bluuebunny/crossref_metadata_2025_split huggingface dataset:
579 Child Sleep Onset Latency Mediates Parental Depression and Non-Compliance in Children with Autism Spectrum Disorder
Authors: Stearns Melanie , Hayse Braden , Nair Neetu , Mazurek Micah , Curtis Ashley , Beversdorf David , Deroche Chelsea , Sohl Kristin , Ner Zarah , Davis Beth , Takahashi Nicole , Muckerman Julie , McCrae Christina S 
Published: May 2021

Abstract

Introduction
Parents who have been diagnosed with depression often report that their children are not compliant and have difficulty falling asleep. Parents with depression are less likely to be consistent or enforce bedtimes resulting in the child having less bedtime rules and getting less sleep. Overtime this may mean the child develops poor sleep habits and difficulty falling asleep. Although these relationships have yet to be studied in children with Autism Spectrum Disorder (ASD), it is an important area given the high prevalence of children with ASD who have sleep difficulties. The current study examined whether parent-reported child sleep onset latency mediated the relationship between parental depression and child non-compliance.

Methods
The sample (N=50) consisted of parents (81% female) reporting on their children aged 6–12 (M=8.63, SD = 2.00; 76% male). All children were diagnosed with ASD and had parent reported sleep complaints. Children and their parents were recruited because they expressed interest in a behavioral treatment sleep study and these data come from the baseline data collection associated with that study. Measures included sleep onset latency on the Child Sleep Health Questionnaire (CSHQ), an item on the Pediatric Symptom Checklist (PSC) which asked if a child follows rules, and a question asking if the parent had been diagnosed with depression.

Results
Analyses were conducting using AMOS 27.0. Slightly less than half (45%) of parents reported having been diagnosed with depression. Parent-reported child sleep onset latency significantly mediated (β =.13) the relation between parental depression and non-compliance. Parents who had been diagnosed with depression were associated with greater child sleep onset latency (β =.32, p = .04) and greater child sleep onset latency was associated with greater non-compliance (β =.40, p = .01). The direct effect between parental depression and non-compliance was not significant.

Conclusion
These results suggest that difficulty falling asleep may help to explain why children of parents who have depression are not compliant. Future research should utilize longitudinal and experimental methodology to determine the causality of these relationships.

Support (if any)
University of Missouri Research Board Grant (McCrae, PI); United States Department of Defense USAMRAA Autism Research Program (McCrae, PI; CTA AR190047).
582 Insomnia-related cognitive and behavioural factors in adolescents with delayed sleep-wake phase disorder
Authors: Cheung Forrest Tin Wai , Chan Joey W , Chan Ngan Yin , Li Xiao , Zhang J , Wing Y K , Li Shirley Xin 
Published: May 2021

Abstract

Introduction
Although delayed sleep-wake phase disorder (DSWPD) shares phenomenological experiences with chronic insomnia disorder, previous research on the conceptual understanding of DSWPD has been limited, with a predominant focus on its chronobiological basis. The present study examined several insomnia-related cognitive and behavioural factors in adolescents with DSWPD.

Methods
Twenty-five adolescents with DSWPD (age = 19.9 ± 1.6; female = 28%), 28 with chronic insomnia disorder (age = 20.4 ± 2.0; female = 61%), diagnosed according to the ICSD-3 criteria, and 25 healthy control (age = 20.4 ± 1.5; female = 68%) were included in the present study. Participants completed 7-day prospective sleep diary and actigraphy monitoring, and a battery of questionnaires on sleep and chronotype measures. Participants were also measured on hyperarousal (Pre-Sleep Arousal Scale, PSAS), sleep reactivity (Ford Insomnia Response to Stress Test, FIRST), sleep-related beliefs (Dysfunctional Beliefs and Attitudes about Sleep, DBAS-16), and sleep hygiene practices (Sleep Hygiene Practices Scale, SHPS). Analysis of covariance (ANCOVA) with gender as the covariate was used for between-group comparisons.

