bluuebunny/crossref_metadata_2025_split huggingface dataset:
0809 Circadian Phase Delays from School Nights to Weekends and Relates to Sleep Characteristics in High School Students
Authors: Hasler Brant , Oryshkewych Nina , Buysse Daniel , Clairmont Kaylyn , Clark Duncan , Guo Kathryn , Siegle Greg , Wallace Meredith 
Published: April 2024

Abstract

Introduction
Developmental shifts towards later sleep/circadian timing during adolescence are often at odds with early school start times, resulting in circadian misalignment and sleep restriction, as well as stark differences between sleep timing/duration on school nights versus weekends. While the sleep aspects of this mismatch have been well-characterized, limited objective data addresses within-person changes in circadian phase across the week. In a sample of high school students, this project aimed to (1) characterize within-person changes in circadian phase from school nights to weekend nights, and (2) examine whether later circadian phase relates to other sleep/circadian characteristics across the full week.

Methods
Sample included 115 high school students (mean age 17.3, 55.7% female, 88.7% White) reporting at least one “standard drink” of alcohol in their lifetime. Participants completed baseline self-report measures, wrist actigraphy for 8 days, and two overnight visits (Thursday and Sunday) for salivary melatonin sample collection. The Munich Chronotype Questionnaire assessed chronotype and social jetlag. Actigraphy measures included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and midsleep timing. Circadian phase was calculated as the dim light melatonin onset (DLMO; 4 pg/ml threshold). Actigraphy and DLMO measures were separately calculated for school nights, weekends, and overall (mean). Linear regression was used to examine associations, covarying for sex, race, and SES.

Results
Circadian phase (DLMO) was systematically later on Sunday (mean 37+/-41 minutes later; d=0.68, p&lt; 0.00). Later school night DLMO was associated with longer SOL (b=0.05,p=0.002), shorter WASO (b=-0.03,p=0.018), and shorter TST (b=-0.18,p=0.001) on school nights, as well as later chronotype (b=-1.72,p&lt; 0.0001). Later weekend DLMO was associated with longer TST (b=0.22,p=0.042) on weekends. Later DLMO (school night, weekend, overall) was associated with larger weekday-weekend differences in actigraphic TST (p’s&lt; 0.001) and more social jetlag (p’s&lt; 0.03).

Conclusion
Circadian phase shows systematic within-person differences across school nights and weekends, broadly paralleling social jetlag based on sleep timing. While later circadian phase was associated with later chronotype, as well as more difficulty falling asleep and less sleep on school nights, this was specific to circadian phase assessed on school nights. Future studies should consider day-of-week of circadian assessments.

Support (if any)
R01AA025626(Hasler)
0811 Multidimensional Sleep Health and Its Association with Cardiometabolic Health in Adolescence
Authors: Nyhuis Casandra , Lenker Kristina , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio 
Published: April 2024

Abstract

Introduction
Multidimensional sleep health (MSH) aims to promote physical and mental well-being and capture the 24-hour experience of sleep by using measures of nighttime sleep and daytime functioning. We have previously updated the existing adolescent MSH model to incorporate objective and subjective measures and, in the present study, we examine its utility in identifying associations between MSH and Metabolic Syndrome (MetS), a cluster of five established risk factors of cardiovascular disease.

Methods
We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. We used the RU-SATED framework–regularity, satisfaction, alertness, timing, efficiency, and duration–to derive an MSH score using actigraphy and self-reports. A continuous MetS score was calculated as the sum of sex-and-age adjusted z-scores of waist circumference (WC), mean arterial blood pressure (MAP), homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides, and HDL.

