bluuebunny/crossref_metadata_2025_split huggingface dataset:
573 Obstructive Sleep Apnea and Total Sleep Duration is Associated With Problems with Physical Function Mobility in Children
Authors: Turakhia Sujay , Xu Sarah , Miller Michael , Maddalozzo John , Issa Yazan , Bhushan Bharat 
Published: May 2021

Abstract

Introduction
To identify the effect of Obstructive Sleep Apnea (OSA) and sleep duration on problems with health-related quality of life (HR-QoL) in children.

Methods
Children ages 8–18 years visiting sleep laboratory from 07/2019 to 01/2020 for overnight PSG participated in the study. Controls seen during 01/2020-02/2020 for issues other than sleep disturbance were recruited from the primary care pediatric clinics. HR-QoL was assessed by PROMIS V1.0 questionnaires. Statistical analysis was conducted using R 3.6.0.

Results
122 children were studied: 64 males (52.4%).Twenty-nine(29.2%) had mild OSA, 8 (8.1%) moderate OSA, 17 (17.1%) severe OSA,46 (46.4%) were diagnosed with No-OSA and 22 (18.0%) were controls. Patients visiting the sleep laboratory had lower physical function mobility compared to controls (p=0.004). With increasing severity of OSA, there was a step wise decrease in physical function mobility (p=0.01). Correlation analysis suggested that physical function mobility was positively associated with total sleep duration (p=0.02) and negatively associated with apnea hypopnea index (p=0.01). Symptoms of anxiety in children was positively associated with number of arousals (p=0.04). Age was positively associated with fatigue (p=0.02) and negatively associated with deep sleep (p&lt;0.001). Regression analysis confirmed that physical function mobility was associated with total sleep duration (p=0.04) and AHI (p=0.02) after controlling for age, gender and number of arousals.

Conclusion
We found interrupted sleep associated with symptoms of anxiety. OSA and reduced sleep duration are associated with problems with physical function mobility after adjusting for age, gender and number of arousals.

Support (if any)
None
577 Daily facilitators and barriers to adolescent sleep: Contribution to actual sleep over 28-days of school and vacation
Authors: Maskevich Svetlana , Shen Lin , Wiley Joshua , Drummond Sean , Bei Bei 
Published: May 2021

Abstract

Introduction
Little is known about what adolescents perceive as helping (facilitators) or preventing (barriers) them from getting sufficient and good quality sleep, and how these factors contribute to their actual sleep.

Methods
205 (54.2% female, 64.4% non-white) Year 10–12 adolescents (Mage = 16.9 ± 0.9) completed daily morning surveys, and their sleep was measured via actigraphy over 2 school-weeks and 2 subsequent vacation-weeks. Morning surveys assessed self-reported sleep and the usage of 8 facilitators and 6 barriers of sleep from the previous night. Linear mixed-effects models were used to examine contributions of facilitators/barriers to actigraphy and self-reported total sleep time (TST) and sleep onset latency (SOL), controlling for age, sex, race, place of birth, and study day, separately for school and non-school days.

Results
On average, adolescents reported using 3.7 facilitators and encountering 1.5 barriers daily. Compared to school, non-school days were characterised by more frequent use of facilitators and more barriers encountered. Overall, facilitators or barriers explained an additional 1–7% (p-values &lt; .01) of variance beyond the covariates. Similar facilitators and barriers contributed to actigraphy and self-reported TST and SOL, however, self-reported sleep variables were more affected. Notable facilitators that predicted longer TST and shorter SOL were: “follow body cues”, “avoid activities interfering with sleep”, “create good sleep environment”, “plan bedtime and go to bed as planned” (only TST on school days), and “manage thoughts and emotions” (only SOL). Notable barriers that predicted shorter TST and longer SOL were: “pre-bedtime thoughts and emotions”, “inconsistent routines”, “unconducive sleep environment”, “activities interfering with sleep” (only non-school) and “other household members’ activities” (only SOL).

