bluuebunny/crossref_metadata_2025_split huggingface dataset:
0922 Nightly Associations Between Pre-Bedtime Activity, Actigraphic Light, and Sleep in Children With ASD and Insomnia
Authors: McGovney K D , Curtis A F , Mazurek M , Chan W S , Deroche C B , Munoz M , Davenport M , Takamatsu S , Takahashi N , Muckerman J , McCann D , Sahota P , Mills B , McCrae C S 
Published: May 2020

Abstract

Introduction
Approximately two thirds of children with Autism Spectrum Disorder (ASD) suffer from chronic insomnia. Current behavioral interventions for insomnia in children with ASD use sleep hygiene guidelines to educate parents and their children regarding sleep promoting habits. However, the relationship between pre-bedtime physical activity/light and sleep is understudied in ASD. The current study examined daily associations between pre-bedtime actigraphically assessed activity/light levels and objective/subjective sleep outcomes in children with ASD and insomnia.

Methods
Thirty children (Mage=8.5 yrs, SD=1.78 yrs) with comorbid ASD and insomnia completed 14 days of actigraphy measuring ambient white light intensity and activity levels every 30 seconds. Validated sleep scoring algorithms (in Actiware V. 6.0.9) estimated objective sleep onset latency (SOL), total sleep time (TST), wake time after sleep onset (WASO), and average activity/light levels 30, 60, and 120 mins prior to bedtime. Additionally, average activity/light levels 120-240, and 240-360 mins prior to bedtime were computed. Children also completed 14 daily sleep diaries (with parental assistance) measuring subjective reports of the same sleep parameters. Associations between daily estimations of pre-bedtime activity levels, light, and nighttime objective and subjective sleep were examined through multilevel modelling. Bonferroni corrections were performed to account for multiple comparisons.

Results
After Bonferroni corrections (p&lt;.025 significance level), greater activity within 30 minutes (B=0.0465, p=.0093) and 60 minutes (B=0.0681, p=.0005) of bedtime were associated with longer subjective SOL. Pre-bedtime light exposure was not a significant predictor of sleep outcomes.

Conclusion
Results suggest that in general, variations in daily pre-bedtime activity, but not light, are associated with worse nightly subjective SOL in children with ASD and insomnia. Findings support that sleep hygiene recommendations in children with ASD include avoidance of higher levels of pre-sleep physical activity. Prospective studies examining temporal causal relationships between pre-bedtime activity and sleep in ASD are warranted.

Support
Research was supported by a University of Missouri Research Board award (McCrae, PI; Mazurek, Co-PI). Data collected as part of clinical trial NCT02755051 Targeting Sleep in Kids with Autism Spectrum Disorder at the University of Missouri (PI: McCrae).
0928 Heart Rate Variability During Sleep in Children and Adolescents with Restless Sleep Disorder or Restless Legs Syndrome and Normal Controls
Authors: Ferri R , Bruni O , DelRosso L M 
Published: May 2020

Abstract

Introduction
Restless sleep disorder (RSD) has been recently characterized clinically and polysomnographically in children and differentiated from restless legs syndrome (RLS). Heart rate variability (HRV) is a reliable method to quantify autonomic changes during sleep. The aim of this study was to characterize HRV in children with RSD, RLS and normal controls, with the hypothesis that children with RSD have a shift toward sympathetic predominance during sleep.

Methods
Polysomnographic recordings from thirty-two children who fulfilled RSD diagnostic criteria (19 boys and 13 girls), 32 children with RLS (20 boys and 12 girls) and 33 controls (17 boys and 16 girls) were included. Four ECG epochs were chosen, one for each stage, and were analyzed for automatic detection of R waves. Time domain and frequency domain HRV parameters were obtained and analyzed.

Results
Age and gender were not statistically different between groups. In terms of time domain only the standard deviation of the average RR interval during stage N3 was slightly but significantly higher in RSD than in RLS patients. In terms of frequency domains, the LF band and the LF/HF ratio were increased in RSD and the HF percentage was lower in RSD during sleep stages N3 and R. The LF band and the LF/HF ratio increased in RLS and the HF percentage was lower in RLS during stage W.

Conclusion
Children with RSD have increased sympathetic activation during sleep, particularly N3 and REM, compared to controls but, as expected, not during wakefulness. Differently, children with RLS have sympathetic activation during relaxed wakefulness preceding sleep and during sleep.

