bluuebunny/crossref_metadata_2025 huggingface dataset:
0736 Adherence to marianismo as a moderator in the relationship between family relationship quality and insomnia among Latina women
Authors: Giorgio Luciana , Diaz Sarah Valentina
Published: May 2023

Introduction

Studies have highlighted the detrimental impact of family conflict and the beneficial effects of family cohesion on insomnia. Given the Latinx cultural value of familism, which emphasizes the centrality of close, warm family relationships, the quality of family relationships may be an especially important risk or protective factor of insomnia among Latinas. Additionally, a high adherence to marianismo, the constellation of Latinx female gender expectations, may amplify the effects of family relationships on insomnia because it emphasizes the woman’s responsibility in maintaining harmonious family relationships. Our aims were to (a)examine the association between family conflict, family cohesion, and insomnia severity and (b)test the moderating effects of marianismo among Latinas.

Methods

Using a subsample of cross-sectional data from Latinas participating in the Hispanic Community Health Study/Study of Latinos(HCHS/SOL) Sociocultural and Sueño ancillary studies(n=604), we conducted weighted, linear regression analyses to test the association among family conflict(Conflict), family cohesion(Cohesion), and insomnia severity(IS). Adjusted models controlled for age, marital status, education, and English/Spanish language preference. A final adjustment was made for depressive symptoms. We conducted moderation analyses(marianismo*Conflict; marianismo*Cohesion) in minimally and fully adjusted models. Conflict was measured using the Family Cultural Conflict subscale of the Hispanic Stress Inventory. Cohesion was measured using a subscale of the Family Environment Scale. Marianismo was operationalized as adherence to the family pillar subscale of the Bem Sex Role Inventory. We used the Insomnia Severity Index to measure IS.

Results

Participants were Mage 41.38(SD=13.41). Most women were married(44.74%), earned >high school diploma(39.71%), and preferred to speak Spanish(76.03%). The mean IS score was 8.02(SD=6.76). Conflict was not statistically significantly associated with IS(SE=0.05, p>.05). One SD increase in Cohesion was associated with a 0.10 decrease in IS in minimally adjusted models(SE=0.05, p=0.04), but was not statistically significant after adjusting for depressive symptoms. Marianismo did not moderate these associations.

Conclusion

Greater cohesion emerged as a robust predictor of reduced insomnia severity in one of the first large-scale studies examining the effects of sociocultural factors on Latinas’ sleep. If replicated using longitudinal data, findings suggest that developing family-based interventions amplifying cohesion, rather than decreasing conflict, may be more beneficial for reducing insomnia among Latinas.

Support (if any)
0739 Effect of Obstructive Sleep Apnea and Insomnia on Cognitive Impairment in World Trade Center (WTC) Responders
Authors: Ravi Sri Saranya , Mullins Anna , De Resende Adriana , Hyung David Kim Do , Legard Alicia , Romero-Castillo Horacio , Parekh Ankit , Black Kathleen , Rapoport David , de la Hoz Rafael , Udasin Iris , Sunderram Jag , Ayappa Indu , Lu Shou-En
Published: May 2023

Introduction

Mild Cognitive Impairment (MCI) is defined as a noticeable decline in cognitive abilities that doesn't interfere with daily activities; MCI may be a precursor of Alzheimer’s disease and related dementia. Elevated risk of MCI has been shown in subjects with obstructive sleep apnea (OSA) in a sleep clinic population and in subjects with insomnia in a general population. OSA and Insomnia both have a high prevalence among members of the World Trade Center Health Program General Responders’ Cohort (WTCHP GRC). Previous research indicated they had a high prevalence of MCI but did not examine sleep. We examined the association between MCI with OSA and/or Insomnia in the WTCHP GRC.

Methods

We assessed MCI by the Montreal Cognitive Assessment (MoCA) in English (n=115) and Spanish (n=27). MoCA < 26 defines MCI. OSA defined by AHI4>=5 or RDI>=15 events/hr, was assessed by home sleep test or in-lab NPSG. A score>7 on the Insomnia Severity Index (ISI) defined insomnia. Education was categorized as < or > bachelor’s (BA/BS) degree; subjects were categorized as Latino or not. Variables were analyzed using linear correlation, t-tests and chi-square tests as appropriate.

Results

The study population consisted of 142 subjects (80%M/20%F, age 58±8 years, BMI=29.7±5 kg/m2., Non-Latino/White=57%, Latino/any race=35%, < BA/BS=65%). OSA prevalence was 65.5% (mean AHI4=10.8±12.5/hr and RDI=21.42±16/hr). Insomnia prevalence was 48% (ISI=8.8 + 6). 48% (n=68) of subjects were classified as MCI. No correlation was observed between MoCA and OSA severity (r=0.1,p=0.24) or ISI (r=-0.1,p=0.1). Subjects without OSA had higher MCI prevalence (MCI_OSA=21.5% vs MCI_noOSA=37%, p=0.018). Lower educational level, race/ethnicity, and language (Spanish/English) (p< 0.001) were associated with MCI.

Conclusion

In this heterogenous cohort, we showed an unexpected lower MCI prevalence in OSA subjects. As shown by others, MCI defined by the MoCA was highly impacted by race/ethnicity, language and education. This suggests that our findings may be influenced by differences in the MoCA scoring and MCI cutoffs in Hispanic populations. To understand the relationship between MCI and sleep disorders in the WTC population, future studies should re-assess the cutoffs used in MoCA scoring or use tools to assess MCI less dependent on ethnicity and educational level.