Conclusion
This intense longitudinal study showed that on a daily basis, adolescents perceive a range of factors as facilitating and preventing sufficient and good quality sleep. These factors are predictive of their actual sleep duration and onset latency and need further research to understand their functions and clinical implications.
Support (if any):
600 Differential Impact of Overnight Delta Power Dynamics on Neurocognition among Adolescents with ADHD versus Healthy Controls
Authors: Lunsford-Avery Jessica , Krystal Andrew , Jackson Leah , Kollins Scott 
Published: May 2021

Abstract

Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with neurocognitive impairment; however, mechanisms contributing to neurocognitive deficits in ADHD are poorly understood. Sleep disturbance is common in ADHD, and our previous work has shown associations between overnight delta power dynamics (lower initial delta peak, slower delta decline) and poorer neurocognition among individuals with insomnia, suggesting these processes may underlie sleep restoration. This study investigates relationships between delta power dynamics and neurocognition among adolescents with ADHD versus healthy controls (HC).

Methods
In this ongoing study, 47 adolescents aged 13–17 (19 ADHD, 23 females, mean age=15.26) participated in a psychiatric evaluation and three nights of ambulatory polysomnography (PSG). Following the third night, participants completed the Cambridge Neuropsychological Test Automated Battery (CANTAB). Spectral analysis was conducted on a single O1-C3 channel and epochs were movement/artifact-free. Sleep variables were averaged over 3 nights. General linear models controlling for age, sex, total sleep time (TST), and wake after sleep onset (WASO) examined the effects of delta dynamics on neurocognition (summary score derived from principal components analysis of CANTAB subtests) and whether these associations differed across groups.

Results
PSG sleep variables did not differ by group (p’s&gt;.05). Significant effects of group (F(7,36)=23.10, p&lt;.0001), delta decline (F(7,36)=10.89, p=.002), and the group by delta decline interaction (F(7,36)=14.23, p=.0006) were observed. Results regarding initial delta peak showed a similar pattern, with a trend toward a main effect of initial delta peak (F(7,36)=3.53, p=.07) and a significant group by initial delta peak interaction effect (F(7,36)=9.91, p=.003) on neurocognition. Lower initial delta peak and slower delta decline were associated with poorer cognition among ADHD, but not HC, youth after covarying for age, sex, TST, and WASO.

Conclusion
Overnight delta power dynamics may contribute to neurocognitive performance among adolescents with ADHD after accounting for sleep restriction and nighttime awakenings, highlighting the potential importance of sleep physiology in understanding neurocognitive deficits in this population. Future studies should identify whether there are phenotypic subgroups within ADHD characterized by disrupted overnight delta dynamics and examine whether insomnia treatments that impact delta decline (e.g., Cognitive-Behavioral Treatment—Insomnia) improve neurocognitive performance among adolescents with ADHD.

Support (if any)
This work was supported by K23MH108704 to Dr. Lunsford-Avery.
610 Self-Reported Sleep and Circadian Characteristics Predict Future Substance Use: A Longitudinal Analysis from the NCANDA Study
Authors: Hasler Brant , Graves Jessica , Wallace Meredith , Claudatos Stephanie , Baker Fiona , Clark Duncan 
Published: May 2021

Abstract

Introduction
Growing evidence indicates that sleep characteristics predict later substance use and related problems during adolescence and young adulthood. However, most prior studies have assessed a limited range of sleep characteristics, studied only a narrow age span, and included relatively few follow-up assessments. Here, we used multiple years of data from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study, which spans the adolescent period with an accelerated longitudinal design, to examine whether multiple sleep characteristics in any year predict substance use the following year.

Methods
The sample included 831 participants (423 females; age 12–21 years at baseline) from NCANDA. Sleep variables included the previous year’s circadian preference, sleep quality, daytime sleepiness, timing of midsleep (weekday and weekend), and sleep duration (weekday and weekend). Each sleep variable’s association with the subsequent year’s substance use (cannabis use or alcohol binge severity) across years 1–5 was tested separately using generalized linear mixed models (zero-inflated Negative Binomial for cannabis; ordinal for binge severity) with age, sex, race, visit, parental education, previous year’s substance use (yes/no) as covariates and subject as a random effect.

