bluuebunny/crossref_metadata_2025_split huggingface dataset:
557 Nasal cavity narrowing in pediatric obstructive sleep apnea
Authors: Cielo Christopher , Vasisht Shubha , Stefanovski Darko , Whelan Rachel , McDonough Joseph , Tapia Ignacio 
Published: May 2021

Abstract

Introduction
The contribution of nasal cavity narrowing to obstructive sleep apnea (OSA) in children has not been well-defined. Acoustic rhinometry is a non-invasive technique that uses acoustic pulses to measure nasal cavity cross-sectional area (CSA) at defined distances from the tip of the naris. This study evaluated the relationship between nasal cavity CSA and OSA in children. We hypothesized that OSA severity would correlate with reduced nasal CSA.

Methods
Children 5–12 years of age with OSA underwent polysomnography and acoustic rhinometry at baseline and after 3 months and 12 months of growth as part of a randomized controlled trial. Statistical analysis of the nasal cavity CSA up to 6 cm from the tip of the naris was performed using mixed-effects linear regression model with visit month, age at visit, trial number, OSA severity, and side (left or right naris), and statistical interaction between OAHI category and distance from the tip of the nose as a fixed effect and the random effects set on the level of individual subject. Least significant differences were used to account for multiple comparisons. An unbiased approach using latent class analysis was used to determine OSA severity categories based on obstructive apnea hypopnea index (OAHI). Post-hoc analysis was used assess the model adjusted (marginal) means and pairwise effects.

Results
112 participants completed testing (50% male, aged 7.9±2.1 years). Median (IQR) OAHI for subjects with mild OSA (n=69) was 4.4/hr (3.2), moderate OSA (n=35) was 9.7/hr (7.1), and severe OSA (n=8) was 21.3/hr (17.2). There was a significant difference in linear trend for nasal cavity narrowing of the CSA between patients with mild vs. moderate OSA, p=0.023. There was no difference in nasal cavity narrowing between the severe group and other groups, likely due to the small sample size of this group.

Conclusion
There is a difference in the anterior nasal cavity narrowing between children with mild OSA and moderate OSA. In addition to structural narrowing from adenotonsillar hypertrophy, this may be another contributor to pediatric OSA.

Support (if any)
R01 HL120909 K23 HL135346 K01 HL130719
561 Association of 25-hydroxyvitamin D and obstructive sleep apnea in adolescent bariatric surgery patients
Authors: Kanney Michelle , Sisley Stephanie 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) is a frequent comorbidity found in children with obesity. However, body mass index (BMI) as a single indicator does not reliably predict the presence of disease. There are no screening tools available which effectively risk stratify pediatric patients to determine the necessity of referral for a sleep study. Recent studies show an association between Vitamin D and OSA in adults, however few studies have examined this potential association in children. In this study we investigate the association of Vitamin D and OSA in pediatric patients.

Methods
We retrospectively reviewed the medical records of adolescent participants referred to our institution’s bariatric program over a two-year period. Inclusion criteria included documentation in the medical record of an initial bariatric clinic assessment, overnight diagnostic polysomnography (PSG) and comprehensive laboratory testing which included serum analysis of lipid profile, hemoglobin A1C, fasting glucose, iron panel, liver function enzymes, and 25-hydroxyvitamin D (25(OH)D) plasma levels. The metabolic profiles and polysomnographic data of patients with and without OSA were compared.

Results
Sixty medical records were reviewed, of which 40 participants were identified that met our inclusion criteria. Participants were grouped according to OSA severity (negative 17%; mild 32%; moderate 32%; severe 12%). There was no significant difference in age, gender or BMI in those with and without OSA (mean age 16.8 ± 0.6 versus 16.2 ± 1.5 years, p=0.13; male gender 32% versus 38%; and BMI 50.5± 5.4 kg/m2 versus 50.17±11.9 kg/m2, p=0.89, respectively). Metabolic profiles for 25(OH)D levels inversely trended with OSA severity (no OSA 21.3± 6.6, mild 17.6± 6.4, moderate 19.5± 5.6, severe 13.25± 5.5, p=0.13). Participants with severe OSA had significantly lower 25(OH)D plasma levels compared to participants without OSA (13.25 ± 5.5 versus 21.3 ± 6.6 ng/ml, p &lt;0.03).

