bluuebunny/crossref_metadata_2025_split huggingface dataset:
581 Impact of Weight on Insomnia Severity, Sleep Quality, and Insomnia Improvement in a Clinically Referred Pediatric Sample
Authors: Duraccio Kara , Graef Danielle , Beebe Dean , Byars Kelly 
Published: May 2021

Abstract

Introduction
Children with overweight/obesity are more likely to have shortened sleep, though little is known about the role of weight status in insomnia severity, sleep quality, and sleep hygiene in clinically referred youth.

Methods
A total of 1133 children (43.7% female) presented to a Pediatric Behavioral Sleep Medicine Clinic for insomnia. At the initial evaluation, caregivers of children ages 2–10.9 years (N = 744) completed the Pediatric Insomnia Severity Scale (PISI) and the Children’s Sleep Habits Questionnaire (CSHQ); adolescents ages 11–18 years (N = 389) completed the PISI, the Adolescent Sleep Hygiene Scale (ASHS), and the Adolescent Sleep Wake Scale (ASWS). The PISI was completed during at least one Pediatric Behavioral Sleep Medicine visit subsequent to evaluation and initiation of treatment. Patient height and weight, objectively measured within 3 months of the initial evaluation, was used to determine sex-adjusted body mass index z-scores (BMIz). Hierarchal linear regression models were used to determine the impact of BMIz on baseline PISI insomnia severity scores, and CSHQ, ASHS, and ASWS total scores, after covarying for income. Repeated-measures general linear modeling was used to determine whether weight status moderated improvement in insomnia severity over time, covarying for income.

Results
For children (ages 2–10.9), weight was not associated with baseline insomnia severity (p=.62) or predictive of insomnia improvement following behavioral sleep medicine intervention (p=.71), though higher weight predicted poorer parent-reported sleep quality (p=.006). For adolescents (ages 11–18), higher weight was predictive of higher baseline insomnia severity (p=.026), though did not predict insomnia improvement over time (p = .86); higher weight was also predictive of poorer sleep hygiene (p&lt;.001) and worse sleep quality (p=.03).

Conclusion
Initial insomnia severity and subjective sleep quality may be worse for youth of higher weight, particularly for adolescents; these findings increase our understanding of how and when overweight/obesity negatively impacts sleep. Fortunately, youth with higher weight respond equally well to pediatric behavioral sleep medicine interventions as their lower-weight peers, suggesting that these interventions need not be modified based on patient weight.

Support (if any)
Cincinnati Children’s Hospital Medical Center Division of Behavioral Medicine and Clinical Psychology’s Research Funds
608 Efficacy of a Treatment for Sleep-Related Problems in Children with Anxiety: A Mixed Methods Study
Authors: Chevalier Lydia , Pariseau Emily , Long Kristin , Langer David , Pincus Donna 
Published: May 2021

Abstract

Introduction
School-aged children with anxiety frequently experience sleep-related problems (SRPs) such as bedtime resistance. Results are mixed, but some children with anxiety also report longer sleep onset latency (SOL). Despite the link between SRPs and mental and physical health consequences, limited research has evaluated the efficacy of brief sleep treatments in this population.

Methods
A mixed methods approach employing a multiple-baseline single-case design and qualitative methods was used to evaluate the efficacy of a four-session parent training intervention in ten children with anxiety and chronic insomnia (M=9.6 years, range 8–12 years, 8 female). Questionnaires on SRPs and anxiety were completed by parents and children at baseline, one-week post-treatment, and one-month follow-up assessments. Subjective SOL (i.e., sleep diary) and objective SOL (i.e., actigraphy) were measured daily during assessment and treatment weeks. Parents and children completed qualitative interviews at the post-treatment assessment.

Results
The majority of participants no longer met criteria for chronic insomnia at post-treatment (n=9) or follow-up (n=6). SRPs (e.g., bedtime resistance) were significantly less frequent at post-treatment and follow-up than at baseline. The majority of participants demonstrated significant reductions in subjective (n=7) but not objective (n=3) SOL at post-treatment or follow-up compared to baseline. Qualitatively, parents and children described improvements in sleep during treatment. Some parents described discovering while completing sleep diaries that their child believed themselves to be taking longer to fall asleep at the beginning of treatment than they actually were (i.e., sleep misperception), and that this sleep misperception improved during treatment.

Conclusion
The findings of the current study support the preliminary efficacy of a brief parent training intervention to treat SRPs in school-aged children with anxiety. They also begin to help elucidate mixed findings in the literature on sleep of children with anxiety by providing a potential reason for discrepancies between subjective and objective SOL in this population. Specifically, qualitative findings suggest that this discrepancy may be related to sleep misperception, that children with anxiety may feel themselves to be taking a long time to fall asleep even when objective measures of SOL are within the normative range.