Results
Overall, better MSH was not significantly associated with lower cMetS (β=-0.07, p=0.22); however, it was significantly associated with lower WC (β=-0.12, p&lt; 0.05). When we examined each MSH dimension and its association with each component of cMetS, good sleep timing was significantly associated with lower WC (β=-0.13, p&lt; 0.05) and higher HDL (β=0.11, p&lt; 0.05) and good sleep efficiency was associated with lower cMetS (β=-0.11, p&lt; 0.05) and lower MAP (β=-0.11, p&lt; 0.05). When we examined each dimension continuously, we found that higher ratings of excessive daytime sleepiness were associated with higher cMetS (r=0.12, p&lt; 0.05) and WC (r=0.11, p&lt; 0.05), more morningness was associated with lower fasting triglycerides (r=-0.10, p&lt; 0.05), later sleep midpoint was associated with lower HDL (r=-0.13, p&lt; 0.05), and longer sleep duration was associated with lower MAP (r=-0.12, p&lt; 0.05) and HOMA-IR (r=-0.11, p&lt; 0.05).

Conclusion
Better sleep health is significantly associated with central obesity, the key driver of MetS. Additionally, our analyses demonstrate that specific dimensions of MSH may contribute differently to cardiometabolic health in adolescence.

Support (if any)
NIH Awards Number R01HL136587, UL1TR000127
0812 Modelling the Impact of Reallocating Sleep and Physical Activity on Anxiety and Depression Symptoms in Adolescents
Authors: Davidson Jordan , Wingerson Matthew , Creasy Seth , Cooper Emily , Brinton John , Bowen Anne , Hawkins Stephen , Cree Melanie , Nadeau Kristen , Melanson Edward , Wright Kenneth , Simon Stacey 
Published: April 2024

Abstract

Introduction
Insufficient sleep and sedentary behavior, both associated with increased anxiety and depression symptoms, are highly prevalent in US adolescents. Our lab previously found that extending adolescents’ sleep duration decreased sedentary behavior (SB). However, the impact of replacing time spent in unhealthy behaviors (e.g., SB) with healthy behaviors (e.g., sleep, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA]) on mental health is unknown. Therefore, we aimed to understand the impact of replacing SB and time-in-bed (TIB) with LPA and MVPA on anxiety and depression symptoms in habitually short-sleeping adolescents using isotemporal modeling.

Methods
Baseline data from a study of habitually short-sleeping (≤7 hours on school nights) and physically inactive (&lt; 3h MVPA/week) adolescents ages 14-19 years were analyzed. During one week of home monitoring, thigh-worn accelerometry assessed SB, LPA, and MVPA; wrist-worn actigraphy estimated TIB. Participants completed PROMIS Anxiety and Depressive Symptoms scales. Isotemporal substitution modeling, which uses cross-sectional data to predict the effect of reallocating time spent in one activity with an equal amount of time spent on another, was used to estimate the effect of movement behavior reallocation on mental health symptoms.

Results
Thirty-four adolescents completed study measures (age=16.0±1.2 years, 70% female, 88% Non-Hispanic White). Reallocating 1 hour/day of SB to an equal amount of LPA within the model was associated with a 4.5-point improved depression T-score (p=0.019) but no difference in anxiety symptoms (p&gt;0.10). Neither replacing 1 hour/day of SB with TIB or MVPA nor replacing 1 hour/day of TIB with LPA or MVPA within the model were associated with changes in depression or anxiety symptoms (all p&gt;0.10).

Conclusion
Replacing 1 hour/day of SB with LPA but not MVPA was associated with significantly lower depression symptoms in habitually short-sleeping, physically inactive adolescents. However, neither reallocation of SB to TIB nor of TIB with PA was associated with mental health symptoms. As this modeling analysis is cross-sectional in nature, further prospective research is needed to evaluate the impact of replacing SB with healthy behaviors, including meeting recommended sleep and PA guidelines, to determine impacts on adolescent wellbeing.

Support (if any)
NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; NIH CTSA UL1TR002535
0813 Sleep Duration Moderates the Association Between Bullying and Suicide Attempts Among U.S. Adolescents
Authors: Narcisse Marie-Rachelle , Barker David , Wolff Jennifer , Carskadon Mary 
Published: April 2024

Abstract

Introduction
Suicide is a major public health issue among adolescents in the United States, with rates having more than doubled over the past 15 years. Bullying is a significant risk factor for suicide attempts during adolescence, while sleep insufficiency is concurrently associated with both bullying and suicide attempts. Although joint presence of these exposures may interact to predict suicide attempts, research has not sufficiently investigated whether sleep duration might moderate the association between bullying and suicide attempts.