Support (if any)

NIOSH/CDC U01OH011481, K24HL109156
0742 Is sleep altered during the menstrual cycle? A polysomnography study from EPISONO
Authors: Ishikura Isabela , Fernandes Guilherme , Hachul Helena , Tufik Sergio , Andersen Monica
Published: May 2023

Introduction

During the reproductive life, woman experiences changes in their hormone levels that characterize her menstrual cycle. This monthly event provides hormonal and body conditions to development of pregnancy and lactation. In addition to alterations in hormones, some women present physical and psychological complaints according to the phase of the menstrual cycle. Sleep has been reported to be deteriorated during menses; however, no conclusive results have been stated. The aim of our study was to evaluate the objective and subjective sleep during 3 different time-points of the menstrual cycle.

Methods

For this study we used the São Paulo Epidemiological Sleep Study (EPISONO) database. Ninety-one women were distributed in follicular (F) phase (N=27), luteal (L) phase (N=39) and menstruation (M, N=25) and undergone a one-night polysomnography. Blood samples and women’s questionnaire data were collected to investigate hormonal levels and information about the menstrual cycle to identify the phase of the cycle during the polysomnography exam. The objective sleep parameters analyzed were: sleep efficiency, sleep latency, REM sleep latency, total sleep time, awakenings index, percentage of stage 1, 2, N3 sleep and REM sleep. The following questionnaires were applied to assess the subjective sleep: Pittsburgh Sleep Quality Index, Insomnia Severity Index, Chalder Fatigue Scale, Beck Anxiety Inventory, Beck Depression Inventory and Epworth Sleepiness Scale. For the statistical analysis we used the Kruskal-Wallis test and post-hoc Dunn, with p< 0.05.

Results

Women in follicular phase exhibited significantly higher sleep efficiency (89.9±9.6%) when compared to luteal (83.7±12.7%; p=0.02) and menstruation (83±10.8%; p=0.008) groups. During the follicular phase the sleep latency was statistically reduced (7.1min) compared to other time-points of the menstrual cycle (L=15.9min; M=22.3min; p=0.02; p=0.03, respectively). The other objective sleep parameters and the results of the questionnaires applied did not present statistical differences during the menstrual cycle.

Conclusion

Women in follicular phase showed better sleep than the other time-points of the menstrual cycle. The sleep latency during menstruation was 3 times longer than the follicular phase, indicating that menstruation may be one of the causes of sleep complaints in women.

Support (if any)

AFIP and CNPq.
0743 Maternal Experiences of Gender Discrimination Are Associated with Worse Postpartum Sleep
Authors: Rayport Yael , Barrera Ana , Thakur Shambhavi , Barnett Natalie , Lucchini Maristella
Published: May 2023

Introduction

Many new mothers experience poor sleep postpartum, which has been found to increase the risk of negative cardiovascular health and mental health outcomes. A few studies have found that experiences of racial/ethnic discrimination are associated with poor maternal sleep, but less is known about the effect of discrimination in other domains. Previous studies have also not accounted for the effect of infant sleep on maternal sleep, which is known to be a major influence in the first year after birth. This study aims to investigate the association between gender discrimination (GD) and postpartum maternal sleep, controlling for infant sleep.

Methods

The cohort comprised 506 mother-child dyads from the customer base of the Nanit Smart Baby Monitor. At 6–12 months postpartum (Mean±SD: 9.2±1.8), maternal experiences of GD (Everyday Discrimination Scale), perceived stress (Perceived Stress Scale (PSS)), and subjective sleep (Pittsburgh Sleep Quality Index) were assessed. Objective measures of infant sleep were obtained using the Nanit Smart Baby-Monitor. Logistic and linear regressions estimated the associations between maternal experiences of GD and maternal sleep, controlling for PSS, household income, infant age and sex, and objective infant sleep duration and wakings.

Results

34.6% of mothers reported experiencing GD. The average PSS score was 15 (± 6.7). Infants had an average sleep duration of 10h (± 1.2) and an average of 3.1 (± 1.4) nighttime sleep wakings. Maternal experiences of GD were associated with shorter sleep duration (OR=1.67, CI=1.07-2.64) and more sleep disturbances (β = 0.77, CI= 0.04-1.49). The PSS was associated with more sleep disturbances (β = 0.11, CI= 0.05-0.16). Objective infant sleep duration was associated with subjective maternal sleep duration (OR=0.57, CI=0.47-0.69).

Conclusion

Maternal experiences of GD are associated with worse postpartum maternal sleep, suggesting that sleep could serve as a biological pathway relating GD and postpartum health. Future research is needed to investigate the long-term implications of maternal experiences of GD on maternal-fetal health.

Support (if any)

This research was supported by the Developmental Psychobiology Parent Infant Award and Nanit
0744 Self-reported Sleep Quality and Insomnia Symptoms Mediate the Association between Depression and Physical Activity in Older Adults
Authors: Li Mengchi , Liu Sofia , Calderon Russell , Huang Jing , Tufa Yeabsira , Waszczuk Dan , Li Junxin
Published: May 2023

Introduction

Lack of physical activity (PA) is prevalent and leads to multiple chronic conditions in older adults. Understanding factors contributing to low PA may help develop effective and sustainable PA interventions and promote health in older adults. Depressive symptoms and poor sleep quality have been linked with low PA in older adults. Depression can lead to sleep disturbances. In this study, we tested the association between depression and physical activity in community-dwelling older adults and the possible mediating role of sleep quality in the association.

