bluuebunny/crossref_metadata_2025_split huggingface dataset:
0900 Obstructive Sleep Apnea Severity, Symptoms Of Attention Deficit Hyperactivity Disorder And Other Comorbid Psychiatric Disorders In Children And Adolescents: A Retrospective Data Analysis
Authors: Skoulos M , Sedky K , Bennett D 
Published: May 2020

Abstract

Introduction
Children and adolescents with obstructive sleep apnea (OSA) are often diagnosed with attention deficit hyperactivity disorder (ADHD). However, the connection between the severity of Apnea/Hypopnea Index (AHI) and ADHD is controversial with research evidence pointing in opposing directions.

Methods
A retrospective study was conducted in a pediatric sleep center at a university hospital setting to investigate the effect between AHI severity, ADHD and/or other comorbid psychiatric disorders. One hundred and thirty-eight participants between the age of 6 and 18 were examined in terms of AHI severity level and their correlation with scores from the Child Behavior Checklist (CBCL) using SPSS program.

Results
A negative correlation between AHI scores and Attention Problems for the entire group of participants was found. Additionally, female adolescents had positive correlations between AHI scores and several affective disorder variables from the CBCL, while male adolescents had negative correlations between AHI levels and several CBCL scores that are typically associated with ADHD and Anxiety disorders.

Conclusion
This study suggests a relationship between OSA severity and psychiatric conditions. However, this relationship can vary depending on age, gender and AHI severity. More research is required to understand this relationship.

Support
Chervin, R.D. How many children with ADHD have sleep apnea or periodic leg movements on polysomnography? Sleep. 2005: 28(9): 1041-1042.
Sedky K, Bennett DS, Carvalho KS. Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: A meta-analysis. Sleep Medicine Reviews. 2014; 18: 349-356
0911 Association Between Chromosomal Abnormality And Sleep Disordered Breathing Characteristics In Children With Prader Willi Syndrome
Authors: Gupta G , Veeravigrom M , Felt B , O’Brien L 
Published: May 2020

Abstract

Introduction
Prader-Willi Syndrome (PWS) is a genetic disorder caused by lack of expression of paternal genes from the chromosomal region 15 q11.2-q13. PWS is associated with excessive daytime sleepiness, sleep-disordered breathing (SDB), hypoventilation and circadian rhythm disturbance. Chromosomal deletion and uniparental disomy (UPD) are the two most common genetic etiologies of PWS. Differences in clinical features between these groups are recognized; however, limited literature exists regarding sleep characteristics.

Methods
The objective was to evaluate sleep characteristics of children with PWS between those with 15q11.2-q13 chromosomal deletion and those with other genetic etiologies. A retrospective chart review of in-laboratory polysomnograms (PSG) in children with PWS prior to growth hormone treatment was performed. The apnea hypopnea index (AHI), REM AHI, NREM AHI, Obstructive Apnea Index (OAI), Central Apnea Index (CAI), hypopnea index, arousal index, presence of hypoventilation, and positional AHI were assessed.

Results
Overall 33 PWS children were identified. Mean age was 5.9 ± 5.19 (range 1-16 years), 57% were male and 85% had SDB. Almost half (42%) had a 15q11.2-q13 chromosomal deletion. Of those without deletion, 30% had UPD. Sleep variables were similar in PWS with and without deletion: AHI (5.9±5.7 vs. 8.54±7.1; p=0.27), NREM AHI (3.3±4.6 vs. 6.2±6.3; p=0.16), CAI (1.1±1.5 vs. 1.9±3.8; p=0.43) SpO2 nadir 82.7±9.9% vs. 85.3±5.7%; p=0.36) and arousal index (10.3±7.8 vs. 15.4±7.8; p=0.09).

Conclusion
Sleep characteristics do not appear to clearly differ between genetic etiologies of PWS. Larger sample sizes are needed to support these findings.

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0926 Examining Sleep In Parents And Children With Behavioral Or Clinical Sleep Disturbances
Authors: Varma P , Jackson M L , Junge M , Conduit R 
Published: May 2020

Abstract

Introduction
Sleep problems, such as insomnia are frequently reported in children. These sleep disturbances have either a behavioral (e.g. difficulties initiating or maintaining sleep) or clinical etiology (e.g. autism, asthma and T1 diabetes). Unlike clinical populations, outcomes in parents of children with behavioral sleep problems are underexamined. This study aimed to examine sleep in parents and children with behavioral or clinical sleep disturbances.