Support (if any)
Boston University Clara Mayo Memorial Research Fellowship
626 Association between Co-Sleep and Behavioral Problems among Preschoolers in Taiwan
Authors: Wu Yu-Ting , Huang Ya-Chuan , Chang Yung-Sen , Yang Chien-Ming 
Published: May 2021

Abstract

Introduction
‘Co-sleep’ is defined as the sleep arrangements in which parents and their child sharing a sleeping surface (bed-sharing or room-sharing). Similar to the other Asian countries, Taiwan has a high reported rates of bed-sharing. Previous researches had shown shorter sleep duration and poorer sleep quality in children with co-sleep. However, the association between co-sleep and the children’s emotional and behavioral problems has not been well studied. This study aims to explore the association between sleeping arrangements and children’s sleep, as well as their daytime emotional and behavioral problems.

Methods
9,582 caregivers of preschoolers (age= 4.70±0.806; Male: Female=52%:48%) completed a questionnaire regarding their children’s sleep schedule, the Children’s Sleep Habits Questionnaire (CSHQ) and Strength and Difficulties Questions (SDQ). The reported frequency on the items of the CHSQ question regarding co-sleep, asking whether the child falls asleep in parent’s or sibling’ s bed or sleep alone, were used to divide the children into three groups: usually co-sleep group, sometimes co-sleep group and sleep-alone group.

Results
Among 2,967 preschoolers, 6,272 children (65.5%) reported usually co-sleep, 816 children (8.5%) reported sometimes co-sleep, and 2,494 children (26%) reported sleeping alone. One-way ANOVAs showed significant differences among three groups in: 1) sleep patterns, including weekday nighttime sleep duration (F=24.43, p&lt;.01), weekend nighttime sleep duration (F=3.13, p&lt;.05), weekday nap duration (F=4.24, p&lt;.05), and weekend nap time (F=4.39, p&lt;.05); 2) sleep problems on the CHSQ, including bed time resistance (F=7027.25, p&lt;.01), sleep onset delay (F=33.06, p&lt;.01), sleep duration (F=65.51, p&lt;.01), sleep anxiety (F=788.48, p&lt;.01), night waking (F=37.90, p&lt;.01), parasomnias (F=47.43, p&lt;.01), sleep disorder breathing (F=7.58, p&lt;.01), and sleepiness (F=13.44, p&lt;.01); 3) behavioral problems and development on the SDQ, including hyperactivity (F=21.16, p&lt;.01), emotional symptom (F=23.08, p&lt;.01), conduct problem (F=8.65, p&lt;.01), peer problems (F=20.59, p&lt;.01), and prosocial (F=17.67, p&lt;.01).

Conclusion
Our results indicate that children with more frequent co-sleep may have shorter sleep duration, more sleep problems as well as more external and internal behavioral problems, while sleep-alone children showed more prosocial behaviors, longer sleep duration, and less sleep problems. The potential developmental problems related to co-sleep may be underestimated in Asian culture and need more attentions.
Support (if any):
637 Cumulative risk associated with poor sleep health in children and adolescents
Authors: Covington Lauren , Ji Xiaopeng , Brownlow Janeese , Laurenceau Jean-Philippe 
Published: May 2021

Abstract

Introduction
Social risk factors are associated with poor sleep outcomes across the life course. It is unclear if this association varies based on biological factors, such as age and gender. Therefore, the purpose of this analysis was to identify if age or gender moderated the association between cumulative risk and sleep duration/regularity in a national sample of children and adolescents.

Methods
We completed a secondary data analysis using the National Survey of Children’s Health 2017–2018 publicly available dataset. In a sample of 36,997 children age 6–17 years, we explored the association between a social cumulative risk index score (CRI) and child sleep duration and regularity. We included eight dichotomous social risk variables in the CRI: parental education

Results
Age was a significant moderator of the association between CRI and short sleep duration, such that the magnitude of the CRI-sleep relationship was greater in school-age children (age 6–11; b = -0.13, p&lt;0.001) compared to adolescents (age 12–17 years; b = -0.05, p&lt;0.001). Age was not a significant moderator between CRI and sleep irregularity. However, CRI independently predicted increased odds of sleep irregularity (OR = 1.30, p&lt;.001) and older age moderately increased the odds of sleep irregularity (OR = 1.21, p = 0.06). Sex was not a significant moderator of the association between CRI and sleep duration or sleep regularity. However, female sex was positively associated with sleep duration (b = 0.06, p = 0.11), but was not a significant independent predictor of sleep irregularity.