Conclusion
Vitamin D levels inversely correlate with OSA severity in severely obese adolescent patients, and may severe as a useful biomarker in the detection of disease.
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565 Adherence to Auto-Titrating CPAP in Children with Trisomy 21 and Obstructive Sleep Apnea
Authors: Barber Lisa , Oheim Chelsea , Valenzuela Andrew , Tomkinson James , Rodden Gregory , Johnson Samantha , Williams Tina , Kang June-Ku Brian 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) is common in children with trisomy 21. The pathophysiology can be multifactorial and challenging to manage. Auto-titrating continuous positive airway pressure (autoCPAP) is an emerging tool for the treatment of pediatric OSA and few studies discuss adherence. This study compares autoCPAP adherence in children with and without trisomy 21 at our center. We hypothesized that autoCPAP adherence would not differ between the two groups.

Methods
A retrospective review of patients aged 0 to 18 years with a diagnosis of OSA as defined by the International Classification of Sleep Disorders Third Edition, and empirically prescribed autoCPAP between 2012 and 2020 was conducted. Patients without available polysomnography or adherence data were excluded. Data included patient demographics, baseline polysomnography characteristics, and autoCPAP usage. Adherence was defined as usage ≥ 4 hours/night on 70% of nights during a consecutive 30-day period as per the Centers for Medicare and Medicaid Services criteria. Descriptive statistics and non-parametric tests were utilized for analysis.

Results
There were 130 total patients included with a mean age of 12.5 years ± a standard deviation of 4.1 years. Seventeen children (13%) had trisomy 21. No statistically significant differences were observed between the trisomy 21 group (T21) and the non-trisomy 21 group (non-T21) with respect to the obstructive apnea hypopnea index (9.5 ± 11.2 in T21, 14.7 ± 22.3 in non-T21, p=0.61), or the oxygen saturation nadir (87.8% ± 4.2% in T21, 84.4% ± 10.8% in non-T21, p=0.57). The percentage of days used ≥ 4 hours in a 30-day period did not significantly differ (52.3% ± 42% in T21, and 49.5% ± 37.5% in non-T21, p=0.64). While 41% of T21 subsequently underwent a CPAP titration for a suboptimal response to autoCPAP (for reasons including intolerance, persistent snoring, or daytime sleepiness), this did not differ significantly from 23% in non-T21 (p=0.11).

Conclusion
Although limited by a small sample size, our data suggest that adherence to autoCPAP did not differ between the trisomy 21 and non-trisomy 21 groups of children with OSA. Empiric autoCPAP is a reasonable treatment option for children with OSA who are not surgical candidates, including those with trisomy 21.
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566 Persistent Sleep Apnea and Desaturation in Preterm Children at 18 Months of Age at High Altitude (2640 M)
Authors: Duenas-Meza Elida , Escamilla Maria , Rincon Laura , Parra Andrea , Bazurto-Zapata Maria , Restrepo Sonia , Torres Jorge Luis , Suarez Miguel , Rojas Arriana , Caparo Elizabeth , Gonzalez-Garcia Mauricio 
Published: May 2021

Abstract

Introduction
Children born at term who live at high altitude (HA) (≥ 2500 m) have different respiratory patterns from those that live at sea level. It is essential to determine these patterns in preterm children due to their high risk of Sleep Apnea-Hypopnea Syndrome (SAHS). The evolution of the apnea hypopnea index (AHI), desaturation index (ODI), and oxygen saturation (SpO2) is unknown in this group at HA. The objective was to characterize the respiratory patterns during sleep of preterm children living at HA and compare it with those of healthy children born at term.

