bluuebunny/crossref_metadata_2025_split huggingface dataset:
0885 Reduction in Emergency Department and Inpatient Hospitalization Visits and Length of Stay in a Cohort of Pediatric Patients Initiated on Positive Airway Pressure for Obstructive Sleep Apnea Syndrome
Authors: Xanthopoulos M S , Williamson A A , Tapia I E , Cielo C M , Ku H , Smith J , Matthews E , Beck S E 
Published: May 2020

Abstract

Introduction
Positive Airway Pressure (PAP) is an efficacious treatment of pediatric obstructive sleep apnea syndrome (OSAS). However, it is unknown whether PAP initiation is associated with reduced healthcare utilization, an important metric of care management. We hypothesized that healthcare utilization would be reduced after initiation of PAP in a cohort of pediatric patients prescribed PAP for OSAS.

Methods
Data were extracted from electronic medical records of 475 patients (Mean±SD age at PAP initiation=7.7±5.7 years; 58.7% male; 40.6% White; 38.3% Black; 18.1% multiracial/other; 12.1% Hispanic/Latinx) prescribed PAP for OSAS and followed in our Sleep Center quality improvement program. We extracted the total number of emergency department (ED) visits and hospitalizations and computed the related average length of stay (LOS) in hours for these visits in the 18 months prior to and 18 months following PAP initiation.

Results
Paired samples t-tests showed that number of ED visits and hospitalizations, and the related visit LOS, were significantly reduced following PAP initiation. The average number of visits reduced from 2.20 pre-PAP to 1.77 post-PAP initiation [t(474) = 3.48, p&lt;.001, effect size = 0.16], while average LOS reduced from 185.14 hours pre-PAP to 42.94 hours post-PAP initiation [t(474) = 4.81, p&lt;.001, effect size = 0.29]. Findings for the significant reduction in LOS held after adjusting for the number of pre and post-PAP ED visits and hospitalizations, average pre-PAP LOS, and patient demographics (age at the time of initiation; sex; race/ethnicity) using multiple linear regression.

Conclusion
PAP initiation was associated with fewer and shorter ED visits and hospitalizations in a large sample of pediatric patients. We speculate that PAP initiation could help reduce morbidity associated with pediatric OSAS, as well as improve healthcare utilization, capacity management and care in this population.

Support
K23HD094905 and Sleep Research Foundation (AAW)
0893 Myofunctional Therapy in Children With Mild Obstructive Sleep Apnea: A Meta-Analysis
Authors: Bandyopadhyay A , Kaneshiro K N , Camacho M 
Published: May 2020

Abstract

Introduction
OSA affects 2-4% of children and untreated OSA can have adverse behavior and quality of life outcomes. 40% of children can have residual obstructive sleep apnea (OSA)despite first line treatment (adenotonsillectomy). Alternative modalities of treatment for OSA are limited. Myofunctional therapy comprises of exercises targeting upper airway muscles that can improve facial growth and have been shown to treat OSA in adults. There is paucity of data on the role of myofunctional therapy (MT) in children. The objective of this study was to systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for OSA in children and to perform a meta-analysis on the polysomnographic and mouth breathing data.

Methods
Medline, Embase, CINAHL, Scopus, Web of Science and Cochrane were searched from inception through October 1st, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.

Results
Eight studies (91 patients) reported polysomnography and/or mouth breathing outcomes. The pre- and post-MT apnea hypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 3.75± 3.14/h to 2.08 ± 2.48/h, mean difference (MD) -1.6 [95% confidence interval (CI) -2.42, -0.78], P =0.0001. Mean oxygen saturations improved from 96.03 ± 1.1% to 96.67 ± 0.95%, MD 0.42 (95% CI 0.21, 0.63), P &lt;0.0001. Lowest oxygen saturations improved from 86.6 ± 7.3% to 90.94 ± 3.05%, MD 1.01 (95% CI 0.25, 1.77), P = 0.009. Mouth breathing decreased in all three studies reporting subjective outcomes.

Conclusion
Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 45% in children with mild obstructive sleep apnea. Mean oxygen saturations, lowest oxygen saturations and mouth breathing outcomes improved in children. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.