Methods

We used baseline data collected from an ongoing randomized clinical trial that aims to improve cognitive health in community-dwelling older adults. Participants’ depressive symptoms and level of PA were assessed using the Geriatric Depression Scale Short Form (GDS) and Physical Activity Scale for the Elderly (PASE). Sleep quality and insomnia symptoms were measured by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), respectively. Multiple regression models were used to test the associations between the variables. Baron and Kenny’s approach and the Sobel test were used to examine the mediation effects of participants’ self-reported sleep quality and insomnia symptoms on the association of depression and PA.

Results

The study sample (n=143) had a mean age of 70 years (SD=6), most were female (n=117, 82%), White (n=77, 54%), and had multiple comorbidities (n=98, 69%). After adjusting for covariates (age, sex, education, income, race, and Body Mass Index [BMI]), higher GDS score was associated with lower PASE (β=-3.58, 95% Confidence Interval [CI]: -7.08, -0.79). Mediation analyses showed that both sleep quality (indirect effect: B=-1.98, CI: -3.80, -0.15) and insomnia symptoms (indirect effect: B=-1.97, CI: -3.94, 0.00) significantly mediated the relationship between depression and PA.

Conclusion

Depressive symptoms were associated with reduced PA among older adults. Self-reported sleep significantly mediated this association. Older adults with more depressive symptoms had worse sleep quality and more insomnia symptoms, which were associated with decreased PA. Our findings suggest we pay more attention to sleep health in older adults, and people with depression may benefit from sleep-focused interventions to promote PA and health.

Support (if any)

R00NR016484
0745 Sleep Characteristics and Cardiovascular Disease Risk Among Midlife Thai Women
Authors: Srimoragot Manassawee , Reutrakul Sirimon , Hershberger Patricia , Park Chang , Quinn Lauretta , Balserak Bilgay
Published: May 2023

Introduction

Sleep disturbances (i.e. poor sleep quality, low sleep efficiency, and Obstructive Sleep Apnea (OSA)) are common during menopausal transition and menopause. These disturbances are associated with increased risk of cardiovascular disease (CVD), obesity, hypertension, and diabetes. However, the association of sleep disturbances and CVD risk among midlife Thai women, living in the US, have not been fully explored. Thus, this study examined the association between sleep characteristics and CVD risk in those women.

Methods

In this cross-sectional study, 120 midlife Thai women completed the Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire, and Menopause Rating Scale. The main outcome, 10-year risk of CVD, was determined using the BMI-based Framingham Risk Score (FRS). Descriptive, bivariate, robust regression, and Structural Equation Model (SEM) analysis for mediation model were performed using STATA 15.1.

Results

Among participants, their mean age was 51.53 years (SD=7.73), length of stay in the USA was 21.77 years (SD=12.96) and CVD risk score was 6.56 % (SD=5.74). Twenty participants (17%) were at high risk of CVD. The mean subjective sleep quality measured by PSQI was 4.18 (SD=3.03). The majority of participants were good sleepers (n=97, 80.83%). The mean sleep efficiency was 95.36% (SD=5.96). A small portion of the participants had a high risk of OSA as assessed by Berlin questionnaire (n=17, 14.17%). Among sleep characteristics, only the increased risk of OSA was significantly associated with higher CVD risk (B=4.601, p< 0.001).

Conclusion

The findings of this study indicated that an increased risk of OSA is associated with the risk of CVD among midlife women. Sleep duration, sleep quality, or sleep efficiency neither mediated nor moderated CVD risk. Future studies should use objective measures of sleep, such as actigraphy, to better elucidate the effects of sleep parameters on cardiovascular risk.

Support (if any)
0746 Designing Realistic Management of Insomnia in Teens (DREAM-IT): Perspectives on CBT-I from Teens, Parents, and Providers
Authors: McQuillan Maureen , Meltzer Lisa , Khan Shajna , Honaker Sarah
Published: May 2023

Introduction

Cognitive Behavioral Therapy for Insomnia (CBT-I) has been established as effective for adults, but less research has been done on its appropriateness for teens. Using a patient-centered approach, we aimed to elicit perspectives on the acceptability and feasibility of CBT-I for teens.

Methods

Teens and parents were recruited via social media, and behavioral sleep medicine providers were recruited via listservs. Focus groups discussed utility, barriers, parent involvement, and potential adaptations for each CBT-I component. We conducted 10 teen focus groups (N = 76, 51% female, 21% male, 28% non-binary; 55% White), 6 parent groups (N = 51, 55% female, 43% male, and 2% non- binary, 47% White), and 2 provider groups (N = 18, 78% female, 17% male, 5% non-binary, 83% White). Providers were predominantly psychologists (78%) and were in practice for M = 9.9 years, SD = 8.09.

Results

Over 60% of teens were “not at all likely” to follow the stimulus control guideline of only using their bed for sleep; a notable barrier included lack of access to other spaces in the home. However, 65% of teens reported willingness to practice sleep restriction, with the adaptation of a two-hour later weekend wake time. Parents were very willing to enforce and/or implement recommendations with their teens, but most teens wanted little or no parent involvement. Providers reported only using sleep logs with teens either “not at all” (14%), “occasionally” (57%), or “half the time” (29%). Similarly, 72% of providers stated that they only discuss cognitive restructuring with teens either “occasionally” or “half the time”. For sleep restriction, most providers (83%) supported taking a more naturalistic, flexible approach. Across stakeholders, limiting screens after bedtime was considered more feasible than before bedtime, and distraction (e.g., listening to audio) was preferred over formal relaxation techniques.

