bluuebunny/crossref_metadata_2025_split huggingface dataset:
544 Burden of Sleep Disturbance in Black Pregnant Women
Authors: White Kaylin , Dunietz Liana , Pitts D’Angela , Kalmbach David , O’Brien Louise 
Published: May 2021

Abstract

Introduction
Black women disproportionately experience poor perinatal outcomes compared to other racial/ethnic groups. Poor sleep has emerged as a strong contributor to adverse pregnancy outcomes and, in the non-pregnant population, sleep-wake disturbances have a high prevalence with often greater severity among Blacks. Nonetheless, the majority of studies have included largely White populations which has restricted our understanding of race-specific burdens and morbidities of sleep disturbance. The goal was to describe the burden of sleep-wake disturbance in Black pregnant women and associations with pregnancy outcomes.

Methods
Black women at least 18years and &gt;28 weeks pregnant were recruited from prenatal clinics. All women completed questionnaires about their sleep including the presence and timing of habitual-snoring (pre-pregnancy or pregnancy-onset), the Epworth Sleepiness Scale (ESS), and the General Sleep Disturbances Scale (GSDS) to determine poor sleep quality and poor daytime function as well as symptoms of insomnia. We also analyzed three commonly-reported sleep problems as individual question items (difficulty getting to sleep, wake up during sleep period, and wake up too early at the end of a sleep period). Demographic information and diagnoses were abstracted from medical records.

Results
Overall, 235 women enrolled; mean age was 27.6 + 6.2 years, mean BMI 31.7 + 9.8kg/m2, and 64% were in receipt of Medicaid. Eighty-percent of women reported &gt;three sleep-wake disturbances, and almost half experienced a burden of &gt;five disturbances. Women with pregnancy-onset habitual-snoring (but not those with pre-pregnancy habitual-snoring) had increased odds of poor sleep quality aOR 8.2 (95% CI 1.9, 35.9), trouble staying asleep aOR 3.6 (95% CI 1.0, 12.5), waking up too early aOR 2.7 (95% CI 1.1, 6.2), excessive daytime sleepiness aOR 2.3 (95% CI 1.1, 4.7), and poor daytime function aOR 8.7 (95% CI 2.5, 29.9). In contrast, women with pre-pregnancy habitual-snoring had increased odds for chronic hypertension, preterm delivery and fetal growth restriction; aOR 2.6 (95% CI 1.1, 6.3), aOR 2.8 (95% CI 1.1, 6.9), and aOR 5.1 (95% CI 1.7, 15.2), respectively.

Conclusion
Black women have a significant burden of sleep-wake disturbances. These findings highlight the excess risk that habitual-snoring confers to sleep-wake disturbances and perinatal outcomes in an infrequently studied yet highly vulnerable population.

Support (if any)
NIH NHLB-IHL089918
547 Earlier-life sleep patterns and risk for delirium in elderly hospitalized patients from a 14-year longitudinal cohort
Authors: Ulsa Ma Cherrysse , Zheng Xi , Li Peng , Hu Kun , Gao Lei 
Published: May 2021

Abstract

Introduction
Delirium is an acute decline in attention and cognition that is associated with cognitive dysfunction in elderly patients. While accumulating evidence points to associations between sleep disturbances and neurocognitive disorders, the temporal relationship between sleep patterns and delirium remains unclear. We tested whether earlier-life sleep duration, daytime dozing, insomnia, and sleep apnea predict incident delirium during hospitalization.

Methods
We studied 315,989 participants (mean age 58.3±7.9; range 37.4–73.7) from the UK Biobank with up to 14 years follow-up, and at least one hospitalization episode. Delirium diagnosis was derived using ICD-10 coding from hospitalization records. Multivariate logistic regression models examined the associations of self-reported baseline sleep duration (less than 6h/6-9h/more than 9h), daytime dozing (often/rarely), insomnia (often/rarely), and presence of prior sleep apnea (ICD-10), with incident delirium. Models were adjusted for age, sex, education, Townsend deprivation index, and major confounders (including number of hospitalizations during follow-up, BMI, neurological/cardiovascular/respiratory diseases, depression/anxiety, chronotype, and sedatives).