Conclusion
Younger children with cumulative risk factors are at risk for short sleep duration. Further research is needed to uncover biological mechanisms underlying multiple sleep parameters across developmental ages.
Support (if any):
655 The Role of Insomnia Symptoms in the Relation between Perceived Vulnerability to Disease and COVID-19 Anxiety
Authors: Campbell Rebecca , Walker Jamie , Makhanova Anastasia , Vargas Ivan 
Published: May 2021

Abstract

Introduction
Individuals who report greater perceived vulnerability to disease (e.g., experience emotional discomfort to situations where pathogen transmission is likely) also have the tendency to endorse more anxiety. Insomnia is also associated with greater anxiety. This study assessed (1) whether perceived vulnerability to disease was associated with increased anxiety related to COVID-19 and (2) whether this association was moderated or mediated by insomnia symptoms.

Methods
1199 primarily female (n = 845), white (n = 982) participants (mage = 30.52) completed an online survey including the Sleep Disorder Symptom Checklist- 25 (SDS-CL-25), Perceived Vulnerability to Disease (PVD) scale, and a rating of COVID-19 anxiety (scale = 0–100; m = 55.81, sd = 25.39). Insomnia symptoms were calculated using the sum of SDS-CL-25 items 3–6 (m = 7.55, sd = 3.58). The PVD subscales germ aversion (GA; m = 4.18, sd = 1.22) and perceived vulnerability to infection (PVI; m = 3.69, sd = 1.39) were also computed.

Results
Regressions were used to test if insomnia mediated the impact of GA and PVI on COVID-19 anxiety. The relations between COVID-19 anxiety and insomnia (b = 1.30, t(1197) = 6.47), GA (b =3.60, t(1197) = 6.09), and PVI (b =3.73, t(1197) = 7.20) were significant (p’s &lt; .001). Mediation analyses using the mediation package in R (bootstrap estimation = 1000 samples) showed direct effects of GA (b = 3.26, 95% CI = 2.04 – 4.42, p &lt; .001) and PVI (b = 3.16, 95% CI = 2.00 – 4.22, p &lt; .001) and mediation effects of insomnia (b =.44, 95% CI = .19 - .73, p &lt; .001; b =.58, 95% CI = .33 - .86, p &lt; .001, respectively). According to the moderation analyses, the association between PVD and COVID-19 anxiety did not significantly vary at different levels of insomnia.

Conclusion
Results suggest insomnia symptoms partially mediate the relationship between perceived vulnerability to disease and COVID-19 anxiety. These associations are likely bidirectional, and therefore, more work in this area is needed, especially with regard to how improved sleep may attenuate risk factors for anxiety.

Support (if any)
K23HL141581 (PI: Vargas)
660 Chronotype Associations with Insomnia, Depressive Symptoms, and Changes in Sleep and Health Behaviors during the COVID-19 Pandemic
Authors: Petrov Megan , Buman Matthew , Epstein Dana , Youngstedt Shawn , Hoffmann Nicole , Mattingly Jennifer , Hasanaj Kristina , Jiao Nana , Kasraeian Kimiya , Sominsky Anthony , Stievater Elena 
Published: May 2021

Abstract

Introduction
Evening chronotype (i.e., night owl preference) is associated with worse insomnia and depressive symptoms, and poorer health behaviors. The aim of this study was to examine the association between chronotype and these symptoms and health behaviors during COVID-19 pandemic quarantine.

Methods
An online survey, distributed internationally via social media from 5/21/2020–7/1/2020, asked adults to report sociodemographic/economic information, changes in sleep (midpoint, total sleep time, sleep efficiency, time-in-bed), and health behaviors (i.e., physical activity, sedentary screen time, and outdoor light exposure patterns) from prior to during the pandemic, chronotype preference (definitely morning [DM], rather more morning [RM], rather more evening [RE], or definitely evening [DE]), and complete the Insomnia Severity Index (ISI) and the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10). Multinomial logistic regression and ANCOVA models, adjusting for age and sex, examined associations of chronotype with COVID-19 pandemic related impacts on sleep, depressive symptoms, and health behaviors.

