bluuebunny/crossref_metadata_2025_split huggingface dataset:
0945 Adolescent Sleep Mediates Maternal Depression and Harsh Parenting
Authors: Stearns M , Wilkerson A , Speed K J 
Published: May 2020

Abstract

Introduction
Mothers dealing with depressive problems often report using more harsh parenting practices. This occurs, in part, due to a scarcity of effective coping mechanisms and increased irritability. In addition, depressed mothers are less likely to set consistent rules and expectations within the home, which may result in children who stay up late. Children who get inadequate levels of sleep also are more likely to have behavior problems, irritability, and defiance toward their parents, particularly in adolescence. However, no studies have examined the potential of adolescent sleep as a contributor to the association between maternal depression and the use of harsh parenting. The current study examined whether mothers’ perceptions of inadequate adolescent sleep duration mediated the relationship between maternal depression and harsh parenting, with child gender as a moderator.

Methods
The sample (N=318) consisted of mothers reporting on adolescents aged 16-18 (M=16.89, SD = .429; 53.4% female) from the 10th wave of the Schools and Families Educating Children Study (SAFE). The SAFE study was a randomized control trial conducted from 1997-2008 designed to investigate children and families living in inner-city Chicago, Il. Measures included the Child Behavior Checklist (CBCL), Center for Epidemiologic Studies Depression Scale (CESD), and the Parenting Practices Questionnaire (PPQ).

Results
Too little adolescent sleep mediated (β = .15) the relation between maternal depression and her reported use of harsh parenting. Mediation was further moderated by child gender, such that the mediation occurred for sons (β = .12) but not daughters.

Conclusion
These results suggest that too little adolescent sleep is the process through which mothers experiencing depressive problems engage in more harsh parenting. In addition, important child gender differences were apparent, such that sons’ lack of sleep may be more related to maternal depression and the use of harsh discipline.

Support
United States Department of Health and Human Services. National Institutes of Health. National Institute on Drug Abuse (5 R01 DA020829)
0963 Perceived Sleep Need in Adolescents and Acceptability of a Morning Bright Light Intervention
Authors: Culnan E , Eastman C I , Crowley S J 
Published: May 2020

Abstract

Introduction
We are testing strategies to make fall asleep times earlier to extend sleep duration of sleep-deprived, delayed adolescents. We explored whether perceived sleep need was associated with the acceptability of an intervention which included earlier bedtimes on school nights and early morning bright light (BL) on one weekend.

Methods
Twenty-three participants (16.0±0.7 years; N=11 female) from the intervention group of a study of adolescents reporting ≤7 h sleep on school nights and late bedtimes (school-night≥23:00; non-school night≥midnight) were included. Participants estimated nightly sleep need during baseline. The intervention included shifting school-night bedtimes 1h earlier than each participant’s usual school night bedtime during the first week and 2h earlier than baseline during the second week. Evening time management goals were used to help participants get to bed earlier. Wake times remained stable because of early school start times. During the weekend in between these 2 weeks, participants lived in the laboratory and received very early morning BL on Saturday and Sunday from two light boxes (~6000 lux; three 50-minute exposures with 10-minute breaks). At the end of the study, an acceptability questionnaire asked about hypothetically engaging in different elements of the intervention (earlier bedtimes, morning BL) at home. Items were summed to create a composite acceptability score.

Results
Participants reported needing 7.8 h (SD=1.2; range=5-9.5h) of sleep. A linear regression demonstrated that needing more sleep was associated with less acceptability when controlling for age and sex, b=1.37, SEb=.60, p=.03.

Conclusion
Adolescents who felt they needed less sleep were more accepting of an intervention that required earlier bedtimes on school nights and waking up very early to receive BL on the weekend. Interventions that produce less weekend sleep deprivation, like including naps, might be more acceptable to all.

Support
R01HL105395 (S.J.C.)
0970 Longitudinal Study Of Infant Sleep Problems And Influencing Factors
Authors: Zhou Z , Wang N 
Published: May 2020

Abstract

Introduction
To investigate the sleep problems and influence factors in infants at the age of 1 month and 6 months through longitudinal questionnaire survey.

Methods
600 healthy infants aged 1 month were selected from May to August 2014 from Chongqing health center for women and children. A self-made sleep questionnaire was used to investigate the infants’s sleep at the age of 1 month and 6 months respectively. Logistic regression model was used to analyze the correlation between sleep problems and factors.