Support
None
0898 The Accuracy Of Split-night Study In Assessing Obstructive Sleep Apnea (OSA) In Children And Adolescents
Authors: Bedoya M , Chini B , Armoni-Domany K , Boh M , Huang G , Md Hossain M , Simakajornboon N 
Published: May 2020

Abstract

Introduction
Split-night polysomnography (PSG) can be used for the diagnosis of OSA, if clinically appropriate, per AASM recommendation based on adult data. However, there are limited data in pediatric population. The aim of our study is to assess the accuracy of split-night-PSG compared with a full-night-PSG in children with OSA.

Methods
A retrospective review was performed in children and adolescents who were diagnosed with OSA during a diagnostic PSG (oAHI &gt;1). Sleep and respiratory parameters from the full-night-PSG(F) were compared with the first three hours of the same PSG(S). Subgroup analysis was performed for age and OSA severity. The results were reported as mean±SD. All variables were compared with paired T-test.

Results
226 met the criteria for entry into analysis. The mean age was 7.8y±5.8. For the whole cohort, there were no significant differences in the mean AHI and oAHI [7.3±11.7(F)vs6.9±13.9(S),p=0.26] between full-night and split-night studies. Subgroup analysis revealed that children aged 2-12 yo (n=120) had significant differences in the mean AHI [6.1±7.1(F)vs4.8±6.4(S)p=0.002] and the mean oAHI [4.8±5.6(F)vs3.9±5.4(S)p=0.03]. In addition, subgroup analysis of mild OSA (n=137) showed a significant difference in the mean AHI (p=0.006), but not in the mean oAHI (p=0.08). There were no significant differences in the mean AHI and oAHI in the moderate to severe OSA group. Based on the first 3 hours of PSG, 16.8%(n=38) of patients were inaccurately classified to have no OSA, while the severity was misclassified in 37.6%(n=85) of patients (underestimated in 30%(n=68) and overestimated in 7.5%(n=17)).

Conclusion
Although there were no differences in the mean AHI and oAHI, split-night-PSG misclassified diagnosis and severity in a significant proportion of our pediatric cohort. In addition, the accuracy of split-night-PSG is influenced by age and severity of OSA. Further studies are needed to identify factors that play a role in these differences.

Support
Cincinnati Children’s Hospital, Children’s Foundation
0905 Obstructive Sleep Apnea In Pediatric Patients With Early Onset Scoliosis
Authors: Panek D , MacKintosh E , DelRosso L , Ruth C , White K , Redding G 
Published: May 2020

Abstract

Introduction
Early onset scoliosis (EOS), defined as curvature of the spine &gt;10 degrees with onset before 10 years of age, is associated with increased rates of restrictive lung disease, pain, and other factors that increase risk of poor sleep. We compared the polysomnographic findings of children with EOS to those of children without EOS. We postulated that children with EOS would have a higher rate of OSA than patients without EOS, and differences in sleep stage distribution, arousals, and limb movements.

Methods
Single-center retrospective chart review performed on 58 subjects with EOS (ages 1-17yr) who underwent PSG from 2003-2019; comparison group of 58 subjects without scoliosis who underwent diagnostic PSG was chosen consecutively (ages 1-18yr). Polysomnographic parameters compared include: sleep stage distribution, arousal index (AI), obstructive/central AHI, mean and nadir oxygen saturation in REM/NREM, and periodic leg movement index. All p-values were adjusted for multiple comparisons.

Results
There was no difference in age or sex distribution between the two groups, though subjects with EOS had lower BMI than those without EOS (median 16.3 (IQR 14.7-19.3) vs. 17.5 (IQR 16.2-21.6), p=0.019). 84% of subjects with EOS had OSA, compared to 66% without EOS. Subjects with EOS and OSA had higher obstructive AHI than the OSA group without EOS, and longer duration of hypopneas. There was no significant difference in sleep stage distribution, AI, or PLMI.

Conclusion
Of pediatric patients referred for polysomnography at our institution, those with EOS had a higher rate of OSA, more severe OSA where present, and lower BMI. We advocate for routine polysomnography for children with EOS due to the high risk of OSA amongst those tested, and further study to better understand the pathophysiology of sleep disordered breathing in this population.