Methods
290 parents (parents Mage = 35.9±5.2y, children Mage = 4.1± 2.3y) were recruited. Child’s sleep was reported using Child’s sleep habits questionnaire (CSHQ). Parent sleep was assessed using Pittsburgh sleep quality index (PSQI), Pre-sleep arousal scale (PSAS), and Glasgow sleep effort scale (GSES). A demographic question on the nature of child’s sleep disturbance was used to categorize parents into a) behavioral (n=206) or b) clinical group (n=84).

Results
Overall, 71% of parents and 67% of children had clinically significant sleep disturbance (PSQI ≥ 5 and CSHQ ≥ 41 respectively). Significant associations were observed between CSHQ and a) PSQI (r=0.47, p&lt;.001), b) GSES (r=0.21, p&lt;.001), and c) PSAS (r=0.46, p&lt;.001). Step-wise regression reported that CSHQ was the strongest predictor of PSQI, accounting for 22% variance in scores (p&lt;.001), followed by PSAS (7%). Independent groups t-tests found no differences in parents’ sleep quality (p=.06) and pre-sleep arousal (p=.38) between clinical and behavioral groups. However, 47% of parents in the clinical group took longer than 30 minutes to fall asleep, as opposed to 30% of parents in behavioral group (t(289)=-2.39, p=.01).

Conclusion
Parents report having poor sleep irrespective of the nature of child’s sleep difficulties. It is possible that parents in the clinical group may underreport their sleep problems due to increased attention towards child’s symptoms and diagnosis. Nevertheless, if any sleep related issues occur in children, the impact on parental sleep should be considered during assessment.

Support
N/A
0927 Variations in Sleep and Glucose in Adolescents with Type 1 Diabetes
Authors: Griggs S , Redeker N S , Jeon S , Grey M 
Published: May 2020

Abstract

Introduction
The association between short sleep duration and poorer glycemic control in adolescents ages 10-16 with type 1 diabetes (T1D) is well established. Researchers have used cross-sectional, between-subjects’ methods, with limited focus on the potential intraindividual variation among these variables. The purpose of this analysis was to examine the within person associations between glucose variability indices (J index, low/high blood glucose index, time in range) and sleep characteristics (bedtime, waketime, total sleep time, sleep efficiency, wake after sleep onset [WASO], awakenings, and sleep fragmentation index) in adolescents with T1D.

Methods
Adolescents monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and either their own continuous glucose monitor (CGM) or a provided blinded CGM. General linear mixed models (GLMM) were used to determine within-person and day level associations.

Results
The sample included 38 adolescents (M age 13.4±1.8; 37.8% male; M A1C 8.2±1.2%). Average glucose levels were controlled in all GLMMs. Adolescents had earlier waketimes on days when more time was spent in hypoglycemia &lt;70mg/dL (β=-0.15, p&lt;0.001). At the person level, adolescents had greater WASO with more % time spent in severe hypoglycemia &lt;54mg/dL with more severe low blood glucose indices (β=0.35, p&lt;0.01 and β=0.34, p&lt;0.01 respectively). At the daily level, adolescents had greater WASO (β=0.20, p=0.01) and more awakenings (β=0.16, p=0.04) on the days they had more overall glucose variability (J index) and more severe high blood glucose indices (β=0.17, p=0.04), but were less likely to have more % time in hypoglycemia (β=-0.15, p=0.02).

Conclusion
Glucose variability was positively associated with poor sleep (e.g., WASO and awakenings) in adolescents with T1D both at the daily and intraindividual level. Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person associations between habitual short sleep duration and glucose variability.

Support
NINR T32NR0008346 & P20NR014126, Medtronic MiniMed provided CGMs at a discounted rate for the study.
0933 Preschoolers Sleep Explains Parent Cognitions and Parenting Behaviors
Authors: Raymond N S , Bérubé A , Mercier K , Forest G 
Published: May 2020

Abstract

Introduction
Children sleep is influenced by biological and socio-environmental factors. The contribution of various bedtime practices on child sleep is now well established. Emerging literature now seeks to understand the influence of more general parenting practices on child sleep. Thus, the current study examined how perceived children needs and parenting behaviors are associated with children sleep.

