bluuebunny/crossref_metadata_2025_split huggingface dataset:
0783 Quality Care of Pediatric Patients Utilizing Continuous Positive Airway Pressure for Obstructive Sleep Apnea
Authors: Castner Lauren , Grekowicz Megan , Samphere Suzanne , Walden Krista , Flint Korina , McKay Karen , Wade Thomas , Willis Rebecca , Malsch Thomasien , Bandla Hari 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is a sleep related breathing disorder affecting 1-5% of children across all age groups. If left untreated, there is a variety of adverse health effects. Adenotonsillectomy (AT) is a common treatment, however some benefit from the use of continuous positive airway pressure (CPAP) treatment. Due to significant improvements of symptoms when CPAP therapy is applied consistently, we aimed to assess our objective measurements of adherence to PAP therapy along with reduction in their signs and symptoms of OSA.

Methods
Utilizing the AASM Quality Measures, medical records from patients enrolled in the Children’s Wisconsin Positive Airway Program were reviewed from January 2019 until December 2019. Guidelines were created for the objective use of CPAP, frequency of documentation for adherence, and symptom assessment within a year of CPAP initiation. The structure of the work was performed with the four step Plan-Do-Study-Act cycle and occurred from January 2020 to December 2020.

Results
Initial review included 62 unique patients started on CPAP during 2019. 61 patients (98%) had appropriate documentation of adherence and 53 patients (89%) with follow up, appreciated a reduction of OSA signs and symptoms. Processes included standardization of electronic medical record templates, respiratory therapist assessment prior to and during clinic visits, and scheduling of appointments when CPAP therapy was recommended. Results remained consistent despite changes during the COVID-19 pandemic and shifts to telehealth visits. 44 patients (100%) had appropriate documentation of adherence prior to their first clinic visit with 40 patients (93%) having a reduction in symptoms by the first clinic visit.

Conclusion
The development of systems to ensure appropriate usage of CPAP allow for reliable assessments of use and improvements. EMR templates can document CPAP adherence, and reassess symptoms, regardless of visit location or staffing model shifts. We had an initial note template and then developed an auto-populated hyperlink that could be used in telephone and clinic encounters for adherence. With standardization and awareness, we ensured patients were receiving optimal care and treatments were adjusted when challenges were apparent.

Support (if any)
Internal funding provided by the Children’s Wisconsin Department of Pediatrics
0803 Insomnia, Mood, and Quality of Life in Children and Young Adults with Congenital Heart Disease
Authors: Maxfield Kate , Melcher Lauren , Bottrill Kenneth , Provencio-Dean Natalie , Hoyer Andrew , Seckeler Michael , Klewer Scott , Edgin Jamie , Combs Daniel 
Published: April 2024

Abstract

Introduction
While mortality rates have decreased in patients with congenital heart disease (CHD), numerous comorbidities associated with CHD persist, including decreased health-related quality of life (HRQOL), depressed mood, and sleep problems. Insomnia is known to worsen mood and HRQOL in children without CHD, therefore we examined the relationship between insomnia, mood and HRQOL.

Methods
We recruited 38 individuals with CHD between the ages of 4-25 years and assessed insomnia, health-related quality of life, anxiety, and depression using the Pediatric Insomnia Severity Index (PISI), Pediatric Quality of Life Inventory (PedsQL), Screen for Child Anxiety Related Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC). T-tests were used to compare differences in HRQOL, anxiety, and depression in individuals with CHD with and without comorbid insomnia. Logistic regression was used to assess whether the presence of insomnia can predict increased odds of clinically significant anxiety or depression.