Support
This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services under grant #T72MC00007/University of Washington Pediatric Pulmonary Center/PI: Redding. The content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
0906 Identification Of Physical Exam Findings With High Predictive Value For Moderate To Severe Pediatric Obstructive Sleep Apnea(osa) In Overweight/obese Children
Authors: Ajisebutu A , Kak I , Thompson N , Honomichl R , Moul D , Mehra R , Shah V 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea(OSA) is highly prevalent and under-diagnosed in the overweight/obese pediatric population largely due to limitations of existing pediatric OSA screening instruments including lack of efficiency and practical implementation and lack of careful consideration of physical examination(PE) findings with high predictive value for OSA. We sought to identify PE finding(s) predictive of pediatric OSA in overweight/obese patients to inform development of an OSA screening tool.

Methods
Overweight/obese patients presenting to the Cleveland Clinic weight-management clinic between 2013-2018 with polysomnogram (PSG) data were included. The association of PE predictors: age, sex, race (white, black, other), neck (NC), waist circumference (WC), tonsil size (TS), height, systolic and diastolic blood pressure (BP) percentiles) in relation to OSA defined by apnea-hypopnea index (AHI)≥5,i.e. clinically significant pediatric OSA, were assessed using univariate and multivariate logistic regression models (OR,95%CI).

Results
Retrospective analysis of 180 overweight/obese patients (BMI percentile&gt;85th for age and sex) and age 12.5±3.7 years were included. The multivariate model showed that only WC was significantly associated (1.03, 1.00 - 1.07, p=0.038) with OSA defined as AHI≥5. A statistically significant interaction of age and sex was observed such that the likelihood of OSA increased in males with older age and conversely decreased in females with older age. (1.26,1.04 -1.52, p=0.038) The reduced multivariate model, which included age, sex, WC, and age*sex interaction term, correctly discriminated AHI &lt;5 vs. ≥ 5 66.5% of the time.

Conclusion
In this large clinic-based overweight/obese pediatric sample, males, older age and WC were significant predictors of OSA and TS was not. A significant interaction of age and sex was observed supporting increased OSA with increasing age in males. Data generated supports value of PE findings of age, sex and WC to incorporate in development of an OSA screening tool for overweight/obese children.

Support
0935 Association Between Chronotype, Sleep Duration, Weekend Catch-Up Sleep, and Depression Among Korean High School Students
Authors: Yang K , Jee Hyun K , Hwangbo Y , Koo D , Kim D , Sunwoo J , Hong S 
Published: May 2020

Abstract

Introduction
The present study aimed to examine the association between chronotype, sleep duration, weekend catch-up sleep (CUS) duration, and depression among Korean high school students.

Methods
A total of 8,565 high school students who were analyzed from 15 nationwide districts in South Korea completed an online self-report questionnaire. Depressive mood was assessed using the Korean version of the Beck Depression Inventory. The following sleep characteristics were assessed: weekday and weekend sleep durations, weekend CUS duration, chronotype, perceived sufficiency of sleep, self-reported snoring and sleep apnea, daytime sleepiness, and sleep environment. Age, sex, body mass index, number of private classes, and proneness to internet addiction were also measured. Logistic regression analysis was conducted to compute odds ratios for the association between depression and sleep characteristics, after controlling for relevant covariates.

Results
The prevalence of depression (BDI ≥ 16) was 1,794 (20.9%). In the analyses of multivariate logistic regression, the late chronotype (odds ratio [OR], 1.71; 95% CI, 1.47-1.99), female (OR, 2.24; 95% CI, 1.99-2.53), underweight (OR, 1.27; 95% CI, 1.02-1.57) and obesity (OR, 1.41; 95% CI, 1.13-1.75), weekday sleep duration (OR, 0.86; 95% CI, 0.81-0.91), weekend CUS duration ≥ 2 hours (OR, 0.68; 95% CI, 0.55-0.85), ESS (OR, 1.08; 95% CI, 1.07-1.10), much (OR, 2.15; 95% CI, 1.63-2.84) and insufficient (OR, 1.71; 95% CI, 1.46-2.01) perceived sleep, snoring (OR, 1.27; 95% CI, 1.11-1.46) and witnessed apnea (OR, 2.10; 95% CI, 1.75-2.52), increased internet addiction (OR, 1.06; 95% CI, 1.05-1.06), high number of private education (OR, 0.76; 95% CI, 0.60-0.95), and poor sleep environment (OR, 1.86; 95% CI, 1.56-2.21) were associated with depression.