Methods
This study draws upon data from the 2021 Youth Risk Behavior Surveillance System, comprising a nationally representative sample of 17,134 participants. Multivariable logistic regression was used to evaluate the relationships among bullying (school/electronic), sleep duration, and past-year suicide attempts among adolescents aged 12-18. Covariates included sex, age, race/ethnicity, screen time, and poor mental health. All analyses accounted for complex survey sampling used by the YRBSS.

Results
15% and 16% of adolescents were bullied at school or electronically, respectively; 10.2% had made ≥ 1 suicide attempt during the past year; 77.3% did not adhere to sleep duration recommendations; and 29.3% reported poor mental health either “most of the time” or “always”. In adjusted models, adolescents who were bullied in school or electronically were three times as likely to attempt suicide vs. those who were not bullied (odds ratio (OR): 3.0, 95% CI:[2.4; 3.7]. Adolescents with ≤4 hours of sleep (10.7%) were twice (OR: 2.6, 95% CI:[1.5; 3.0]) as likely to attempt suicide. Sleep duration significantly moderated the association between bullying in schools and suicide attempts (F5,44=3.1;p=0.019), with those who were bullied showing a higher likelihood of suicide attempts with lower (≤4-6 h) or higher (8-10+h) sleep duration. Those reporting no bullying showed reduced likelihood of suicide attempts as sleep duration increased to 7 hours, and the likelihood remained constant with more hours of sleep. Sleep duration did not moderate this association for electronic bullying.

Conclusion
Bullying (school/electronic) and short sleep duration significantly increase the odds of reported suicide attempts in teenagers. Future research is needed to elucidate why sleep moderates suicide attempts differently among adolescents who are bullied vs. those who are not.

Support (if any)
COBRE Award Number P20GM139743
0815 A Machine Learning Approach to Identify Factors Associated with Adolescent Sleep Outcomes
Authors: Ricketts Emily , Kaplan Katherine , McMakin Dana , Patriarca Guadalupe , Mathew Gina , McGrew Tylor , Chang Anne-Marie , Hale Lauren 
Published: April 2024

Abstract

Introduction
Beyond natural physiological changes coinciding with puberty, several factors perpetuate poor sleep health in adolescents. However, there is limited research examining their relative importance. This investigation used two popular machine learning approaches to identify the relative significance of key factors associated with multiple sleep outcomes, including bedtime, sleep duration, and social jetlag, in a diverse sample of adolescents.

Methods
Participants were 3,381 adolescents from the age 15 wave (M=15.59, SD=0.76) of the Future of Families and Child Wellbeing Study. Sixty-eight factors spanning child- and parent-reported socio-demographics, neighborhood environment, sleep behaviors, activities, psychopathology, family, school, physical health, and dietary patterns, were identified through literature review and author consensus. Variables were entered into lasso penalized regression (LASSO) and random forest machine learning models for variable selection and establishing the order of factor importance. Self-reported social jetlag (sleep midpoint on weekend nights minus sleep midpoint on school nights) and weekday and weekend bedtime and time in bed were dependent variables.

Results
Factors overlapping between LASSO and random forest in their association with sleep outcomes are reported. Delinquent behavior, peer delinquency, consuming sweet drinks, parent removal of adolescent privileges, and smartphone use near bedtime were associated with greater social jetlag. Irregular bedtime routine, delinquent behavior, and peer delinquency were associated with later weekday bedtime. Consuming breakfast and joint (parent and child) and independent (child) decisions surrounding selecting shows and movies were associated with earlier weekday bedtimes. Delinquent behavior, peer delinquency, and difficulty falling asleep were associated with later weekend bedtimes, while joint (parent and child) and independent (child) decisions surrounding selecting shows and movies were associated with earlier weekend bedtimes. Consuming breakfast more days was associated with longer weekday time in bed, while irregular bedtime routine, peer delinquency, parent verbal aggression, difficulty falling asleep, and smartphone use near bedtime were associated with shorter weekday time in bed. Delinquent behavior was associated with shorter weekend time in bed.

