bluuebunny/crossref_metadata_2025_split huggingface dataset:
560 Infant OSA: Impact on Growth and Development Outcomes
Authors: Kochhar Rashi , Pereira Nicola , Liu Katie , Morse Elliot , Veler Haviva , Maresh Alison 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) related growth and developmental deficits were previously described in young children. However, growth and development outcomes of OSA in infants is not as clear.

Methods
We retrospectively reviewed polysomnography (PSGs) of infants 0–12 months of age done at one tertiary care, urban medical center, between 2012–2019. Indications for the studies were symptoms or high risk for OSA. Diagnosis of OSA was determined when obstructive apnea hypopnea index (oAHI) &gt;1/hr. Demographic information and physician diagnosed developmental and growth delays were collected from medical records.

Results
A total of 83 infants were included, mean age was 4.4months (6 days-12 months). Mean baseline oAHI was 16.8/hr (1–91.46/hr). 23 patients were noted to have failure to thrive (27.7%), 27 patients had general developmental delay (32.5%), 22 patients had speech delay (26.5%), and 9 patients had motor delay (10.8%). Out of all the patients with any form of delay (N=46), 39.13% were premature, 71.73% had an underlying neurologic abnormality and 39.13% had some other underlying diagnosed syndrome. 2 patients had delay but no associated comorbidity. Patients without any developmental delay showed trend towards likelihood of more severe OSA compared to patients with any delay (p=0.0455).

Conclusion
Infant OSA is a separate entity from pediatric OSA and requires a better understanding of its association with developmental outcomes. Infants are particularly vulnerable to obstructive sleep-disordered breathing related to their upper airway anatomy, adverse pulmonary mechanics and a REM-predominant sleep state distribution. We describe a cohort of 83 infants undergoing PSGs in their 1st year of life with developmental and growth follow up until 2nd year of life. Most of the infants with moderate to severe OSA had some delay in their development. Infants without diagnosed delay, were less likely to have severe OSA. It remains unclear to what degree OSA is responsible for these findings as opposed to pre-existing comorbidities. Additional prospective, controlled studies with standardized developmental assessments are warranted to assess causality.
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568 Sleep Evaluation in Down Syndrome: What is the Adherence to American Academy of Pediatrics DS Guidelines?
Authors: Morse Anne Marie 
Published: May 2021

Abstract

Introduction
Specialized health care guidelines for children with Down Syndrome (DS) published by the American Academy of Pediatrics (AAP) provided specific recommendations based on the higher risk needs of individuals with DS. Obstructive sleep apnea (OSA) is reported to be present in 50–79% of individuals with DS. According to the AAP guideline, all individuals with DS should have a polysomnography (PSG) evaluating for OSA by 4 years old and then screened by history and physical exam annually thereafter. An interim analysis of an ongoing Down Syndrome Research study was evaluated to determine rate of adherence to these guidelines.

Methods
The Dimensional, Sleep, and Genomic Analyses of Down Syndrome to Elucidate Phenotypic Variability study enrolled down syndrome patients 30 months and older, as well as first degree relatives to participate. Patients completed a standardized clinical sleep interview, childhood sleep habits questionnaire and was asked to complete 2 week sleep diary, actigraphy and polysomnography. We aimed to characterize the rate of PSG completion by 4 years of age, number of research PSGs completed and rate of OSA identified on research PSG.

Results
A total of 31 patients were consented. The median patient age was 10 years old with a slight female predominance (15F:12M). 27 patients completed the sleep interview and 19 successfully completed a scorable polysomnography. Only 7 patients had completed a PSG previously by age of 4 years. 11 of 19 studies demonstrated obstructive sleep apnea ranging from mild to severe severity (1.7–42.5/hr). REM AHI (range 1.2–58.2/hr, mean 19/hr and median 12.3/hr) demonstrated increased severity.

Conclusion
Despite AAP guidelines recommending universal PSG evaluation by the age of 4 years of age, only 26% of patients interviewed has a PSG successfully completed previously. Additional recommendations by AAP include yearly surveillance of symptoms although there is poor correlation between parent report and polysomnogram results. Of the 19 research completed PSGs, 58% demonstrated OSA with the mean and median results consistent with moderate to severe OSA and worsening during REM sleep. Improved effort to successfully obtain PSG in this population is needed. Further study is ongoing to evaluate the relationship to other health and cognitive outcomes.

