bluuebunny/crossref_metadata_2025_split huggingface dataset:
0822 The 3-30-300 Rule for Green Space Exposure and Sleep in Elementary School Children
Authors: Grigsby-Toussaint Diana , Yang Jue , Acevedo Aliana Rodriguez , Evans Gabrielle , Johnson Azia , Katz Abby , Kemball-Cook William , Nwanaji-Enwerem Ugoji , Romero-Ramos Yaideliz , Story Diane , Ury Brooke , Cheol-Shin Jong , Barker David , McGeary John , Dunsiger Shira 
Published: April 2024

Abstract

Introduction
In 2015, the United Nations identified a target of “universal access to safe, inclusive and accessible, green and public spaces “to be implemented by 2030. However, few guidelines exist to equitably increase access to the health-promoting qualities of high-quality green space. Recently, the “3-30-300” rule was introduced as a benchmark to ensure universal access to green space. This study aimed to use the 3-30-300 benchmark for green space exposure, to determine whether these metrics are associated with sleep phenotypes in elementary school children.

Methods
Elementary school children in grades 1-3 in the ongoing Project Greenspace, Sleep, and Mental Health (G-SPACE) study in Rhode Island were recruited to wear a GPS and an accelerometer for seven days. The 3-30-300 rule was applied to their residential address. ‘3’ was quantified using the Green View Index (GVI), derived from the panoramic street view from Google. ‘30’ refers to a minimum 30% tree canopy within a 200m buffer of the home;‘300’ is based on home distance to ≥50m² greenspace within 300m. The association between the mean greenspace measurements and sleep measures, Total Sleep Time (TST, hours), Sleep Efficiency (SEF), and Wake After Sleep Onset (WASO, minutes) was analyzed using T-tests.

Results
There is no statistically significant difference between viewing more than three trees versus less (TST mean 9.19 vs 8.95, SEF mean 88.5% vs 87.9%, and WASO mean: 37.8 vs. 39.6); having ≥ 30% tree canopy versus less ( TST mean: 9.16 vs 9.01, SEF mean 88.1% vs 88.2%, and WASO mean: 38.4 vs 39 ); and having 50m2 greenspace within 300m versus without (TST mean: 8.94 vs 9.18, SEF mean 88.3% vs 88.2%, and WASO mean: 38.5 vs 38.8).

Conclusion
Participants that met the benchmarks for the 3-30-300 rule did not have better sleep measures compared to those that did not. Due to the multifactorial nature of sleep, this benchmark may not capture the contextually relevant locations that may influence sleep health profiles among children.

Support (if any)
Project G-SPACE is supported by the National Institutes of Health/National Institute on Minority Health and Health Disparities (R01MD016241) and NIGMS 5P20GM139743
0828 Investigation of Sleep Disturbances in Pediatric Patients with Septo-Optic Dysplasia
Authors: McCarty Grae , Danieli Hana , Karakas Cemal , Singer Emily 
Published: April 2024

Abstract

Introduction
Septo-optic dysplasia (SOD) is a heterogenous neurodevelopmental condition diagnosed based on the presence of two or more of the following findings: optic nerve hypoplasia, absence of the septum pellucidum, dysgenesis of the corpus callosum, and pituitary hormone abnormalities. Sleep disturbances in SOD are common, however, they have not been well characterized. This study aims to investigate and characterize sleep disturbances in SOD.

Methods
We used the Slicer-Dicer tool to identify pediatric patients (&lt; 21 years) from EPIC with a diagnosis of SOD (ICD Q04.4) who had encounters between July 2013 and July 2023 at Norton Children’s Hospital, KY, USA.

Results
We identified 35 patients (M:F=12:23) with SOD. The mean age was 9.5 years (SD:4.5). Twenty-six patients described a sleep disturbance including snoring (n=5), insomnia (n=8), and frequent arousals (n=5). Of those, ten patients had previous polysomnography (PSG) at a mean age of 4.5 years (SD:3.3). For those who underwent PSG, the mean total sleep time was 381.3 minutes (SD:75.8); the median sleep latency was 14.0 minutes (SD:34.1); four patients had a prolonged sleep latency of &gt; 20 minutes (IQR:5.1-70.9); the mean sleep efficiency was 70.7% (SD: 26.9); the median percentage of N1 sleep was 0.15 % (IQR:0-0.6), N2 42.9% (IQR:35.3-49.9), N3 38.1% (IQR: 25.1-43.4), REM 21.8% (IQR:16.1-28.2). Four patients had an elevated arousal index of &gt; 10. The mean AHI was 8.2 (SD:11.6). No patients had central apnea or elevated periodic limb movements. Of the 35 patients, eight had obstructive sleep apnea and seven used medications, such as melatonin, to assist with sleep.

