bluuebunny/crossref_metadata_2025_split huggingface dataset:
0903 Screening Of Pediatric Obstructive Sleep Apnea Using Video Monitoring
Authors: Ikeda K , Yagi T , Chiba S 
Published: May 2020

Abstract

Introduction
In Japan, the many of the patients are not able to access the specialized sleep medical facilities for overnight polysomnography(PSG) due to less availability and cost issues. Purpose of the study is to examine whether combination of video monitoring and other clinical examinations can reliably predict the severity of pediatric OSA compared with PSG.

Methods
Between April 1, 2012 and March 31, 2019, total of 175 children (3-12 years of age, boy 122, girl 53) with SDB were enrolled in this individual prospective-cohort study. In-laboratory based PSG were performed for all patients and sleep stages and respiratory events were manually scored. Video monitoring was performed during PSG. Modified video-recording test scoring system (based on Sivan et al 1996), were scored by laboratory technicians. Other clinical examinations were extracted from each PSG with ENT examinations, cephalogram, and rhinomanometry for all patient

Results
Multiple linear regression analyses was performed with a forward stepwise approach in which independent predictors that were significantly related to severity of OSA (AHI: 5/hr and 10/hr). Applying the multiple logistic regression analysis, the independent predictors for AHI 5/hr were ODI 3% &gt;3/hr, rhinomanometry (NR&gt;0.5 Pa/cm3/sec), enlargement of tonsils (Brodsky classification more than 2), two video monitoring items and total score, with an accuracy of predictive statistic model was 88.0% (sensitivity 78.3%, and specificity 93.0%). For the severity above AHI 10/hr, the independent predictors were Cephalogram parameter (Fx&gt;84°), Oximetry (ODI 3% &gt;5/hr) and BMI&lt;15 with the video monitoring parameters of whole night inspiratory noise (loud) and chest retraction contribute to predict with the sensitivity 91.5%, the specificity 82.6% and the accuracy 88.0%.

Conclusion
Video monitor scoring parameters contributed to predict both AHI 5/hr and 10/hr with good overall sensitivity, specificity and overall accuracy compare with the combination of objective results alone. Instead of PSG, the combination of video scoring system and multiple clinical examinations could potentially provide reliable diagnostic approach for pediatric OSA with high accuracy. These results will support to establish more efficient diagnostic strategy for both patients and physicians

Support
N/A
0912 Central Sleep Apnea Patterns On Pediatric Polysomnograms
Authors: Rao H S 
Published: May 2020

Abstract

Introduction
Central sleep apneas (CA) are frequently seen on pediatric polysomnograms (PPSG) independently or in conjunction with obstructive sleep apnea (OSA). In the pediatric population, the AASM defines CA as the absence of chest and/or abdominal movement associated with a cessation of airflow of more than 20s or longer than 2 baseline respiratory cycles if associated with an arousal, an awakening or oxygen desaturation ≥ 3%. Scoring CAs on PPSG based on AASM definition can cause confusion among providers as CAs are generally associated with central nervous disorders causing reduced or absent respiratory drive.

Methods
Retrospective review of 71 consecutive diagnostic PPSGs to analyze patterns of CAs scored per AASM definition was performed. None of the children had a disorder causing reduced respiratory drive. Data on age, obstructive AHI (Apnea Hypopnea Index), CO2, Oxygen saturation, Central AHI and diagnosis were collected.

Results
68 of 71 children had varying degree of OSA and CAs. Three main patterns of CAs were observed: occurring in NREM, following sigh breaths or arousals and CAs seen in REM sleep. CO2 and oxygen saturation were in the normal range.

Conclusion
In our study, CAs were more often seen in young children related to reduced functional residual capacity and immaturity of chest wall. CAs in REM sleep was seen more often in children with lung disorders and gastroesophageal reflux. CAs associated with arousals/awakenings were seen in conjunction with OSA or periodic limb movement disorder (PLMD). Though a finding of CAs &gt;5/hour is considered significant, the minimum number of events required to cause a specific disorder or syndrome remains elusive and may be different in different patient populations. As such, there is no threshold of the number of central apneas associated with disease. CAs associated with disorders causing reduced or absent respiratory drive are mostly seen in NREM sleep and associated with abnormal gas exchange. The context in which the CAs are seen on PPSGs should be clearly described to avoid confusion among ordering providers. In CAs associated with arousals/awakenings, it is important to target the cause of arousals such as OSA or PLMD.