Results
With regard to cannabis use, greater eveningness and shorter weekday sleep duration predicted an increased risk for additional days of cannabis use the following year, while greater eveningness and later weekend midsleep predicted a greater likelihood of any cannabis use the following year. With regard to alcohol binge severity, greater eveningness, greater daytime sleepiness, and shorter sleep duration (weekday and weekend) all predicted an increased risk for more severe alcohol bingeing the following year. Post-hoc stratified analyses indicated that some of these associations may differ between high school-age and college-age participants.

Conclusion
Our findings extend prior work, indicating that eveningness and later sleep timing, as well as shorter sleep duration, especially on weekdays, are risk factors for future cannabis use and alcohol misuse. These results underscore a need for greater attention to sleep characteristics as potential risk factors for substance use in adolescents and young adults and may inform future areas of intervention.

Support (if any)
Grants from NIH: R01AA025626 (Hasler) and U01AA021690 (Clark) and UO1 AA021696 (Baker & Colrain)
613 Variation in Sleep Beliefs and Behaviors Among Caregiver-Child Dyads Participating in a Sleep Extension Intervention
Authors: Williamson Ariel , Wu Katherine , Jawahar Abigail , Juste Lionola , Zemel Babette , Dinges David , Fiks Alexander , Mitchell Jonathan 
Published: May 2021

Abstract

Introduction
Given the high prevalence and poor outcomes of insufficient child sleep, effective interventions for the pediatric primary care setting are needed. Collecting family perspectives on intervention strategies is critical to understand and enhance outcomes, particularly among children who do not experience improvements. This study examined variation in qualitative family sleep beliefs and behaviors by quantitative child sleep outcomes of a sleep extension intervention.

Methods
A total of 24 caregiver-child dyads (child age 9–12 years, M age 11.3 (SD:1.0) years; 46% male; 50% non-Latinx White; 29% Black) participated in a mobile health sleep extension intervention, between March-December 2019, and completed post-intervention semi-structured telephone interviews to solicit intervention perceptions. The intervention used a 25 factorial design consisting of sleep duration goals and weekly performance feedback, with random assignment to sleep health promotion messaging and financial incentive conditions. Sleep duration was assessed via Fitbit Flex 2 devices during 2-week baseline and 7-week intervention periods. We developed a codebook using a grounded theory approach and conducted coding in NVivo. We compared preliminary qualitative themes among children who showed a &gt;=30-minute improvement in sleep duration (‘responders’) versus those who did not (‘non-responders’).

Results
Of the 24 dyads, 38% (N=9 dyads) were classified as non-responders. Preliminary qualitative themes included: family beliefs about sleep and electronics usage; the study impact on sleep behaviors; and an enhanced awareness of child sleep. Intervention responder and non-responder dyads similarly described family restrictions on evening electronics usage (e.g., electronic parental controls; physical removal of devices) to benefit child sleep. However, more children classified as intervention responders described the benefits of these restrictions and expressed beliefs about the negative impacts of electronics on sleep. Whereas caregivers of both responders and non-responders described efforts to remind their child to go to bed earlier during the intervention, caregivers in the responder group described being more focused on and active in child sleep extension strategies. These included setting bedtime reminders and adjusting family activities to ensure an extended sleep schedule.

Conclusion
Addressing caregiver-child beliefs about sleep behaviors and engagement in sleep extension strategies could augment sleep extension intervention outcomes in future research.

Support (if any)
K01HL123612 (JAM), CHOP (JAM), K23HD094905 (AAW)
615 Sleep Restriction Leads to Fewer Prosocial Responses to Ambiguous Social Vignettes among School-aged Children
Authors: Gonzalez Rogelio , Meir Priel , Palmer Cara , Alfano Candice 
Published: May 2021

Abstract

Introduction
Introduction. After sleep deprivation, adults demonstrate reduced ability to accurately discriminate socio-emotional cues, including increased perceptions of threat and decreased recognition of subtle emotional facial expressions. Experimental studies in youth are far more limited, but sleep loss may have more profound effects on detection of socio-emotional cues during development when these abilities are still developing. The current study therefore compared children’s responses to ambiguous social vignettes after a night of adequate sleep and two nights of sleep restriction (SR). We hypothesized that SR would result in fewer pro-social responses compared to when children were rested.