Conclusion
Patients with SOD have fragmented sleep and are at increased risk of obstructive sleep apnea. The presence of sleep disturbances in patients with SOD is likely multifactorial. Many patients with SOD have midline brain defects and midline areas that regulate sleep such as the suprachiasmatic nucleus (SCN) of the hypothalamus and the pineal gland may be impacted by their condition.

Support (if any)
0834 Bedtime and Naptime Routines: Associations with Newborn and Parental Sleep Outcomes
Authors: Mindell Jodi , Leichman Erin S , Mack M Catherine , Carson Mikayla 
Published: April 2024

Abstract

Introduction
A consistent bedtime routine is associated with better sleep and well-being in young children. However, little is known about the prevalence of bedtime and naptime routines in newborns, and their association with sleep outcomes in both the newborns and their parents.

Methods
Parents (67% mothers, 33% fathers) of 135 newborns (1-15wks; M=8.2wks) from the US and UK completed an online questionnaire addressing questions about sleep and routines in newborns, as well as measures of sleep in the parents (PROMIS sleep disturbance scale and sleep-related impairment scale).

Results
Overall, 62% (n=84) reported having a bedtime routine and 20% (n=27) a naptime routine for their newborn. Of these families, 50% started a bedtime routine before 4 weeks of age with 58% starting a naptime routine within the same time frame. Most parents who engaged in a bedtime routine indicated that they liked it (79%), it was easy (70%), it helped their newborn fall asleep (62%) and sleep for longer stretches overnight (54%). For those with naptime routines, approximately half liked them (54%) and reported they were easy (50%), but fewer thought they helped their newborn nap (35%). Most parents thought that sleep routines helped them bond with their newborn (88% bedtime, 69% naptime). Further, newborns with a bedtime routine had longer stretches of sleep (5.1h vs. 4.2h, p=.023), shorter total time awake during the night (128.6m vs. 175.7m, p=.002), and trended toward fewer night wakings (2.1 vs. 1.7, p=.070). Finally, parents who had bedtime routines for their newborn were less likely to experience sleep disturbances themselves, p=.017, but there were no differences in sleep-related impairment.

Conclusion
Over half of all newborns have a bedtime routine, but only 20% a naptime routine. However, these routines are liked by parents and associated with increased sleep consolidation in newborns and decreased sleep disturbances in parents. A simple recommendation of instituting sleep routines for newborns may result in improved sleep outcomes for newborns and their parents.

Support (if any)
Kenvue, Skillman, NJ, USA
0835 Impact of Daylight Saving Time Change on Parental Anxiety, Stress, and Infant Sleep Expectations
Authors: Thakur Shambhavi , Lucchini Maristella , Kahn Michal , Barnett Natalie 
Published: April 2024

Abstract

Introduction
Daylight Saving Time (DST) transitions can disrupt infant sleep routines, and lead to temporary sleep disturbances, potentially contributing to heightened stress levels for parents. This study examines the associations between DST-related stress, parental anxiety, and parental and infant sleep.

Methods
602 parents of infants aged 0-24 months (11.45±5.5) from the US were recruited,79% mothers. A week prior to the spring DST transition, parents completed the Pittsburgh Sleep Quality Index (PSQI) and the Edinburgh Postnatal Depression Scale-3A (EPDS-3A) to assess perinatal anxiety. Additionally, they reported concerns regarding the impact of the DST change on their child's sleep (How long do you think it will take your child to adjust to the new time? How stressed are you about the impact of daylight saving on your child's sleep?). Objective infant total sleep time (TST) was measured using Nanit autovideosomnography for 7 nights prior to the DST change. Logistic regression analysis was performed with anxiety as the predictor and stress and anticipation about DST as the outcomes. Furthermore, a Wilcoxon test compared the average sleep duration of infants and parents between the anxious and non-anxious groups. An EPDS-3A score ≥5 was considered anxious. Infant age was a covariate in all analyses.