Support
None
0918 Quebec Adolescents’ Insomnia Symptoms, Mental Health & Access to Sleep Care
Authors: Gruber R , Somerville G , Finn C , Boursier J 
Published: May 2020

Abstract

Introduction
Our school boards are part of the Quebec Center Of Excellence For Mental Health, and are thus mandated to identify and then prevent/treat factors that could negatively affect the mental health of their students. As part of this mission, we conducted a study that aimed 1) to examine the prevalence of insomnia in typically developing students in Quebec and their associations with students’ mental health, and; 2) to assess student access to behavioral sleep interventions in Quebec.

Methods
145 (Age 15.53+1; 75 Girls, 70 Boys) typically developing students. Insomnia symptoms were measured using the Insomnia Severity Index. Sleep was measured by Actigraphy. The Youth Self Report was used to measure students mental health. Access to care was measured using a detailed questionnaire.

Results
The key findings were: 1) 45% of the students reported poor sleep quality, dysfunction during the day due to sleepiness, difficulty falling or staying asleep, and excessive daytime sleepiness. Total scores on self-reports sleep measures were positively significantly correlated with Actigraphy measures of sleep duration and quality and with each other; 2) Robust positive associations were found between insomnia and psychiatric symptoms after adjusting for common risk factors, including age, socioeconomic status, and gender; 3) None of the students had access to sleep care and 25% of them reported using over-the counter sleep aids with minimal success.

Conclusion
These findings are alarming because they show that: 1) insomnia symptoms are prevalent in Quebec students and are strongly associated with the symptomatology of mental distress in students who do not meet the diagnostic criteria of a psychological disorder, and; 2) these students do not have access to insomnia care. These findings suggest that treatment of insomnia could offer an incredible opportunity to protect and improve the sleep and the mental health of these students.

Support
Canadian Institute of Health Research grant to Reut Gruber
0919 Health Disparities in the Persistence of Childhood Insomnia Symptoms in the Transition to Adolescence: The Penn State Child Cohort
Authors: Bourchtein E , Puzino K , Calhoun S L , Criley C , He F , Vgontzas A N , Liao D , Bixler E O , Fernandez-Mendoza J 
Published: May 2020

Abstract

Introduction
A strong body of cross-sectional evidence indicates that social determinants of health (SDH), such as race, ethnicity, socioeconomic status, and sex/gender, are linked to sleep problems, including insomnia symptoms. Few studies have examined the longitudinal association between SDH and the persistence and remission of insomnia symptoms in the transition between childhood and adolescence, a critical period for sleep health.

Methods
The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y at baseline), of whom 421 were followed up as adolescents (12-23y at follow-up). All subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Childhood insomnia symptoms were defined as a parent- and/or self-report of difficulty falling and/or staying asleep. All subjects or their parents identified the subject’s sex, race, and ethnicity, and reported on socioeconomic status (SES) of the household.

Results
Females (32.7%) and racial/ethnic minorities (25.0%) were associated with a significantly lower remission rate as compared to males (53.3%) and non-Hispanic whites (48.3%), respectively. Non-Hispanic whites of low SES were associated with a significantly lower full remission rate (26.3%) as compared to non-Hispanic whites of higher SES (42.0%), while racial/ethnic minorities were associated with the lowest full remission rates regardless of whether they were of low (9.1%) or higher (11.1%) SES.

Conclusion
Our novel data indicate that gender-, racial/ethnic- and socioeconomic-related disparities in insomnia not only occur as early as childhood but are important determinants of insomnia’s chronic course throughout development.