Results
Individuals with CHD and insomnia (PISI score ≥8) demonstrated significantly lower health-related quality of life, more depressive symptoms, and higher total anxiety compared to individuals with CHD without insomnia. Individuals with insomnia had a mean HRQOL score of 63.1 ± 15.6 vs 77.8 ± 18.9 in the group without insomnia (p=0.03). Individuals with insomnia had a mean total depression score on the CES-DC scale of 21.5 ± 14.6 vs 7.3 ± 5.6 for those without insomnia (p=0.009). Clinically significant depression in the insomnia group was 24 times greater (95% confidence interval [95% CI] 2.3-247.4, p=0.008) compared to those without insomnia. The mean total anxiety score for individuals with insomnia was 25.0 ±19.6 compared with 12.4 ± 10.3 in those without insomnia (p=0.03), and the odds of clinically significant anxiety in the insomnia group vs those without insomnia was 4.44 (95% CI 0.9-21.8, p=0.07).

Conclusion
Insomnia is associated with markedly worse HRQOL, depression and anxiety in individuals with CHD. Further study is needed to evaluate the role of insomnia recognition and treatment in order to improve HRQOL and mood in children and young adults with CHD.

Support (if any)
No support
0804 Acceptability and Patient-centered Outcomes for Infant Behavioral Sleep Intervention in Black Families
Authors: Ahmed Safia , Chung Alicia , McKenzie Lara , Whitlow Jazmyne , McAdams Rebecca , Roberts Kristin , Mindell Jodi , Honaker Sarah 
Published: April 2024

Abstract

Introduction
While the efficacy and acceptability of infant behavioral sleep intervention has been developed and tested in White families, less is known about how Black mothers understand and perceive behavioral sleep recommendations. The objective of the Sleep Guidance in Black Families with Infant Children (SLUMBER) study was to evaluate the perspectives of Black mothers with infants on the acceptability and cultural appropriateness of standard infant behavioral sleep recommendations. As part of this study, we examined maternal perspectives on participation in an infant behavioral sleep program and desired patient-centered outcomes.

Methods
Participants were recruited through Black parent groups on Facebook and WhatsApp, along with more general social media campaigns targeting individuals who identified as Black. Semi-structured interviews were conducted with Black mothers (n=18; 55.6% with a college degree) with an infant &lt; 9 months (M=4.5, SD=2.8; 66.7% male). Interview transcripts were analyzed within the NVivo software using a grounded theory thematic descriptive approach.

Results
Many mothers (n=11, 61.1%) indicated a high interest level in participating in a sleep program. Facilitators to participation included addressing current problem areas with their infant’s sleep and social support. The most identified barrier to participation was potential poor alignment between program recommendations and personal values, particularly pertaining to the acceptability of approaches involving infant crying without immediate intervention. Desired program outcomes that mothers most frequently described included a more consistent or predictable sleep/wake pattern, their baby learning to sleep independently, and increased sleep consolidation.

Conclusion
Black mothers endorsed high interest in participating in an infant behavioral sleep program, although over one-third were not interested. Personal and cultural alignment with program recommendations is important to parents, supporting the need for culturally sensitive interventions, with particular attention to variability in perceived acceptability of approaches involving infant crying. Infant behavioral sleep intervention programs should focus on achieving patient-centered outcomes, such as schedule consistency and sleep consolidation.

Support (if any)
This research is supported by The Center for Injury Research and Policy at Nationwide Children’s Hospital through Grant Number R49CE003074 from the Centers for Disease Control and Prevention. Dr. Chung's time is supported by the National Heart, Lung, and Blood Institute under award number 1K01HL169419-01.
0806 The Effect of a Sleep Promotion Program in Adolescents with Insufficient Sleep: A Randomized Controlled Trial
Authors: Wescott Delainey , Goldstein Tina , Wallace Meredith , Miller Elizabeth , Buysse Daniel , Harvey Allison , Rofey Dana , Levenson Jessica 
Published: April 2024

Abstract

Introduction
Adolescent sleep is compressed by early school start times and often competes with school, extracurricular, and social demands. Insufficient and mistimed weeknight sleep contributes to large shifts in weekend-weekday sleep-wake schedules, which may lead to adverse physical and mental health outcomes. The Sleep Promotion Program (SPP) is a brief, scalable, behavioral intervention that aims to increase sleep duration and regularity while building motivation and efficacy to change sleep behaviors. This secondary analysis tested whether the SPP changed actigraphy-assessed sleep.

