bluuebunny/crossref_metadata_2025_split huggingface dataset:
589 Sleep features longitudinally associated with refractive errors in preschoolers
Authors: Rayapoullé Alexis , Gronfier Claude , Forhan Anne , Heude Barbara , Charles Marie-Aline , Plancoulaine Sabine 
Published: May 2021

Abstract

Introduction
Refractive errors are very common, in particular in children and adolescents, leading to global health issues, academic implications and economic costs. The process of emmetropization in child development is a multifactorial and active mechanism, and is yet to be fully understood. Light exposure and endogenous circadian rhythmicity are thought to have an important role in this process. They are also known to be both cause and consequence of various sleep habits. The study aims at investigating the role of sleep duration and timing in refractive error development of preschoolers.

Methods
Sleep duration and timing were assessed at age 2 and 5 years, and vision problems at age 5 through parental auto-questionnaires in 1,130 children from the EDEN birth-cohort. We performed both cross-sectional and longitudinal analyses using logistic regression models, before and after adjusting for age, sex, socio-economic status, nap duration, time spent outdoors and daily screen-time. We conducted multiple imputations to deal with missing data on covariates. The shape of the association was considered by splitting sleep duration into tertiles.

Results
At age 5 years, 20.4% of the children were prescribed glasses (2% for myopia, 11.9% for hyperopia and 6.8% for unknow reason). Children slept on average (SD) 11h05 (30 min) per night at age 2 and 10h49 (48 min) at age 5. Average bedtime and midsleep were 8.36 pm (30 min), 2.06 am (36 min), and 8.54 pm (30 min), 2.06 am (24 min) at age 2 and 5, respectively. In the raw longitudinal analysis, a U-shaped association was observed between nocturnal sleep duration at age 2 and eyeglass prescription at age 5: 2-years-old children sleeping 11h30 had a higher risk to have an eyeglass prescription by the age of 5. Later midsleep and bedtime at age 2 were associated with an increased risk of eyeglass prescription at age 5. All associations, except the one concerning bedtime, were barely changed after adjustment while becoming borderline significant.

Conclusion
Duration and timing of sleep at age 2 were associated with subsequent onset of refractive errors in preschoolers from a general population. Sleep and light hygiene might be targets for prevention.
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591 Sleep disturbances and executive function outcomes after critical care hospitalization in children with acquired brain injury
Authors: Williams Cydni , Lim Miranda , McEovy Cindy , Hall Trevor , Drury Kurt , Shea Steven 
Published: May 2021

Abstract

Introduction
Annually, over 60,000 children require critical care admission for acquired brain injury (ABI) in the US, and many face long-term cognitive morbidity. Over 50% of these children also develop sleep/wake disturbances (SWD). Given the importance of sleep to brain development and healing after injury, we hypothesized SWD in children after ABI would portend worse cognitive outcomes in domains of executive function.

Methods
We performed a prospective observational study of N=80 children aged 6–18 years with ABI evaluated 1–3 months after critical care hospitalization. SWD were evaluated using the Sleep Disturbances Scale for Children (SDSC). The primary outcome was the Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2) Global Executive Composite (GEC; an age and gender adjusted T-score). Secondary cognitive outcomes included age adjusted scaled scores (ss) from the Delis Kaplan Executive Function System (DKEFS), Wechsler Intelligence Scale for Children, 5th Edition (WISC-V), and Children’s Memory Scale (CMS). Relationships between the SDSC and cognitive measures were evaluated using Spearman correlation (rs). Multiple linear regression evaluated associations between SWD and GEC T-scores controlling for patient and ABI characteristics.

Results
Sixty-five (81%) eligible children completed evaluation, and 48% had clinically significant SWD (total SDSC ≥39). Significant correlation (p&lt;0.05) was found between the SDSC total score and worse GEC T-score (rs=0.60), and worse ss for CMS numbers forward (rs= -0.39), WISC-V coding (rs=-0.36), DKEFS number letter switching total time (rs=-0.38), and DKEFS category fluency (rs=-0.43). Presence of SWD was significantly associated with a full standard deviation worsening in the GEC T-score (β-coefficient= 10.2, 95% Confidence Interval=1.0–19.3) when controlling for age, race, gender, admission Glasgow Coma Scale, critical care intervention, and chronic comorbidities.