Methods
We conducted a cross-sectional study in Bogotá, Colombia (altitude: 2640 m). We included 302 children, 127 were preterm with an average of gestational age of 31weeks (SD: 2.9) and an average weight at birth of 1600 g (SD: 594) and 175 healthy full-term infants. Three groups were defined according to age: Group I: 3–4 months, Group II: 6–7 months,, Group III: 10–18 months. All children underwent nocturnal polysomnogram to evaluate their respiratory variables: AHI, average and minimum SpO2, ODI, and T90 during sleep and analyzed the data according to the parameters of the American Academy of Sleep Medicine

Results
302 polysomnograms were performed, 54.3% were girls and were distributed by groups as follows: Group I:105 patients (34.8%), 16 preterm, Group II: 107 patients (35.4%), 46 preterm and Group III: 90 patients (29.8%), 65 preterm. We observed higher respiratory parameters within each age strata in premature infants compared to children born at term. Preterm infants had higher ODI, AHI, obstructive apnea hypopnea index (O-AHI), and Central Apnea hypopnea index (C-AHI). Although the effect decreases over time, we found a significant difference in the first age group. There was a high persistence index in children with a history of preterm birth living at high altitude. We also found a significant decrease in AHI, ODI across time in healthy and preterm children p&lt;0.01

Conclusion
Premature children living at HA persist with higher ODI and AHI compared to children of similar ages born at term. The high desaturation index indicates the presence of intermittent hypoxia that persists in these children over time
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571 Evaluating Need for Follow up Polysomnograms after Adenotonsillectomy in children
Authors: Rao Harish 
Published: May 2021

Abstract

Introduction
Most children with Obstructive sleep apnea (OSA) undergo repeat polysomnogram (PSG) following adenotonsillectomy (T & A). Repeat PSG is often performed regardless of presence of symptoms of sleep disordered breathing after T & A. PSG data performed before and after T & A performed at our institution over past 2 years were reviewed. Data was collected on patient characteristics such as age, sex, BMI, comorbidities and AHI on pre-T & A study. Data was then analyzed looking at patient characteristics that can help predict significant OSA (AHI &gt;5) in post T & A study.

Methods
Retrospective review of 50 consecutive PSGs before and after T & A performed at our institution over past 2 years was performed. Data was collected on age, sex, Obstructive AHI, BMI, O2 nadir and comorbidities to identify patient characteristics to predict significant OSA (AHI&gt;5) in the post T & A study.

Results
Age range of our cohort was 2–16 years. Average age and BMI of our cohort was 5.8 years (median 5 years) and 16.6 respectively. 8 patients had significant OSA (AHI&gt;5) in the after T & A study. AHI (&gt;20) and increased BMI z-score at baseline was highly predictive of significant OSA (AHI&gt;5) in the after T & A study.

Conclusion
Based on our data, follow up PSG is warranted if AHI is &gt;20/hour on baseline diagnostic PSG. Similarly, high BMI z-score at baseline study is also highly predictive of significant OSA (AHI&gt;5) in the post T & A study. Most children with associated comorbidities with mild (AHI 2–5 hour), moderate (AHI 5–10/hour) and lower end of severe OSA (AHI 10–20/hour) do not need repeat PSG after T & A unless symptoms of sleep disordered breathing are present. We are analyzing larger PSG database to identify other patient characteristics that may signal need for follow up PSG. As PSGs are expensive and time consuming, follow up PSGs should be performed only if clinical suspicion for residual OSA is high to optimize resource utilization.
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578 Sleep Attitudes and Beliefs in Children with Juvenile Idiopathic Arthritis and Their Caregivers
Authors: Zhai Shumenghui , Ward Teresa , Palermo Tonya , Ringold Sarah 
Published: May 2021

Abstract

Introduction
Sleep deficiency is highly comorbid in children with juvenile idiopathic arthritis (JIA), affecting approximately 40% of children. In this study, we examined children’s and parents’ beliefs and attitudes about sleep, their self-efficacy, and self-regulation in sleep-related behaviors and managing JIA, and if these factors were associated with their self-report and actigraphic sleep patterns.

Methods
The sample included 44 children with JIA (22 girls; mean age 10.5±1.8) and their parents. Dyads completed the Dysfunctional Beliefs and Attitudes about Sleep Scale and Self-Efficacy Scale. Children completed the Index of self-regulation. Parents completed the Pittsburgh Sleep Quality Index and PROMIS sleep-disturbance. Children wore an actiwatch and completed electronic sleep diaries for ten days. Scored actigraphy variables included children’s total sleep time (TST), wake time after sleep onset (WASO), sleep efficiency (SE, %); sleep diaries included the variables of children’s time in bed (TIB). Parents’ self-reported variables included sleep-disturbances and sleep quality (SQ).