Results
The incidence of nigt-waking, difficulty in falling asleep and night crying at 1 month of age were 30%, 17% and 14.1%, respectively, and at 6 months were 7.3%, 9.3% and 13.1%, respectively. Results of the Logistic regression analysis model of sleep problems of infants at 1 month old were: 1. body length grade, baby touch, sleep alone, putting the infants back into bed after being picked up and quiet, night feeding were the protective factors of night-waking, while diaper changing is the risk factor; 2.body length grade, listening to music, orderly bedtime routine, comforting without holding and putting the infants back into bed after being picked up and quiet were protective factors for difficulty in falling asleep, while diaper changing is the risk factor; 3. listening to music, orderly bedtime routine, watching and waiting, holding until sleep were all protective factors of night-crying. Logistic regression model analysis results of sleep problems of infants aged 6 months were: 1. The risk factors of night-waking include putting the infants back into bed after being picked up and quiet, holding the infants until falling asleep, diapers changing, and parent-children interaction before bedtime. 2. Listening to music and sleeping alone in a bed were protective factors for difficulty in falling asleep. 3. Touching, orderly bedtime routine and comforting without holding are protective factors of night-crying.

Conclusion
Sleep problems in infants are common and decrease with age. The factors of sleep problems at the age of 1 and 6 months are different, Targeted prevention are beneficial to the prevention of infant sleep problems.

Support
Chinese center for disease control and prevention grant
0974 Family-Based Study Of Sleep In Autism Spectrum Disorder Without Intellectual Disability
Authors: Elkhatib Smidt S D , Ghorai A , Gehringer B , Dow H C , Smernoff Z , Taylor S C , Zhang J , Rader D J , Almasy L , Brodkin E S , Bucan M 
Published: May 2020

Abstract

Introduction
Sleep problems are a common concern in children with autism spectrum disorder (ASD) that can persist into adulthood. This study aims to further explore sleep in ASD without intellectual disability (ASD w/o ID).

Methods
We recruited individuals with ASD w/o ID (probands) and relatives as part of the Autism Spectrum Program of Excellence (ASPE) at the University of Pennsylvania. Actimetry data were collected via a wrist-worn tri-axial accelerometer for 21 days. Data from 212 participants were considered. We analyzed sleep data using the algorithms GGIR, ChronoSapiens, and PennZzz. The sleep traits of proband and sibling pairs were compared using paired t-test or Wilcoxon signed-rank test. We used the Social Responsiveness Scale, Second Edition (SRS-2) to assess social impairment and restricted/repetitive traits. We compared SRS-2 scores to sleep traits using partial Spearman or Pearson correlations adjusting for age (171 participants).

Results
Probands demonstrated later sleep onset (p = 0.03), decreased M10 average (10-hour period of highest activity/day; p = 0.006), decreased relative amplitude (measure of rest-activity rhythm; p&lt;0.001), and decreased total daytime activity (p = 0.005) compared to siblings. Regarding social function and restricted/repetitive traits, adult males showed an inverse correlation between SRS-2 total score and sleep efficiency (r = -0.2, p= 0.04) and a positive correlation between SRS-2 total score and intradaily variability (r = 0.3, p = 0.02). Adult females showed an inverse correlation between SRS-2 total score and M10 average (r = -0.3, p = 0.02) and between SRS-2 total score and relative amplitude (self-report r = -0.4, p = 0.001; informant r = -0.3, p = 0.005).

Conclusion
This study focuses on the analysis of sleep traits in ASD including the relationship between social function and sleep. Thus far, the most robust findings are decreased daytime activity and relative amplitude in individuals with ASD w/o ID compared to siblings. We have also shown that ASD social impairment may be related to sleep dysfunction.

Support
NIH T32HL07713, anonymous donor, and the Institute for Translational Medicine and Therapeutics of the Perelman School of Medicine at the University of Pennsylvania.
0977 Risk Factors For Developing Sleep Disorders In Children
Authors: Johnson A K , Santos A A , Araujo L G , Gonsalves V S , Walker B L , Santos A B , Ajayi A O 
Published: May 2020

Abstract

Introduction
Unidentified sleep disorders can affect emotional, cognitive and social development in children. Screening for sleep disorders within the pediatric population is not common practice during medical visits. The objective of this study is to identify specific questions related to behavioral and physiological factors having potential to screen and detect those at risk for sleep disorders in a general pediatric clinic.

Methods
A retrospective archive from electronic medical records was analyzed from 1,361 children patients, 0-18 years old, that visited a pediatric clinic from March-November of 2019. Children or their parents reported on the presence of eight objective behavioral and physiological factors on the Kids Sleep Screener Questionnaire (KSSQ), which were used as potential risk factors for sleep disorders. Propensity of daytime sleepiness was measured through the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). Scores higher than 11 were considered a positive indicator of potential sleep disorders because of excessive daytime sleepiness. Positive scores from the ESS-CHAD were used for comparison with the KSSQ factors using chi-square test of SAS software.