Methods
In a first study, 88 mothers (children 2-71 months) recruited during community activities completed the Child’s Sleep Habit Questionnaire, as well as a questionnaire regarding child needs (CN) and parents response to those needs (RN). Multiple linear regression analyses examined child sleep associations first to CN and then to RN, controlled by the child developmental score. Following this first study, 12 vulnerable mothers (children 39-68 months) participated in a child sleep intervention specifically developed for vulnerable families. The same measures were administered and Wilcoxon t-tests were calculated to compared pre and post intervention scores.

Results
Daytime sleepiness (β=.26, p=.008), sleep anxiety (β=.29, p=.007) and children cognitive development (β=-.32, p=.008) explained 31,6% of CN variance. Daytime sleepiness (β=.26, p=.03), and bedtime routine (β=-.68, p=.00), explained 20,8% of RN variance. Following the child sleep intervention, no change in CN were obtained, but a significant improvement in RN was found (Mpre=5.28 ± 1.60, Mpost=4.33 ± .65, p=.045).

Conclusion
Results suggest that parents perceived more needs in their child when they present higher daytime sleepiness, higher sleep anxiety and cognitive developmental difficulties. On the other hand, parents have more difficulty responding to their child needs when they see sleepiness in their child or struggle with bedtime routine. A child sleep intervention does not seem to change the perception of child needs but have a positive impact on the parent response to those needs.

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0939 Anxiety Symptoms Moderate the Effects of Sleep Loss on Children’s Emotions
Authors: Alfano C A , Bower J , Harvey A , Beidel D , Sharp C , Palmer C A 
Published: May 2020

Abstract

Introduction
An abundance of cross-sectional research links inadequate sleep with poor emotional health, but experimental studies in children are rare. Further, the impact of sleep loss is not uniform across individuals, and pre-existing anxiety might potentiate the effects of poor sleep on children’s emotional functioning.

Methods
N=53 children (mean age 9.0 years; 56% female) completed multi-modal, emotional assessments in the lab when rested and after two nights of sleep restriction (7h and 6h in bed, respectively). Sleep was monitored with polysomnography and actigraphy. Subjective reports of affect and arousal, psychophysiological reactivity, and objective emotional expression were examined during two emotional processing tasks, including one where children were asked to suppress their emotional responses.

Results
After sleep restriction, deleterious alterations were observed in children’s affect and their emotional reactivity, expression, and regulation. These effects were primarily limited to positive emotional stimuli. The presence of anxiety symptoms moderated most of the alterations in emotional processing observed after sleep restriction.

Conclusion
Results suggest inadequate sleep preferentially impacts positive compared to negative emotion in pre-pubertal children and that pre-existing anxiety symptoms amplify these effects. Implications for children’s everyday socio-emotional lives and long-term affective risk are highlighted.

Support
NIMH grant #R21MH099351
0940 Adolescent Sleep Quantity, Parenting Permissiveness, and Sugary Beverage Consumption
Authors: Rubens S L , Thai C L 
Published: May 2020

Abstract

Introduction
Research suggests that poor sleep is associated with sugary beverage consumption (SBC), however, little is known about contextual factors that may play a role in this association. This study examined the association between sleep quantity and SBC while accounting for parenting permissiveness among a national sample of adolescents.

Methods
Participants included 1542 adolescents (Mean age = 14.47, SD=1.60) participating in the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating survey, a web-based survey administered in 2014. Multivariable regression models were used to examine associations between sleep quantity (&lt;8 hrs, 8-10hrs, &gt;10hrs) and frequency of sugary beverage consumption in the past week (soda, energy drinks, sports drinks; not at all to 3+ times/day) while controlling for parenting permissiveness and sociodemographic factors (age, sex, parent education level, race).