Results
Relative to healthy control group, insomnia and DSWPD group showed significantly more insomnia symptoms as measured by Insomnia Severity Index (p&lt;.001). As compared to healthy control group, DSWPD group showed significantly more delay in circadian phase based on sleep diary and actigraphy derived mid-point of sleep, as well as greater preference towards eveningness as measured by the Morningness-Eveningness Questionnaire. DSWPD group also showed significantly more cognitive and somatic hyperarousal (p&lt;.001, d = 1.36–2.31), sleep reactivity (p&lt;.001, d = 1.73), dysfunctional belief about sleep (p&lt;.001, d = 1.59), as well as poorer sleep hygiene practices (p&lt;.001, d = 2.62), compared to healthy control. There were no significant differences in the circadian parameters, PSAS, FIRST, DBAS-16, and SHPS between DSWPD and insomnia groups.

Conclusion
Several insomnia-related cognitive and behavioural factors, namely hyperarousal, sleep reactivity, maladaptive beliefs about sleep, and poor sleep hygiene, are also evident in youths with DSWPD. The findings had important implications for the conceptual understanding and clinical management of DSWPD.

Support (if any)
This work was supported by the Seed Fund for Basic Research (University Research Committee, The University of Hong Kong) awarded to Dr. Shirley Li.
595 The associations between excessive daytime sleepiness and emotional lability in typically developing adolescents
Authors: Giorgio Lisa-Marie , Somerville Gail , Boursier Johanne , Gruber Reut 
Published: May 2021

Abstract

Introduction
Excessive daytime sleepiness (EDS), defined as a tendency to fall asleep unintentionally during the day, and emotional lability, characterized by emotional outbursts and quick changes in mood, are prevalent amongst adolescents. They contribute to functional impairments and are inter-related, but are frequently investigated independently. In addition, sleep duration is related to both EDS and emotional/behavioral regulation, but previous studies did not take this into account. The aim of this study was to characterize the associations between emotional lability, impulsivity and EDS in adolescents while controlling for objectively measured sleep duration. It was hypothesized that higher levels of EDS in adolescents would be associated with higher levels of emotional lability and impulsivity in adolescents above and beyond the impact of sleep duration.

Methods
Participants included 52 typically developing adolescents (38 females) aged 11 to 16 years old (Mean age = 13.10 years, SD = 1.59). EDS was measured using the Sleep Disorders Inventory for Students. Emotional lability and impulsivity were measured using the Conners Global Index Scale. Sleep was measured using actigraphy and sleep logs.

Results
Parallel multiple regression analyses were conducted with EDS as the independent variable, and emotional lability or impulsivity as the dependent variables, while controlling for age, gender, bedtime, waketimes, and sleep duration. These analyses revealed significant positive association between EDS and emotional lability such that adolescents with high levels of EDS also presented with high levels of emotional lability (F(6, 51) = 4.631, p = &lt; .001, β =.62, p = &lt;.001). There were no significant associations found between EDS and impulsivity.

Conclusion
This study found that EDS was associated with emotional, but not behavioral, dysregulation in adolescents. Interventions aimed at reducing EDS and at improving adolescents’ emotional regulation should be considered as a means to optimize adolescents’ daytime functioning. Limitations of the current study include the use of a cross-sectional design that does not permit determination of causality. Future research should be conducted to better understand the mechanisms underlying the interplay between EDS and daytime functioning of adolescents.
Support (if any):
597 Sleep Bruxism in Preschool Children: Associations with Emotional-Behavioral Problems
Authors: Laganière Christine , Kenny Samantha , Gaudreau Hélène , Pokhvisneva Irina , Bouvette-Turcot Andrée-Anne , Meaney Michael , Pennestri Marie-Helene 
Published: May 2021

Abstract

Introduction
Several psychosocial factors contribute to the etiology of sleep bruxism in childhood, including emotional-behavioral problems, as well as environmental and familial factors. It is known that sleep bruxism is prevalent in preschoolers, but most etiology studies were conducted with school-aged children or adolescents. Studies focusing on younger, preschool-aged populations that consider family-related factors are lacking. This study aimed to assess the relationship between emotional-behavioral problems and the presence of sleep bruxism in preschoolers, while taking maternal depressive symptoms into consideration.