Support
Partial support by a grant of the Italian Ministry of Health RC n. 2751598 (R.F.)
0930 Prenatal Cannabis Use and Sleep Outcomes in Children 9-10 Years of Age in the Adolescence Brain Cognitive Development Study
Authors: Winiger E , Hewitt J 
Published: May 2020

Abstract

Introduction
The fetal brain is densely populated with CB1 receptors that increase in number throughout gestation and might be involved in sleep processes since they are found in many brain areas related to the regulation of the sleep-wake cycle. THC binds to CB1 receptors, possibly altering neurodevelopment and fetal cortical circuitry in the womb. Studies have found prenatal cannabis use is associated with early sleep factors from as early as few days after birth to 3 years of age, yet no studies have examined associations in later childhood.

Methods
We used data from the Adolescent Brain Cognitive Development (ABCD) study to determine whether maternal reports of cannabis use while pregnant were associated with child sleep outcomes (The Sleep Disturbance Scale for Children) among 11,875 children ages 9-10. Regression analyses accounted for the nested nature of families (twin and non-twin sibling) and were estimated controlling for potential covariates including daily tobacco and weekly alcohol use during pregnancy, mother’s education, combined household income, parental marital status, child sex, and child age.

Results
Amongst mothers in our sample, 6% endorsed using cannabis while pregnant. Prenatal cannabis use was associated with lower sleep duration, disorders of initiating and maintaining sleep, disorders of arousal, sleep wake disorders, disorders of excessive somnolence, and a summed sleep score (all b &gt;0.09 and p &lt; 0.04) but not with sleep latency, sleep breathing disorders, and sleep hyperhidrosis (all b &lt;0.08 and p &gt;0.09).

Conclusion
Prenatal cannabis use was associated with increased childhood sleep deficits including shorter sleep duration and higher endorsements of sleep disorder symptoms. This is the first report of prenatal cannabis use being associated with sleep in childhood as late as 9-10 years of age. Although causality is not established, the results suggest potential long-term effects of prenatal cannabis use on sleep and the need for abstinence from cannabis use while pregnant.

Support
T32 DA017637. The ABCD Study is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, U24DA041147, U01DA041093, and U01DA041025 (https:// abcdstudy.org/federal-partners.html).
0934 Ambulatory Blood Pressure Monitoring During Overnight Polysomnography in Children and Adolescents
Authors: DelRosso L M , Chan J , Ruth C , Arp M , Ferri R 
Published: May 2020

Abstract

Introduction
During NREM sleep, sympathetic nervous system input decreases and systolic blood pressure drops. Sleep disorders can alter this mechanism. Ambulatory blood pressure monitors (ABPM) are increasingly used in children and are superior to clinic blood pressure in predicting cardiovascular morbidity and mortality. We aim to assess the effect of ABPM use during a sleep study in children and adolescents.

Methods
Subjects were children ages 7-18 from Seattle Children’s Hospital who underwent a sleep study for evaluation of suspected obstructive sleep apnea. Excluded children with known hypertension or taking a medication that altered blood pressure. An ABPM was placed on the right arm during the overnight sleep study and programmed to record BP every hour. Studies from children without OSA were analyzed for all sleep parameters. Data was compared with a control of children who underwent PSG and did not wear the ABPM. BP measurement was recorded and the PSG was reviewed for sleep stage, arousal, or awakening.

Results
To date, we have 15 children with ABPM age mean 11.6, SD 2.9 and 35 controls age mean 10.97 and SD 3.1, age, sex and BMI did not vary between groups. None of the PSG parameters was statistically different between groups including total sleep time, sleep efficiency, arousal index or sleep stage distribution. An average of 10 BP readings was obtained per patient. 53% of BP readings in N1 resulted in awakenings, compared to 39% in N2, 5% in N3 and 14.8% in REM. Systolic, diastolic, heart rate and mean arterial pressure showed appropriate dipping during sleep with appropriate circadian increase at 4 AM. Pulse pressure remained the same.

Conclusion
We have demonstrated the feasibility of using ABPM during PSG in children. Although sleep macroarchitecture did not show any significant difference in sleep efficiency or arousal index, further evaluation of each ABPM insufflation during the sleep study showed a sleep stage specific, sleep disruption with awakenings more likely to occur during N1 or N2 and less likely to occur during N3 or REM sleep. There was normal dipping and as expected circadian variability in the values.