Support
National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)
0931 Parenting Stress Can Be Predicted by Parent and Child Sleep, and Can Be Reduced by an Intervention Targeting Child Sleep in Vulnerable Families
Authors: Potvin J , Mercier K , Bérubé A , Raymond N , Forest G 
Published: May 2020

Abstract

Introduction
Studies suggest that family intervention programs should consider different sources of parenting stress (PS). Knowing that child sleep has an impact on PS, this study aimed to examine if a child sleep intervention can affect PS in vulnerable families.

Methods
In a first study, parent and child sleep habits along with PS were assessed using Parenting Stress Index-Short Form, Pittsburgh Sleep Quality Index and homemade questions assessing child sleep. Measures were administered to 138 community mothers (children 3-79 months). Multiple linear regression analyses examined mothers and child sleep associations to PS, controlled by family income. Following results of this first study, 11 vulnerable mothers (children 39-68 months) participated in a child sleep intervention specifically developed for vulnerable families. Measures administered were the same as for study 1, but in this study, the Child Sleep Habits Questionnaire was used to assess the child sleep. Wilcoxon’s t-test compared pre and post-intervention measures.

Results
In the first study, sleep onset latency (SOL; β= -.25; p= .003), waketime (β= -.28; p= .003) and sleep aids (β= -.19; p= .048) explained 23.6% of PS variance. When child sleep variables were added to the model, only bedtime resistance was significant (β= -.23; p= .023) and increased the explained variance to 30.6%. Following the child sleep intervention, no significant changes in parent sleep were observed. However, results show improvement of child bedtime resistance (Mpre=10.73; Mpost=8.36; p= .027) and PS (Mpre=3.50; Mpost=3.82; p= .05).

Conclusion
Our results suggest that higher PS is explained by greater struggles in parents sleep (higher SOL, later waketime and higher use of sleep aids) as well as bedtime resistance behaviors in children. Furthermore, PS can be reduced by an intervention improving child bedtime resistance, even if parent sleep is not improved.

Support
0943 Increased Non-REM Sleep Instability in Children with Restless Sleep Disorder
Authors: DelRosso L M , Hartmann S , Baumert M , Bruni O , Ferri R 
Published: May 2020

Abstract

Introduction
Restless sleep disorder (RSD) is a newly recognized condition characterized by motor movements involving large muscle groups with frequent repositioning or bed sheets disruption. We analyzed cyclic alternating pattern (CAP) in these children, a marker of sleep instability that might be associated with the motor episodes of RSD and may play a role in their daytime symptoms.

Methods
Polysomnographic recordings from thirty-eight children who fulfilled RSD diagnostic criteria (23 boys and 15 girls), 23 children with restless legs syndrome (RLS, 18 boys and 5 girls) and 19 controls (10 boys and 9 girls) were included. For CAP analysis, a previously developed, highly precise automated system, based on a deep learning recurrent neural network, was used.

Results
Age and gender were not statistically different between groups. RSD patients showed a lower percentage of A3 CAP subtypes than controls (median 9.8 vs. 18.2, p=0.0089), accompanied by shorter duration of the B phase of the CAP cycle (median 28.2 vs. 29.8 in controls, 30.2 in RLS, p=0.005) and shorter CAP cycle duration than both controls and RLS subjects (median 33.8 vs. 35.0 in controls, 35.8 in RLS, p=0.002). Finally, RSD children also showed a longer duration of CAP cycle sequences, when compared to controls (median 172.7 vs. 141.9, p=0.0063).

Conclusion
In conclusion, our study indicates that NREM sleep EEG shows an increased instability in RSD; these findings add to the current knowledge on the mechanisms of this newly recognized sleep disorder and suggest that sleep instability might be a favoring mechanism for the emergence of the motor episodes characterizing RSD.

Support
Partial support by a grant of the Italian Ministry of Health RC n. 2751598 (R.F.)
0944 Shhh! Initiative: Sleep Health Practices In Pediatric Hospitals
Authors: Benoit K M , Harkins E , Olsen S , Sterni L , Wolfson A R 
Published: May 2020

Abstract

Introduction
Hospitalizations often result in significant sleep disruption, despite the importance of sleep in healing (Cmiel, et al., 2004). Research-to-date has focused primarily on adult intensive care (ICU) with minimal focus on pediatric patients. The aim of this study was to assess pediatric inpatient healthcare providers’ understanding of and attitudes towards sleep in the hospital environment with the goal of developing a sleep health educational intervention as well as modifications to standards of care that unnecessarily interrupt sleep of pediatric inpatients.