Results
4,025 developed delirium (12.7/1,000). There was a U-shaped association between sleep duration and delirium, where short [17.3/1,000; OR 1.18, 95% CI: 1.05–1.33, p=0.006] and long (28.8/1,000; OR 1.49, 95% CI: 1.30–1.70, p&lt;0.001) sleepers had elevated risk compared to regular 6-9h sleepers. Often daytime dozing (25.3/1,000; OR 1.38, 95% CI: 1.20–1.58, p&lt;0.001) and sleep apnea (21.7/1,000; OR 1.21, 95% CI: 1.03–1.42 p=0.02) also had increased the risk for delirium, but the latter was attenuated by the inclusion of BMI and hypertension. However, we did observe further risk when two or more of the above traits were present (OR 1.59, 95% CI: 1.29–1.95 p&lt;0.001). No effects on incident delirium were observed from insomnia.

Conclusion
Earlier-life sleep patterns, in particular longer sleep and daytime dozing, are associated with an increased risk for delirium. Sleep patterns may reflect unmeasured health status; further work is warranted to confirm the associations using objective sleep/circadian measures, examine underlying mechanisms, and test whether optimizing sleep patterns can reduce the risk of developing delirium.

Support (if any)
NIH [T32GM007592 and R03AG067985 to L.G. RF1AG059867, RF1AG064312, to K.H.], the BrightFocus Foundation A2020886S to P.L. and the Foundation of Anesthesia Education and Research MRTG-02-15-2020 to L.G.
558 A Surface Electrode Adjacent to Vagal Nerve Stimulator Lead Can Aid in Characterizing VNS Mediated Sleep Disordered Breathing
Authors: Chan Jeremy , Wrede Joanna 
Published: May 2021

Abstract

Introduction
Vagal nerve stimulators (VNS) are a nonpharmacological treatment for patients with refractory epilepsy. The VNS can decrease seizure frequency by over 75% in 40% of pediatric patients with refractory epilepsy. An underrecognized side effect is sleep disordered breathing (SDB). The purpose of this study was to demonstrate how a sensor placed adjacent to the VNS lead can distinguish whether SDB is due to VNS discharge.

Methods
Five pediatric patients (ages: 5–8) with refractory epilepsy with VNS were referred to our sleep center for concern for SDB. Each patient underwent a polysomnogram (PSG) that included a standard PSG montage with a surface electrode placed adjacent to their left lateral neck to detect VNS discharge. VNS associated apnea hypopnea index (vAHI) was calculated by determining the number of hypopneas and obstructive apneas occurring during VNS discharge.

Results
Of the 5 patients, three met pediatric criteria for obstructive sleep apnea (OSA). Patient 1 had an obstructive AHI (oAHI) of 21.3 events/hr with a vAHI accounting for 79% of the total (16.8 events/hr), patient 2 had an oAHI of 16.6 events/hr with a vAHI accounting for 57% of the total (9.5 events/hr), and patient 3 had an oAHI of 1.9 events/hr with vAHI accounting for 68% of the total (1.3 events/hr). Because of these findings, the VNS settings of all 3 patients were changed with the goal of reducing SDB due to VNS discharge. Upon repeat PSG, patient 2 had reduced OSA with an oAHI of 3 events/hr, with no events associated with VNS discharge. The remaining 2 patients did not exhibit VNS associated SDB, however, both experienced increased respiratory rate during VNS discharge.

Conclusion
We demonstrated that a surface electrode adjacent to the VNS is able to temporally co-register VNS discharges and enabled us to directly correlate SDB to VNS stimulation in 3 patients with refractory epilepsy. Because of our findings, we titrated the VNS parameters in all 3 patients, with one showing resolution of VNS associated SDB on repeat PSG. We propose that an added surface electrode to detect VNS discharge be considered as standard practice in PSG studies of patients with VNS.
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567 Validity of Sleep Related Breathing Disorder Scale and Anthropometrics in Obese/Overweight Children with Obstructive Sleep Apnea
Authors: Jimenez Leyden Lozada , Brubaker Jennifer , Thompson Nicolas , Honomichl Ryan , Mehra Reena , Shah Vaishal 
Published: May 2021

Abstract

Introduction
Prevalence of OSA, a multifactorial disorder associated with significant morbidity, has increased due to the pediatric obesity epidemic. A key existing gap is lack of a valid OSA screening tool in overweight/obese pediatric patients incorporating anthropometrics. Our aim is to examine the validity of inclusion of anthropometrics to the existing SRBD scale to detect moderate (apnea hypopnea index-AHI≥5) or severe OSA(AHI≥10).