Support
0941 Defining Disrupted Nighttime Sleep in Pediatric Narcolepsy
Authors: Maski K P , Pizza F , Colclasure A , Steinhart E , Little E , Diniz Behn C , Vandi S , Antelmi E , Plazzi G , Scammell T 
Published: May 2020

Abstract

Introduction
Disrupted nighttime sleep (DNS) is a core narcolepsy symptom subjectively described as spontaneous awakenings during the night, but researchers use varied polysomnogram (PSG) definitions based on sleep state transitions, NREM 1% and poor sleep efficiency. These sleep measures have yet to be validated to determine the best objective measure of DNS. Furthermore, it unknown to what extent DNS occurs in pediatric narcolepsy as children have greater sleep drive than adults. Here, we assess the construct validity of various DNS objective measures and evaluate its diagnostic utility for pediatric Narcolepsy Type 1 (NT1) when combined with a nocturnal Sleep Onset REM period (nSOREMP) in a large cohort of pediatric patients with CNS hypersomnias.

Methods
Retrospective, cross-sectional study of consecutive PSGs and multiple sleep latency tests (MSLTs) obtained at Boston Children’s Hospital and University of Bologna. Participants were drug-free or drug naïve, ages 6-18 years and slept at least 6 hours during the PSG. We analyzed associations between objective DNS measures and outcomes of self-reported sleep disturbance, Epworth Sleepiness Score, mean sleep latency, NT1 diagnosis, and CSF hypocretin values when available. We then combined the best performing DNS measure with the presence of a nSOREMP to determine the diagnostic value for NT1 using bootstrap analysis. We included n=151 NT1, n=21 narcolepsy type 2 (NT2), n=27 idiopathic hypersomnia (IH) and n= 117 subjectively sleepy controls in this analysis.

Results
Across groups, the Wake and NREM 1 bouts index had the most robust associations with objective sleepiness, subjective sleep disturbance and CSF hypocretin levels (p’s &lt;0.0001). From 1000 bootstrap samples, the Wake/N1 index and presence of a nSOREMP have greater diagnostic accuracy for NT1 than the nSOREMP alone (p&lt;0.0001).

Conclusion
Among a variety of sleep quality measures, we find that a Wake and NREM 1 bout index is the best objective measure of DNS. In combination with a nSOREMP, this DNS measure can aid in pediatric NT1 diagnosis using PSG alone and potentially reduce diagnostic delays.

Support
This study was supported by K23 National Institutes of Health (NINDS, K23 NS104267-01A1) grant and Investigator Initiated Research grant from Jazz Pharmaceuticals, Inc. to Dr. Maski
0953 The Maintenance of Wakefulness Test (MWT) in Pediatric Hypersomnia
Authors: Jaroenying R , Hantragool S , Xu Y , Hossain M M , Simakajornboon N 
Published: May 2020

Abstract

Introduction
The Maintenance of Wakefulness Test (MWT) is a recommended procedure to evaluate the efficacy of treatment for hypersomnia. Limited data have been published on the use of the MWT in children and adolescents. This study aims to describe the clinical characteristics, MWT findings and their implication in the management of children with hypersomnia.

Methods
This study reviewed the charts of children with hypersomnia who had MWT performed at Cincinnati Children’s Hospital Medical Center (CCHMC) between January 1, 2007 and January 31, 2018. Demographics, clinical characteristics, MWT findings, diagnoses and managements of children with hypersomnia were obtained.

Results
Fifty-three patients with hypersomnia who had MWT were included (mean age 17.29 years, range 12.5-22.75 years), 32 (60%) were male, and 40 (75%) were Caucasian. The diagnosis included narcolepsy (41, 77%), idiopathic hypersomnia (7, 13.2%), narcolepsy with OSA (11, 20%) and OSA (4, 7.5%). A mean sleep latency for all studies was 23.24 minutes (range 1.25-40 minutes). Twenty seven (50.9%) patients had mean sleep latency &gt;20 minutes (passed MWT) which indicate adequate control of treatment, while 26 (49.1%) had mean sleep latency &lt;20 minutes (failed MWT) including 5 (9.4%) with mean sleep latency &lt;8 minutes. There was no difference between patients who had passed MWT and failed MWT in the mean of Epworth sleepiness scale (12 vs 11), age (16.8 vs 17.6 years), or BMI (29.2 vs 26.3). Higher percentage of narcolepsy with cataplexy was found in patients who failed MWT (46.2% vs 22.2%, P 0.06). Findings from the MWT caused the changes of management in 25/26 (96.1%) who failed MWT, and 8/27 (29.6%) who passed MWT (P&lt;0.001).