Results
Among the eight factors, snoring was the strongest risk factor and increased sleep duration was the weakest risk factor associated with a positive ESS-CHAD. Relationships among risk factors and the increased likelihood for developing sleep disorders were statistically significant (p&lt;0.05-p&lt;0.0001) and identified as following: snoring by 2.46 times, restless sleeper by 2.03 times, behavioral or learning difficulties by 1.43 times, nocturnal awakenings by 1.16 times, excessive sleepiness during the day by 1.10 times. Sleep onset latency and increased sleep duration were weak indicators due to a likeliness of less than one time (p&lt;0.05) to be associated with a positive ESS-CHAD. Abnormal sleep behavior was not a statistically significant risk factor (p≥0.05) for potential sleep disorders in children.

Conclusion
There were associations between seven behavioral and physiological risk factors with overall sleep propensity in children. These results exhibit that the KSSQ is an important tool to identify potential sleep disorders in children and the need for follow up with a sleep specialist. The KSSQ is under validation for becoming a standard sleep screener in pediatrics.

Support
N/A
0981 Sleep Practices In Pediatric Cancer—Does Sleep Hygiene Matter For Reducing Cancer Symptom Burden?
Authors: Daniel L C , Gross Y , Meltzer L , Forrest C , Barakat L 
Published: May 2020

Abstract

Introduction
Sleep disturbances are common during pediatric cancer treatment and recent evidence suggests a correlation between sleep and symptom burden. Improving nighttime sleep may impact patients’ ability to cope with symptoms. The current study tests the interaction between sleep hygiene and sleep disturbances in predicting cancer-related symptoms to determine if the relationship between sleep and symptoms is different for patients with better sleep hygiene.

Methods
102 caregivers of children with cancer (ages 5-17, M=10.12, SD=4.02; 58% female) completed parent-proxy Pediatric Sleep Practices Questionnaire (yielding routine consistency and sleep opportunity scores) and measures of cancer-related symptoms (PROMIS Sleep Disturbance, Fatigue, and Pain Interference; PedsQL—Cancer Module-Nausea subscale). The interaction between sleep disturbances and sleep hygiene (consistency, opportunity) on each symptom (pain, nausea, fatigue) were tested using PROCESS moderation.

Results
81% of caregivers report that their child receives sufficient sleep but only 12% reported regular consistent sleep patterns/routines. Sleep opportunity was not related to sleep disturbances or cancer-related symptoms, but more routine consistency was related to fewer sleep disturbances (r=.30, p=.003). The interaction between sleep disturbances and routine consistency significantly predicted pain interference [R2=.16, F(3, 98)=6.37, p&lt;.001; Bint =-0.17, p=.028] and nausea [R2=.16, F(3, 98)=6.47, p&lt;.001; Bint=0.46, p=.004]. The interaction between sleep disturbances and sleep opportunity significantly predicted nausea [R2=.15, F(3, 98)=5.76, p=.001; Bint =0.68, p=.016] but not pain interference. Both interaction models predicting fatigue were not significant.

Conclusion
The sleep/pain and sleep/nausea relationships are stronger in patients with more consistent sleep routines and the sleep/nausea relationship is also stronger in patients with sufficient/well-timed sleep opportunities. Sleep and fatigue were moderately related across all levels of both sleep hygiene components. Clinical interventions that target sleep hygiene together with sleep disturbances such as nighttime awakenings and poor sleep quality may be more effective in addressing cancer-related symptoms such as pain and nausea.

Support
This work was supported in part by funding from the Patient-Centered Outcomes Research Institute (PCORI-D-17-00187; PI Christopher Forrest).
0984 Less Consistent Bedtimes Explains The Relationship Between Household Poverty And BMI In Toddlers
Authors: Covington L B , Armstrong B , Black M M 
Published: May 2020

Abstract

Introduction
Consistent bedtimes, in conjunction with physical activity and diet have been linked to healthy weight in childhood. Young children living in impoverished families are at risk for obesity, and the mechanisms of obesity etiology are not fully understood. This study compares the role of bedtime consistency, physical activity and diet quality as mediators between household poverty and toddler weight gain.

Methods
207 toddlers participating in an obesity prevention trial wore Actical accelerometers for up to 7 consecutive days, at 3 time points over 12 months. At each assessment, gender-specific BMI-for-age z-scores (zBMI) were calculated from toddlers’ weight/length according to WHO standards. Household poverty ratio was calculated based on the number of household members and annual income. Diet quality was assessed using Healthy Eating Index (HEI-2015) from 24-hour dietary recall. Physical activity and sleep were measured using ankle accelerometry (Actical; Sadeh algorithm used for sleep). Bedtime consistency was defined as SD of sleep onset across 7 days. A multi-level mediation model was conducted in the SPSS macro MLmed examining toddler bedtime consistency, physical activity and diet quality as mediators between household poverty and toddler zBMI. The analysis adjusted for toddler age, gender, total sleep time and intervention group.