Methods
Consecutive obese/overweight(n=89) patients(body mass index-BMI percentile&gt;85th for age/gender) in obesity management clinic with SRBD scale, polysomnogram(PSG) and anthropometrics (neck circumference (NC),waist circumferences(WC), height), systolic and diastolic blood pressure(BP) percentiles are included. Receiver operating characteristic(ROC) analysis with AHI as the outcome variable, sensitivity, specificity, positive(PPV), negative predictive values(NPV) for an SRBD cutoff score of 8 and SRBD score found using Youden’s index in ROC and 95% confidence intervals using the exact binomial method are presented. Prediction model, interaction and discrimination (Outcome:AHI; Independent: age, sex, WC, NC, SRBD) were analyzed.

Results
Study population characteristics: age 12.6±3.4years, 55% female, 62% non-white and AHI=13.0±20.7,AHI&gt;5=65.1% and AHI&gt;10=37.1%. No significant differences were noted in item endorsement or SRBD total score using either AHI≥5 or AHI≥10 (all P&gt;0.10). The area under the ROC curve for SRBD detecting AHI≥5 and 10 was 0.491(95%CI=0.352–0.630) and 0.559(95%CI=0.439–0.679). SRBD≥8 had sensitivity 0.759(0.628–0.861), specificity 0.387(0.218–0.578), PPV 0.698(0.570–0.808), NPV 0.462(0.266–0.666), for AHI≥5 and for AHI≥10, 0.848(0.681–0.949), 0.375(0.249–0.515), 0.444(0.319–0.575), 0.808(0.606–0.934) respectively. The SRBD cutoff score for Youden’s index was 7 for both AHI cutoffs of 5 and 10 and produced similar results to using SRBD cutoff score of 8. The prediction models including age, sex and WC (NC was not significant) had optimism-corrected c-statistics of 0.724 and 0.627 for AHI≥5 and 10, respectively. Adding SRBD total score to the models actually reduced these values to 0.702 and 0.614.

Conclusion
SRBD alone has fair sensitivity, but poor specificity for significant OSA in overweight/obese. The addition of anthropometrics to SRBD decreased discrimination of OSA in prediction models. Anthropometrics may differ in pre pubertal and post pubertal phenotypes of OSA and may or may not aid in increasing predictability of OSA with SRBD.
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574 Sleep-disordered breathing symptoms in children who co-sleep: Are caregivers better reporters?
Authors: Alvi Nimra , Clarke Allison , Patwari Pallavi 
Published: May 2021

Abstract

Introduction
Medical consensus advises against co-sleeping for infants to protect against SIDS, but co-sleeping in older children is often dismissed if not associated with caregiver distress. While some families may choose to co-sleep due to cultural, circumstantial, or psychosocial factors, this choice can also be due to medical concerns warranting greater caregiver attention. We aimed to explore characteristics of co-sleeping children referred for sleep disordered breathing and hypothesized that children with polysomnogram confirmed obstructive sleep apnea (OSA) would have higher caregiver-reported sleep disordered breathing symptoms as compared to children without confirmed OSA.

Methods
Caregivers who accompanied their child for polysomnogram were asked to complete a questionnaire that included sleep-related symptoms of sleep-disordered breathing (snoring, apnea, gasping/choking), restlessness, and parasomnias. Inclusion criteria are age &gt;1.0 years and &lt;18 years, baseline study for sleep disordered breathing, and completed questionnaire. Retrospective chart review included demographic information, BMI, co-morbid conditions, and polysomnogram results. The cohort was divided into 2 groups based on polysomnogram confirmed diagnosis of “snoring” or “OSA”.

Results
Of 75 co-sleeping children, 27 (36%) had a diagnosis of snoring and 48 (64%) of OSA. The cohort was similar in age, gender, and insurance type for snoring and OSA groups (Average 5.7 +/- 2.6 yrs and 5.4 +/- 2.9 yrs, respectively; 41% and 35% female, respectively; 44% and 50% Medicaid, respectively). Notable differences in the snoring and OSA groups were found with BMI z-score (1.6 +/- 4.6 and 1.0 +/- 1.5, respectively) and absence of co-morbid conditions (44% and 63%, respectively). Regarding reported symptoms, the snoring-group compared to OSA-group had lower report of gasping/choking (19% vs 29%), bedwetting (7% vs 13%), and nightmares (7% vs 15%); and had higher report of movement (74% vs 60%), kicking (48% vs 31%), and startle/jump (30% vs 19%).

