bluuebunny/crossref_metadata_2025_split huggingface dataset:
607 Longer slow wave sleep and exacerbated core symptom severity in autism spectrum disorder
Authors: Buck Casey , Kawai Makoto , Hara Ruth O’ , Chick Christina , Anker Lauren , Schneider Logan 
Published: May 2021

Abstract

Introduction
Sleep disturbances in individuals with autism spectrum disorder (ASD) are common, yet previous studies have reported inconsistent findings on the associations between sleep architecture and core features of ASD. Our goal is to examine 1) the difference in sleep architecture, especially SWS, between children with ASD and typically developing controls (TD), 2) the association between SWS and core symptoms in ASD, and 3) the association of slow wave activity (SWA) spectral power and ASD symptoms.

Methods
We used ambulatory polysomnography (PSG) to record the sleep architecture in 61 children and adolescents (age 6 to 18) with ASD and 73 typically developing controls (TD) in their sleeping environment. We performed an analysis to examine 1) the difference in sleep architecture between ASD and TD, and 2) the association of SWS with core symptoms of ASD with the Autism Diagnostic Interview-Revised (ADI-R) and Repetitive Behavior Scale (RBS).

Results
Children and adolescents with ASD showed a higher SWS ratio and lower REM ratio than TD. Delta (1–4 Hz) relative power during total sleep was higher in ASD than TD. Further, a higher ratio of SWS predicted more severe behavioral symptoms as measured by the ADI-R and the Ritualized Behavior subscale of the RBS. Delta power did not show a significant association with core symptoms.

Conclusion
A higher ratio of SWS may reflect the neuronal immaturity specific to ASD in this age group. It may help us understand the underlying mechanism of the clinical symptoms in children with ASD.

Support (if any)
Support for this work was provided to Dr. O’Hara by a grant from the Simons Foundation Autism Research Initiative (SFARI). Dr. Kawai is supported by the National Institute on Aging of the National Institutes of Health K23AG053465, and his contribution to this manuscript was made possible by an award from the American Sleep Medicine Foundation (#157-BS-16), a foundation of the American Academy of Sleep Medicine, 2018 NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation, and Autism Working Group Award from Mosbacher Family Foundation. All authors gratefully acknowledge all participants and their families.
609 Comparing parental sleep goals for younger versus older toddlers
Authors: Mindell Jodi , Collins Meghan , Leichman Erin , Rotella Katie 
Published: May 2021

Abstract

Introduction
This study aimed to assess parental sleep goals, comparing younger (12-23.9-month-olds) and older toddlers (24-35.9-month-olds) in consideration of developmental differences.

Methods
Parents (98.0% mothers) of 401 toddlers (12–35 mos; M=22.49 mos; 49% male) in the US completed an online survey, including an abbreviated Brief Infant Sleep Questionnaire and a list of 58 desired areas of change (DACs). There were 230 one-year-olds (1yos; M=17.42mos) and 171 two-year-olds (2yos; M=29.30mos), with no difference in parent age between groups (M=34.41 years).

Results
25.7% reported a perceived sleep-problem, whereas 94.8% indicated at least one sleep-related DAC. Parents of one- and two-year-olds reported similar rates of DAC for overnight sleep (58% vs. 49%), morning sleep (55% vs. 52%), and naps (70% vs. 64%), p&gt;.05. Parents of 2yos, however, reported bedtime as a DAC at a higher rate (59% vs. 79%), p&lt;.001. Twenty-five percent of specific bedtime DACs (n=8) were endorsed by ≥10% of parents. Parents endorsed falling asleep without an adult (17% of 1yos vs. 22% of 2yos) and falling asleep without nursing (10% vs. 9%) at similar rates, p&gt;.05. Parents of two-year-olds were more likely to endorse: getting through bedtime routine quickly/easily without stalling (10% vs. 30%,), earlier bedtime (10% vs. 24%), falling asleep faster at bedtime (24% vs. 10%), falling asleep without a pacifier (11% vs. 19%), falling asleep faster while alone (8% vs. 16%), and falling asleep without stalling/making requests (3% vs. 18%), p&lt;.05.

