bluuebunny/crossref_metadata_2025_split huggingface dataset:
0907 Implementation Of Pathway For Severe Obstructive Sleep Apnea Management In Children
Authors: Gehring S , Auricchio L , Kidwell S , Oppy K , Smallwood S , Kalra M 
Published: May 2020

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is associated with neuro-cognitive, cardiovascular and metabolic morbidity in children. Adeno-tonsillectomy is the first line of treatment for OSA with PAP therapy and Oxygen supplementation being alternative therapeutic options in select cases. Severe Obstructive Sleep Apnea is a known risk factor for postoperative respiratory complications after adenotonsillectomy. Therefore, inpatient adenotonsillectomy with close monitoring is recommended for this group of children. Challenges to safe and timely care for this high risk group of children can be overcome with effective coordination of care between different locations and health care providers.

Methods
All children seeking treatment at Dayton Children’s Division of Sleep Medicine were managed through a pathway developed by a multi-disciplinary team involving sleep medicine, otolaryngology and clinical logistics. Severe OSA was defined as AHI ≥15 events/hr (children &lt;2 year old), AHI ≥15 events/hr with three or more Oxygen desaturations &lt;80% (children ≥2 to &lt;6 years old), AHI ≥ 30 events/hr with three or more Oxygen desaturations &lt;80% (Children ≥6 to 18 years old).

Results
A total of 78 children were diagnosed with severe OSA in 2019. All children were successfully triaged to appropriate therapeutic option (Adenonotonsillectomy, PAP, O2) within 24 hours of diagnosis. Urgent adenotonsillectomy was performed on the same day in 4 children and within 2 weeks on 12 children. There was no postoperative respiratory complication after urgent adenotonsillectomy. Thirteen children had adenotonsillectomy after 2 weeks. PAP therapy was started in 28 children (34%). Therapy was initiated on the same day in 10 children and the next day on one child. Oxygen supplementation was started in 21 children (27%).

Conclusion
A multidisciplinary collaborative approach can result in delivery of timely and safe care for severe OSA in children.

Support
NA
0961 Comparison of Clinical Characteristics of Children With Narcolepsy With and Without Sleep Related Movement Disorders
Authors: McIntyre E A , Oles S K , Bandyopadhyay A , Daftary A 
Published: May 2020

Abstract

Introduction
Narcolepsy is known to be associated with sleep related movement disorders (SRMD) including periodic limb movement and restless leg syndrome. However, there is paucity of data comparing the clinical characteristics of children with narcolepsy with and without SRMD.

Methods
Retrospective chart review of all children presenting to the sleep clinic for sleep problems between March 2016 to June 2017 was performed. Demographics, sleep intake patient questionnaires and ICD-10 codes for comorbidities and sleep diagnoses were collected. Children with diagnosis of narcolepsy (ICD-10 G47.4) were included in this study. Cohort was divided into 2 groups- with and without co-existing diagnoses of sleep related movement disorders (ICD-10 G47.6). Demographics, presenting symptoms, Epworth sleepiness scores and prevalence of sleep comorbidities were compared using T-test (continuous) and Chi square (categorical). Unadjusted odds ratio was calculated for demographics and presence of SRMD. P value of &lt;0.05 was considered significant.

Results
28 (F=14,50%) children with narcolepsy were included. 25% children were diagnosed with SRMD. Mean (SD) age of children with SRMD presenting to the sleep clinic was 11.14 (5.08) years while mean age (SD) of children without SRMD was 9.52 (3.87) years. Age and race of children with and without SRMD were not statistically different. There was an increased prevalence of females in the group with narcolepsy and SRMD compared to the group without SRMD (86%vs38%, p=0.029). Epworth sleepiness score was not statistically different between the 2 groups. Female gender increased the odds of SRMD in children with narcolepsy (OR:9.75, 0.98- 96.56).

Conclusion
Children with narcolepsy can present with comorbid sleep related movement disorder. Females were more likely to present with associated SRMD compared to males.

Support
None
0976 Temporal Associations Between Sleep And Suicidality In Ultra-high Risk Adolescents And College Students During An Intensive Longitudinal Study
Authors: Franzen P L , Merranko J , Zelazny J H , Hamilton J L , Sewell C , Goldstein T R 
Published: May 2020

Abstract

Introduction
Studies consistently demonstrate a link between subjective sleep disturbances and the continuum of suicidality, although this evidence primarily comes from retrospective, cross-sectional studies using limited items to assess sleep. Longitudinal assessment of well-defined and measured sleep/wake behaviors with high-risk individuals are needed to enhance the specificity of near-term suicide risk detection and render concrete targets for suicide prevention.