Conclusion
Eveningness preference, insufficient weekday sleep duration, short weekend CUS duration, and self-reported snoring and sleep apnea were associated with an increased risk for depression.

Support
0936 Cardiometabolic Disorders are Independently Associated with Excessive Daytime Sleepiness in Young Adults
Authors: Fernandez-Mendoza J , Puzino K , Calhoun S L , Qureshi M , He F , Liao J , Vgontzas A N , Liao D , Bixler E O 
Published: May 2020

Abstract

Introduction
Cardiometabolic risk factors (CMR), including obesity, hypertension, diabetes and hypercholesterolemia, have been associated with sleep apnea and insufficient sleep, both of which can lead to excessive daytime sleepiness (EDS). We hypothesized that CMR are associated with EDS in young adults independent of sleep apnea, sleep duration and mental health disorders (MHD).

Methods
The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) and 425 another 7.0 years later during young adulthood (24.4±2.6y). Subjects underwent a 9-h in-lab polysomnography in childhood and adolescence and parent- or self-reported standardized surveys at all time points. Self-reports in young adulthood and in-lab measurements in childhood were used to ascertain CMR and sleep apnea. Parent-reports in childhood and self-reports in young adulthood were used to ascertain the presence of MHD and EDS. Logistic regression models adjusted for age, race, sex, snoring/observed apneas, insomnia symptoms, and sleep duration in young adulthood as well as mean arterial blood pressure, body mass index percentile and apnea/hypopnea index in childhood.

Results
CMR (OR=2.71, 95%CI=1.69-4.36) and MHD (OR=4.61, 95%CI=2.79-7.62) were associated with EDS in univariate models. After adjusting for covariates in childhood and young adulthood, CMR and MHD remained independently associated with EDS (OR=2.32, 95%CI=1.29-4.16 and OR=2.78, 95%CI=1.59-4.87, respectively).

Conclusion
EDS in young adults with CMR or MHD does not solely arise from sleep apnea, insufficient sleep or other sleep disturbances. EDS may be the result of central pathophysiologic mechanisms or the functional impairment associated with cardiovascular, metabolic and mental health disorders. These data further support that youth with these disorders should be screened for EDS and appropriately managed.

Support
National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0937 The Evaluation of Brain Maturation by REM Sleep Analyses During Puberty Using Fast Fourier Transform
Authors: Lopes M , Roizenblatt S 
Published: May 2020

Abstract

Introduction
Brain maturation has been associated with electroencephalogram (EEG) changes during rapid eye movement (REM) sleep. There is a higher delta power during sleep in the first decade of the human EEG and this fact might be related to puberty period. Most studies assessed EEG during wakefulness and NREM sleep. The aim of this study was to evaluate changes in the REM sleep EEG spectral analysis across puberty.

Methods
Twenty healthy children were studied. They were divided into two groups: early puberty (n=10, ageranging from 6 to 12) and late puberty (n=10, age= ranging from 13 to 18). Polysomnography was performed in 2 nights, one for adaptation purpose. The Tanner scales were obtained and exclusion criteria were the presence of sleep and daytime complaints at least 14 days before recruitment. Fast Fourier Transform (FFT) was performed in C3-A2 derivation throughout all night. The FFT was calculated in 4s windows and the mean of delta (0.5-2.0 Hz), delta 2 (2.0-4.0 Hz), theta (4.0-8.0 Hz), alpha (8.0 - 12.0 Hz), sigma (12.0-16.0 Hz) and beta (16.0 - 20.0 Hz) were obtained.