Conclusion

Stakeholder perspectives highlighted the need to adapt CBT-I components for teens, and identified adaptations that were acceptable for teens, and already utilized by providers. Additional focus groups will further assess the acceptability and feasibility of adaptations prior to implementation in an RCT.

Support (if any)

Grant #: 249-SR-21 from the American Academy of Sleep Medicine Foundation.
0749 Adolescents’ Self-Reported Insomnia, Subjective Experiences And Objective Sleep Measures During The COVID-19 Pandemic
Authors: Gruber Reut , Somerville Gail , Saha Sujata , Gauthier-Gagne Gabrielle , Little Charlotte
Published: May 2023

Introduction

Studies examining adolescents’ sleep during the COVID-19 pandemic yielded inconsistent results, with some studies finding a significant increase in insomnia symptoms but others finding no change. A majority of these studies used retrospective or concurrent reports of insomnia symptoms and did not include objective sleep measures, making it impossible to know the extent to which the reported symptoms were associated with actual sleep patterns. In addition, these studies did not account for factors that might have biased adolescents’ subjective reporting of insomnia such as negative emotions or high levels of pre-bedtime cognitive arousal. The goal of the present study was to examine the associations of self-reported symptoms of insomnia among typically developing adolescents with their emotional experiences, cognitive arousal at bedtime, and objective sleep measures during the COVID-19 pandemic.

Methods

Participants. Seventy-six adolescents (33 female, M(SD) age = 13.74(0.87) years). Procedure. Each participant’s sleep pattern was assessed in the home environment using actigraphy and a sleep log for seven consecutive nights in 2021. Adolescents provided information regarding their experiences during the COVID-19 pandemic using the COVID-19 Adolescent Symptom & Psychological Experience (CASPE) questionnaire; information regarding their arousal at bedtime using the Pre-Sleep Arousal Scale and information regarding the insomnia symptoms using the Insomnia Severity Index.

Results

Principal-component analysis produced a three-factor solution for the CASPE labeled as Negative-Anxious, Negative-Angry and Positive Emotions. Hierarchical regression analysis was conducted to examine the cross-sectional associations among adolescents’ emotional responses and subjective and objective sleep measures during the COVID-19 pandemic. Being a girl, reporting high level of pre-bedtime cognitive arousal and high Negative-Anxious emotions accounted the explained variance in adolescents’ self-reported insomnia symptoms. Actigraphy measured sleep efficiency, latency or duration did not increase significantly the explained variance.

Conclusion

These findings suggest that documentation of adolescents’ insomnia during the COVID-19 pandemic might have captured adolescents’ negative emotions rather than their objective sleep patterns. Limitations The cross-sectional design of this study limits the ability to determine causality.

Support (if any)

CIHR, SSHRC
0754 Sleep Ecology in Low-Income Mexican American Toddlers
Authors: Meltzer Lisa , Martinez Suzanna , Tschann Jeanne , Tietbohl Caroline , Jimenez-Zambrano Andrea , Reedy Julia , Valdes Estefania Miramontes , Thompson Darcy
Published: May 2023

Introduction

Healthy sleep is critical for child development, yet disparities exist, with Latino children disproportionately affected by deficient sleep. Most of what is known about sleep ecology and interventions to improve sleep in young children is based on studies of primarily White, non-Latino, and economically-advantaged families. To ensure the effectiveness of interventions, it is important to understand the contribution of socioecological factors on sleep among toddlers in low-income Mexican American families.

Methods

This study employed in-depth interviews with a purposeful sample of low-income Mexican American Spanish-speaking (n=10) and English-speaking mothers (n=10) of toddlers (18-34 months old). Interviews focused on daily sleep routines, perceptions of toddler sleep behaviors, and environmental contributors. Transcripts were coded by two investigators and analyzed using a content analytic approach.

Results

For sleep-related parenting practices, 70% of mothers reported late child bedtimes (≥9:00 pm), 75% reported room/bed sharing, and almost a third of children fell asleep at bedtime with a bottle or cup. Maternal beliefs about child sleep included concerns that child crying during the night might disturb neighbors or wake siblings, and child sleep quality improved when the child is not hungry. Contextual factors impacting sleep included schedules, neighbors, and siblings. Specifically, later weekday bedtimes were attributed to maternal (but not paternal) work schedules, while wake times were often a result of a sibling’s school schedule. Weekend bedtimes were commonly reported to be delayed for toddlers due to families watching movies. Noisy neighbors, in particular upstairs neighbors, were identified as disrupting children’s sleep. Siblings were identified as both facilitating sleep (e.g., helping with routines) and disrupting sleep (e.g., distracting child at nap time).

Conclusion

Findings provide insights on socioecological factors and parental beliefs about sleep ecology in low-income Mexican American toddlers that have implications for the design of interventions to improve child sleep. For example, commonly used behavioral sleep interventions have children sleeping in their own room, or require some crying during the night. However, these approaches may not be a good fit or feasible for this population. To address sleep health disparities, further work is needed to understand socioecological factors that require inclusive adaptations to pediatric sleep interventions.