Results
Parents experiencing anxiety before DST were 1.98 times more likely (CI 1.15-2.42) to report being stressed about the DST change (p&lt; 0.001), and were 1.66 times more likely (CI 1.15-2.42) to anticipate &gt;3 days adjustment period for their child following DST (p=0.007) than those who did not experience anxiety. There was no significant difference in TST between infants of anxious and non-anxious parents, but non-anxious parents slept for an average of 11 minutes longer than anxious parents (p=0.017).

Conclusion
This study demonstrates that parents experiencing anxiety exhibit higher stress levels and more negative expectations regarding their infants’ sleep during the DST transition than non-anxious parents. Moreover, anxious parents reported shorter sleep durations before the DST change compared to non-anxious parents. Notably, there was no significant difference in TST between infants of the non-anxious and anxious parent groups.

Support (if any)
0837 Associations Between Sleep Health, Diet Quality and Movement Behaviors in a Community Sample of Preschoolers
Authors: Covington Lauren , Brewer Benjamin , Alvarado Adriana Verdezoto , Cordova Angeni , Archer Emma , Ji Xiaopeng , Patterson Freda , Robson Shannon 
Published: April 2024

Abstract

Introduction
Lifelong sleep, diet and movement behaviors are formed during the preschool (age 3-5) years. Inadequate sleep health (i.e., short duration, late bedtimes, low quality) and poor diet quality are independently associated with physical inactivity and subsequent risk of obesity development. Not known is how sleep health and diet quality may interact in association with movement behaviors (moderate-to-vigorous physical activity [MVPA] and sedentary behavior [SB]) during this critical period of the life course. This study explored the interaction between diet quality and sleep health on movement behaviors in a community sample of preschoolers.

Methods
Preschoolers from families living in Delaware communities wore an Actigraph on their waist for up to one-week (average wear time=6 days) to measure sleep health, SB, and MVPA. Sleep health metrics included sleep duration (minutes), timing of sleep onset and offset (hours), and sleep efficiency (percentage of time in bed spent asleep). Parents completed 3-days of dietary records for their child, and Nutrition Data Systems for Research (NDS-R) software was used to analyze these dietary records. Healthy Eating Index 2015 (HEI-2015) scores were derived (higher scores=better diet quality). Generalized Linear Models utilizing GEEs quantified the associations between sleep health and diet quality on SB and MVPA; and the interaction between diet quality and sleep health was explored. Models adjusted for age, sex, race, parent education, and BMI.

Results
In a sample of 24 preschoolers (mean age=4.6 years, SD=0.78; 50% male, 63% White, non-Hispanic), there was a significant interaction between diet quality and sleep timing on movement behaviors. Having an HEI-score above the sample median of 61 was associated with less SB (p&lt; 0.001), but having a late bedtime (p&lt; 0.001) and late wake time (p=0.004) tempered this association. Similarly, having an HEI-score above the median was associated with more MVPA (p&lt; 0.001), but having a late bedtime (p&lt; 0.001) and late wake time (p=0.03) tempered this association.

Conclusion
Our findings underscore the interdependence of health behaviors in preschoolers. Future integrated interventions may consider targeting multiple behaviors, including sleep timing, diet and physical activity, to impede early childhood obesity development.

Support (if any)
2020 Center for Innovative Health Research Interdisciplinary GOLD Research Grant
0838 Sleep Hygiene in Mexican American Toddlers: Bedtime Screen Use and the Role of Maternal Beliefs and Self-efficacy
Authors: Thompson Darcy , Kaizer Laura , Schmiege Sarah , Clark Lauren , Cabrera Natasha , Ringwood Haley , Meltzer Lisa , Valdes Estefania Miramontes , Gorman Carol , Colunga Ariadna Juarez , Spacone Anne , Babiak Marko , Tschann Jeanne 
Published: April 2024

Abstract

Introduction
Good sleep hygiene includes restricting screen use in the hour before bedtime. Despite this, bedtime screen use starts for many in early childhood. To inform the design of interventions aiming to promote quality sleep, a better understanding of parental conceptualizations about their children’s bedtime screen use is needed. We evaluated whether maternal beliefs about bedtime screen use and self-efficacy to limit bedtime screen use are related to toddler screen use before bedtime in Mexican American families.