Conclusion
Children with ABI requiring critical care have high rates of SWD after discharge that are associated with significantly worse executive function outcomes in overall function (BRIEF-2 GEC) and direct objective assessments (DKEFS, WISC-V, CMS) evaluating aspects of executive functioning including attention, processing speed, cognitive flexibility, and working memory. SWD may serve as a modifiable target to improve cognitive outcomes in this vulnerable pediatric population.

Support (if any)
This work is supported by the National Heart Lung and Blood Institute (K23HL150229-01)
593 Odds of Receiving Sleep Diagnoses in Common Pediatric Chronic Medical Conditions
Authors: Munoz Tomas , Patel Palakkumar , Adavadkar Pranshu 
Published: May 2021

Abstract

Introduction
Sleep disorders (SD) are under-diagnosed in the general pediatric population. Children with chronic medical conditions (CMC) tend to have a higher prevalence rate of SD; however, the studies about the rates of diagnosis of SD are limited. We examined the odds of receiving SD diagnoses in children with various CMC and hypothesized that if this likelihood is established, screening tools can be developed to increase the rates of diagnoses and improve clinical outcomes.

Methods
Chi-square test and regression analysis were used to test the association between SD and CMC based on ICD-9 and -10 diagnosis codes retrieved from the Medicaid claims submitted for children (0 to 18 years) enrolled in the Centers for Medicare and Medicaid Services-funded Coordinated Health Care for Complex Kids (CHECK) project, at an urban, public tertiary care hospital. Children without a CMC were excluded.

Results
Among 16,609 children with CMC (mean [SD] age of 9.1 [5.3] years; 56.4% male; 77% with multiple CMC), 14.1% received a diagnosis of SD. Compared to the cohort without a particular CMC, children with attention deficit hyperactivity disorder (ADHD), obesity, developmental disorder, or asthma had following odds of receiving sleep diagnosis respectively (odds ratio (OR) [Confidence Interval]): insomnia (6.9 [5–9.5]; 2.4 [1.7–3.2]; 1.6 [1.2–2.3]; 0.7 [0.5–1]), circadian rhythm disorders (6.1[2.7–13.7]; 2.8 [1.3–2.6]; 3.0 [1.4–6.4]; 0.5* [0.2–1.1]), hypersomnia (2.9 [1.0–8.6]; 7.8 [3–20.2], 0.9* [0.3–2.6], 0.8* [0.3–2.2]), and sleep-related movement disorder (1.9* [0.9–4.3]; 4.4 [2.5–7.8]; 2.2 [1.2–3.9]; 0.6*[0.3–1.1]). (*=p value &lt;0.05).

Conclusion
Odds of receiving sleep diagnoses vary across CMC. Among others, strong associations between obesity-hypersomnia and ADHD-insomnia were noted. This information may help clinicians implement appropriate screening interventions to improve early SD detection and management. Further studies to examine these associations are necessary.
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594 Sleep Trajectories Between the Age of 2 and 5 are Associated with Blood Cytokine Levels at Age 5 in the EDEN Birth-Cohort Study
Authors: Radmanish Masihullah , Khalfallah Olfa , Glaichenhaus Nicolas , Forhan Anne , Heude Barbara , Charles Marie-Aline , Davidovic Laetitia , Plancoulaine Sabine 
Published: May 2021

Abstract

Introduction
There is a reciprocal interaction between sleep and the immune system. Activation of the immune system changes the quality of sleep, and sleep regulates innate and adaptive immune responses. While these interactions have been studied in adults and adolescents, only a few studies have focused on school age children and none on preschoolers. Here, we have studied the association between night sleep trajectories between the age of 2 and 5 and serum levels of four cytokines in 5-year-old children.

Methods
A total of 687 children (44% girls) from the EDEN French birth cohort were included. Information on night sleep trajectories between 2 and 5 was available in all included individuals, as well as the levels of Tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, interferon gamma (IFN-gamma), and IL-10 in 5-year-old children. The associations between sleep trajectories and cytokines were assessed by multivariate linear regressions adjusted for socioeconomic, familial, maternal, perinatal and child factors.