Support (if any)

R01HL163859
0757 Associations between Objective Sleep Health and Cardiovascular Health in Adolescents with Type 1 Diabetes
Authors: Holtman Sydney , Cooper Emily , Brinton John , Dobbin Mia , Cree-Green Melanie , Snell-Bergeon Janet , Nadeau Kristen , Simon Stacey L
Published: May 2023

Introduction

Adolescents with type 1 diabetes (T1D) are at risk for early-onset cardiovascular disease due to increased arterial stiffness, decreased endothelial function, and early-stage hypertension compared to healthy peers. Poor sleep health has been associated with greater glycemic variability, increased insulin resistance, and poorer cardiovascular health; however, the relationship between sleep and vascular health has not been studied in adolescents with T1D. The aim of this study was to evaluate associations between objectively measured sleep and cardiovascular health in this population. We hypothesized that better sleep health would correlate with better cardiovascular health.

Methods

Twenty-four adolescents with T1D completed the study during the academic year. Sleep was monitored for one week at home with actigraphy. Watchpat-assessed apnea hypopnea index (AHI) and vascular measures were obtained during an overnight study visit. EndoPAT estimated reactive hyperemia index (RHI) and augmentation index (AI). Dynapulse measured systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP), heart rate (HR), pulse wave velocity (PWV), and brachial distensibility and resistance (BrachD, BrachR). Correlations between sleep and vascular measures were examined.

Results

Participants were an average age of 15.5±1.1 years (54.2% female, 83.3% White non-Hispanic, BMI 58.8 ±25.8%ile, HbA1c 7.5±1.2%). Average school night (weekday) sleep duration was 6.7±0.8 hours and average sleep efficiency (SE) was 82.8±6.9%. The majority (87.5%) of participants slept less than the clinical recommendation of 8-10 hours per night. Worse actigraphy-estimated SE was associated with higher DBP (r=-0.52, p=0.02; mean= 59.2±6.7mmHg) and MAP (r=-0.46, p=0.04; mean= 79.5±7.5mmHg). Higher AHI was associated with higher BrachR (r=0.81, p< 0.001). No significant associations were identified between sleep variables and RHI, AI, HR, PWV, or BrachD (all p>0.05).

Conclusion

Poorer SE and higher AHI were associated with poorer indicators of vascular health in adolescents with T1D, consistent with prior literature linking poorer sleep health with risk factors for hypertension in adults with T1D. Further research is needed to determine if improving sleep can improve cardiovascular comorbidities in adolescents with T1D.

Support (if any)

JDRF 2-SRA-2019-848-S-B; JDRF 2-SRA-2022-1144-M-B; Ludeman Center for Women’s Health Research COVID-19 Relief Supplemental Grant; Colorado Clinical & Translational Research Center Maternal & Child Health Pilot Award; CTSA UL1 TR002535
0759 Multidimensional Sleep Health is Associated with Emotional Well-being in Adolescents
Authors: Nyhuis Casandra , Calhoun Susan , He Fan , Liao Jason , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio
Published: May 2023

Introduction

Multidimensional sleep health (MSH) is a population-based approach to capture the 24-hour experience of sleep by incorporating measures of nighttime sleep and daytime functioning that promote physical and mental well-being. We have updated the existing adolescent MSH model to incorporate objective and subjective sleep measures and, in the present study, examined its utility in identifying associations between MSH and behavioral and emotional well-being.

Methods

We studied 377 adolescents (16.4 ± 2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Using the RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – we derived an MSH composite score based on actigraphy-measured and self-reported sleep data. We examined the associations between MSH and scores on both the adolescent version of the Child Behavior Checklist (CBCL) and on the Pediatric Behavior Scale (PBS). CBCL’s internalizing, externalizing, thought and attention problems scores were self-reported, while similar behavioral and emotional cluster scores on the PBS were parent-reported.

Results

Higher MSH scores were associated with lower thought (r=-0.21, p< 0.001), externalizing (r=-0.18, p< 0.001), attention (r=-0.16, p< 0.01) or internalizing (r=-0.12, p< 0.05) problems. Higher MSH scores were associated with lower scores on the rule-breaking (r=-0.27, p< 0.001) and aggressive (r=-0.21, p< 0.001) externalizing subscales. For the internalizing subscales, higher MSH scores were associated with lower anxious-depressed (r = -0.17, p< 0.01), withdrawn-depressed (r=-0.14, p< 0.01), and somatic complaints (r=-0.12, p< 0.05) scores. Analyses based on parent reports on the more fine-grained PBS cluster scores replicated CBCL’s associations; for example, higher MSH scores were associated with lower depression (r=-0.19, p< 0.01) and inattention (r=-0.12, p< 0.05) as observed by parents.

Conclusion

Optimal sleep health, when considered as a multidimensional construct, is associated with emotional well-being and better behavioral outcomes in adolescents. Our MSH model, derived from objective and subjective sleep metrics, is able to capture similar trends from self-report and parent-report measures of emotion and behavior.