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NIMH
570 Comparing NIV Adherence in Early versus Advanced Stage Sleep Disordered Breathing for Children with Neuromuscular Disease
Authors: Bedi Prabhjot , Hasbun Guillermo , Castro-Codesal Maria 
Published: May 2021

Abstract

Introduction
Children with neuromuscular disease (NMD) typically develop progressive sleep disordered breathing (SDB), including obstructive sleep apnea (OSA), nocturnal hypoxemia and/or hypoventilation, due to loss of upper airway muscle tone and weakness of respiratory muscles. Commonly, the SDB initially presents during rapid eye movement (REM) sleep, as this stage is associated with physiological muscle atonia, but then progresses to non-REM (NREM) sleep and ultimately daytime respiratory insufficiency. Non-invasive ventilation (NIV) is currently the treatment of choice for children with NMD and SDB. However, the use of NIV in REM-related SDB is less demonstrated and adequate therapy adherence is unclear. The aim of this study is to determine differences in NIV adherence in children with early (REM) versus advanced (non-REM) SDB.

Methods
Children (0–18 years) diagnosed with NMD and using NIV for the past 10 years were included. Demographic, clinical, technology-related, and sleep study data were collected from medical charts and polysomnography reports. Adherence data (mean hours of NIV use and % days NIV was used &gt;4hrs) were collected from NIV machine downloads. Children were categorized into two groups based on based on their apnea-hypopnea index (AHI) ratio between REM and NREM sleep. Children with REM-SDB were defined as a REM/NREM AHI ratio of ≥ 2. Children with NREM-SDB were defined as a REM/NREM AHI ratio &lt; 2.

Results
A total of 14 children (9 REM-SDB and 5 NREM-SDB) were included in the analysis. Both groups were comparable with respect to demographic, clinical, and technology-related characteristics. A total of 24 adherence reports were available for the cohort (16 REM-SDB and 8 NREM-SDB). The mean hours of NIV use per night was comparable between the REM-SDB and NREM-SDB groups (9.2±1.3hrs vs. 9.0±0.4hrs respectively), but the percent days NIV was used &gt;4hrs was higher in the NREM-SDB group (68.7±9.6 vs. 93.0±2.7, p=0.03).

Conclusion
NIV adherence was high for children with both REM-SDB and NREM-SDB. While hours of NIV use were comparable between both groups, suggesting good NIV tolerance through the night, children with REM-SDB had a lower percentage of days with NIV use &gt;4hr, suggesting less willingness to use the therapy.
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572 Utility of Split Night Polysomnograms in Children
Authors: Rao Harish 
Published: May 2021

Abstract

Introduction
Overnight in-lab polysomnograms (PSG) are the gold standard for diagnosis of sleep disordered breathing in children. As the wait time for adenotonsillectomy (T & A) at our institution was several months, we implemented split night PSGs with positive airway pressure (PAP) during the initial diagnostic PSG if AHI&gt;30 (Emergency SNPSG). Planned SNPSG were performed on children who are undergoing PSG after T & A, eliminating follow-up titration PSG if the PSG is positive for OSA (residual AHI&gt;10/hour). We present data on the outcomes of the SNPSG.

Methods
Retrospective chart review of consecutive SNPSGs done over last 2 years at our institution was performed. Data on SNPSGs (planned or emergency), age, sex, diagnostic study duration, diagnostic study AHI, PAP pressure and subsequent PAP adherence were collected. Data on sleep efficiency, arousal, sleep architecture, REM sleep were compared between diagnostic and titration part of the SNPSG. Study was considered successful if patient was able to tolerate PAP during titration and also if adherent to PAP at follow up.

Results
48 studies met the criteria for SNPSG, with 60% of SNPSG being emergency SNPSG with AHI&gt;30. Our cohort’s age ranged from 2–18 years (median age 8 years); 33 were males. Majority of the emergency SNPSG were in younger children (80% &lt; 5 years), 75% of them continued to use PAP (mostly CPAP) until T & A with wait time being more than 3 months. Average wait time for T & A was 4 months. 25% of patients continued to use PAP following T & A as residual AHI was &gt;10/hour. 98% of the patients were able to tolerate PAP during titration section with restoration of sleep architecture including REM with reduction in AHI, arousals and improved sleep efficiency. Bilevel PAP was used in 10% of patients in mostly planned SNPSG.