Results
A shorter sleep duration trajectory (&lt;10h/night, 4.5% of children) was associated with higher levels of IL-6 when compared to the reference trajectory (≈11h30/night, 37.4% of children). A longer sleep duration trajectory (≥11h3/night, 40.9% of children) was associated with higher levels of IL-10. A changing sleep duration trajectory (≥11h30/night followed by 10h30/night, 5.6% of children) was associated with increased levels of TNF-alpha. No statically significant association was observed between sleep duration trajectories and IFN-gamma.

Conclusion
This first longitudinal study in preschoolers demonstrates an association between sleep duration trajectories and blood levels of IL-6, IL-10 and TNF-alpha. While association does not imply causation, our results are compatible with an impact of sleep duration on low-grade inflammation in preschool children. Should our results be replicated in an independent study sample, it would pave the way for a better understanding of the interactions between sleep and the immune system.
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596 Sleep Outcomes and Sleep-Related Behaviors in NICU Graduates
Authors: Burnham Alisa , Kucheruk Olena , Brown Emily , Mindell Jodi 
Published: May 2021

Abstract

Introduction
Previous studies of sleep patterns and problems in preterm infants and toddlers have yielded inconsistent results, with some studies noting differences on salient sleep parameters and others indicating similarities. Furthermore, little is known about any differences about sleep-related behaviors. Thus, the current aims of this study were to assess sleep patterns, problems, and sleep-related behaviors in young children born prematurely who were NICU graduates.

Methods
Caregivers of 262 children (53.4% boys; 35.9% Black, 40.5% White, 23.6% Other) being followed in a neonatal follow-up clinic at their corrected age one-year (10–16 months) or two-year (22–28 month) visit completed the Brief Infant Sleep Questionnaire-Revised SF (BISQ-R SF).

Results
At approximately one year of age, infants were going to bed at 8:36, taking 33 minutes to fall asleep, and waking .63 times per night for 19 minutes, for a total nighttime sleep duration of 8’01”. Similarly, at approximately two years of age, infants were going to bed at 8:16, taking 26.7 minutes to fall asleep, and waking .94 times per night for 16.3 minutes, for a total nighttime sleep duration of 8’26”. Sleep problems were reported by 18.1% and 19.6% of caregivers, respectively, with the majority indicating that their child slept well (78.5% and 76.5%) and minimal bedtime difficulties (13.6% and 14.6%). The majority of infants slept in their own crib (81%), with infants more likely to room share at 1-year compared to 2-year (49% vs 35%), and almost half falling asleep independently (43% and 46%).

Conclusion
Overall, sleep patterns and parent-perceived sleep problems (18–20%) in these NICU graduates were better than expected, and similar to normative data of similar age children (Sadeh et al., 2008). However, these infants/toddlers obtained less nighttime (8–8.5 hrs vs 10 hrs). Sleep education of parents of NICU graduates should not only focus on sleep behaviors, but also on ensuring sufficient sleep.
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601 Comparison of Sleep Parameters in Children with Achondroplasia and Trisomy 21
Authors: Gustave Jodi , Gaza Kaelyn , Marriner Jennifer , Rani Seema , Strang Abigail , Chidekel Aaron 
Published: May 2021

Abstract

Introduction
Children with achondroplasia and Trisomy 21 (T21) have increased incidence of sleep disturbances including sleep disordered breathing. Abnormal sleep architecture has been documented in children with T21. It is important to continue to analyze sleep parameters in both groups since poor sleep quality is associated with neurocognitive impairment.

Methods
Following IRB approval, we performed a retrospective chart review of patients at Nemours/A.I. duPont Hospital for Children in Wilmington, DE with achondroplasia and T21 who underwent an initial polysomnogram (PSG) between 2015 and 2020. We compared sleep architecture parameters between the groups including sleep efficiency, total sleep time (TST), sleep latency, arousal index and concentration of N3 and REM sleep.

Results
In patients with achondroplasia (n=49, mean age 5.8 months and 63.3% male), 12% reported restless sleep. PSG data revealed TST of 392 minutes, mean sleep efficiency of 82%, mean sleep latency of 9.4 min, mean arousal index of 40, 22% REM sleep and 32% N3 sleep. In the patients with T21 (n=32, mean age 17.8 months and 50% male), 59% reported restless sleep. PSG data revealed TST of 393 minutes, mean sleep efficiency of 82%, mean sleep latency of 14 minutes, arousal index of 35, 15% REM sleep and 40% N3 sleep. The differences in REM and N3 sleep between the two groups were statistically significant (p-values of 0.001 and 0.04, respectively), but the differences in arousal index, TST and sleep efficiency were not.