Conclusion
Our result suggests that the MWT has clinical usefulness in evaluating responses to treatment for conditions associated with hypersomnia in children. Changes in management occurred in almost all patient who failed MWT. Interesting, there was no difference in subjective sleepiness between adolescents who passed and failed MWT, indicating the need to obtain objective data in this population. Future study is required to explore normative MWT data in pediatric population and to compare MWT with other tools such as driving simulation test.

Support
None
0956 Vitamin D and Sleep in Children
Authors: Al-Shawwa B , Ehsan Z , Ingram D G 
Published: May 2020

Abstract

Introduction
The impact of vitamin D on human health including sleep has been well described in adults. Its deficiency has been associated with multiple sleep disorders such as decrease in sleep duration, worsening of sleep quality and even obstructive sleep apnea. Such correlation is less evident in pediatric population. In the current study, we examined the relationship between sleep architecture and vitamin D status in children referred to a sleep clinic.

Methods
Retrospective-cohort study in a tertiary care children’s hospital over a one-year period. Children who underwent an in-laboratory-overnight-polysomnogram and had a 25-hydroxy vitamin D level (25-OH-vitD) obtained within 120 days of the sleep study were included. Patients with obstructive or central sleep apnea were excluded. Data from polysomnograms (PSG) and Pediatric Sleep Questionnaires (PSQ) were collected and analyzed.

Results
A total of 39 patients were included in the study with mean age of 6.6 years and 46% females. Twenty (51%) patients had vitamin D deficiency (25-OH-vitD less than 30 ng/ml). Children with vitamin D deficiency had less total sleep time (470.3 minutes +/-35.6 vs 420.3 minutes +/-61.7, p=0.004) and poorer sleep efficiency (91.9 % +/-5.6 vs 84.5 % +/-9.5, p=0.015) compared to vitamin D sufficient children. In addition, vitamin D deficient children had later weekday bedtimes (21:02 +/- 1:01 vs 20:19 +/- 0:55, p=0.037) and later weekend bedtimes (21:42 +/- 0:59 vs 20:47 +/- 1:08, p=0.016) with tendency for later wake up time that did not reach statistical significance. The remainder of polysomnographic findings and PSQ data were not different between the two groups.

Conclusion
Vitamin D deficiency in children is associated with objectively measured decreased sleep duration and poorer sleep efficiency. Furthermore, vitamin D deficiency was associated with delayed bedtimes, suggesting that vitamin D may influence circadian rhythm. Future prospective studies in children would be helpful in validating the effect of vitamin D on sleep.

Support
None
0975 Iron Infusion Protocol For Restless Leg Syndrome In Pediatric Patients
Authors: Taravath S , Peedin M 
Published: May 2020

Abstract

Introduction
Iron dextran protocols have been studied for adults with restless leg syndrome; this study aims to determine the benefit of iron infusions (iron dextran or sucrose) in the improvement or resolution of restless sleep in pediatric patients.

Methods
IRB approval was granted by New Hanover Regional Medical Center. A retrospective chart review was performed using the hospital’s electronic medical record (EMR). A data report was requested for all pediatric patients who received the iron dextran protocol. Patients who received at least one dose of iron dextran or iron sucrose per the protocol were included. Manual data collection included patient demographics, CBCs, iron panels, the dose of iron they received, polysomnogram results, symptom resolution (as described by the physician), and adverse events.

Results
Between January 1, 2017 and January 3, 2018, 55 patients received iron dextran per the weight-based protocol. Patients’ ages ranged from 23 months to 17 years and 5 months old. Of the 55 patients, 27 patients (49%) had documented restless leg syndrome and/or symptoms of leg pain or movement during sleep. All patients experienced restlessness or difficulty sleeping prior to the infusion. Of the 27 patients who experienced leg pain, 10 patients (37%) experienced an improvement in their leg pain or restlessness. Fifty-five percent (55%) of patients in this group reported an improvement in sleep symptoms.

Conclusion
Iron dextran protocols have been studied for adults with restless leg syndrome, but this is the first published data for a weight-based protocol in pediatric patients. While only 27 patients included in this study had a diagnosis of restless leg syndrome or leg pain symptoms, all patients experienced restlessness or other negative sleep symptoms.
Overall, most patients with restless leg syndrome experienced an improvement in their leg and sleep symptoms. No patients reported worsening of symptoms. Intravenous iron dextran infusion may greatly improve the quality of life for children with restless leg syndrome or poor sleep quality. With the overall safety of the iron infusions, this protocol’s benefits outweigh their risks and should be considered in this patient population.