Support (if any)

National Institutes of Health (R01HL136587, UL1TR000127)
0765 Enlarged perivascular spaces in infancy: associations with autism diagnosis, cerebrospinal fluid volume, and later sleep problems
Authors: Garic Dea , McKinstry Robert , Rutsohn Joshua , Slomowitz Rebecca , MacIntyre Leigh , Pandey Juhi , Schultz Robert , St. John Tanya , Estes Annette , Dager Stephen , Botteron Kelly , Hazlett Heather , Styner Martin , Piven Joseph , Shen Mark
Published: May 2023

Introduction

Since the re-discovery of the glymphatic system, there has been an increased interest in perivascular spaces (PVS) and cerebrospinal fluid (CSF) characteristics in relation to sleep. Enlarged PVS (ePVS) are associated with neurological disorders and sleep problems, and excessive extra-axial CSF (EA-CSF) volume is associated with autism spectrum disorder (ASD). However, ePVS has not been studied in infancy in relation to autism, EA-CSF volume, or sleep problems. The objectives of this study, therefore, are to examine whether ePVS is 1) more prevalent in infants who later develop ASD, 2) related to EA-CSF volume, and 3) associated with later sleep problems.

Methods

The study was conducted on a prospective, longitudinal cohort from the Infant Brain Imaging Study (IBIS). Participants underwent neuroimaging at 6-, 12-, and 24-months of age, and parent-reported Children’s Sleep Habits Questionnaires (CSHQ) were collected at a follow-up visit at school age (age range = 7-12 years, M = 10.0). A total of 311 participants were included: 47 infants at high familial likelihood for ASD who were later diagnosed with ASD (HL+), 180 high likelihood infants not diagnosed with ASD (HL-), and 84 low likelihood control infants (LL-). The CSHQ was available on a subset of 109 participants.

Results

Significant group differences in ePVS rates were found at 24 months of age (p=0.041), with 44.7% of the HL+ group having ePVS, compared to 26.7% in the HL- group (p=0.017) and 26.2% in the LL- group (p=0.031). ePVS at 24 months was associated with greater EA-CSF volume from 6-24 months (p=0.002) and greater sleep disturbances at school-age (p=0.006), regardless of ASD diagnosis.

Conclusion

The presence of ePVS during infancy was associated with ASD diagnosis, elevated EA-CSF volume, and more frequent sleep disturbances. Results suggest that infants with ePVS should be monitored for early signs of ASD and potential long-term sleep problems, particularly sleep disturbances. Further examination is needed to establish whether early ePVS is ASD-specific or an indication of early glymphatic system dysfunction that can put infants and children at risk for atypical brain development and later sleep problems.

Support (if any)
0767 INSIGHT Responsive Infant Parenting Intervention and Child Sleep at Age 6 Years
Authors: Hohman Emily , Hernandez Erika , Dadzie Adwoa , Master Lindsay , Anzman-Frasca Stephanie , Savage Jennifer , Buxton Orfeu , Paul Ian
Published: May 2023

Introduction

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers resulted in more responsive bedtime parenting and longer infant sleep duration in the first year after birth. The current analysis evaluates intervention effects on parent-reported sleep behaviors and objectively-measured sleep at child age 6 years.

Methods

Mothers (n=279) were randomized to the RP or control intervention, delivered by nurses at home and clinic visits through child age 2.5 years. Sleep content focused on establishing bedtime routines, age-appropriate bedtimes, and promoting self-soothing at bedtime and after night wakings. At 6 years, children completed wrist actigraphy (Spectrum Plus) for 7 days during the school year. Children with ≥3 valid days were included in analyses (n=162). Mothers (n=173) completed the Children’s Sleep Wake Scale and Children’s Sleep Hygiene Scale. Study group differences for 10 sleep actigraphy variables (M/SD of onset, offset, and midpoint of sleep timing, sleep maintenance efficiency, and total sleep time), as well as survey scores, were examined.

Results

Children (mean age 6.7 years, 96% non-Hispanic White) slept on average 8.8 hours ± 33 minutes per night, with 40% meeting the minimum recommendation of 9 hours. The mean sleep onset time was 9:14 pm ± 50 minutes. There were no significant study group differences in any actigraphy variables. RP mothers reported higher scores for Total Sleep Quality (4.6 ± 0.5 vs. 4.4 ± 0.6, p=0.03), ‘Going to Bed’ subscale (4.3 ± 0.8 vs. 4.0 ± 0.9, p=0.03), which captures child compliance with bedtime, and ‘Reinitiating Sleep’ subscale (4.6 ± 0.9 vs. 4.2 ± 1.1, p=0.005), which captures the child’s ability to go back to sleep on their own after waking. Total Sleep Hygiene score did not differ between groups.

Conclusion

The INSIGHT intervention targeting sleep in infancy was associated with improved parental perception of bedtime stalling and self-soothing behaviors at age 6 years. However, this did not translate into differences in sleep duration, timing, or quality measured by actigraphy. Future research should examine strategies to maintain the impacts of the RP intervention on infant sleep into middle childhood.

Support (if any)

R01DK088244, KL2TR002015
0768 Melatonin use for sleep disturbance in school-aged children and adolescents: An Australian pharmacy perspective
Authors: Lee Samantha , Yeung Kingston , Bin Yu Sun , Cheung Janet
Published: May 2023

Introduction

Melatonin is a widely used pediatric sleep aid. While readily available internationally, regulatory changes in Australia have only recently allowed over-the-counter access for patients aged over 55, triggering renewed public interest in melatonin. However, melatonin access for younger patients with sleep disturbances remains a prescription-only medicine. Furthermore, pharmacist opinions about the use of melatonin in pediatric patients remain unexplored. This study aimed to investigate Australian community pharmacists’ perspectives toward melatonin use in school-aged children and adolescents.