Conclusion
Across both approaches, the most consistent findings draw attention to delinquent behavior, bedtime routine regularity, smartphone use, and difficulty falling asleep as targets to optimize adolescent sleep health. Findings have implications for clinical and policy recommendations.

Support (if any)
0816 Infant Bedtime and Bedtime Variability Are Independently Associated with Total Sleep Duration
Authors: Lucchini Maristella , Takur Shambhavi , Ordway Monica , Barnett Natalie 
Published: April 2024

Abstract

Introduction
Sleep-related behaviors in the realm of pediatrics encompass elements that facilitate sleep, such as a regular sleep schedule, following a bedtime routine, and positive parent-child interactions before bedtime. Several studies have shown a positive association between an early bedtime, consistent routines and parent-infant interaction promoting infant independence in falling asleep with longer sleep duration and less night awakenings. Nonetheless, few studies have investigated bedtime regularity. Thus, we examined the relationships among infants' bedtime, bedtime regularity, total sleep time, night awakenings and sleep latency in infants over the course of one month, utilizing subjective and objective sleep data

Methods
We recruited 253 infants 4-11 months old (mean 6.7±2months), 46% males. Parents completed surveys on socio-demographic information and the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Objective sleep measures including average bedtime (BT), total sleep time (TST), number of night awakenings (NA) and the standard deviation for bedtime (BTV), were collected for one month using Nanit auto-videosomography (mean 24±5.3nights). Linear and logistic regressions modeled the relationship between BT and BTV as predictors of objective metrics of TST and NA and sleep latency collected from the BISQ-R. Infant’s sex and age were included as covariates.

Results
Compared to a BTV of 15minutes or less, a BTV of 45minutes to 1 hour was associated with a TST shorter by 28.0±10.2minutes, and a BTV of more than 1hour to TST shorter by 33.5±11.8min. Compared to a BT before 7pm, later BT was associated with a shorter TST. Specifically, TST was 19.7±10 min (p=0.03) less when BT was between 7-8PM, 63.8±10.0 min (p&lt; 0.001) less for BT at 8-9PM, and 126.4±12.7 min (p&lt; 0.001) less when BT was after 9PM. NA were not associated with BT or BTV. BT was associated with sleep latency, with infants going to bed after 9pm being more likely to take more than 16 min to fall asleep compared to infants going to bed before 7pm (OR 9.9 CI 1.22-80.4,p=0.03).

Conclusion
Higher BTV and BT after 7PM were independently associated with shorter TST in infants. These results provide important information for clinical practice and further work should explore how to incorporate this information in sleep interventions.

Support (if any)
0817 Influencing Factors in the Decision-Making Process of U.S. Parents Regarding the Use of Melatonin for Children
Authors: Hartstein Lauren , Garrison Michelle , Lewin Daniel , Boergers Julie , Hiraki Brandon , Harsh John , LeBourgeois Monique 
Published: April 2024

Abstract

Introduction
Parents are increasingly turning to exogenous melatonin to help children sleep, despite a lack of experimental research examining its efficacy and the safety of long-term use. In the U.S., melatonin is classified as a dietary supplement and no prescription is needed to obtain it. Given recent surges in pediatric consumption, current data on the factors contributing to parents’ decisions to administer melatonin to their children are vital in order to understand perceptions and concerns surrounding its use.

Methods
Parents of 1039 U.S. children ages 1.0-13.9 years completed an online questionnaire on children’s development, sleep health, and melatonin use. Data on 212 children who either took melatonin in the past 30 days (N = 131) or at some point previously (N = 81) were included in the present analysis. Open-ended questions on why parents administered melatonin and why they stopped (if applicable) were categorized through thematic coding.