Support
0992 Prevalence Of Insufficient Sleep Duration And Consequences On Daytime Sleepiness, Mood And Academic Performance In Thai Adolescents
Authors: Rojrattanadumrong R , Sudnawa K K , Areekul W , Jaroenying R 
Published: May 2020

Abstract

Introduction
Insufficient sleep duration in adolescents is key public health concerns in many societies. This study aims to assess the prevalence of insufficient sleep duration and the association between short sleep with daytime sleepiness, depressive symptoms, and anxiety among Thai adolescents.

Methods
Thai adolescents aged 11 -18 years completed a self-administered questionnaire including Phramongkutklao Hospital Sleep disorders center Questionnaire, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), The Children depress Inventory (CDI) scale and Child Anxiety Related Emotional Disorder (SCARED).

Results
232 adolescents with the mean age of 14.58 (range 11-18) years participated in this survey. The average total sleep time was 7.44 hours. The overall prevalence of insufficient sleep duration (sleep duration &lt;8 hours) was 37.5% and the small difference was found between males (42.0%) and females (32.7%). Compared with those who had a sleep length of 8 hours and more, insufficient sleep duration group exhibited higher in BMI and less in Grade Point Average (GPA). Subjective sleep insufficiency among Thai adolescent also had higher percentage of subjects with ESS ≥10 (43.2% vs 21.3%, P &lt;0.001), depressive symptoms (56.3% vs 39.3%, P 0.012) and anxiety (54.0% vs 38.6%, P 0.022) compare to those with adequate sleep duration.

Conclusion
High amount of Thai adolescents with poor sleep duration were observed in the study, consistency with prior surveys. Insufficiency sleep duration group had significantly increased daytime sleepiness, mood and anxiety problems among Thai adolescents. These findings emphasized the development of interventions to improve sleep duration in Thai adolescents and more sample size should be achieved in the future.

Support
None
0993 Impact Of Changing School Start Times On Parent Sleep
Authors: Meltzer L J , Plog A E , McNally J , Wahlstrom K L 
Published: May 2020

Abstract

Introduction
No studies have previously considered how healthy school start times impact parents. Since parent and child sleep schedules, in particular wake time, are associated, we examined whether changing school start times would impact parent sleep (elementary school [ES] 9:00am to 8:00am, middle school [MS] 8:00am to 8:50am, high school [HS] 7:10am to 8:20am).

Methods
Parents of students (grades K-12) completed online surveys pre-change, one-year, and two-years post-change (2017 n=11,579; 2018 n=8,884; 2019 n=8,796), reporting weekday bedtime and wake time (sleep duration calculated bedtime to wake time). Four PROMIS sleep questions asked about sleep “quality”, feeling “alert” upon waking, feeling “tired” during the day, and “daytime problems” because of sleep. Finally, parents were asked one-year post-change how happy they were about the new school start times.

Results
Parents with only ES students reported earlier bedtimes and wake times (10 and 13 minutes). Parents with &gt;1 HS student woke later (HS only: 22 minutes; MS and HS: 25 minutes; ES and HS: 10 minutes; all 3 levels: 14 minutes) and slept longer (HS only: 19 minutes; MS and HS: 21 minutes; ES and HS: 12 minutes; all 3 levels: 18 minutes), with changes maintained two years. Similarly, parents of only ES students reported no change in sleep quality/impairment. Post-change, more parents with &gt;1 MS or HS student reported good sleep quality (average increase=6.9%), feeling alert (average increase=5.8%), not feeling tired (average increase=5.0%), and having few daytime problems (average increase=4.2%), with benefits maintained two-years post-change. Across levels, parents who were “very happy” about start time changes slept longer than “very unhappy” parents (12-30 minutes); however, across levels, child sleep did not differ between happy and unhappy parents.

Conclusion
This is the first study to examine the impact of changing start times on parents of students in grades K-12. Study results show no significant impact on parents of elementary students. However, similar to students, parents of middle/high school students reported later wake times and increased sleep duration. Notably, parents’ happiness with start time changes was related to parent, but not student, sleep duration.

Support
Robert Wood Johnson Foundation’s Evidence for Action Grant