Methods
Participants (N=46) included ultra-high-risk adolescents (N=29 ages 12-18) and college students (N=17 ages 18-24). For up to 12 weeks, participants wore an actigraph to yield objective data on sleep/wake, and concurrently completed daily cellphone-based ratings of subjective sleep and suicidality. Generalized estimating equations were used to examine the association between sleep parameters (subjective and objective) and the odds of next-day suicidal outcomes (i.e., passive death wish [PDW], suicidal ideation, suicidal intent) controlling for age, gender, and depression severity.

Results
Significant quadratic relationships were observed between actigraphy-derived total sleep time (TST) and probability of next-day PDW (Z=3.7, p=0.0002), suicidal ideation (Z=2.1, p=0.04), and suicidal intent (Z=2.78, p=0.006), with increasing suicidality at low and high values of TST. Low sleep efficiency (&lt;75%) was associated with increased odds of next-day PDW (OR=1.24, Z=2.07, p=0.038). Subjectively (sleep diary measures), low sleep quality (&lt;50 on 100-point scale) was associated with increased odds of next-day suicidal ideation (OR=1.57, Z=3.42, p&lt;0.001), and longer sleep onset latency (&gt;20 minutes) with next-day suicidal intent (OR=3.00, Z=2.37, p=0.018).

Conclusion
Poor sleep health may signal increasing suicide risk, and are modifiable risk factors. We document a significant temporal association whereby objectively-derived short and long TST and low sleep efficiency, as well as subjective sleep quality and sleep onset latency, predicts next day’s suicidality. Further understanding of the temporal association between sleep and suicidality may hold promise to inform real-time monitoring and preventive strategies. Interventions targeting these factors may therefore help reduce suicidality in high-risk youth.

Support
American Foundation for Suicide Prevention; University of Pittsburgh Clinical and Translational Science Institute
0983 Sleep Associated With Executive Functioning Among Adolescents Across The Adhd Continuum
Authors: Lunsford-Avery J R , Krystal A D , Carskadon M A , Kollins S H 
Published: May 2020

Abstract

Introduction
Executive functioning (EF) deficits are a key feature of ADHD, and sleep disturbances may be an important contributor. Specifically, disturbed sleep is prevalent in ADHD and similar EF deficits are observed in ADHD and sleep disorders. Associations between disrupted sleep and EF in ADHD are poorly understood, particularly during adolescence. This study is among the first to examine relationships between sleep and EF using polysomnography (PSG) among adolescents across the ADHD symptom continuum.

Methods
In this ongoing study, 42 adolescents aged 13 to 17 (mean age = 14.86, 20 females) completed 3 nights of at-home PSG recording (total sleep time; TST) and self-reports of sleep quality, daytime sleepiness, and chronotype. Seventeen had ADHD and 25 were healthy controls (HC). Participants and parents also completed a measure of EF (BRIEF-2; global and behavioral, emotional, and cognitive subscales). Linear regressions controlling for age and sex evaluated associations between sleep and EF.

Results
Self-reported poorer sleep quality and greater daytime sleepiness and eveningness tendency (p’s&lt;.05), but not TST, were associated with poorer self-reported global EF among adolescents. Shorter TST and greater eveningness were correlated with poorer parent-reported global EF (p’s&lt;.05). Follow up analyses examine differential relationships between sleep and behavioral, emotional, and cognitive domains of EF and between ADHD and HC groups.

Conclusion
This study is among the first to examine relationships between sleep and EF across the ADHD continuum in an adolescent-specific sample using PSG. Objectively-measured TST as well as subjective measures of sleep were associated with poorer EF in adolescents across the ADHD continuum. Prevention/intervention strategies focused on sleep may support EF among adolescents, and future studies should examine this possibility. In addition, given variability in EF among individuals with ADHD, future studies should investigate whether sleep disturbances identify a phenotypic subgroup within ADHD at risk for EF deficits.

Support
This work was supported by NIMH K23 MH108704 (Dr. Lunsford-Avery)
0987 Characterizing Scratch And Limb Movements In Atopic Dermatitis During Sleep
Authors: Gillow G M , Robins C , Palomo R , Sheldon S S , Fishbein A B 
Published: May 2020

Abstract

Introduction
Children with atopic dermatitis (AD) experience significant sleep disruption due to nocturnal scratching. Our group has found distinct patterns of limb movements in contrast to control and PLMD patients. To expand on previous findings, our objective was to characterize timing and duration of scratch v. non-scratch movement in children with AD coincidentally undergoing polysomnography (PSG).