Conclusion
Our study showed that children with T21 subjectively noted more restless sleep compared to patients with achondroplasia although TST and sleep efficiency were similar. Patients with achondroplasia had a higher arousal index that was not statistically significant. Children with achondroplasia had a shorter sleep latency and more robust REM concentration, likely due to their younger age. There was a higher concentration of N3 sleep in patients with T21. This is likely due to the decrease in REM concentration. In conclusion, it is important to establish expected sleep parameters in patients with achondroplasia and T21 to maximize sleep quality and mitigate negative neurocognitive effects of poor sleep.
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603 Socioeconomic Status and Caregiver Perception of Young Children’s Sleep
Authors: Lupini Francesca , Williamson Ariel , Daniel Lauren , Mindell Jodi 
Published: May 2021

Abstract

Introduction
Socioeconomic status (SES) has been associated with variation in child sleep problems, but few studies have examined variation by SES in caregiver-reported early childhood sleep problems, patterns, and health behaviors. We hypothesized that, compared to higher-SES caregivers, lower-SES caregivers would report poorer sleep outcomes and sleep health behaviors, but lower rates of caregiver-perceived sleep problems.

Methods
A total of 309 caregivers (97% parents) of young children (M child age=3.59 years; 53.1% girls; 15% non-Hispanic/Latinx White, 57% non-Hispanic/Latinx Black, 20% Hispanic/Latinx White, 8% Hispanic/Latinx Black) completed the Brief Child Sleep Questionnaire. SES was measured via income level (lowest=$0-$20,000; middle= $20,001-$50,000; highest= $50,001 or greater).

Results
The prevalence of a caregiver-reported child sleep problem was similar across SES (17.6% of lowest SES group, 8.8% of middle, and 15.5% of highest, p&gt;.05). However, ANCOVA models covarying for child race/ethnicity, age, caregiver age and education indicated sleep outcomes varied by SES. Caregivers in the lowest SES group reported significantly longer child sleep onset latency (SOL) than the middle or highest groups (p=.008), more frequent night wakings than those of middle SES (p=.009), and longer night waking duration than those of the highest SES, (p=.047). There were no significant differences by SES for child bedtime, total nighttime sleep, and total (24-hour) sleep duration. Logistic regression models with the same covariates showed no variation by SES for sleep behaviors, including caffeine consumption, presence of bedroom electronics, and bedtime resistance. Within each SES group, logistic regression models indicated that increased night wakings were uniquely associated with greater likelihood of endorsing a child sleep problem in the middle SES (p=.045) and highest SES groups (p=.040), but not in the lowest SES group.

Conclusion
Although caregiver-reported child sleep problems did not significantly differ across SES, lower-SES caregivers reported longer child sleep onset latency and increased number and duration of night wakings. Furthermore, night wakings were associated with perceived sleep problems, but only in middle and highest SES families. Clinicians should consider specific sleep parameters, such as SOL and night wakings, in addition to caregiver-reported child sleep problems when assessing and addressing child sleep problems, especially in lower-SES families.

Support (if any)
Funding: NIH K23HD094905 (AAW)
605 Sleep problems are associated with behavioral problems and decreased quality of life in children with Fontan circulation
Authors: Robertson Kirstin , Seckeler Michael , Klewer Scott , Hsu Chiu-Hsieh , Edgin Jamie , Provencio-Dean Natalie , Lopez Silvia , Parthasarathy Sairam , Combs Daniel 
Published: May 2021

Abstract

Introduction
Children with congenital heart disease who undergo a Fontan procedure are at higher risk of behavior and attention problems as well as reduced quality of life compared to age-matched peers. While sleep problems are associated with behavior and attention problems in children without Fontan circulation, this relationship has never been examined in children with Fontan circulation. We hypothesized that sleep problems in this population may increase the risk of behavior problems and also reduce health related quality of life (HRQOL).