Methods
Three hundred eighty-three mother-child dyads from the Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN) cohort were included in the present study. Mothers completed the Child’s Sleep Habits Questionnaires (CSHQ; includes the frequency of bruxism), a questionnaire about their child’s emotional-behavioral problems (CBCL; anxiety and depressive problems), and reported their own depressive symptoms (CES-D). Measures were completed at two timepoints: when children were 4 and 5 years old. Generalized Estimating Equation (GEE) models were used to evaluate the relationship between sleep bruxism frequency and children’s emotional-behavioral problems, while controlling for maternal depressive symptoms, child’s biological sex, family socioeconomic status, and age.

Results
Maternal reports indicated that 12% of children experienced sleep bruxism at least sometimes at age four, and 20% did at age five. Children’s anxiety and depressive symptoms were associated with increased sleep bruxism frequency (p &lt; 0.05). Associations between children’s emotional-behavioral problems and bruxism remained statistically significant when controlling for maternal depressive symptoms, child’s biological sex, family socioeconomic status, and time (p &lt; 0.05).

Conclusion
In this normative cohort of children, sleep bruxism was associated with anxiety and depressive symptoms in children as young as age four. Furthermore, this relationship can still be observed when the severity of maternal depressive symptoms is considered. Whether anxiety and depressive symptoms contribute to sleep bruxism, or vice versa, remain to be further investigated. Nevertheless, results suggest that screening of emotional-behavioral problems should be considered in children experiencing sleep bruxism.

Support (if any)
Fonds de recherche du Québec - Santé
598 Sleep Variability and Infant Anthropometry during the First 6 Months
Authors: Tsai Shao-Yu , Tung Yi-Ching , Tsai Shao-Yu 
Published: May 2021

Abstract

Introduction
Sleep plays a crucial role in children’s health and development, and emerging evidence suggests that sleep disturbances during infancy negatively impact both the neurocognitive and socioemotional outcomes later in life. However, no study has taken the variability of sleep into account when examining physical growth in infancy, which is a critical period for both healthy sleep and weight development. The purpose of the study was to examine the association between sleep variability and physical growth in infants aged 6 months.

Methods
316 healthy infants recruited during their 6-month well-child checkups had their weight and length measured, and wore an actigraph on the ankle for a week. Average weekday, weekend, and all week sleep duration were computed, with infants categorized into three groups: regular sleep, weekend catch-up sleep, and weekend sleep curtailment. General linear model analyses were performed with sleep variability as the primary predictor variable of interest and infant anthropometry as the dependent variable.

Results
Average weekday daily sleep duration was 10.76 (1.06) hours which was similar to the average weekend daily sleep duration of 10.68 (1.06) hours. In both unadjusted and adjusted models controlling for potential confounding variables, infants in the weekend catch-up sleep group (30.4%) and those in the weekend sleep curtailment group (34.5%) had significantly higher weight-to-length ratios, body mass index, and weight-for-age z scores when compared with infants in the regular sleep group (35.1%, all p &lt; 0.05).

Conclusion
Weekday-weekend sleep pattern differences exist even as early as in the first 6 months of life, and either weekend catch-up sleep or weekend sleep loss is associated with higher infant anthropometric markers. Our findings suggest that sleep assessments in infants in well-child checkups should include not only global assessments of average sleep duration but also address sleep pattern regularity.