Methods
Retrospective chart review of PSG, video footage was synchronized with the EEG and limb electrode readings using a time/date generator and was then operationally classified as either scratching or non-scratching movement. Analysis of data was done using SPSS and groups were compared using an ANOVA.

Results
We analyzed four previously completed sleep studies in children with atopic dermatitis (1 female and 3 males), mean age years±SD 11.3±1.0, mean BMI±SD 21.9±7.1, mean AHI±SD 2.3±0.8. Average scratch duration was not significantly different by sleep stage, N1v.N2v.N3v.REM (mean scratch duration in seconds±SD= 9.0±1.5 v 6.3±3.2 v. 11.9±11.8 v. 6.3±7.3, respectively p=0.65). However, frequency of scratching events were more common during N2v.N1v.N3v.REM (mean scratching events±SD= 9.3±3.9 v 3.8±1.7 v. 4.3±4.3 v. 1.3±1.9, respectively p=0.02). Yet, given the duration of total time spent in sleep stages, minutes of scratching events occupied the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 3.9±0.9 v. 0.6±0.4 v. 0.4±0.2 v. 0.3±0.5, respectively, p&lt0.01). Interestingly, non-scratch related movements were not significantly different between sleep stages (p=0.2). However, non-scratch related movements trended to occupy the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 9.3±7.7 v. 2.1±1.6 v. 1.5±0.8 v. 1.9±1.4, respectively, p=0.05).

Conclusion
Our results suggest that scratching episodes in children with AD occur most commonly during N2 sleep, but occupy the largest % of N1 sleep. Future work will include comparing these limb movements to age and gender-matched allergic rhinitis patients.

Support
This study was unfunded.
0988 Interaction Of Race/Ethnicity And Adverse Childhood Experiences: Links To Subsequent Childhood Sleep Duration
Authors: Rojo-Wissar D M , Sosnowski D W , Jackson C L , Maher B S , Spira A P 
Published: May 2020

Abstract

Introduction
Adverse childhood experiences (ACEs) and sleep disturbances independently affect health and development across the lifespan. While burgeoning research suggests a link between ACEs and sleep health among adults, few studies have examined the association between ACEs and sleep in childhood or whether these associations vary by sex or race/ethnicity.

Methods
Using prospective data from 2,063 children (49% female; 20% Non-Hispanic [NH] White, 55% NH Black, 25% Hispanic/Latino) from the Fragile Families & Child Wellbeing Study, we used multiple linear regression analyses to examine associations between primary caregiver reports of child cumulative ACEs (i.e., physical abuse; emotional abuse; neglect; household dysfunction; possible range=0 to 10) at age 5 and primary caregiver reports of average sleep duration (minutes) at age 9. We used interaction terms to examine whether these associations varied by sex (reference group: males) or race/ethnicity (reference group: NH Whites). If significant, we used plots to visually investigate other potential between-groups differences (i.e. non-overlapping 95% CIs) and tested these statistically using linear combinations of estimator tests. If there were significant group differences, analyses were stratified by sex or race/ethnicity.

Results
Associations between ACEs and sleep duration significantly varied by race/ethnicity but not sex, such that the magnitude of the association was stronger in NH Whites compared to NH Blacks (p&lt;.0001) and in Hispanics/Latinos compared to NH Blacks (p&lt;.0001). In analyses stratified by race/ethnicity and adjusted for both sex and age 5 sleep duration, each unit increase in ACE score was associated with a 6.66 minute shorter sleep duration in NH Whites (B=-6.66, SD=2.10, p=0.002), a non-significant 2.20 minute shorter sleep duration in NH Blacks (B=-2.20, SD=1.52, p=0.148), and a 4.36 minute shorter sleep duration in Hispanics/Latinos (B=-4.36, SD=2.03, p=0.032).

Conclusion
We found that cumulative ACEs were associated with shorter sleep duration across race/ethnicity and more strongly related in NH White and Hispanic/Latino children. Prospective studies with subjective and objective sleep measures investigating multiple sleep parameters are needed that identify factors (e.g., cumulative disadvantage) that differentially affect associations across race/ethnicity and characterize health outcomes of ACEs and sleep duration.