Results
A subsample of 579 participants (M age: 39y, range: 18–80; 73.6% female), currently under quarantine and neither pregnant nor performing shift work, represented each chronotype evenly (~25%). Participants delayed their sleep midpoint by 72.0min (SD=111.5) during the pandemic. DE chronotypes had a greater delay than morning types (M±SD DE: 91.0±9.0 vs. RM: 55.9±9.2 & DM: 66.1±9.3; p=0.046) with no significant change in other sleep patterns relative to other chronotypes. However, DE and RE chronotypes had greater odds of reporting that their new sleep/wake schedule was still not consistent with their “body clock” preference relative to morning types (Χ2[15]=54.8, p&lt;0.001), reported greater ISI (F[3,503]=5.3, p=.001) and CES-D-10 scores (F[3,492]=7.9, p&lt;.001), and had greater odds for increased or consistently moderate-to-high sedentary screen time (Χ2[12]=22.7, p=0.03) and decreased physical activity (Χ2[12]=22.5, p=0.03) than DM chronotype. There was no significant difference in change in outdoor light exposure by chronotype (Χ2[12]=12.1, p=0.43).

Conclusion
In an international online sample of adults under COVID-19 pandemic quarantine, evening chronotypes, despite taking the opportunity to delay sleep to match biological clock preference, reported their sleep/wake schedules were still inconsistent with personal preference, and reported greater insomnia and depressive symptoms, and odds of engaging in poorer health behaviors than morning chronotypes.
Support (if any):
664 Characteristics of respondents to a virtual trial of a digital behavioral treatment for insomnia during the COVID-19 pandemic
Authors: Thorndike Frances , Saver Keith , Braun Stephen , Williams Karren , Xiong Xiaorui 
Published: May 2021

Abstract

Introduction
Rates of sleep disturbance and sleep medication use have increased during the COVID-19 pandemic, at a time when face-to-face delivery of behavioral insomnia treatments is severely limited. To support research during the pandemic, the FDA released guidelines promoting the use of “alternative methods” to conduct trials in a virtual or decentralized manner. Currently, few data exist regarding the impact of virtual trial enrollment during a pandemic. This abstract presents data from a decentralized, open-label, single-arm real-world clinical trial of the Somryst prescription digital therapeutic for insomnia, which provides insight on who seeks care for insomnia using virtual research methods.

Methods
In alignment with FDA guidance, the DREAM trial began enrolling patients in March, 2020 with an expected final sample size of 350 adults (Clinical Trial # NCT04325464). This abstract presents data from participants seeking enrollment into the trial via an online screening. Demographic and sleep variables were collected to confirm eligibility.

Results
Of 1,063 respondents, the majority were female (62%) and the most common age brackets were ages 30–39 (22%); 40–49 (20%); and 50–59 (20%). Most respondents (63.8%) did not report being under the care of a healthcare provider for their insomnia. Respondents reported sleep problems for an average of 12.9 years; sleep problems 5 nights/week; and sleeping an average of 5.4 hours/night. Geographic diversity was high with respondents from 45 states and Washington DC. Of those passing initial screening (N=270), 5.5% reported having another diagnosed sleep disorder, 14.4% reported a comorbid psychological condition, 58.9% reported taking a medication for insomnia, and 30.7% reported taking a medication for depression. Using the Insomnia Severity Index, 16.7% had subthreshold/mild insomnia (score 8–14), 60.0% had moderate insomnia (score 15–21), and 23.7% had severe insomnia (score &gt; 21).

Conclusion
Respondents to this decentralized trial reported moderate-severe, long-lasting insomnia with high rates of medication use for sleep and depression. Results demonstrate that virtual trials can quickly draw a highly geographically diverse research population, overcoming logistical challenges inherent in a pandemic and resulting in recruiting appropriate, but more geographically diverse, samples than those typically observed in randomized trials of cognitive behavioral therapy for insomnia (CBT-I).
Support (if any):
690 An Analysis of Objective and Subjective Sleep and Infection Symptoms of Medical Personnel Working through the COVID-19 Pandemic
Authors: Eldringhoff Hannah , Mickelson Carolyn , Moore Lonique , Pirner Maddison , Doyle Scott , Mantua Janna , Mckeon Ashlee 
Published: May 2021

Abstract

Introduction
There is a well-established connection between sleep and the immune system, and in the midst of a global pandemic, it is vital to understand the relationship between COVID-19 symptomatology and sleep. While our communities practice safety protocols, medical personnel working on the COVID-19 response effort are at high risk for exposure and contraction. This creates an urgent need to better understand whether sleep may contribute to COVID-19 symptom onset, severity, and recovery. This study examined the relationship between subjective and objective sleep during infection.