Methods

A qualitative study was conducted in a convenience sample of community pharmacists/interns practicing in metropolitan Sydney. Participants completed an online questionnaire capturing demographic information and practice context. Participants subsequently indicated their interest in participating in an in-depth semi-structured interview. Interviews were guided by a schedule of questions exploring pharmacists’ knowledge, beliefs, and attitudes toward melatonin use in pediatric patients. The interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach to identify emergent themes. Recruitment continued until thematic saturation was reached.

Results

Twenty-four interviews were conducted with pharmacists (n=19) and interns (n=5). Participants were mostly female (67%) with a mean age of 29.8 (range: 22-56) years. Pharmacists managed 25.3 (1-300) sleep-related inquiries per day on average and received direct product requests for melatonin 15.9 (2-100) times per week. Preliminary analyses identified three key themes: Conflicting Opinions on Safety, Product Cost and Formulation Availability, and Gaps in Clinical Education. Pharmacists’ involvement in pediatric melatonin use has largely been within the domains of dispensing or compounding prescriptions. While melatonin was perceived as a “better choice over other sedatives” for children, pharmacists expressed uncertainty about the evidence base concerning long-term use in younger age groups, relying heavily on physicians for prescribing discretion and patient supervision. The need for affordable proprietary products with flexible dosing options and targeted education around melatonin and circadian sleep health was also expressed by participants.

Conclusion

Findings allude to the need for greater availability and accessibility of pediatric-specific melatonin formulations, as well as refinement of clinical education resources that specifically address the use of melatonin among school-aged children and adolescents.

Support (if any)
0769 Multidimensional Sleep Health in Adolescents from the General Population: Definition, Thresholds and Construct Validity
Authors: Nyhuis Casandra , Ell Johanna , Calhoun Susan , He Fan , Liao Jason , Spiegelhalder Kai , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio
Published: May 2023

Introduction

The RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measures.

Methods

We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Each MSH domain was categorized as “good” or “poor” using cut-offs informed by prior studies and expert consensus. Good cut-offs, assigned a score of 1, that were derived from actigraphy-measured data included: the standard deviation of sleep midpoint ≤1-h (RU), mean of sleep midpoint 2:00-4:00 (T), mean value of sleep efficiency ≥85% (E), and mean total sleep time ≥7.5-h (D). Good cut-offs derived from self-reported rating scales included the absence of insomnia symptoms (S) or excessive daytime sleepiness (A). Values considered poor based on these cut-offs were assigned a score of 0. Scores were summed across all domains to obtain a composite score ranging from 0 to 6, with higher scores indicating better MSH. Morningness and Tanner staging were self-reported, while Sleep and Arousal clusters scores on the Pediatric Behavior Scale were parent-reported.

Results

The mean composite score was 3.03 ± 1.30 and domains A and D were most commonly rated as poor (64.5% and 65.3%, respectively). Younger age (r=-0.13, p< 0.05) and identifying as non-Hispanic white (r=-0.14, p< 0.01) were significantly associated with higher MSH scores, while sex (r=-0.04, p=0.40), Tanner staging (r=-0.06, p=0.29) or BMI percentile (r=-0.07, p=0.15) were not. Greater morningness (r=-0.29, p< 0.01), less disturbed sleep (r=-0.28, p< 0.01) and higher arousal (r=-0.21, p< 0.01) scores were associated with higher MSH scores.

Conclusion

Our data-driven approach can be used to assess MSH in the adolescent population. Our definition captures previously identified health disparities in MSH in adults and shows optimal construct validity against self-reports of circadian preference and parent observations of adolescents’ degree of sleep disturbance and arousal. Improving sleep duration and daytime alertness appear to continue to be the most relevant domains impacting overall MSH in adolescents.

Support (if any)

NIH (R01HL136587,UL1TR000127)
0771 An Innovative Intervention on Parental Sleep Beliefs and Practices: Its Effects on Children's Short-Term Sleep
Authors: Pétrin Rachel , Bérubé Annie , Pennestri Marie-Hélène , Touchette Evelyne , Forest Geneviève
Published: May 2023

Introduction

Inadequate parental sleep beliefs and practices have been associated with the development and maintenance of sleep difficulties in children. Disrupted sleep at a young age leads to adverse child outcomes and affects parents' sleep and family functioning. Our goal was to evaluate the effects of improved parental sleep beliefs and practices on child and parent sleep in the short term. Hence, we designed an innovative intervention for developing parenting skills in children's sleep management.

Methods

15 caregiver-child dyads with preschool-age children were recruited through daycare centers and placed in small groups for a two-hour intervention and a follow-up. Children's and parents' sleep were respectively measured using the Children’s Sleep Habits Questionnaire (CSHQ) and the Pittsburgh Sleep Quality Index (PSQI). Parental beliefs were assessed by three subscales (Setting Limits, Anger, Doubt) of the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ). Parental practices were measured by two factors (Sleep Conflict, Sleep Dependence) of the Parent-Child Sleep Interactions Scale (PSIS). Data were collected before the intervention and two weeks later. Paired-sample t-tests were used to measure changes in each variable.