Conclusion
The majority of parents of toddlers endorsed a sleep-related desired area of change, with two-thirds wanting to change something about bedtime and naps, and over half wanting to change something about overnight and morning sleep. Parents of older toddlers (2yos) were more likely to desire changes at bedtime than parents of younger toddlers (1yos), especially related to stalling and discontinuing pacifier use. As toddlers age, bedtime problems are more likely. Health care providers should be aware of developmental changes, such as increased language and assertions of independence, that seem to mostly affect bedtime when addressing sleep issues in toddlers.

Support (if any)
Johnson & Johnson Consumer Inc., Skillman, NJ, USA.
612 Early Protective Factors of Child Sleep Quality Trajectory: Results from the Healthy Brain and Behavior Study
Authors: Dai Ying , Liu Jianghong 
Published: May 2021

Abstract

Introduction
Poor sleep quality is associated with many adverse health outcomes for children and adolescents. Recently, increasing knowledge has been gained for understanding risk factors for poor sleep, but there is little knowledge about early protective factors for sleep quality in young people. The purpose of this study was to investigate whether prenatal obstetric and psychosocial factors, and happiness during childhood would predict child sleep quality across time.

Methods
A total of 290/454 children aged 11–12 years in the Healthy Brain and Behavior Study were included in analysis. Prenatal obstetric and psychosocial factors were recalled by mothers through structured interviews. Childhood happiness and child sleep quality across 1, 3, 5, 11, and 12 years of age were reported by mothers through questionnaires. Two-level linear mixed-effects modeling was conducted.

Results
Overall, children’s average sleep quality increased from 1 to 5 years, followed by a decrease during 5 to 12 years. Prenatal care (β = 0.376, SE = 0.169, p = 0.027), better maternal psychosocial support during pregnancy (β = 0.045, SE = 0.016, p = 0.007), and higher childhood happiness (β = 1.333, SE = 0.274, p &lt; 0.001) were associated with better sleep quality across childhood. Childhood happiness during previous developmental age predicts better sleep quality at later age (β = 1.526, SE = 0.350, p &lt; 0.001). Other prenatal factors including prenatal gestation and parturition history, substance use during pregnancy, maternal labor and delivery complications, and neonatal conditions were not associated with child sleep quality trajectory.

Conclusion
Prenatal care, prenatal psychosocial support, and childhood happiness are protective factors of child sleep quality across 1–12 years of age. Future prospective longitudinal studies are needed to understand the causal relationship between early protective factors and sleep quality in childhood and adolescence.

Support (if any)
This study is supported by the Pennsylvania Department of Health (SAP# 4100043366), the Clinical & Translational Research Center, Perelman School of Medicine, University of Pennsylvania (grant number UL1-RR-024134).
614 The Development and Psychometrics of an Assessment of Children’s Sleep Environments
Authors: Peltz Jack , Rogge Ronald , Buckhalt Joseph , Elmore-Staton Lori 
Published: May 2021

Abstract

Introduction
Approximately half of school-aged children (ages 5–18) get either insufficient sleep during school nights or barely meet the required amount of sleep expected for healthy functioning (National Sleep Foundation, 2014).This percentage increases as children develop into adolescents (National Sleep Foundation, 2006). Accordingly, sleep problems and insufficient sleep are so pervasive that they could be considered an epidemic due to their adverse impact on children’s mental and physical health (Owens, 2015; Shochat et al., 2014). Fundamental to children’s sleep health is their sleep environment (Billings et al., 2019; Spilsbury et al., 2005). Despite its importance, however, there remains a noticeable absence of valid and reliable assessments of this construct. The current study sought to develop a measure of children’s sleep environments to support research and clinical work on youth’s sleep health.

Methods
A total of 813 parents (Mage = 40.6, SD = 8.6; 72% female) completed an online survey regarding their child’s (Mage = 10.5, SD = 3.8; 45% female) sleep environment and sleep-related behavior. The majority of families identified as Caucasian (approximately 80%). Parents reported fairly high annual incomes (Median = $75,000), but 28.2% of families reported incomes less than $50,000. A total of 18 items (total scale score; alpha = .74) were selected from a pool of 38 items developed from previous research that examined aspects of the sleep environment and were entered into an exploratory factor analysis from which 4 factors emerged: general sleep environment (10 items, alpha = .91), sleeping alone vs. with siblings (2 items, alpha = .78), presence of electronic screens (4 items, alpha = .75), and emotional environment (2 items, alpha = .80).