Results
Although nearly half of children who recently took melatonin had bedtime resistance (51.1%) or difficulty falling asleep (46.2%), 24.4% had no reported behavioral sleep problems. Parents’ most common reasons for giving melatonin were to help children fall asleep (49.3%) or wind down before bedtime (22.7%). Parents also reported administering it to adjust for changes to regular sleep routines (17.5%) or to shift circadian rhythms (11.4%). Parents frequently reported initiating melatonin on their own (50.0%), with less than half following the recommendation of a healthcare provider (48.1%). Parents often stopped giving melatonin when they felt their child didn’t need it anymore (32.0%). Fewer parents discontinued use due to negative side effects (9.3%) or concerns about health and safety (13.3%).

Conclusion
Parents reported giving their child melatonin for a variety of reasons related to sleep and circadian timing. Melatonin use was frequently initiated without the recommendation of a medical professional, which raises concerns about misinformation given the gaps in scientific research and variable quality of over-the-counter supplements. Greater research and wider dissemination of guidelines are needed to support parents in making informed decisions regarding their child’s melatonin use.

Support (if any)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (F32-HD103390; R01-HD087707)
0818 Room-sharing and Bed-sharing: Reasons, Beliefs, and Sleep in Mothers and Toddlers from Mexican American Families
Authors: Meltzer Lisa , Williamson Ariel , Tschann Jeanne , Ringwood Haley , Martinez Suzanna , Barron Ileana , Marraudino Elena , Thompson Darcy 
Published: April 2024

Abstract

Introduction
Sleep is essential for development, yet best practices in pediatric sleep are based on studies of primarily non-Latino White families, where rates of room-sharing, bed-sharing, and feeding to sleep are relatively low in toddlers. This ongoing study characterizes room-sharing and bed-sharing reasons, beliefs, practices, and sleep among mothers and toddlers in Mexican American families.

Methods
51 Mexican American mothers (19-43 years; mean education 12.3 + 3.2 years) of toddlers (77% boys; 12-15 months) completed surveys in Spanish (67%) or English. Mothers and toddlers wore an actigraph for 7 nights. Surveys included Bed-sharing and Room-sharing Beliefs (poor parent sleep, poor child sleep, child dependent on parent for sleep, parent preference to have child nearby) and the Brief Infant Sleep Questionnaire (sleep ecology, room-sharing reasons, sleep-related practices).

Results
Room-sharing was common (88%), with room-sharing reasons including parental preference to have child nearby (PREF, 53%), space/logistics (SPACE, 33%), and child needing parent to sleep (NEED, 13%). All NEED mothers reported bed-sharing with their toddler, with 50% of PREF and 47% of SPACE mothers reporting bed-sharing. SPACE mothers agreed that bed-sharing contributed to poor parent and child sleep more than PREF or NEED mothers (medium effect size). PREF mothers disagreed that bed-sharing made a child depend on parent for sleep more than the other groups (large effect size). Toddlers falling asleep at bedtime while feeding was common among all room-sharing mothers (SPACE=67%, PREF=88%, NEED=100%), although higher in bed-sharing families (96% vs. 65% own bed). Parent sleep timing (midpoint) was delayed 48 minutes for SPACE mothers vs. NEED mothers, while child sleep timing was 30 minutes delayed in bed-sharing toddlers and 54 minutes delayed in toddlers who fell asleep feeding. Toddlers who fell asleep feeding had a 35 minute longer sleep opportunity, but a 33 minute shorter sleep duration than non-feeding toddlers.

Conclusion
Early findings from our ongoing study of sleep in mothers and toddlers from Mexican American families suggest sleep ecology beliefs and practices differ from findings in U.S. non-Latino White families. Findings highlight the importance of cultural and ecological sensitivity when designing interventions to reduce sleep disparities and improve overall toddler health.

Support (if any)
R01HL163859