Methods
Methods. A total of 53 healthy children aged 7–11 years old (M = 9.08, SD = 1.34; 56.6% female) completed two counterbalanced emotional assessments; one after a night of 10 hours in bed (assessed via at-home polysomnography) and one a week later after two consecutive nights of SR (7 hours and 6 hours in bed, respectively). At each assessment, children listened to three brief stories depicting ambiguous social vignettes with peers or adults. After each story, children were asked what they would do next in the situation. Responses were recorded verbatim and later coded by blind raters as prosocial, avoidant, aggressive, or ambivalent.

Results
Results. A difference in response type was detected for one of the three types of vignettes after SR compared to when rested (χ2 (1) = 4.51, p = .02). Specifically, stories including ambiguous actions of another child at school resulted in 1.47 lower odds of a prosocial response compared to all other types when children were sleep restricted.

Conclusion
Conclusion. Our preliminary findings suggest that inadequate sleep may undermine children’s behavioral responses in ambiguous social situations with peers. These preliminary results require replication, but such investigations may provide greater insight into mechanism that explain documented relationships between sleep and social problems in childhood.
Support (if any):
617 Electrocardiogram Abnormalities in Children Undergoing Polysomnography
Authors: Amin Ankit , Paola Mogavero Maria , Ferri Raffaele , Delrosso Lourdes 
Published: May 2021

Abstract

Introduction
Monitoring electrocardiogram (EKG) is an integral component of pediatric polysomnography (PSG). There is limited data regarding arrhythmia and conduction disturbances in the pediatric population undergoing a PSG. In this work we will present abnormal EKG findings during PSG in our sleep center.

Methods
A retrospective chart review from children at Seattle Children’s Hospital who underwent PSG read by a single Sleep Medicine physician (LD) in the last year was carried out. Data included age, sex, type of EKG abnormality, sleep diagnosis from PSG. Data from children with 1st or 2nd degree atrioventricular block (AVB) were compared to those from children with premature ventricular contractions (PVC).

Results
A total of 1,235 PSG were included. Twenty-four children (9 girls and 15 boys) aged 2–17 years (median 9 years) were identified with arrhythmias or conduction disturbances (1.9%). Nineteen out of 24 of these children (79.2%) had oAHI &gt;1/hour; this frequency was not significantly different from that found in the whole group of 1,235 children (Chi-square test p=0.16). When comparing PSG parameters from children with AVB with those with PVC, we found no statistically significant difference. Seven out of nine children with AVB and seven out of ten with PVC had oAHI &gt;1/hour (Fisher exact test p=0.56) while eight children with AVB out of nine and four out of ten with PVC were males, and this difference was the only statistically significant difference found (Fisher exact test p=0.04). None of the children were found to have a structural or conduction abnormality when referred to cardiology.

Conclusion
Our study found ECG abnormalities in 1.9 % of children undergoing PSG. None of the children were found to have abnormal findings after cardiology referral. Our study supports that EKG abnormalities are rare in PSGs of children and not associated with cardiac disease or sleep disorders, but appear more commonly in males.
Support (if any):
627 Adolescent Delayed Sleep Phase and Circadian Irregularity Associated with Substance (Mis)Use in Young Adulthood
Authors: Calhoun Susan , Krishnamurthy Venkatesh , Bui Linda , Ciarletta Matt , Liao Jiangang , He Fan , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio 
Published: May 2021

Abstract

Introduction
Substance use disorders are reaching epidemic proportions among adolescents and young adults. While disturbed, insufficient sleep is known to be associated with substance use, little is known about the role of circadian misalignment in precipitating or perpetuating substance misuse.

Methods
The Penn State Child Cohort is a population-based sample of 700 children (Mdn=9y), who were followed-up 8 years later as adolescents (N=421, Mdn=16y) and 15 years later as young adults (N=492, Mdn=24y). In adolescence, a delayed sleep phase was defined as a 7-night actigraphy-measured mean sleep midpoint later than 4:00 AM, while an irregular circadian phase as a within-subjects standard deviation in sleep midpoint greater than 1 hour. Alcohol, tobacco, and drug use was ascertained by parent- and/or self-reports in adolescence, while alcohol, tobacco and marijuana use was ascertained by self-reports in young adulthood. Logistic regression models tested the association between delayed and irregular circadian phase with substance use adjusted for age, sex, race/ethnicity, BMI, SES, mental health problems and psychoactive medications.