Results
Approximately 58% (n = 1075) of participants reported receiving the recommended 8-10 hours of sleep, while 35% (n = 646) reported receiving less than this recommended amount and 7% (n = 138) reported sleeping more than the recommended amount of time. Findings from multiple regression models indicated that, when accounting for parenting permissiveness and sociodemographic factors, adolescents who slept the recommended number of hours (8-10) reported less frequent consumption of soda (β = -.18, p = .02) and energy drinks (β = -.12, p = .003) compared to those who slept less than 8 hours. Sleep quantity was not associated with frequency of sports drink consumption in unadjusted and adjusted models (p &gt; .05).

Conclusion
While effect sizes are small, findings suggest that sleep quantity is associated with caffeinated sugary beverage consumption above and beyond parental permissiveness. Given the public health concerns of SBC, examining the influence of developmentally appropriate sleep interventions on SBCs in adolescents is essential.

Support
n/a
0946 Parent-Perceived Sleep Problems Associated with Common Medical Issues During Infancy
Authors: Mindell J A , Leichman E S , Williamson A A , Gould R A , Hiscock H , Quach J 
Published: May 2020

Abstract

Introduction
Sleep problems are highly prevalent during infancy. However, little research has been conducted on associations between these sleep issues and common medical concerns in early development. Thus, the purpose of this study was to assess the prevalence of parent-perceived sleep problems in infants with common medical problems.

Methods
Participants were 5,097 children from the Longitudinal Study of Australian Children—Birth Cohort. Caregiver-reported child sleep problems and medical concerns were assessed at ages 0-1 year. Chi-square analyses were used to examine associations between the presence of a parent-perceived sleep problem and medical concerns.

Results
Wheezing (29.6%), eczema (14.9%), and food/digestive allergies (5.0%) were the most commonly identified medical concerns. In addition, 17.1% of caregivers reported a moderate/severe child sleep problem. Infants who had a moderate to severe parent-identified sleep problem experienced higher rates of overall medical care/needs, wheezing, eczema, food/digestive allergies (p&lt;.001), ear infections (p&lt;.05), and other illnesses (p&lt;.01) than those infants without a sleep problem. No differences were observed with regard to hearing problems, vision problems, developmental delay, diarrhea/colitis, anemia, or other (non-ear) infections. Furthermore, parents reported higher rates of sleep problems for infants with medical problems (20.0-37.5%) than for infants without medical problems (16-17%), especially related to needing medical care (sleep problems = 27%), food/digestive allergies (27%), eczema (23%), and wheezing (20%), p=.001.

Conclusion
Overall, common medical issues during infancy, including food/digestive allergies, eczema, and wheezing, are associated with greater parent-endorsed child sleep problems. Primary care providers should assess for and address sleep problems when treating common medical concerns during infancy.

Support
This project was partially supported by Johnson and Johnson Consumer Health (JAM, ESL, and RAG) and NIH K23HD094905 (AAW).
0951 Sleep Stabilization Patterns Define Pediatric CNS Hypersomnia Conditions
Authors: Maski K P , Colclasure A , Little E , Steinhart E , Scammell T , Navidi W , Diniz Behn C 
Published: May 2020

Abstract

Introduction
Narcolepsy type 1 (NT1) is caused by loss of hypocretins, neuropeptides that promote consolidated nocturnal sleep and sustain daytime wakefulness. In mouse models of NT1, sleep in the light period is characterized by more brief wake bouts, fewer long wake bouts, and longer REM sleep bouts. It is unknown if this sleep pattern is present in NT1 patients and whether it can distinguish NT1 sleep from other CNS hypersomnia conditions [narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH)].

Methods
Participants (6-18 years of age, drug -naïve or drug free) had diagnostic PSG/MSLT testing at Boston Children’s Hospital between 2009-2018. PSG records were rescored blinded to diagnosis. We calculated Kaplan Meier survival curves for nocturnal wake and sleep stages extracted from the nocturnal PSGs. To adjust for differences in survival related to age, sex, and race, we used Cox proportional hazards models. In total, we performed survival analysis and compared wake/sleep stages for 4 groups: NT1 (n=46), NT2 (n=12), IH (n=18) and subjective sleepy controls (n=48).