Conclusion
SNPSG can be implemented with fair degree of success during initial PSG with PAP used until T & A is performed. Planned SNPSG are also useful with residual severe OSA eliminating need for subsequent titration study. When indicated, 75% of our cohort continued to use PAP with fair adherence (&gt;70% nightly use) following SNPSG.
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585 The Relationship between Napping and Behavioral Problems among Vocational High School Students in China
Authors: Han Jing , Huang Rendong , Yue Lei , Cui Naixue , Cao Fenglin 
Published: May 2021

Abstract

Introduction
Although napping is very common and related to the outcome of individual development, the relationship between napping and health is not the same in different social and cultural contexts. In China, napping is considered as a healthy lifestyle and is often associated with better adolescent development outcomes. As a special group of teenagers (the academic level does not meet the requirements of ordinary high school), vocational high school students have a higher incidence of behavioral problems than ordinary high school students. Therefore, the purpose of this study is to explore the characteristics of napping and its relationship with behavioral problems in vocational high school students.

Methods
The napping questionnaire, Youth Self Report (YSR), general information questionnaire and other tools for covariates were used to measure 2505 high school students (62.04% boys, 37.96% girls, 16.71±0.02 years), recruited by convenient sampling. The relationship between nappingand behavioral problems was analyzed by multiple linear regression.

Results
72.58% of the participants reported taking a midday nap at least three days per week during the past month, and 55.79% of our sample reported naps more than 30 minutes. Multiple regression analysis showed that nap frequency was negatively associated with high school students’ behavior problems after controlling for general characteristics and other important covariates. Compared with high school students who did not nap or napped less than 1 time/week, high school students who napped 1–2 times/week or 3–4 times/week had lower level of both internalizing behavior problems and externalizing behavior problems. There was no statistically significant association between nap duration and behavior problems.

Conclusion
This study finds that when napping is allowed, moderate frequency of napping is associated with lower level of internalizing and externalizing behavioral problems in vocational high school students, while nap duration is not significantly associated with behavioral problems. Further research is needed to explore the mechanism of the relationship between napping and behavior problems.
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586 Large Body Movements on Video-Polysomnography are Associated with Daytime Dysfunction in Children with Restless Sleep Disorder
Authors: Liu Wei , Thomas Dye , Horn Paul , Garner David , Simakajornboon Narong 
Published: May 2021

Abstract

Introduction
Restless sleep disorder (RSD) is a recently described disorder of children and adolescents with complaints of restless sleep and is characterized by large body movements which interfere with nocturnal sleep, are associated with daytime dysfunction, and are not better explained by another disorder (1, 2). Polysomnography criteria for RSD includes the scoring of large body movements (LBMI) and identified an LBMI ≥ 5 as sensitive and specific for RSD. As data is currently limited to two pediatric centers, our study aims to identify RSD cases at our institution, characterize their PSG, and determine their effect on daytime dysfunction and quality of life.

Methods
This single center retrospective study included 41 children with complaints of restless sleep and 35 sex- and age-matched children with RLS/PLMD collected from February 2018 to November 2020. The video PSGs were re-scored utilizing the previously published criteria (1,3). We used two LBMI thresholds, LBMI ≥ 5 and an exploratory LBMI ≥ 4. We then compared Epworth Sleepiness Scores (ESS), Pediatric Quality of Life measures (PedsQL), PSG characteristics, LBM associated awakenings and ferritin level between groups.

Results
Twenty-one children (mean age=8.3 ± 3.13 SD) met the LBMI&gt;=4 criteria, of which 11 (age=8.4±3.81 SD) met the LBMI&gt;=5 criteria. All three groups reported decreased quality of life (PedsQL total LBMI&gt;=4=66.21±20.28, LBMI&gt;=5=72.39±18.24, RLS/PLMD=55.54±19.86), low mean ferritin values (LBMI&gt;=4=33.18 ± 20.11, LBMI&gt;=5 =28.38 ± 12.68, RLS/PLMD = 36.57±25.46), and increased wake after sleep onset (WASO) (LBMI&gt;=4 = 42.82 ± 34.26, LBMI&gt;=5=44.38 ± 38.4, RLS/PLMD = 52.34 ± 42.03), with no significant differences between groups. Both LBMI&gt;=4 and LBMI&gt;=5 groups exhibited higher ESS compared to the RLS/PLMD group (LBMI&gt;=4=10.36±7.13; LBMI&gt;=5=11.13±5.19; RLS/PLMD=6.17±4.04; LBMI&gt;=4 vs RLS/PLMD, P=0.05; LBMI&gt;=5 vs RLS/PLMD, P = 0.032). Both awakenings and WASO associated with LBM were high in LBMI&gt;=4 and LBMI&gt;=5 (Awakenings: LBMI&gt;=4=8.43±9.96, LBMI&gt;=5 =8.00±12.19, WASOassociatedLBM: LBMI&gt;=4=23.60±44.64 LBMI&gt;=5=29.46±57.57)

