related injury. Adults with very short, short, and long sleep were 37%, 15%, and 22% more likely to be injured than adults with healthy sleep (p< 0.05). Adults with trouble staying asleep were 36% more likely to be injured than adults who never had trouble staying asleep (p< 0.01). Adults who woke up never rested or rested on some days were 49% and 36% more likely to be injured (p< 0.01) Adults who took medications for sleep on some days or every day were 24% and 36% more likely to be injured (p< 0.05; p< 0.001). Adults who had trouble staying asleep some days were 22% more likely to have a fall-related injury (p< 0.05). Respondents with long sleep were 43% less likely to have sports-related injuries (p< 0.05). Those who had trouble staying asleep were 3.5 times more likely to have experienced a MV-related injury (p< 0.01).

Conclusion

Sleep health is strongly associated with injuries among adults. Further studies are needed to determine causality in the observed associations.

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