Results

Significant improvements were observed in scores on CSHQ subscales measuring Bedtime Resistance (t(14)=3.15, p=.004; M=11.3 vs M=9.47), Sleep Onset Delay (t(14)=3.21, p=.003; M=2.40 vs M=1.67), Parasomnias (t(14)=2.35, p=.017; M=10.9 vs M=9.87), and Daytime Sleepiness (t(14)=2.90, p=.006; M=13.0 vs M=11.3). Accordingly, total CSHQ scores were significantly lower (t(14)=4.70, p<.001; M= 55.7 vs M=49.5) reflecting less sleep disturbance in children. Parents' sleep was of superior quality, with global PSQI scores marginally decreased (t(14)=1.75, p=.051; M=6.93 vs M=6.20). Lower Sleep Conflict scores (t(14)=3.44, p=.002; M=7.67 vs M=4.8) and total PSIS scores (t(14)=3.59, p=.001; M=13.3 vs M=9.00) indicated better parental sleep practices.

Conclusion

These preliminary results show that parental interventions on children’s sleep management can improve child sleep and parental sleep practices. These results also highlight that parental practices about their child’s sleep can change independently of their beliefs. Long-term measures will help verify the course of changes in parents' sleep and beliefs regarding their child’s sleep.

Support (if any)

This project was funded by the Social Sciences and Humanities Research Council of Canada (SSHRC).
0773 Behavioral sleep characteristics may differ in toddlers with epilepsy compared to children without epilepsy
Authors: Gupta Gita , Saylam Ezgi , Patel Anup , Dang Louis , O'Brien Louise , Ibadat Shewar , Sturza Julie , Neff Katherine , Shellhaas Renée
Published: May 2023

Introduction

Sleep is cited as a prominent concern by many caregivers of children with epilepsy. Few studies have examined this issue systematically.

Methods

Caregivers of 11 toddlers (12-36 months old) were recruited from two academic Pediatric Neurology clinics and responses were compared to children without epilepsy (n=343). Caregivers responded to a novel questionnaire being developed for infants and toddlers. Two domains were analyzed (Caregiver/Child Behavior and Comfort Object/Bedtime Routine). The domain score equaled the sum of the scores for each item divided by the number of items answered. Items in the Caregiver/Child Behavior domain were: 1.“My child’s total sleep time and sleep routine are problematic for me”; 2.“I am frustrated by my child’s sleep problem”; 3.“I worry about my child’s health due to their sleep problem”; 4.“My child wakes up shortly after they have fallen asleep”; 5.“My child wakes up distressed in the middle of the night”; 6.“My child’s sleep is restless”; 7.“My child does not seem well rested during the day”; 8.“My child requires a parent/caregiver's presence to fall asleep (e.g. in the room, in the bed)”; 9.“My child moves their legs in a cycling pattern, or kicks and moves their legs excessively in the middle of the night”. Items in the Comfort Object/Bedtime Routine domain were: 1. My child requires a parent/caregiver's presence to fall asleep (e.g., in the room, in the bed)”; and 2.“My child requires the presence additional comfort measures (e.g., aromatherapy, noise machine, weighted blanket, music) to fall asleep”.

Results

The Caregiver/Child Behavior score was higher (worse) in toddlers with epilepsy (3.40; SD 0.72) compared with controls (1.94; SD 0.93) p< 0.0001. Yet, toddlers with epilepsy had lower (better) scores in the Comfort Object/Bedtime Routine domain (2.23; SD 1.25) compared with controls (3.20; SD 1.25) p=0.01.

Conclusion

Sleep behavior is complex in toddlers with epilepsy and can lead to parental frustration and worry in comparison to toddlers without epilepsy. Further investigation into this relationship could provide opportunities for effective interventions to improve sleep and quality of life for children with epilepsy.

Support (if any)

NIH2T32HL110952-06
0775 Differences in subjective sleep measures in mothers and fathers of premature infants: A preliminary study
Authors: Socarras Laura Ramos , Lebel Valérie , Forest Geneviève
Published: May 2023

Introduction

It has been documented that newborn’s sleep is strongly associated with maternal and paternal sleep. However, mothers seem to be more affected by their infant’s sleep than fathers. These associations are not well known in families of premature newborns yet. This was the objective of the present study.

Methods

30 families of premature newborns (mothers, fathers and infants) participated in this study one month after discharge from the hospital. Parents completed, among other measures, sleep diaries during three consecutive weekdays for themselves and their child. Multiple linear regression analyses were computed to examine the association between sleep duration and nocturnal awakenings of the premature infant and their mothers’ and fathers’ sleep duration and number of awakenings during the night. Analyses were done separately for mothers and fathers.

Results

Regression models for parents’ sleep duration were significant and explained 31.7% of the variance in mothers’ sleep duration (p=.009) and 30.8% of the variance in fathers’ sleep duration (p=.01). Infants’ sleep duration was the only significant predictor in both models (□=.663, p=.005 and □=.670, p=.005, respectively for mothers and fathers). Thus, shorter sleep duration in premature infants predicted shorter sleep duration in mothers and fathers. Analyses of parents’ nocturnal awakenings showed that the model was significant for mothers (p<.001), but not for fathers (p=.372). The variables explained 73.4% of the variance in mothers’ awakenings, and infants’ nocturnal awakenings was the only significant predictor (□=.801, p<.001).

Conclusion

Our results suggest that premature infants’ sleep is strongly associated with mothers and fathers’ sleep. In addition, it seems that nocturnal awakenings are particularly associated with the mothers, but not the fathers’ awakenings during the night, which may be related to their involvement in feeding schedules during the night. Future studies should focus on sleep disturbances in families of preterm infants and on interventions targeted for both mothers and fathers that can be implemented to improve sleep in this population.

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