Results
The subscales demonstrated distinct patterns of correlations with related constructs, and unique predictive variance in explaining children’s daytime sleepiness even after controlling for children’s sleep hygiene, behavior problems, and sleep problems.

Conclusion
The current study is one of the first to demonstrate a valid/reliable assessment of children’s sleep environments. Not only will this measure provide researchers with an assessment of a fundamental influence on children’s sleep, but it will also enable clinicians to better measure this construct and support effective sleep health recommendations.
Support (if any):
619 Electronic Media Use and Sleep Among Children in Foster Care with Anxiety
Authors: Kim Josephine , Rigos Priscilla , Valentine Madeline , Nogales Josefina Muñoz , KIm Jinu , McGlinchey Eleanor , Alfano Candice , Ripple Carol , Wolfson Amy 
Published: May 2021

Abstract

Introduction
Electronic media (EM) use has long been associated with poor sleep in children. Children’s use of EM may also be related to emotional distress – anxiety being one of the more prevalent issues, which has been tied to sleep-related problems as well (e.g., Fors & Barch, 2019; Alfano et al., 2007). Children in foster care have often been victims of trauma, which can lead to significant emotional and sleep difficulties (e.g., Kovachy et al., 2013). The Fostering Sleep study examined the association between EM use and sleep among children in foster care; and the additional influence of anxiety.

Methods
Participants were caregivers of foster care children recruited from private Facebook foster care support groups across the United States. The study used a cross-sectional design examining sleep patterns and behaviors, EM use and mental health among children in foster care. An online survey, hosted by Qualtrics, was distributed to caregivers via Facebook. The data of 443 foster care children between the ages of four and 11 (M=6.37, SD=2.21) were included in the analyses.

Results
Children in foster care using EM at bedtime go to bed later than those who are not (p&lt;.001), and their sleep quality was better than those who did not use EM around bedtime (p&lt;0.01). Additionally, 33.3% reported anxiety as a primary diagnosis by a mental health professional. Children without anxiety as their primary diagnosis were found to be more likely to use EM around bedtime (p=.038).

Conclusion
This preliminary analysis indicates the prevalence of EM use close to bedtime may not necessarily be detrimental to sleep for this population; perhaps activities such as watching one’s favorite programming or talking to a loved one online can be comforting and therefore helpful to sleep onset (Eggermont & Van den Bulck, 2006). However, examination of other factors such as type of technology, content of media, and duration of use is warranted. Moreover, children with anxiety as a primary diagnosis may be using less EM at bedtime because EM use may trigger symptoms of anxiety (i.e., Fors & Barch, 2019).
Support (if any):
622 Bedtime, Sleep Duration, and Sleep Quality as Predictors of Externalizing Symptoms in Children in Foster Care
Authors: Rigos Priscilla , Kim Josephine , Nogales Josefina Muñoz , Valentine Madeline , KIm Jinu , McGlinchey Eleanor , Alfano Candice , Ripple Carol , Wolfson Amy 
Published: May 2021

Abstract

Introduction
A strong association between sleep disturbances and externalizing symptoms has been found among school-aged children. In particular, there is a known association between sleep disturbances, irritability, emotional dysregulation, and hyperactivity (e.g., Coto et al., 2018). Limited research, however, has examined this association in a high-risk population of children, such as those in foster care who are at increased risk for sleep disturbances due to heightened exposure to trauma. Thus, the following study sought to assess the association between sleep quality and externalizing symptoms in a population of children in foster care.

Methods
Caregivers with children ages 4–11 were sampled from private Facebook community foster care groups across the United States (n = 410). Caregivers were provided a link to a survey powered by Qualtrics where they were asked to report on the children under their care’s weekday bedtime, overall sleep quality (e.g., “Please rate your child’s overall sleep quality over the last two weeks”), and sleep onset (e.g. “On weekdays, how long does it usually take for your child to fall asleep?”). Child behavioral issues were assessed via the Eyberg Child Behavior Inventory (ECBI) Parent Rating Form.