Methods
This study used data from a larger study enrolling Mexican American families with toddlers (15-26 months old) recruited from a federally qualified health system. Participants were asked how much they agreed that using a screen device before bed helps little children sleep better (belief) and how confident they were about limiting their toddler’s bedtime screen use (self-efficacy). Screen use before bedtime was measured via a 7-day diary completed by mothers, resulting in a count of nights the child used a screen device in the hour before bedtime. We used multiple regression to evaluate whether maternal beliefs and self-efficacy were associated with toddlers’ bedtime screen use, adjusting for child age, and maternal education and employment status.

Results
Participants (n=286) were on average 31.4 years old (SD=5.9) and 73% reported ≤ high school degree. Mean child age was 21.7 (SD=3.1) months. Over one-third (36%, n=103) of children used a screen device in the hour before bedtime at least 4 nights per week. Mothers’ stronger beliefs that screen use before bed helps with sleep (Incidence rate ratio (IRR)=1.22, 95% CI 1.06-1.41) and mothers’ lower self-efficacy to limit bedtime use (IRR=0.79, 95% CI 0.70-0.89) were associated with greater toddler bedtime screen use.

Conclusion
Maternal beliefs and self-efficacy regarding limiting screen use at bedtime should be considered in interventions addressing toddler sleep hygiene in this population.

Support (if any)
Research reported in this publication was supported by NIH/NINR (R01NR017605, PI: Thompson) and NIH/NCATS Colorado CTSA Grant Number UM1 TR004399. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
0842 Parent Engagement with Digital Sleep Health Interventions for Young Children: A Global Scoping Review
Authors: Chung Alicia , Nechyba Ashley , Deaton Laurel , Miller Jennifer , Mansour Rania , Johnson Margarita , Elvariste Stessie , Liu Jenny , Metayer Menessa , Shorter Shayla , Vieira Dorice 
Published: April 2024

Abstract

Introduction
It is widely recognized that young children may experience sleep problems early in life that affect child development outcomes. Digital technology offers an accessible platform to reach and engage families of young children with sleep health solutions early in life.Our global scoping review aimed to investigate the use of digital technology as a resource to facilitate parental interventions aimed at enhancing sleep health among children in early childhood (3 –8 years old).

Methods
We performed a scoping review of peer-reviewed articles published from inception to 2023 for the following databases: PubMed, Embase, Web of Science including FSTA and Scielo, MEDLINE, Cochrane Library, Engineering Village, CINAHL, APA PsycInfo, Global Health and citation searching. In conjunction with the authors, two librarians conducted an extensive literature search, and the strategies can be found at [osf.io/74hba]. Our methodological approach encompassed a systematic review of key terms related to sleep, communication, parental involvement, and internet-based intervention. Inclusion criteria included intervention studies with parents of children 3-8 years old via digital communications (e.g. social media, telehealth, websites, mobile apps, wearable devices) to address sleep health in their child. Exclusion criteria included platforms unrelated to sleep, studies that digitally recruited participants but did not use a digital platform, studies with children outside the target age, or protocol studies. Review Registration: https://doi.org/10.17605/OSF.IO/TNFY2

Results
Four articles met the final inclusion criteria. A final sample size of 194 parent-child dyads across Australia, Canada, the Netherlands, and the United States were enrolled. Mean child age was 5 years old and mean parent age was 37. Sleep health behavior outcomes in children addressed by digital mobile health solutions included bedtime resistance, night wakings, sleep onset, sleep duration, obstructive sleep apnea, sleep latency and independent sleep in child’s own bed. Sleep health outcomes also included positive improvements in parent sleep health education.

Conclusion
Parent engagement with child sleep health interventions yielded favorable outcomes, enhancing the overall sleep health of children. More research is needed to understand tailored interventions for sustained sleep health improvements in child sleep.

Support (if any)
K01HL169419-01
0843 Improving Daytime Sleepiness in Children with Narcolepsy: A Quality Improvement Initiative
Authors: Gurbani Neepa , Dye Thomas , Simmons Danielle , Pascoe John , Mullen Lisa , Schuler Christine , Simakajornboon Narong 
Published: April 2024

Abstract

Introduction
Narcolepsy affects 25-100/100,000 people in the US. Daytime sleepiness associated with pediatric narcolepsy negatively impacts quality of life (QoL), academics, vocational function, and personal safety. The Epworth sleepiness scale (ESS) is a validated tool that measures daytime sleepiness. We aimed to improve daytime sleepiness in children with narcolepsy at our center using quality improvement process to increase the percentage of narcolepsy patients with at least a 30% improvement of ESS from baseline.