Methods
Fifty volunteers (age 35.15±9.97) considered high risk for COVID-19 participated in the study. The sample consisted mostly of medical personnel (93.27%) working through the pandemic. Over six months, participants completed monthly surveys and daily logs via Qualtrics. These surveys included questions about sleep, infection symptoms, COVID-19 tests and diagnoses, and mood. Wrist-worn actigraphy was collected continuously throughout the study. Sleep duration, latency, wake after sleep onset, and efficiency were processed using Philips Actiware 6.0. Actigraphy and survey data were analyzed using SPSS v. 25.

Results
Sixty-two percent of participants experienced infection symptoms. Those experiencing symptoms were significantly more likely to report having poorer sleep quality t(255.59)=5.78, p=&lt;.001, poorer mood upon waking t(258.03)=6.53, p=&lt;.001, feeling less alert upon waking t(255.61)=4.56, p=&lt;.001, and spending more time awake at night t(2.66.98)=-7.29, p=&lt;.001. Results showed that compared to those asymptomatic, participants with cough t(2164)=2.07, p=.039, diarrhea t(2161)=2.51, p=.012, and headache t(106.18)=7.05, p=&lt;.001 all had significantly less total sleep time, while those with body aches spent significantly more time awake at night t(2164)=2.10, p=.036.

Conclusion
This preliminary examination of the data broadly suggests that medical personnel experiencing infection symptoms may have difficulty obtaining adequate sleep. Further, specific infection symptoms may share a stronger relationship with key sleep parameters than others. These findings support further testing of the bi-direction relationship between infection symptoms and sleep. Results from this research will contribute to enhancing prevention, detection, and treatment guidance related to future domestic and globally-experienced infections.

Support (if any)
Support for this study comes from there Military Operational Medicine Research Program of the United States Army Medical Research and Development Command.
692 Longitudinal Stability of Sleep and Health Correlates in Adults with Autism Spectrum Disorder
Authors: Puzino Kristina , Pearl Amanda , Calhoun Susan , Essayli Jamal , Alexander Danielle , Murray Michael , Fernandez-Mendoza Julio 
Published: May 2021

Abstract

Introduction
Individuals with Autism Spectrum Disorder (ASD) experience sleep disturbances to a greater degree than the general population. The majority of research investigating sleep disturbances in ASD has focused on children and adolescents. The aim of the current study was to determine the stability and health correlates of self-reported sleep disturbances in adults with ASD.

Methods
Participants included 55 adults with ASD recruited from state-funded Pennsylvania programs (31.2±7.6 years old, 80% male, 10.9% minority). Patient-Reported Outcomes Measurement Information System (PROMIS) measures assessing Sleep Disturbances, Sleep-Related Impairment, Fatigue, Anxiety, Depression, Anger, and Physical Health, were completed at baseline and every 90 ± 14 days over a 2-year period. Intraclass correlation coefficients (ICC) were calculated for each sleep outcome, and interpreted as 0.00–0.20=“poor stability,” 0.21–0.40=“slight stability,” 0.41–0.60=“moderate stability,” 0.61–0.80=“substantial stability,” and 0.81–1.00=“almost perfect stability” across the first three time-points. Linear mixed models examined the independent association of sleep disturbances, sleep-related impairment, and fatigue on anxiety, depression, anger, and physical health over the two-year period.

Results
Sleep-related impairment (ICC=0.73) and fatigue (ICC=0.64) were substantially stable, while sleep disturbances were moderately stable (ICC=0.58). All three sleep-related outcomes were independently associated with anxiety (sleep-related impairment p=0.012; sleep disturbance p&lt;0.001; fatigue p=&lt;0.001) and anger (sleep-related impairment p=&lt;0.001; sleep disturbance p=0.001; fatigue p&lt;0.001) across the two-year period. Sleep disturbance (p=&lt;0.001) and fatigue (p&lt;0.001), but not sleep-related impairment (p=0.267), were associated with depression across the two-year period. In contrast, none of the sleep-related outcomes (sleep-related impairment p=0.285; sleep disturbance p=0.250; fatigue p=0.709) were associated with physical health over time.

Conclusion
Measures of sleep-related impairment, fatigue, and sleep disturbance remained stable over time, suggesting that they can provide clinicians and researchers with a brief, accurate, and reliable way to assess patient-reported sleep outcomes in adults with ASD. Furthermore, given the stability of these sleep measures and their independent association with elevated mental health outcomes, there is a need for evidence-based treatments targeting sleep difficulties and associated symptomology in adults with ASD, a particularly underserved population.

Support (if any)
Pennsylvania State Bureau of Autism Services through the Autism Services, Education, Resources, and Training (ASERT) grant