Conclusion
One quarter of children with complaints of restless sleep met the standard criteria for RSD. Both children with RSD (including the exploratory LBMI≥ 4 group) and RLS/PLMD had increased WASO, low ferritin and decreased quality of life, but the RSD group had more daytime sleepiness compared to RLS/PLMD.
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588 Wake Up and Learn: A School Based Sleep Education and Surveillance Program
Authors: Morse Anne Marie , Blessing Kristina , Snyder Mallory , Liscum Denise 
Published: May 2021

Abstract

Introduction
Insufficient sleep, especially for students, has been a hot topic in news for the past few years. However, despite this increase in media attention, the number of adolescents with unrecognized sleep difficulties continues to grow. A partnership between Janet Weis Children’s Hospital (Geisinger) and Montgomery School District was established to pilot a program called “Wake Up and Learn” (WUAL). WUAL is a population based preventative sleep screening and education program for 7th to 12th graders through an asynchronous virtual platform. This is a descriptive summary of implementation of WUAL and early phase results.

Methods
The WUAL team consists of a board-certified pediatric sleep specialist, school guidance counselor and 2 project managers. The Protection of Pupil Rights Amendment (PPRA) was considered. A letter describing the program with an opt-out option was provided. WUAL website was developed to serve as an educational resource and to access the surveys. The surveys were generated using REDcap and included the Epworth sleepiness scale -CHAD (ESS) and the childhood sleep habits questionnaire (CHSQ). The surveys became available online and the students were instructed access the website and complete the surveys as part of class time.

Results
A total of 289 surveys were accessed, 287 ESS (99%) and 281 CSHQ (97%) were completed. Pathologic ESS scores (&gt; 9), suggesting excessive daytime sleepiness (EDS), was identified in 75 students (26%). Scores suggestive of sleep dysfunction (&gt; 41) on the CSHQ was found in 184 students (65%). Out of the 184 students 64 students also had an abnormal ESS.

Conclusion
This method of screening has demonstrated a high degree of successful completion. Based on early data, sleep pathology may be more prevalent than typically reported in children (20–25%). EDS was common, present in a quarter of students. However, of 184 students with abnormal CHSQ only 35% also had EDS. This suggests that there may be a need to identify alternative daytime dysfunction, such as school performance or mental health symptoms. This is an ongoing program that will have further updates and plans for expansion to more school districts.

Support (if any)
Grant Funding Support from Jazz Pharmaceuticals and Janet Weis Children’s Hospital (Geisinger)
616 Restless sleep and other comorbidities in children with attention deficit hyperactivity disorder
Authors: Kapoor Vidhi , Ferri Raffaele , Stein Mark , Ruth Chris , Reed Jennifer , Delrosso Lourdes 
Published: May 2021

Abstract

Introduction
The etiology of restless sleep has recently been identified as secondary to various medical and sleep conditions. Parents of children with ADHD complain of restless sleep and sleep disturbances in their children. We aimed to assess restless sleep causes in our patient population with ADHD and establish the prevalence of restless sleep disorder (RSD), as recently defined.

Methods
A retrospective study of children with ADHD who underwent polysomnography was carried out. Diagnostic and descriptive information collected for each patient included age, sex, polysomnographic parameters, sleep disorders, psychiatric comorbidities, and medications.

Results
Sixty-six PSGs were reviewed. The mean age of children was 11.6 (±3.6 SD) years; 17 were female and 49 were male. Parents of 54 (81.1%) children had concerns of restlessness during sleep; 47 (71.2%) children had obstructive sleep apnea, 17 (25.8%) had PLMS ≥5/hour, 13 (19.7%) had RLS, 6 (9.1%) had RSD, 27 (41%) had depression or anxiety, 5 (7.6%) had insomnia.