Results
Adolescents with a delayed sleep phase (n=164) showed later bed and wakeup times, lower morningness scores and greater circadian phase irregularity. Cross-sectionally, a delayed sleep phase in adolescence was associated with 1.9-fold odds (95%CI=1.1–3.2) of alcohol, tobacco and/or drug use; specifically, the odds of alcohol and tobacco use associated with a delayed sleep phase were 1.9-fold (95%CI=1.1–3.4) and 2.4-fold (95%CI=1.1–5.3), respectively, while non-significant for drug use (n=28) for which mental health problems were among the strongest risk factors (OR=3.0, 95%CI=1.3–6.8). Longitudinally, an irregular circadian phase in adolescence was associated with 2.2-fold odds (95%CI=1.1–4.5) of alcohol, tobacco and/or marijuana use in young adulthood; specifically, the odds of alcohol use in young adulthood associated with an irregular circadian phase in adolescence were 1.9-fold (95%CI=1.1–3.5), while non-significant for tobacco (n=58) or marijuana use (n=76) for which mental health problems were the strongest risk factor (OR=2.2, 95%CI=1.3–3.7).

Conclusion
A delayed or irregular circadian phase in adolescence is associated with substance use, particularly alcohol use in the transition to adulthood. Beyond disturbed and insufficient sleep, circadian misalignment should become a target of early interventions to prevent substance use disorders.

Support (if any)
R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127
631 Sleep SMART in Adolescents with Neurodevelopmental Disorders
Authors: Hanish Alyson , Jo Klein Abbey , Mathews Therese , Berger Ann , Kupzyk Kevin , Ellis Cindy , Kuhn Brett 
Published: May 2021

Abstract

Introduction: Introduction
Sleep disturbances are common in adolescents with neurodevelopmental disorders (NDDs). Inclusion of vulnerable populations such as adolescents with NDDs into sleep intervention efforts is essential as they are at high-risk for poor physical/mental health outcomes. The objective of this study is to pilot a sequential, multiple assignment, randomized trial (SMART) design to compare the impact of a sequence of sleep interventions, based on treatment response, to optimize sleep health in adolescents with NDDs.

Methods: Methods
Recruitment began June 2019 using convenience sampling. The SMART pilot feasibility study includes 1-week of baseline sleep data, and two 4-week periods of a sleep intervention (9-week total study enrollment). Interventions include exogenous melatonin, The Bedtime Bank, and their combination. Exogenous melatonin (liquid, immediate release, 3mg) is administered 30 minutes before bedtime. The Bedtime Bank, a behavioral sleep intervention, is based upon contingency contracting that relies on a credit- or debt-based system to hold adolescents accountable for maintaining a consistent bedtime. At baseline participants completed demographics, PROMIS pediatric sleep questionnaires, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), salivary & urinary endogenous melatonin measurement, and one week of actigraphy. Upon enrollment, participants were randomly assigned to either melatonin or The Bedtime Bank. Participants who respond (nightly increase in total sleep time (TST) ≥18 minutes) remain on the assigned intervention; if non-responsive participants are re-randomized to a different sleep intervention or combination.

Results: Results
At baseline, participants (n=29, aged 10–18 years) had an average TST of 7 hours 11 minutes. PROMIS Sleep Disturbance (M=64.3, SE=2.5), PROMIS Sleep-Related Impairment scores (M=58.9, SE=2.2), and CASQ scores (M=40.0, SD= 10.5) were higher than reported normative values. Salivary DLMO & urinary 6-sulfatoyxmelatonin analysis is ongoing. For participants who completed the full 9-week trial, nearly 30% (n=7/24) were responsive (increased baseline TST ≥18 minutes) to one of the 4-week interventions.

Conclusion: Conclusion
Baseline data of the enrolled participants demonstrates poor indicators of TST, sleep disturbance, and sleep related impairment. Preliminary results of this SMART indicate some adolescents are responsive to sleep interventions aimed to improve their TST.

Support (if any)
Support: This clinical trial is funded by the National Institute of Nursing Research, National Institutes of Health (1K01NR017465-01A1).