Results
NT1 patients had worse survival of wake bouts compared to controls (p&lt;0.001). In addition, NT1 patients had decreased survival of both NREM 2 and REM sleep bouts compared to all groups (all p&lt;0.001), and, the survival of REM sleep bouts decreased with age (p=0.006). Compared to controls, NREM 2 bouts survived longer in IH patients and whereas NREM 1 bouts survived longer in the NT2 group (p’s&lt;0.006). There were no group effects for NREM 3, but survival of NREM 3 was less in the older IH patients compared to older controls (p&lt;0.02).

Conclusion
Pediatric NT1 patients have unique sleep fragmentation characterized by unstable wake, NREM 2 and REM bouts. Though less severe as NT1, NT2 patients sustain lighter sleep. In contrast, IH patients show overly stable NREM stage 2 sleep and plausibly this contributes to their characteristic sleep inertia. Further research is needed to determine if sleep stability patterns can be used to diagnose CNS hypersomnia conditions and differentiate treatment responsiveness.

Support
K23 National Institutes of Health (NINDS, K23 NS104267-01A1) and Investigator Initiated Research grants from Jazz Pharmaceuticals, Inc. (Dr. Maski)
0954 Sleep of Gifted Children Using Actigraphy
Authors: Bastien L , Théoret R , Godbout R 
Published: May 2020

Abstract

Introduction
Intellectual giftedness is characterized by an intellectual development superior to peers (QI &gt; 120) while emotional and relational development corresponds to the age norms. Anecdotal reports from parents suggest that they sleep poorly compared to typically developing (TD) peers. We measured sleep of gifted children using actigraphy.

Methods
Thirteen gifted children (10 boys, mean age = 10.58, SD = 2.11) were studied. Giftedness was identified using Renzulli’s three-factor definition of giftedness conceptualise in terms of above-average ability and high levels of task commitment (refined or focused form of motivation), and creativity. Sleep was measured with actigraphy for two weeks and compared to normative data from TD children using T-tests.

Results
Compared to normative data from TD children, gifted children had a significantly shorter sleep latency (p &lt; 0.001), longer sleep periods (p = 0.001), shorter total sleep time and more wake time after sleep onset (p = 0.03). These differences were present both on week nights and weekend nights except that total sleep time was shorter in gifted children only during weekends (p &lt; 0.001).

Conclusion
These data suggest that gifted children sleep poorly, and more so upon weekends. Whether this correlates with daytime functioning remains to be determined.

Support
N/A
0958 The Prevalence of Depression in Children With Chronic Sleep and Respiratory Disorders
Authors: Thakkar N , Trivedi R , Greenberg P , Ramagopal M 
Published: May 2020

Abstract

Introduction
In 2017, 13.3% of US adolescents aged 12 to 17 had at least one major depressive episode (NIMH, 2019). The risk of depression is higher in children with sleep apnea, and children with depression or anxiety have a 1.2-1.8 times higher rate of asthma related ED visits. Therefore, the purpose of this study was to determine the prevalence of depression symptoms in children with chronic disorders. We hypothesized that subjects with sleep disorders would have a higher prevalence of positive depression scores than subjects with respiratory disease, and that the prevalence would be highest in subjects with both conditions.

Methods
The Patient Health Questionnaire-9 (PHQ-9) was administered to children between the ages of 12 and 18 to screen for depression as part of a pulmonary or sleep clinic visit. Each patient’s PHQ-9 results were scored as normal, mild, moderate, or severe for levels of depression severity. Additionally, a chart review was conducted to gather their demographic and clinical data.

Results
Of a total of 87 subjects,71 (81.6%) had a respiratory disorder and 40 (46.0%) subjects had a sleep disorder. Due to the amount of overlap of respiratory and sleep disorders amongst the subjects, depression severity rather than chronic disease was chosen as the primary outcome. Using multiple linear regression, when all other factors were held constant, the average depression score increased by 5.0 when patients had a combination of asthma and obstructive sleep apnea (p-value = 0.02) and also increased by 2.4 for subjects who were female (p-value = 0.01).

Conclusion
It is important to identify depression in children with chronic illness, as it can lead to higher healthcare utilization. Additionally, as mental health status may significantly impact health outcomes for patients with chronic disease, it would be beneficial to evaluate mental health in all pediatric patients with chronic disease. However, further research is needed to investigate these associations.

Support
None