Conclusion
In a pediatric sleep medicine referred group of patients with ADHD, who are known to have significant sleep and psychiatric comorbidities, obstructive sleep apnea, RLS, and RSD were found to be the most prevalent sleep disorders, whereas depression and anxiety were the most common psychiatric disorders. Complaint of secondary restless sleep seems to be common, while primary restless sleep disorder was seen in approximately 9% of children. The results of this study aid pediatricians and child psychiatrists in screening children with ADHD for associated sleep disorders.
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629 Sleep problems among children and adolescents with epilepsy in Thailand: single-center cross-sectional study
Authors: Jaroenying Rasintra , Rattanarat Pluemkamon , Suwanpakdee Piradee 
Published: May 2021

Abstract

Introduction
Sleep problems are common in pediatric epilepsy and may influence seizure control, daytime performance, and quality of life. The aim of this study was to investigate parent-reported and self-reported sleep problems in a sample of children and adolescents with epilepsy in Thailand.

Methods
Epileptic children age 1–18 years and their parents in epilepsy clinic completed the Phramongkutklao Hospital Sleep disorders center Questionnaire, Sleep Related Breathing Disorder- Pediatric Sleep Questionnaire (SRBD-PSQ)

Results
A total of 59 participants with the mean age of 10.8 years completed the questionnaires. The most common sleep complaint was a disorder of maintaining sleep 36 (61.01%). Several sleep manifestations were detected including disorder of initiating sleep 14 (23.7%), snoring 29 (49.2%), leg kicking 16 (27.1%), sleep talking 19 (32.2%), sleep walking 4 (6.7%), teeth gliding 18 (30.5%), nightmares 15 (25%), night terrors 8 (13.5%) and nocturnal enuresis 16 (27.1%). The frequency of sleep disordered breathing problems (SRBD-PSQ &gt;0.33) was 33.9%.

Conclusion
The prevalence of sleep problems among children with epilepsy in Thailand is high. Therefore, a highlighting should be given to address sleep in children and adolescents with epilepsy. Further studies are needed to evaluate the effects of antiepileptic drugs, type of seizure or associated factors on sleep disruption in this population.

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None
632 Family History of Children Diagnosed with Obstructive Sleep Apnea
Authors: Porterfield-Pruss Kristi , Willis Denise , Spray Beverly , Jambhekar Supriya 
Published: May 2021

Abstract

Introduction
Limited evidence suggests a familial association of OSA. It is not known how often children who require positive airway pressure (PAP) devices have a family member with OSA or that requires PAP. It is felt that PAP adherence in children is affected by PAP adherence in parents. We wanted to explore the relationship of OSA in children requiring PAP to OSA in immediate family members as well as the association of obesity and adherence between children and family members.

Methods
Caregivers of children who utilize PAP devices at home were invited to complete an electronic questionnaire regarding family history of OSA. Descriptive statistics were utilized to summarize results.

Results
The study was completed by 75 participants. The majority of children were male (64%, 48/75), black (47%, 35/75) and non-Hispanic (88%, 66/75). The mean age was 11.8 years (median 13) and mean BMI was 32.8 (median 29.8). The mean AHI on the diagnostic polysomnogram was 28.4 events per hour (median 15.3). Mean adherence to PAP &gt; 4 hours per night was 56.5 (Median 68.2). Most, 87% (65/75), have other underlying medical problems. Twenty-four percent (18/75) have a biological father with OSA of whom 61% (11/18) are considered moderately/extremely obese. Of mothers, 13% (10/75) have OSA and 70% (7/10) are obese. Overall, 29% (22/75) had either a paternal (11%, 8/75) or maternal (19%, 14/75) grandfather with OSA of which 36% (8/22) are obese. For grandmothers, 31% (23/75) have OSA and 22% (5/23) are obese with more being paternal (19%, 14/75) compared to maternal (12%, 9/75). Of the 73 total family members reported to have OSA, 86% (63/73) use PAP and most (65%, 41/63) use it for &gt; 4 hours every night. Few participants had siblings with OSA.

Conclusion
There were more fathers with OSA than mothers, but mothers were reported to be obese more often. Grandparents were reported to have OSA but were reported to be obese less often than parents. Maternal grandparents with OSA were reported to be obese more than paternal grandparents. The majority of family members with OSA who use CPAP report nightly use.
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