Results
Children’s mean TST was 7.7 hours (±0.7), mean SE of 77%, and mean WASO of 1.1 hours (±0.4). After adjusting for child sex and age, children’s beliefs and attitudes towards sleep (BAS) were positively correlated with their self-efficacy in carrying out sleep-related behaviors (r=.6, p&lt;.0001). Parents’ BAS were positively correlated with child self-efficacy in sleep (r=.4, p&lt;.05) and TIB (r=.4, p&lt;.001). Children’s self-regulation was positively correlated with parents’ SQ (r=.4, p&lt;.05). In the first regression model, parents’ self-efficacy in managing their child’s JIA and parents’ sleep disturbances explained 25% of the variance of children’s TST, (F(4,35)=2.8, p=.039). Both parents’ self-efficacy and sleep disturbances were significant predictors of children’s TST. In the second regression model, children’s self-regulation, self-efficacy, and parents’ sleep disturbances explained 32% of the variance of parents’ self-reported SQ, (F (3,39)= 6.12, p=.002).

Conclusion
The findings suggest that self-efficacy, self-regulation, BAS in both children and parents were associated with better sleep health. Interventions that incorporate parent-child shared decision making about sleep-related knowledge, motivation, skills for setting/achieving goals, and problem-solving strategies are needed for families with children with JIA and sleep deficiency.

Support (if any)
This work was supported by the NIH/ /NINR (P30NR016585, R21NR01747).
580 Psychosocial Functioning Mediates Parental Depression and Sleep Behaviors in Children with Autism Spectrum Disorder
Authors: Hayse Braden , Stearns Melanie , Nair Neetu , Mazurek Micah , Takahashi Nicole , Muckerman Julie , McCrae Christina S 
Published: May 2021

Abstract

Introduction
Parents who have been diagnosed with depression often report that their children have poor sleep behaviors. This relationship may occur because the children of parents with depression are more likely experience poor psychosocial functioning, which can negatively impact their sleep. Children with Autism Spectrum Disorder (ASD) are particularly at risk for sleep difficulties, and it is important to better understand these relationships as scant to no research has been done which investigates parental depression, child psychosocial functioning, and child sleep among children with ASD. The current study examined whether parental perception of their child’s psychosocial functioning mediated the relationship between parental depression and their child’s sleep behaviors.

Methods
The sample (N=36) consisted of parents (81% female) reporting on their children aged 6–12 (M=8.56, SD = 1.86; 75% male). All children were diagnosed with ASD and had sleep complaints as reported by their parents. Children and their parents were recruited because they expressed interest in a behavioral treatment sleep study and these data come from the baseline data collection associated with that study. Measures included Sleep Behaviors factor from the Child Sleep Health Questionnaire (CSHQ), the Pediatric Symptom Checklist (PSC), and a question asking if the parent had been diagnosed with depression.

Results
Analyses were conducting using AMOS 27.0. Child psychosocial functioning significantly mediated (β = .12) the relation between parental depression and child sleep behavior. Parents who had been diagnosed with depression were more likely to report greater child psychosocial difficulties (β =.39, p = .01) and child psychosocial difficulties were associated with a greater likelihood of the child having worse sleep behavior (β =.32, p = .04). The direct effect between parental depression and child sleep behavior was not significant.

Conclusion
These results indicate that child psychosocial functioning may help to explain the connection between diagnosed parental depression and poor child sleep behavior among children with ASD. This suggests that psychosocial functioning may be an important aspect to target in sleep interventions, particularly for children with ASD.

Support (if any)
University of Missouri Research Board Grant (McCrae, PI); United States Department of Defense USAMRAA Autism Research Program (McCrae, PI; CTA AR190047).
584 Response to Intravenous Ferric Carboxymaltose in the Treatment of Childhood Restless Legs Syndrome/Periodic Limb Movement Disorder
Authors: Edlund Wendy , Kotagal Suresh 
Published: May 2021

Abstract

Introduction
Pediatric Restless Legs Syndrome (RLS)/Periodic Limb Movement Disorder (PLMD) are treatable disorders affecting quality of life. The first line therapy is oral iron, which may have gastrointestinal side effects or suboptimal absorption. Consequently, parenteral iron preparations are needed, but have been insufficiently studied in children. This study evaluates the response to intravenous ferric carboxymaltose (FCM) in pediatric RLS/PLMD.