Conclusion
Although we predicted that co-sleeping would be associated with increased caregiver vigilance, witnessed sleep-disordered-breathing symptoms was only higher for report of gasping/choking and did not differ significantly for report of snoring and apnea in children with and without OSA. Interestingly, co-sleeping in children without OSA appeared to be more strongly related to report of sleep disruption in the form of restless sleep.
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575 Sleep Duration in American Children with Autism Spectrum Disorder and the Role of Physical Activity
Authors: Smidt Stacey Elkhatib , Gooneratne Nalaka , Brodkin Edward , Bucan Maja , Mitchell Jonathan 
Published: May 2021

Abstract

Introduction
Sleep dysfunction is prevalent in autism spectrum disorder (ASD) and can have major daytime behavioral consequences. Emerging evidence suggests that physical activity may be associated with improved sleep in children, including those with ASD. We aimed to determine if there was an association between physical activity and sleep duration in American youth and if the association was consistent in children with and without ASD.

Methods
We analyzed data from children ages 6–17 years whose caregivers completed the 2018 National Survey of Children’s Health (N=20,980). ASD was self-reported (N=687), and we determined if reported ASD was mild, moderate, or severe, and if reported ASD occurred with intellectual disability (ID). Participants self-reported their weekday sleep duration and days of physical activity in the past week. We classified children as sleep sufficient or insufficient based on age-specific recommendations. Logistic regression was used to determine if physical activity and ASD were associated with sleep sufficiency. Physical activity-by-ASD interaction terms were used to determine if any physical activity association was modified by ASD status. Covariates included: age, sex, race, Hispanic ethnicity, highest caregiver education level, and overweight status.

Results
Compared to children without ASD, children with ASD were 29% less likely to have sufficient sleep (OR=0.71; 95% CI: 0.52–0.99), but this association attenuated to the null after adjusting for physical activity (OR=0.77; 95% CI: 0.55–1.07). Compared to zero days, being physically active for 1–3, 4–6 or 7 days in the past week was associated with increased odds of sufficient sleep, even with adjustment for ASD status (e.g., 4–6 days: OR=1.85; 95% CI: 1.48–2.32). We did not observe a statistically significant interaction between physical activity and ASD status with respect to sleep sufficiency (P-interaction=0.571), which remained consistent when using ASD severity and ASD with ID exposure variables.

Conclusion
Physical activity was associated with increased odds of meeting age-specific sleep duration recommendations in children with and without ASD. Our observations support pursuing physical activity in future studies as a potential intervention target to improve sleep duration in children, including those with ASD.

Support (if any)
NIH T32HL07713 and University of Pennsylvania’s Institute for Translational Medicine and Therapeutics
576 Clinical characterization of insomnia disorder in adolescence
Authors: Yuksel Dilara , Prouty Devin , Kiss Orsolya , Volpe Laila , Arra Nicole , Dulai Teji , Durley Ingrid , Obilor Todd , Baker Fiona , de Zambotti Massimiliano 
Published: May 2021

Abstract

Introduction
Insomnia is common in adolescence, particularly in older girls, with an overall prevalence comparable to major depression. Despite being associated with adverse outcomes such as an increased risk for substance dependence and suicidality, insomnia in adolescence is still under-recognized, under-diagnosed, and under-treated, and poorly described in the literature. This study aims to investigate the clinical features of insomnia in adolescence, in both boys and girls.

Methods
Eighty-five post-pubertal adolescents (16–18 years) with (N=39, 26 girls) and without (N=46, 28 girls) DSM-5 insomnia symptoms underwent a detailed clinical evaluation, including a clinical interview with a trained clinician and an extensive questionnaire battery investigating sleep behaviors, stress, coping skills, emotion regulation, mood, and personality traits.

Results
Adolescents with insomnia symptoms exhibit poorer sleep and sleep-related behaviors, such as higher insomnia severity scores, lower sleep hygiene, higher dysfunctional beliefs and attitudes about sleep, and higher pre-sleep negative thought content compared with controls (p&lt;0.05). They also indicated higher stress levels associated with school performance and peer pressure, higher susceptibility to work overload and greater depressive symptoms than controls (p&lt;0.05). Insomnia girls reported a lower perceived sleep quality, higher perceived stress levels, and a higher sleep vulnerability to stress than insomnia boys (p&lt;0.05). Exploratory network analyses unveiled profound group differences in the extent of multi-symptoms’ interconnection, with network complexity being lower in adolescents with insomnia symptoms and showing distinct symptoms’ centrality and clustering.

Conclusion
Insomnia in adolescence needs to be considered in the context of both classical insomnia-related features, as well as adolescence-specific factors, such as school and peer stress. Network analysis may be a promising approach to unveil hidden relationships and patterns among insomnia symptoms and behaviors, and to better characterize insomnia, possibly advancing early recognition and treatment of the disorder.