Support
5T32MH014592-39, 5T32DA007292-27, Z1A ES103325-01
1000 Social Media Use And Actigraphic Measures Of Sleep Timing Among High-risk Adolescents
Authors: Hamilton J L , Goldstein T R , Sewall C , Zelazny J , Rode N , Gibbons B , Franzen P L 
Published: May 2020

Abstract

Introduction
Social media use is a risk factor for poor sleep among adolescents. It remains unclear whether social media use before bed impacts later sleep timing or whether youth turn to social media because of sleep problems, which impacts sleep timing. No study to date has examined this relationship using prospective designs and objective sleep measures among high-risk adolescents, who may be particularly vulnerable to social media use.

Methods
As a preliminary test of this relationship, 25 adolescents and young adults in an intensive outpatient program for depression and suicidality completed baseline measures of social media use and wore actiwatches for up to three months. Social media use included: 1) minutes of use within 2 hours of going to sleep, and 2) frequency of social media use due to difficulty falling or staying asleep. To examine social media as a predictor of sleep timing over the next month, actigraphic measures of sleep timing (i.e., onset) were used in the first month after baseline.

Results
Multilevel modeling indicated that higher levels of social media use in the 2 hours before bed (mean = 46.94 minutes) predicted later sleep timing (B = .02; SE = .01; p= .003). Similarly, higher frequency of social media use due to perceived sleep problems predicted later sleep timing (B = .22; SE = .11; p= .04). Models covaried for age, gender, and prior-day depressed mood. When simultaneously entered, only minutes of social media use in the 2 hours before bed significantly predicted later sleep timing.

Conclusion
Findings suggest that the relationship between social media use and sleep timing among adolescents with depression and suicidality may be driven by both social media use before bed and media use due to sleep problems. Research assessing objective social media use and daily relationships are needed to further disentangle this relationship.

Support
Jessica L Hamilton is supported by a T32 fellowship from NHLBI (HL082610; PI: Buysse). This research is supported by grants from the American Foundation for Suicide Prevention and University of Pittsburgh Clinical and Translational Science Institute.
1001 Intravenous Ferric Carboxymaltose For Restless Legs Syndrome In Children And Adolescents
Authors: DelRosso L M , Ferri R , Allen R P , Chen M L , Kotagal S , Picchietti D 
Published: May 2020

Abstract

Introduction
Substantial scientific evidence implicates brain iron deficiency in the pathophysiology of restless legs syndrome (RLS). Current clinical guidelines recommend oral and intravenous iron (IV) in the treatment of both adult and pediatric RLS but studies using ferric carboxymaltose (FCM) are lacking in children and adolescents.

Methods
Retrospective case series of children and adolescents with RLS treated with IV FCM who had serum ferritin levels &lt;50 μg/L. Patients were offered a single dose of IV FCM, 15 mg/kg if weighting &lt;50 kg or 750 mg if weighting &gt;50 kg. Iron profile, serum ferritin, and severity assessment by the International Restless Legs Study Group severity scale (IRLS) were collected pre- and post-infusion. Clinical Global Impression Scale (CGI) was used instead of the IRLS for children. Phosphorus level and adverse effects were assessed post-infusion in all patients. Age and sex-matched children with RLS treated with oral iron supplementation (mean dosage 1.5±0.62 mg/kg/day) were included as a comparison group.

Results
Twenty-eight subjects (15 females, mean age 11.5 years, SD 4.23) and 24 controls were included. Baseline ferritin levels were not significantly different from those of controls but increased significantly from 13.9±7.02 to 112.9±12.00 μg/L after 8 weeks from infusion (p&lt;0.000001), when they were also significantly higher than control values (34.2±21.64 μg/mL, p&lt;0.000001). Transferrin saturation increased from 22.8±9.77% to 31.7±6.81% (p&lt;0.0001), total iron binding capacity decreased from 366.7±51.32 to 302.0±37.83 μg/dL (p&lt;0.0000035). RLS was reported to be resolved or improved in all children treated with IV iron (vs. 62.5% of controls) while none of them reported no change (vs. 37.5% of controls; Chi-square test 9.84, p&lt;0.002). IRLS Score decreased in adolescents from 30.7±22.68 to 3.2±4.21 (p&lt;0.000008) while CGI-I was “very much improved” in six children and “much improved” in four. Side effects were reported in 17.8% of patients treated IV and 20.8% controls (Chi-square 0.0169, p=0.897). FCM side effects included lightheadedness and gastrointestinal discomfort. Post IV phosphorus levels were normal in all participants.