Support (if any)
This study was funded by the National Health Research Institutes, Taiwan, NHRI-EX102-10229PC.
599 Exploring Ways to Optimize Parental Involvement in Adolescent Sleep Interventions
Authors: Zoltanski Ava , Levenson Jessica , Reyes Zoe , Bahary Sigalle , Ford Hannah , Patel Garima , Miller Elizabeth , Mukundan Aishwarya 
Published: May 2021

Abstract

Introduction
Sleep is critical to the health and functioning of adolescents, but most teens do not obtain the recommended amount of sleep each night. Some sleep interventions have been efficacious in promoting sleep among adolescents, though others have had a more limited impact. One potential strategy for improving the efficacy of adolescent sleep promotion programs is to optimize the role of parents in supporting their child’s sleep. Recent findings on parental involvement in adolescent sleep suggest that monitoring can improve sleep duration but may be challenged by disagreements about sleep between parents and adolescents. Thus, it is crucial to understand how to involve parents in adolescent sleep promotion while supporting adolescent autonomy. Here, we report qualitative data on strategies for involving parents in adolescent sleep promotion in a way that is acceptable and effective. This data was collected specifically to inform the development of a sleep promotion program for adolescents.

Methods
We conducted 9 focus groups (3 each for youth, parents of adolescents, and healthcare providers treating adolescents). Transcripts of focus group proceedings were coded and thematically analyzed using inductive and deductive approaches, focusing on parents’ current role in their child’s sleep and the proposed role of parents in an adolescent sleep program.

Results
Some parents report being involved in their child’s sleep habits by setting bedtimes and supervising a consistent sleep routine. Adolescents prefer parental support that encourages child autonomy for their own sleep routine. To maintain healthy sleep habits, parents report that physicians or other trusted adults may play a key role in facilitating the negotiation of sleep habits that addresses the priorities of both parents and adolescents.

Conclusion
Our findings support adolescent preference for autonomy in their health behaviors consistent with their developing independence during this development period. Future work should focus on improved understanding of how adolescents and parents can negotiate adolescent autonomy and should examine the efficacy of a sleep promotion program based on varying levels of parental involvement.
Support (if any):
620 Description of 14&6 variant on polysomnography
Authors: Powell Weston , Nash Jessica , Ruth Chris , Chan Jeremy , Lockhart Carey 
Published: May 2021

Abstract

Introduction
Benign variants or incidental findings are often identified on routine polysomnography. One such variant is 14-and-6 hertz positive spikes, first described on EEG in 1951; however, the significance of 14-and-6 positive spikes found on polysomnography has not been previously described.

Methods
We conducted a retrospective review of patients with 14-and-6 Hz spikes on polysomnography and compared clinical findings on polysomnography with age and sex-matched controls.

Results
Mean age was 8.6 years (range 2–16). Sleep indices did not differ between cases and controls. Patients with 14-and-6 Hz spikes had lower obstructive apnea-hypopnea index and were less likely to be diagnosed with obstructive sleep apnea. Patients with 14-and-6 Hz spikes did not differ from controls in frequency of formal neurology evaluation, whether a full EEG was obtained, or neurologic diagnoses. Patients with 14-and-6 Hz spikes were less likely to be diagnosed with behavioral or developmental disorders.

Conclusion
14-and-6 Hz spikes can be seen in children of all ages and does not seem to be associated with any sleep, neurologic, or developmental disorders.
Support (if any):
628 Longitudinal Association between NREM Sleep Depth and Arousability with ADHD and Internalizing Disorders in Adolescence
Authors: Ricci Anna , Fernandez-Mendoza Julio , He Fan , Calhoun Susan , Younes Magdy , Fang Jidong , Lukenbill Nicole , Vgontzas Alexandros , Liao Duanping , Bixler Edward 
Published: May 2021

Abstract

Introduction
Sleep depth decreases in the transition from childhood to adolescence, even in typically developing (TD) youth. However, it remains unknown whether this developmental trajectory in NREM sleep depth differs across adolescents with psychiatric/behavioral disorders.

Methods
We analyzed the sleep EEG of 392 subjects aged 5–12 at baseline and 12–22 at follow-up (45.2% female, 23.2% racial/ethnic minority), of whom 246 were TD adolescents (controls), 62 were diagnosed with a psychiatric/behavioral disorder and were taking stimulant, anti-depressant, anxiolytic, sedative and/or anti-psychotic medications, and 84 were un-medicated. NREM sleep depth was measured at both time points using the odds ratio product (ORP), which provides a standardized continuous EEG measure of NREM sleep depth/arousability (higher ORP reflects lighter NREM sleep). General linear models examined mean differences between groups on the percent change in ORP between baseline and follow-up (ΔORP) while adjusting for sex, race/ethnicity, age, BMI and AHI at follow-up, and PSG system, psychiatric/behavioral disorders, psychoactive medications and ORP at baseline as well as time-to-follow-up.