Results
Between-person effects revealed that less household poverty was associated with more consistent bedtimes. Children with less consistent bedtimes, but not poor diet quality or physical activity, had higher zBMI. Bedtime consistency indirectly explained the association between average household poverty and average toddler zBMI over 12 months.

Conclusion
Children who generally have less bedtime consistency, above and beyond physical activity and diet quality, had higher zBMI. This link uniquely indirectly explained the association between household poverty and zBMI. Inconsistent bedtimes may indicate lack of structure in other health behaviors, and therefore, continued longitudinal research examining family routines may inform obesity prevention strategies.

Support
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), R01HD056099
0994 Assessment Of Sleep-wake And Circadian Rhythm Disruption In Children And Adolescents Diagnosed With Craniopharyngioma
Authors: LaRosa K N , Crowley S J , Hancock D , Caples M , Merchant T E , Crabtree V M , Mandrell B 
Published: May 2020

Abstract

Introduction
Patients with craniopharyngioma are at increased risk for hypersomnia/narcolepsy and circadian rhythm disruption, secondary to hypothalamic-pituitary involvement of the tumor. We assessed youth with craniopharyngioma to determine presence of the dim light melatonin onset (DLMO) and concurrent sleep disturbance.

Methods
Fifty-two patients (7-21 years; 51% female) enrolled on our institutional protocol for craniopharyngioma that included surgery, proton therapy, or both. In-home salivary melatonin was collected after surgery and hourly beginning 3 h before to 1 h after habitual bedtime to determine the DLMO, which was defined as the time that melatonin exceeded a 4 pg/mL threshold. Polysomnography and a next day multiple sleep latency test (MSLT) were also conducted.

Results
Hypersomnia/narcolepsy was indicated in 86% of patients. DLMO was detected in 29 (56%) patients and averaged 21:04 (±1:14). All but 2 patients with a DLMO had a concurrent sleep diagnosis (18 hypersomnia, 8 narcolepsy, 1 insomnia). In those we could not compute a DLMO, melatonin was above the 4 pg/mL threshold in 19 (37%), suggesting that the DLMO was likely earlier than the sampling window. Two (4%) did not reach threshold, suggesting that the DLMO was later than the window. For patients in which DLMO was not computed, all but 4 had a concurrent sleep diagnosis (7 hypersomnia, 9 narcolepsy, 1 MSLT not completed). Three (6%) participants showed a pattern of melatonin decreasing before bedtime (2 hypersomnia, 1 narcolepsy). Sleep disorder diagnosis was not associated with whether a DLMO was detected or not.

Conclusion
DLMO did not occur within the sampling window in 44% of patients with the majority due to the DLMO likely occurring before sampling started. Simultaneous assessment of both sleep-wake disturbance and circadian phase could provide more informed sleep interventions for excessive sleepiness and circadian misalignment in this patient population.

Support
This study was supported by cancer center grant (CA21765) from the National Cancer Institute, and ALSAC.
Disparities in Burnout and Satisfaction With Work–Life Integration in U.S. Physicians by Gender and Practice Setting
Authors: Marshall Ariela L. , Dyrbye Liselotte N. , Shanafelt Tait D. , Sinsky Christine A. , Satele Daniel , Trockel Mickey , Tutty Michael , West Colin P. 
Published: May 2020

Purpose
To explore the interaction between practice setting (academic practice [AP], private practice [PP]) and gender in relation to physician burnout and satisfaction with work–life integration (WLI).

Method
In 2017, the authors administered a cross-sectional survey of U.S. physicians and characterized rates of burnout and satisfaction with WLI using previously validated and/or standardized tools. They conducted multivariable logistic regression to determine the interaction between the included variables.

Results
Of the 3,603 participants in the final analysis, female physicians reported a higher prevalence of burnout than male physicians in both AP (50.7% vs 38.2%, P < .0001) and PP (48.1% vs 40.7%, P = .001). However, the multivariable analysis found no statistically significant gender-based differences in burnout (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.76–1.17, P = .60). Women and men in AP were less likely to report burnout than men in PP (OR 0.70, 95% CI 0.52–0.94, P = .01 and OR 0.69, 95% CI 0.53–0.90, P < .01, respectively); women in PP did not report different burnout rates from men in PP (OR 0.89, 95% CI 0.68–1.16, P = .38). Women in both AP and PP were less likely to be satisfied with WLI than men in PP (OR 0.62, 95% CI 0.47–0.83, P < .01 and OR 0.75, 95% CI 0.58–0.97, P = .03, respectively); men in AP did not report different satisfaction with WLI than men in PP (OR 1.05, 95% CI 0.82–1.33, P = .71).

Conclusions
Gender differences in rates of burnout are related to practice setting and other differences in physicians’ personal and professional lives. These results highlight the complex relationships among gender, practice setting, and other personal and professional factors in their influence on burnout and satisfaction with WLI.