Methods
We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent-reported diagnosis of a sleep problem with reported behavioral concerns and HRQOL as measured by the child health questionnaire (CHQ) in 558 children with Fontan circulation. Analysis was performed using logistic regression or Wilcoxon sum rank test, as appropriate, with Bonferroni correction for multiple comparisons.

Results
Parent-reported sleep problems were present in 10% of participants. Sleep problems were associated with a 4.6x higher risk of attention problems, 10.2x higher risk of anxiety problems, 3.9x higher risk of behavioral problems, 9.5x higher risk of depression, 5.0x higher risk of developmental delay, 6.9x higher risk of learning problems and 2.2x higher risk of speech problems (p=0.04 for speech problems, p&lt;0.001 for all others). Parent report of a sleep problem was associated with decreased physical HRQOL (z-score -1.3 [interquartile range-2.2, -0.2] vs 0.0 [-0.8, 0.4], p&lt;0.001) and psychosocial HRQOL (-0.9 [-1.9, 0.0] vs 0.0 [-0.8, 0.7], p&lt;0.001) compared to children without a reported sleep problem. Report of a sleep problem was associated with significantly lower HRQOL across all subdomains of the CHQ (p&lt;0.05 for all subdomains).

Conclusion
Children with Fontan circulation with sleep problems have an increased risk of behavioral and developmental problems as well as reduced HRQOL. Better understanding of sleep problems is needed in children with Fontan circulation, as sleep disorders may represent a reversible cause of behavioral problems and decreased HRQOL in this population.

Support (if any)
Funding to DC from the American Heart Association, University of Arizona Health Sciences Center, and NIH-NHLBI. Fontan study data obtained from the Pediatric Heart Network.
606 Incidence & Influence of Drug Screening in Children with Hypersomnolence During MSLT: Analysis of the Children’s Wisconsin Cohort
Authors: D’Andrea Lynn , Handa Arun , Amos Louella , Bandla Hariprasad , Castner Lauren , Grekowicz Megan , Graf Danielle , Kump Theresa , Pan Amy , Barbeau Jody 
Published: May 2021

Abstract

Introduction
The Multiple Sleep Latency Test (MSLT) is a validated test for evaluation of hypersomnolence in children and adults. AASM practice parameters recommend performing urine drug screens (UDS) in patients undergoing MSLT to identify substances that alter MSLT results. The study aims are to determine the incidence of positive UDS and their influence on MSLT variables in a cohort of children evaluated for hypersomnolence.

Methods
All children undergoing an MSLT in Children’s Wisconsin sleep laboratory over an 8-year period (11/1/2012 to 9/30/2020) were included in this retrospective chart review study. Clinical and demographic data, including UDS results were manually abstracted. Record validation conducted by random allocation. Data were summarized as median and IQR or n (%). Chi-square test or Fisher’s exact test were used to examine associations between categorical variables.

Results
236 children completed an MSLT. The sample had a median age of 14.1 (IQR 10.5–16.2) years (50.9% female; 63.1% Caucasian). Narcolepsy I (“N1”; n=14; 5.9%), Narcolepsy II (“N2”; n=56; 23.7%), Idiopathic Hypersomnia (“IH”; n=39; 16.5%) were frequently diagnosed. Most children (97.9%) completed a UDS; 60.2% tested positive. Common substances found on UDS were caffeine (62.6%), OTC medications (40.3%), and prescription medications (33.8%), however nicotine (14.3%) and cannabis (5.8%) were also seen. Caffeine was commonly found in those diagnosed with N1 (70%), N2 (69.4%), and IH (54.2%). Fewer children diagnosed with narcolepsy were positive for prescription medications compared to those diagnosed with IH (21.7% versus 41.7%) although results did not reach significance (p=0.08). No child with N1 tested positive for prescription medications. ≥2 substances were found in 43.2% of positive drug screens. OTC medications and caffeine were most commonly co-occurring (23%); OTC analgesics being the most common OTC medication. No association between positivity for &gt;2 substances and sleep diagnosis was found (p=0.5).

Conclusion
More than half of children undergoing an MSLT had a positive UDS for &gt;1 substance. The impact of these substances on PSG/MSLT parameters (total sleep time, mean sleep onset latency, sleep onset REM periods) is under investigation through additional analysis. Based on the above data our findings support the AASM guidelines of children obtaining a UDS on the day of MSLT.
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