Conclusion
This open-label, observational and retrospective study indicates that FCM IV infusion is an effective treatment for pediatric RLS with higher efficacy than oral iron supplementation.

Support
1002 Endorsement Of Sleep Problems Indexes Autism Severity In Children And Adolescents: Evidence From A Large Community Sample
Authors: Saletin J M , Koopman-Verhoeff M , Han G , Barker D H , Carskadon M A , Anders T F , Sheinkopf S J 
Published: May 2020

Abstract

Introduction
Individuals with autism spectrum disorder (ASD) often experience sleep problems. A reliance on case-control studies rather than dimensional samples limit our ability to understand how sleep problems distinguish diagnosis and severity of ASD. To address this need, we present preliminary findings from a large community sample of individuals with heterogeneous autism phenotypes.

Methods
All participants (≤ 21 years) were selected from the Rhode Island Consortium for Autism Research and Treatment (RI-CART) (final n= 977; 233F; 11.27±4.13 years), a public-private-academic registry of families in Rhode Island affected by ASD-like symptoms. Participants completed the Autism Diagnostic Observation Schedule, 2nd Edition to confirm the presence of diagnosable ASD. Each caretaker also completed dimensional measures of functional impairment: Social Responsiveness Scale, 2nd edition and the Vineland Adaptive Behavior Scale (2nd/3rd editions). Caretakers were asked whether the participant suffered current/past sleep problems: yes/no. All analyses are adjusted for age, sex, race, ethnicity, caregiver education, and scale-version (e.g., 2nd/3rd ed., where applicable).

Results
Endorsement of sleep problems distinguished ASD diagnosis: a confirmed diagnosis of ASD was associated with greater prevalence of sleep problems compared to ASD diagnosis (OR: 1.58; 95% CI: 1.05,2.38; p = .028). Across the sample, endorsement of sleep problems was associated with impairments in adaptive behavior (b = -4.73; 95% CI: -7.47,-2.00045; p = .001) and social responsiveness (b = 6.72; 95% CI: 3.27,10.16; p &lt; .001).

Conclusion
These data from a heterogenous community sample provide evidence for a link of sleep to the phenomenology of ASD. While the search for better diagnostic indicators of ASD continues, we recommend that clinicians consider a brief assessment of sleep behaviors of patients with such neurodevelopmental conditions as autism.

Support
Simons Foundation Autism Research Initiative, Hassenfeld Child Health Innovation Institute at Brown University. K01MH109854 (JMS), NIGMS Advance CTR (JMS). KNAW Ter Meulen Grant (MEKV).
Disturbed nighttime sleep in children and adults with rhythmic movement disorder
Authors: Laganière Christine , Pennestri Marie-Hélène , Rassu Anna Laura , Barateau Lucie , Chenini Sofiène , Evangelista Elisa , Dauvilliers Yves , Lopez Régis 
Published: May 2020

Abstract

Study Objectives
Rhythmic movements (RMs) during sleep are frequent and often considered as benign in children. Disabling forms are diagnosed as RM disorder and may persist in adulthood. Whether RMs severely impact sleep architecture in patients with RM disorder remain unclear. We performed a case–control study to characterize the clinical and polysomnographic patterns of children and adults with a diagnosis of RM disorder in comparison to controls, and to assess the associations between the RMs and the sleep architecture.

Methods
All consecutive patients (n = 50; 27 children, 35 males) with RM disorder from a single sleep clinic (from 2006 to 2019) underwent a comprehensive clinical evaluation and a polysomnographic recording in comparison to 75 controls (42 children and 53 males).

Results
About 82% of children and adult patients had a complaint of disturbed nighttime sleep. Comorbid neurodevelopmental, affective or sleep disorders were found in 92% of patients. While RM sequences defined by video polysomnographic criteria were observed in 82% of patients (in wakefulness and in all sleep stages), no similar sequences were observed in controls. Patients had altered sleep continuity, with low sleep efficiency, increased wake time after sleep onset, and frequent periodic leg movements and apnea events. The severity of RMs was associated with disrupted nighttime sleep, even after controlling for comorbid motor and respiratory events.

Conclusions
RM disorder is a rare, highly comorbid and disabling condition both in children and adults with frequent disturbed nighttime sleep that may contribute to the burden of the disease.