Methods
An online survey was administered to pediatric inpatient staff (nurses, physicians, residents) at a Mid-Atlantic children’s hospital focused on assessing their understanding of sleep in the context of inpatient care (N = 316). Respondents were 30-50 years old (54%), primarily identified as female (88%), and most (60%) reported being in a nursing position.

Results
Quantitative findings (N = 316) revealed that 65% reported patients were sometimes, rarely, or never allowed to sleep without being awakened from administration of non-critical medications. A majority (63.8%) reported that sometimes, rarely, or never do they consider interruption of sleep in decisions on when to give medications, while 54.9% reported the quantity and quality of sleep is rarely/never considered in a patient’s treatment. Qualitative responses (N = 248) confirmed these findings with 34.3% reporting that they considered re-scheduling medications to minimize sleep interruptions. Despite this finding, only 15.7% reported they would assess or give attention to sleep in the context of patient recovery and treatment.

Conclusion
Pediatric healthcare providers are aware of the importance of sleep for their patients; however, they are not prioritizing sleep as a part of treatment in their behaviors and decisions. Next steps include developing and implementing an intervention for pediatric healthcare providers to follow through on limiting sleep interruptions as well as focusing on sleep in the treatment process.

Support
N/A
0949 Should Parents and Children Share the Same Bed? A Systematic Review of the Consequences of Bedsharing on Sleep and Child Development
Authors: Morneau A , Vallieres A 
Published: May 2020

Abstract

Introduction
Bedsharing is a common practice worldwide except in Western societies where it is more controversial. The advantages and disadvantages of bedsharing on child health, safety, and development have been widely debated. This study examines the potential consequences of bedsharing on sleep and child development.

Methods
The systematic review was conducted in accordance with PRISMA guidelines and the University librarian advisor. Height electronic data base were searched with no limit on date. To be selected, studies must include only regular practice of bedsharing, have been conducted with children sharing the bed with their parents before the age of three, use an observational design, and present results on sleep quality or duration. The effect of bedsharing was assessed with six outcome measures: sleep quality, sleep duration, attachment quality, autonomy and independence, cognitive skills, as well as emotional and behavioural problems. Due to high heterogeneity in the measures used between studies, a narrative synthesis was done. Studies’ quality was assessed using the Scottish Intercollegiate Guidelines Network framework.

Results
A total of 28 publications were included, 17 of which were cross-sectional and 11 prospective studies. The studies were carried out between 1989 and 2017 in 25 countries. Sample sizes range from 41 to 55,831 participants aged from 6-week to 18-year old. Samples presented an equivalent amount of boys and girls. 16 studies reported data only on sleep, 7 only on child development, and 5 on both. The quality of the studies was considered low and moderate. For sleep, studies have shown a significant increase in the number of nocturnal awakenings among children who share the parental bed. Evidence of an association between bedsharing and other sleep parameters (difficulty falling asleep, resistance to bedtime, and sleep duration) is inconclusive. Regarding child development, only three studies found a positive impact on autonomy, cognitive skills, and anxiety. The absence of significant results in the remaining studies suggests that bedsharing is not a determining factor in child development.

Conclusion
The heterogeneity between studies and the quality of available data prevents definitive conclusions about the effects of regular bedsharing on sleep and child development.

Support
No financial support
0950 Effects of Sodium Oxybate (SXB) on Body Mass Index (BMI) in Pediatric Patients With Narcolepsy
Authors: Dauvilliers Y , Lammers G J , Lecendreux M , Plazzi G , Maski K , Kansagra S , Mignot E , Menno D , Wang Y , Rosen C L 
Published: May 2020

Abstract

Introduction
Obesity is a common comorbidity of pediatric narcolepsy. SXB is a standard of care for cataplexy and excessive daytime sleepiness in narcolepsy. BMI decreases have been observed with SXB treatment. We examined BMI changes by BMI percentile category at study entry in pediatric participants.