Methods
We performed a retrospective chart review of children who received FCM between May 2018 and January 2019 for treating RLS/PLMD. Serum ferritin before and after the infusion were compared. Where possible, the Clinical Global Impressions of Improvement (CGI-I) was evaluated. Side effects documented in the charts were extracted. The median administered dose of FCM was 10.1 mg/kg (range 9.6–20.8) over 0.6 to2 hours.

Results
There were 27 patients, with mean age of 10.0 +/-4.2 years. 52% were female. 24 had RLS and 3 had PLMD. 20/27 (69.7%) had prior oral iron therapy; 4/20 (26.0%) experienced side effects. Adverse events from FCM infusion included procedure-related anxiety in 4/27, nausea in 1/27, infusion site pain in 2/27, and tachycardia in 1/27. One patient developed subcutaneous extravasation of iron with brownish skin discoloration and a resulting adjustment disorder. Three patients had phosphorus checked following infusion; all were normal. Serum ferritin was available both before and after the infusion for 17 patients. Mean serum ferritin prior to infusion was 27.2 +/-15.7 µg/L (range 6–58) and after the infusion it was 109.8 +/-49.34 µg/L (range 27–192). Mean ferritin increase was 82.6 +/-41.5 µg/L (range 14–160; p=0.0001). Post-infusion ferritin was over 50 µg/L for all but 2 of the subjects, with follow up ranging from 31–266 days (mean 120 days). A larger increase was seen at higher doses (p=0.01). Ferritin increase was not impacted by age, gender, symptom severity, PLMI or prior ferritin level. CGI-I was applied to 15 patients with sufficient follow-up documentation and showed improvement in 86%, with 79% much or very much improved.

Conclusion
The administration of FCM in children with RLS/PLMD is associated with a satisfactory rise in serum ferritin and modest symptomatic improvement.
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587 Temporal Daily Relationships Between Sleep Deficiency and Pain in Youth with Systemic Lupus Erythematosus
Authors: Wi Dahee , Ward Teresa 
Published: May 2021

Abstract

Introduction
Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory autoimmune disorder characterized by recurrent episodes of pain and is more prevalent in youth of color. Although sleep deficiency (poor quality and an inadequate amount of sleep) and pain are interrelated, most of what is known about SLE pain and sleep rely on reports from adults. Less is known about these associations in youth with SLE, leaving a critical gap in care for this population. This study aims to describe the temporal daily relationships between sleep deficiency and pain in 11-to 18-year-old youth with SLE.

Methods
Twenty-three youth (n=21 girls, n=9 Hispanic) with SLE (mean age=14.7 □ 2.2) participated in the study. Youth wore actigraphy and completed electronic sleep diaries for consecutive 10 days. Actigraphic sleep variables (Total Sleep Time [TST], Sleep Efficiency [SE]) and self-reported Sleep Quality (diary SQ) were examined as predictors of next-day pain in the morning. Average daytime pain was examined as a predictor of nighttime sleep (both actigraphic and self-reported sleep variables). Pubertal stage and ethnicity (Hispanic vs. Non-Hispanic) were entered as covariates in all models.

Results
Of the sample, the mean TST was 7 □ 1.2 hours and the mean SE was 73.5 □ 9.2% as measured by actigraphy. On average, diary SQ negatively predicted next-day pain in the morning (p &lt;.001). On average, pain negatively predicted TST (p &lt;.05) and diary SQ (p &lt;.001). The within-subject relationships between sleep and next-day pain were not significant. Daytime pain predicted neither actigraphic nor self-reported sleep quality.

Conclusion
Poor sleep is a modifiable behavior, and improving sleep quality may reduce pain intensity in youth with SLE. Although further study is needed, the findings suggest that sleep is a potential target for interventions to alleviate symptoms of pain in this population.

Support (if any)
This work was funded by NIH/NINR P30NR016585 (MPI: MMH, TMW), R21NR017471 (TMW); University of Washington, School of Nursing, Research and Intramural Funding (RIFP); Hester McLaws Nursing Scholarship.