Support (if any)
National Heart, Lung and Blood Institute (NHLBI) R01HL139652 (to MdZ)
583 Treating Insomnia in Youth Depression: A Randomized Controlled Trial of CBT for Depression vs. CBT for Insomnia
Authors: Li Shirley Xin , chan Ngan Yin , Lam Siu Ping , Lui Tsz Ting , Chan Joey W , Tam Barry Ka-Hang , Zhang J , Li Albert Martin , Espie Colin , Wing Y K 
Published: May 2021

Abstract

Introduction
Insomnia is often comorbid with depression in youths and both may reciprocally exacerbate clinical outcomes and lead to a constellation of detrimental consequences. The present study aimed to test the efficacy of cognitive behavioral therapy (CBT) for insomnia (CBT-I) and CBT for depression (CBT-D), when compared with waitlist control, in youths with comorbid insomnia and depression.

Methods
112 participants aged 12–24 years old (67.9% female) with insomnia and depression according to DSM-5 diagnostic criteria were randomised to one of the following conditions: 8-week group CBT-I (n=33), 8-week group CBT-D (n=39), or waiting-list control (n=40). Insomnia (Insomnia Severity Index, ISI) and depressive symptoms (Hamilton Rating Scale for Depression, HAMD) were assessed at baseline and post-intervention. The two active treatment groups were additionally followed up at post-treatment one-month.

Results
Linear mixed model showed that both treatment groups (CBT-D: Cohen’s d = -0.44, p&lt;.001; CBT-I: Cohen’s d =-0.56, p&lt;.001) had significantly lower ISI scores at post-intervention follow-up, as compared to the waitlist group. There was a significant difference in clinically meaningful improvement in insomnia (a reduction of ISI score ≥ 6 from baseline to post-intervention follow-up) between the groups (CBT-I: 73.1%; CBT-D: 40.0%; WL: 28.6%; p=.002). Moreover, there was a significant difference in remission of depression (HAMD≤7) at post-intervention follow-up (CBT-D: 75.9%; CBT-I: 81.5%; WL: 22.9%) (p &lt;.001). Both CBT-D and CBT-I resulted in comparable improvements in insomnia and depressive symptoms at one-month follow-up (p&gt;.05).

Conclusion
Preliminary evidence from this study supports the efficacy of CBT-I for improving both sleep and mood in youths with comorbid insomnia and depression.

Support (if any)
This work was supported by Early Career Scheme, Research Grants Council, Hong Kong SAR (Ref. 27613017).
590 Neighborhood Safety and Sleep During Childhood
Authors: Gaston Symielle , Riley Nyree , Gullett Lauren , Harmon Quaker , Baird Donna , Jackson Chandra 
Published: May 2021

Abstract

Introduction
Neighborhood safety has been associated with sleep health among adults; however, few studies have investigated its association with sleep characteristics during childhood.

Methods
Using data from 1,693 Black/African-American women enrolled in the Study of Environment, Lifestyle and Fibroids from 2010 to 2012, we investigated associations between neighborhood safety and sleep at age 5 years. Participants, aged 23–35 years, reported childhood neighborhood safety (unsafe, somewhat safe, very safe) and light sleep (yes/no). Participants, with assistance from their mothers or others, provided information on participants’ frequency of good sleep hygiene as a child (i.e., to bed by 8 p.m. in a quiet, dark room) as always/most of the time, sometimes, or rarely/never. Adjusting for relative childhood household income and both mother’s and father’s age at participant’s birth, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to compare sleep characteristics for participants who reported unsafe vs. very safe neighborhoods.

Results
While 20% of participants reported living in an unsafe neighborhood, 41% reported a somewhat safe neighborhood and 39% reported a very safe neighborhood at age 5 years. The unadjusted prevalence of always/most of the time going to bed by 8 p.m. in a quiet, dark room was highest among participants who reported very safe neighborhoods. After adjustment, participants in unsafe neighborhoods were substantially more likely than those in very safe neighborhoods to only sometimes (vs. always/most of the time) go to bed: by 8 p.m. (PR=1.57 [95% CI:1.21–2.03]), in a quiet room (PR=2.11 [1.43–3.11]), and in dark room (PR=1.44 [1.09–1.90]). Patterns were similar for frequencies of rarely/never and often practicing good sleep hygiene. Light sleep was not associated with neighborhood safety.

Conclusion
Perceived neighborhood safety was associated with multiple sleep dimensions in childhood.
Support (if any):