Methods
Participants were aged 7-17 years with narcolepsy with cataplexy. SXB-naive participants were titrated to an optimal SXB dose, then entered a 2-week stable-dose period; participants taking SXB at study entry entered a 3-week stable-dose period. After a 2-week, placebo-controlled, double-blind, randomized-withdrawal period, all participants entered an open-label safety period (total study duration: ≤1 year). Weight categories were defined using BMI percentiles at study entry based on growth charts from the Centers for Disease Control. BMI percentile was categorized as: underweight (&lt;5%ile), normal (≥5%ile to &lt;85%ile), overweight (≥85%ile to&lt;95%ile), obese (≥95%ile).

Results
Among SXB-naive participants, median (Q1, Q3) BMI percentile decreased with SXB treatment in participants who were categorized as normal-weight and overweight/obese at baseline (normal-weight, n=16: 76.5 [57.8, 82.4] at baseline, 35.0 [20.5, 62.6] at week 52; overweight/obese, n=35: 97.6 [93.6, 99.1] at baseline, 86.7 [72.5, 97.9] at week 52). Of participants who were normal-weight at baseline, 15/16 remained normal-weight at week 52. Of participants who were overweight at baseline, 9/10 were normal-weight at week 52. Of participants who were obese at baseline, 7/25 were normal-weight, 3/25 were overweight, and 15/25 remained obese at week 52. Among participants taking SXB at study entry, BMI percentile decreased, but to a lesser degree. Decreased weight or weight loss was reported as an adverse event in 13 participants (11 SXB-naive; 1 participant withdrew). Four participants became underweight during the study but returned to normal-weight by study end.

Conclusion
Decreases in BMI percentile and category were observed with SXB treatment in pediatric participants with narcolepsy.

Support
Jazz Pharmaceuticals
0968 Sleep-disordered Breathing In Schaaf-yang Syndrome
Authors: Powell W , Rech M , Schaaf C , Wrede J 
Published: May 2020

Abstract

Introduction
Schaaf-Yang Syndrome (SYS) is a genetic disorder caused by truncating variants in the MAGEL2 gene located in the maternally imprinted, paternally expressed Prader-Willi syndrome (PWS) region at 15q11-13. The SYS phenotype shares features with PWS, a disorder with known high incidence of central and obstructive sleep apnea (OSA). However the spectrum of sleep-disordered breathing in SYS has not been described.

Methods
We performed a retrospective analysis of polysomnograms from 22 of the known 115 patients with molecular diagnosis of SYS. Sleep characteristics including total sleep time, latency, efficiency, % sleep stages, apnea-hypopnea index (AHI), obstructive index, central index, and oxygenation were analyzed for the whole group and by truncation location (c.1996dupC variants [n=11] or other locations [n=11]). Only the initial diagnostic study or initial diagnostic portion of a split-night study was used in analysis (analytic n=21).

Results
We collected 33 sleep study reports from 22 patients, ages 2 months - 18.5 years. Mean analyzed sleep time was 357 minutes (129-589 min) with mean sleep efficiency of 71.45% (45-94%) and sleep latency of 24.8 minutes (0-146 min). The mean apnea-hypopnea index (AHI) was 19.1/hr (0.9 -49/hr) with mean obstructive AHI of 16.3 (0.6-49/hr). Mean central index was 2.8/hr (0-14/hr). 18/21 (86%) were diagnosed with OSA, and 13/21 (62%) with moderate or severe OSA (oAHI &gt;5/hr). Central sleep apnea was diagnosed in 2/21 (9.5%). 15 studies reported periodic limb movement index (PLMI) with mean of 7.8 (0-67/hr) and 4/15 (26%) with PLMI &gt;5. Comparison of genotype groups did not reveal any difference in presence of OSA or severity of OSA.

Conclusion
OSA is frequently identified on polysomnography in patients with SYS. Central sleep apnea is less common, which is in contrast to PWS. The majority of patients with OSA had moderate or severe OSA, and 47% had severe OSA.

Support
N/A