Results
A linear regression model was utilized to assess if child weekday bedtime, weekday total sleep duration, and overall sleep quality were unique predictors of externalizing symptoms when controlling for age. Results suggest that weekday sleep duration and bedtime were not significant unique predictors of child behavioral issues, though were significantly and positively correlated at the bivariate level (p=.02, p=.04). Sleep onset and overall sleep quality, irrespective of child age, were found to be significant unique predictors of child behavioral issues and accounted for 1% and 11% of the total variance, respectively.

Conclusion
Results suggest that delayed sleep onset and poorer sleep quality were predictive of increased behavioral issues for children in foster care. Findings persisted when controlling for age, which suggests that children in foster care experiencing sleep disturbances may benefit from more behaviorally focused sleep interventions to improve externalizing behaviors and increase sleep health.
Support (if any):
623 Melatonin Use in the Pediatric Intensive Care Unit: 5 year single center experience
Authors: Jacobson Jessica , Tylka Joanna , Glazer Savannah , Cosme Rosario , Patwari Pallavi 
Published: May 2021

Abstract

Introduction
Pediatric patients requiring intensive care are at risk for unavoidable sleep and circadian disturbances because of the frequency and nature of delivering care for severe illness in this setting. There is growing appreciation for sleep as an essential component for neuropsychological and physical health. While exogenous influences (light and noise) and endogenous evaluation (melatonin levels) have been evaluated in this setting, there has not yet been investigation of current practice for exogenously administered melatonin in the pediatric intensive care unit (PICU). We aimed to evaluate baseline practice and changes in melatonin administration after implementation of delirium education.

Methods
In 2018, pediatric delirium education was implemented and included identification of sleep disturbance. A 5-year retrospective chart review (3-years baseline and 2-years after delirium education) was completed based on a pharmacy database that identified all patients who had melatonin administration while in PICU. Each admission was counted as an unique encounter. Data collection included patient age, date of admission, and length of stay (LOS). Data for melatonin included dose, starting date, duration of treatment (number of days), and indication. Indications for melatonin were (1) delirium, (2) insomnia, (3) circadian sleep wake disorder, (4) previous home medication, and (5) unable to determine from chart review.

Results
Over 5 years (2015 – 2020), 182 (6.0%) patients admitted to PICU (average age 9.3 +/- 5.8 years, average LOS 24.9 +/- 56.3 days) were given melatonin (average dose 4.0 +/- 2.3 mg). The most frequent indication for melatonin administration was continuation as a home medication (45.9%) and least frequent was sleep-wake disturbance (3.9%). The percentage of patients given melatonin as compared to total PICU admissions, nearly doubled from 4.4% in baseline group to 8.2% in post-delirium-education group. Further, “delirium” as indication for melatonin increased from 5.2% (baseline) to 15.4% (post-education). There were no notable changes for administration indication “insomnia” (18.2% vs 19.2%) or “unknown” (22.1% vs 19.2%).

Conclusion
This is the first exploratory study to evaluate frequency and indication of melatonin use in the PICU and changes in practice after implementing delirium education. Delirium education that includes sleep disturbance has had significant impact on frequency of melatonin administration.
Support (if any):
625 The association between circadian rhythms and psychosocial functioning in children with attention deficit hyperactivity disorder
Authors: Li Xiao , Shea Ka Sin Caroline , Lau Lok Fan , Dino Wong Ching Kwong , Chiu Waiyan Vivian , Mandy Yu Wai Man , Martin Li Albert , Wing Y K , Kelly Lai Yee Ching , Xin Li Shirley 
Published: May 2021

Abstract

Introduction
Circadian rhythm disturbances, including delayed circadian rhythm and increased motor activity, are commonly seen in attention-deficit hyperactivity disorder (ADHD). Previous research suggested a link between circadian rhythm disturbances and poor psychosocial functioning in children, but such a relationship has not been examined in children with ADHD. This study aimed at examining the association between circadian-related parameters and psychosocial functioning in children with ADHD.