Results
Overall, medicated (80.4%, 95%CI=66.2–94.6) and un-medicated (66.1%, 95%CI=53.0–79.1) subjects showed a higher ΔORP compared to controls (52.2%, 95%CI=40.0–64.5, p&lt;0.01 and p&lt;0.05, respectively) but did not differ between each other (p=0.134). Specifically, un-medicated subjects with ADHD (n=56) showed a higher ΔORP (77.3%, 95%CI=62.4–92.1) compared to controls (p&lt;0.01), while subjects with ADHD on stimulant medication (n=36) did not differ (66.1%, 95%CI=48.9–93.2) from controls (p=0.268) or from un-medicated ADHD subjects (p=0.303). Subjects with internalizing disorders on psychoactive medications (n=29) showed a higher ΔORP (104.9%, 95%CI=82.8–127.0) compared to controls (p&lt;0.01) and to un-medicated subjects (n=27) with internalizing disorders (60.1%, 95%CI=36.8–83.3, p&lt;0.01), who did not differ from controls (p=0.772).

Conclusion
The greater increase in ORP in the transition to adolescence in un-medicated youth with ADHD suggests that decreased NREM sleep depth may be a biomarker of the disorder. In contrast, the greater increase in ORP in medicated youth with internalizing disorders suggests that psychoactive medications impact NREM sleep depth in these children as they transition to adolescence. These data have important implications for sleep EEG studies that include medicated and un-medicated youth with comorbid psychiatric disorders.

Support (if any)
NIH Awards Number R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127
644 Sleep Quality in Intensive Care Unit Patients with Advanced Heart Failure
Authors: Edmiston Elizabeth , Dolansky Mary 
Published: May 2021

Abstract

Introduction
Around 75% of Americans with heart failure (HF) report poor sleep quality, a much higher percentage than the general population. This is especially concerning since poor sleep quality is associated with poor cardiac event-free survival. Persons with HF are hospitalized often and between 10–51% of those hospitalized are admitted to an intensive care unit ICU. Poor sleep quality is a common complaint in ICU with over 50% of patients rating sleep quality as poor to very poor. The purpose of the study was to evaluate changes in sleep quality in persons with advanced HF who were admitted to an ICU.

Methods
Persons with advanced HF admitted to ICU were recruited into this pilot study (age 29–89). Using the Pittsburgh Sleep Quality Index, self-reported sleep quality was assessed at three time points: pre-admission, during hospitalization, and post-discharge. Scores greater than five indicated poor sleep quality. A Repeated Measures Analysis of Variance (RMANOVA) test compared means from the same participant over time for sleep quality (N=22).

Results
At baseline, 93% of participants reported poor sleep, 90% during hospitalization, and 86% post-discharge. A significant difference among the three time points was found [F (2, 42) =5.341; p&lt;.01]. The mean sleep quality score pre-admission was 11.77 and SD=3.69, during hospitalization M=12.27 and SD=3.65, and post-discharge M=9.32 and SD=4.56. The mean difference of sleep quality pre-admission and sleep quality during hospitalization was not significant. However, the mean difference of sleep quality pre-admission and sleep quality post-discharge was significant (Mean difference=2.46; p&lt;.05). Also, a significant difference in sleep quality during hospitalization and post-discharge was found (Mean difference=2.96; p&lt;.05).

Conclusion
The number of participants who reported poor sleep during hospitalization was much larger than previously reported in the literature. Also, participants reported significantly better sleep quality post-discharge than pre-admission and during hospitalization. Furthermore, this population may be vulnerable for poor sleep due to symptom severity prior to hospital admission, diuretic use, and poor sleep hygiene. Implementation of sleep hygiene strategies are needed during hospitalization to promote sleep and to teach sleep hygiene self-management.
Support (if any):