Results
We found differences during NREM and REM sleep between two groups (U-test, p&lt;0.05). In REM sleep, the delta 2 (U-test, p=0.02)and theta power were higher in early puberty group (U-test p=0.04). The delta power correlated negatively with the duration in minutes of stage 1 (rs=-0.46 p&lt;0.05), and the wake time after sleep onset (rs=-0.48, p&lt;0.05) and correlated positively with sleep efficiency (rs=0.45, p&lt;0.05). Theta power during REM sleep also correlated positively with N3 sleep stage (rs=0.45, p&lt;0.05).

Conclusion
The REM sleep can be an extremely useful biomarker of brain function for future therapeutic protocols. The present results suggest that there are changes in REM sleep EEG throughout puberty, and that they may be related to puberty brain maturation. The hormone therapy may have an action in the REM behavioral Sleep Disorder. Future studies are need to evaluate this hypothesis.

Support
N/A
0947 Parent-Perceived Sleep Problems and Sleep Goals in Infants and Toddlers: A Global Sample
Authors: Mindell J A , Goh D , Collins M , Bartle A , Kohyama J , Sekartini R , Veeravigrom M , Leichman E S 
Published: May 2020

Abstract

Introduction
The aim of this study was to assess parent perceptions of sleep problems in young children and parent-identified areas of change in a global sample.

Methods
Caregivers (95.6% mothers) of 1555 infants/toddlers (birth-37 mos; M=12.2 mos; 49.5% male) completed an online survey, representing Indonesia (n=187), Japan (n=718), New Zealand (n=231), Singapore (n=199), and Thailand (n=221). The survey included an abbreviated version of the Brief Infant Sleep Questionnaire, and a list of potential sleep-related areas of change.

Results
36.9% reported a perceived sleep-problem, whereas 92.9% indicated an area of desired change related to their child’s sleep. In terms of areas of change, 82.5% endorsed bedtime/how child falls asleep, 70.0% nighttime sleep, and 57.8% related to the morning. As expected, 99.7% of parents who endorsed a problem indicated a desired change compared to 88.9% who did not perceive a problem, p &lt; .001. Those who noted a problem were more likely to endorse a change at bedtime (92.5%) and during the night (90.1%), compared to the morning (68.8%). There were country-based differences, with caregivers in New Zealand (47.0%) and Singapore (44.2%) more likely to report a child sleep problem compared to Thailand (35.3%), Japan (34.1%) and Indonesia (29.4%), p &lt; .001. No differences were noted in parent-report of desired change across Japan, New Zealand, Singapore, and Thailand (94-96%) but were significantly higher than Indonesia (83.4%).

Conclusion
Although one-third of parents of young children in a global sample indicate a perceived sleep problem, almost all parents wish to change something about their child’s sleep, primarily relate to bedtime and during the night. Sleep education and assessment delivered by health care providers should focus not only on what families consider to be “problematic,” but also what families would like to modify, or improve, about their child’s sleep within a developmentally appropriate framework.

Support
Johnson & Johnson Consumer Inc., Skillman, NJ, USA.
0959 Associations Between Sleep and Academic Performance in Typically Developing Adolescent Girls
Authors: Gruber R , Lin L , Santisteban J , Boursier J , Somerville G 
Published: May 2020

Abstract

Introduction
Healthy sleep promotes cognitive functioning and is associated with better academic performance, whereas insufficient, poor, and inconsistent sleep schedules are associated with poor school performance. Several studies have identified gender differences in the timing, duration, and quality of sleep in adolescence, with adolescent girls having poorer sleep compared to adolescent boys, yet research shows that girls outperform boys academically. This could be because sleep might not affect all subjects similarly and previous studies regarding sleep and academic performance combined both genders. The goal of the present study was to determine which aspects of academic performance are specifically associated with short or poor sleep in typically developing adolescents girls.

Methods
80 adolescent girls aged 12-17 years participated in the study. Sleep was assessed in the home environment for five consecutive weeknights using actigraphy. Academic performance was assessed using report card grades.

Results
Hierarchical regression analyses adjusted for age, pubertal status, and socioeconomic status revealed that longer average sleep time was significantly associated with higher grades in mathematics. No significant associations were found between sleep variables and grades in other subjects.

Conclusion
Longer average weekday sleep duration is associated with better mathematics grades in typically developing adolescent girls.

Support
NSERC grant to Reut Gruber