Methods
We created a multidisciplinary quality improvement (QI) team in 2019 and used standard QI methods. Key drivers included access to care, patient and family engagement in care, follow up tracking, and complete provider documentation. We conducted plan-do-study-act (PDSA) cycles and tracked progress with a run chart. Interventions included pre-visit planning tool enhancement, tracking duration between visits and missed clinic visits, contacting patients with ≥2 missed visits, tracking prescriptions, identifying patients without referrals for behavioral/psychological support, and treating comorbid sleep disorders. Process measures included the ESS completion rate and days between visits. The primary outcome measure was improvement on the ESS. A secondary outcome measure was improvement in QoL (10% improvement in the PedsQL score).

Results
Between 2019 and 2023, 101 patients had 605 visits. The ESS completion rate (&gt;90% pre-COVID), decreased during COVID to 57% and improved to a median of 70% in 2023. The ESS completion rate was lower for telehealth (36%) than in-person visits (90%). Pre-COVID, the median days between visits was below goal (&lt; 200 days) at 156 days but increased to 210 days in December 2020. Approximately three years after project initiation, 62% of patients had at least a 30% improvement in the ESS score. Improvements were sustained over 16 months. Average decrease in ESS score was 9.9 points (score range: 0-24)since 1/2020. The median baseline PedsQL score was 64.7 (borderline unhealthy) and increased by 14%.

Conclusion
Using QI methods and multiple interventions, we increased the percentage of narcolepsy patients with at least a 30% improvement in the ESS score to &gt;60%. Ongoing challenges include accommodating increased patient volume, reducing process variation in ESS completion, and standardizing documentation practices for ESS scores.

Support (if any)
0845 The Contributions of Sleep and Circadian Parameters to Adolescents ADHD Symptoms
Authors: Gruber Reut , Alyagon Michal , Saha Sujata , Somerville Gail , Gauthier-Gagne Gabrielle , Little Charlotte , Wise Merrill 
Published: April 2024

Abstract

Introduction
Attention-deficit/hyperactivity disorder (ADHD) is a chronic and debilitating disorder that negatively impacts adolescents’ academic achievements and interpersonal relationships. Individuals with ADHD are two to three times more likely to experience sleep problems. It has been proposed that untreated sleep problems exacerbate ADHD. However, empirical evidence regarding the relative contributions of specific sleep issues to the daytime manifestation of ADHD symptoms among adolescents is limited. The objective of this study was to determine the relative contributions of sleep and circadian parameters to adolescents' ADHD symptoms.

Methods
A sample of 40 unmedicated adolescents (26 girls, 18 boys) between the ages of 12 to 15 years (M= 13.9; SD = 0.95) with no psychiatric or medical comorbidities participated in the study. Sleep EEG was recorded using a single night of ambulatory sleep EEG (Sleep Profiler) monitoring with frontal derivations during the school week in the child’s home. Automated sleep/wake scoring was performed using the system followed by visual scoring and analysis by an experienced pediatric sleep specialist. In addition, adolescents were asked to complete questionnaires regarding insomnia and circadian problems and ADHD symptoms. Parents were asked to provide demographic information and complete questionnaires regarding their child’s ADHD symptoms, sleep, and daytime behavior.

Results
Linear regression analysis revealed that PSG-based sleep duration, adolescents’ reported insomnia symptoms, and parents' reported Restless Leg Syndrome symptoms contributed to the manifestation of adolescents’ ADHD symptoms above and beyond gender or SES. No other effects were significant.

Conclusion
Adolescents’ ADHD symptoms were related to different sleep problems requiring different interventional strategies. These findings provide compelling motivation for the development of interventions that use sleep as a means to improve the daytime functioning of adolescents with ADHD. Clinical Implications Given the negative impact of unhealthy sleep on adolescents’ mental, cognitive, and physical health, it is essential that clinicians integrate sleep assessments and interventions into their screening, diagnosis and ongoing care for adolescents, particularly when caring for adolescents with behavioral and functional difficulties.

Support (if any)
CIHR Grant 418638 to Dr. Reut Gruber