Methods
Seventy-nine children with ADHD were recruited into this study (age range: 6–12 years, 75.9% male). They were assessed by parent-report questionnaires on sleep problems (Children’s Sleep Habits Questionnaire, CSHQ), ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale, SWAN), and psychosocial functioning (Strengths and Difficulties Questionnaire, SDQ). Actigraphic data collected for seven consecutive days were analyzed using parametric and nonparametric methods. The relationship between circadian parameters and psychosocial functioning was analyzed using multiple regression while controlling for age, sex, ADHD medication, total sleep time, and CSHQ total score.

Results
Later acrophase was significantly associated with higher scores on SDQ emotional problems (St. β = 0.30, p = 0.03) and SWAN inattention subscale (St. β = 0.27, p = 0.043). Lower relative amplitude was associated with higher scores on SDQ hyperactivity symptoms (St. β = -0.29, p = 0.045) and SDQ total difficulties (St. β = -0.31, p = 0.036). Higher levels of mean activity level during the least active 5-h period (L5) were related to higher scores on SDQ peer problems (St. β = 0.38, p = 0.021), SDQ internalizing problems (St. β = 0.38, p = 0.020) and SDQ total difficulties (St. β = 0.33, p = 0.036). Later onset of L5 was associated with increased SDQ emotional problems (St. β = 0.26, p = 0.046).

Conclusion
Circadian rest-activity rhythm disturbances (delayed phase, blunted rest-activity rhythms, higher level of nocturnal activity, and later onset of nocturnal rest) were associated with poor psychosocial functioning in children with ADHD. Further longitudinal studies are needed to examine the effects of circadian disruption on psychosocial functioning in children with ADHD.

Support (if any)
This work was supported by the Health and Medical Research Fund (Project No.: 30160604).
630 Longer Sleep Duration Reduces the Odds of Hypertension in Children Referred to Nephrology for Elevated Blood Pressure
Authors: Kogon Amy , Masqood Anam , LoGuidice Jillian , Myers Kevin , Mitchell Jonathan 
Published: May 2021

Abstract

Introduction
Lifestyle modification is often prescribed as first line-therapy for hypertension in childhood. We aimed to determine if there was an association between sleep duration and hypertension in children referred for evaluation to Nephrology for elevated blood pressure (BP). We hypothesized that, longer sleep duration would be associated with a reduced likelihood of a hypertension diagnosis.

Methods
Medical record data were retrospectively extracted from patients referred to the Children’s Hospital of Philadelphia’s pediatric nephrology clinic for the evaluation of elevated BP, without a prior hypertension diagnosis. Ambulatory blood pressure monitoring (ABPM) data collected between December 2015 to December 2018 were extracted. Hypertension was defined by ABPM according to American Heart Association recommendations for pediatric ABPM and we evaluated BP indexed to sex and height. Sleep duration was calculated as the difference between self-reported time of sleep onset and offset. Regression models were adjusted for age, sex, race, body mass index, and weeknight status.

Results
Our sample included 249 patients, with a mean age of 14.5 (SD: 3.1) years. Of these, 29% were obese and 42% met criteria for hypertension. Mean sleep duration was 9.3 (SD: 1.6) hours per night and duration was shorter with increasing age in years (β=-0.11, 95% CI: -0.18, -0.05) and on week vs. weekend nights (β=-0.62, 95% CI: -1.05, -0.24). Each additional hour of sleep was associated with lower daytime systolic BP Index Z-score (β=-0.12, 95% CI: -0.20, -0.05), lower daytime diastolic BP Index Z-score (β=-0.11, 95% CI: -0.19, -0.03) and 19% reduced odds of daytime hypertension (OR=0.81, 95% CI: 0.67, 0.98). Each additional hour of earlier timing of sleep onset was associated with lower daytime systolic BP Index Z-score (β=-0.10, 95% CI: -0.19, -0.01), lower daytime diastolic BP Index Z-score (β=-0.16, 95% CI -0.25, -0.06) and 16% reduced odds of daytime hypertension (OR=0.84, 95% CI: 0.68, 1.05).

Conclusion
In children referred for the evaluation of elevated BP, longer sleep duration and earlier sleep onset were associated with a reduced likelihood of being diagnosed with hypertension. Targeting improvements in sleep should be further investigated as part of first line therapy to treat pediatric hypertension.

Support (if any)
NIH/NHLBI K01HL123612