Methods
Participants (ages 13-15) with insufficient and irregular sleep (N=44) were randomized to the SPP intervention (n=24) or waitlist control (n=20). The SPP included sleep psychoeducation and a face-to-face clinician session, relying on evidence-based strategies for promoting sleep within a motivational interviewing framework. Participants wore an ActiWatch during their baseline and follow-up which occurred after the intervention or the waitlist period. We hypothesized participants randomized to SPP would lengthen and stabilize sleep from baseline to follow-up compared to controls. We tested a group (intervention vs. waitlist) by time (baseline vs. follow-up) interaction on actigraphy-assessed sleep duration, timing, and regularity (weekend-weekday shift in timing) using multilevel models with a random intercept.

Results
We included 38 participants with at least 4 weekday nights and 1 weekend night of actigraphy (n=23 intervention, n=15 waitlist). The intervention group delayed their weeknight bedtimes (~45 minutes; b=0.69, SE=0.27, p=0.01), delayed their weeknight waketimes (~1 hour; b=0.68, SE=0.32, p=0.03), and simultaneously decreased the difference between weekend-weekday bedtimes (b=-1.1, SE=0.5, p=0.04) compared to controls (i.e., increased regularity). Weekend sleep timing and total sleep time did not change significantly.

Conclusion
The SPP intervention regularized weekend-weekday sleep timing in adolescents with insufficient and irregular sleep, likely driven by delaying weeknight sleep times. Given that this study was primarily conducted during the COVID-19 pandemic, when many participants reported delayed school start times, participants randomized to SPP were able to regularize their weekend-weekday sleep schedules while simultaneously adapting their weeknight sleep schedules to better fit their preferred timing. Regularizing sleep may be an attainable first step to improving sleep in adolescents. Future work will examine whether sleep regularization associates with mental health outcomes.

Support (if any)
K23HD087433, Pittsburgh CTSI
0807 Ferric Carboxymaltose versus Iron Sucrose for Pediatric Sleep-related Movement Disorders
Authors: Ingram David , Balfaqih Yaslam , Al-Shawwa Baha 
Published: April 2024

Abstract

Introduction
Intravenous (IV) ferric carboxymaltose (FCM) and iron sucrose have previously been reported as effective therapies for sleep-related movement disorders (SRMDs) in children. While FCM has a more robust ability to optimize iron stores, iron sucrose is sometimes required instead due to insurance coverage. In this study, we compared clinical and laboratory outcomes of children in our center who underwent either FCM or iron sucrose infusion for SRMDs.

Methods
This was a retrospective study of all children who underwent either IV FCM or iron sucrose infusion in our outpatient infusion center between 1/2023 and 12/2023. While FCM was initially requested for all children, iron sucrose was ordered instead if dictated by insurance coverage. Children were included if the infusion was ordered by a pediatric sleep physician for treatment of confirmed SRMD, there were baseline and follow-up ferritin results available, and there was follow-up clinical information regarding sleep symptoms.

Results
Overall, there were n=40 iron infusions (n=18 FCM and n=22 iron sucrose) that had follow-up clinical and laboratory data available for analysis. There were no significant differences in weight, age, sex, or baseline ferritin level between groups. Children who underwent FCM infusion had significantly higher follow-up ferritin levels compared with iron sucrose (117.9 +/-52.1 vs 69.7+/-38.8 ng/mL, p=0.002) despite longer time to follow-up lab draw (71.3+/- 40.5 vs 28.1+/-37.1 days, p=0.010). Clinical improvement in sleep was noted in children underwent FCM and iron sucrose (72.2% vs 63.6%, p=0.564). Repeated infusions were needed significantly more often with iron sucrose compared with FCM (27.3% vs 0.0%, p=0.024). Each group had 1 case of mild gastrointestinal symptoms during infusion, otherwise no significant infusion reactions were noted. There were no cases of significant hypophosphatemia noted following FCM infusion (mean=4.4+/-0.7, none &lt; 2.0 mg/dL).

Conclusion
Intravenous iron therapy is a safe and effective treatment modality for pediatric SRMDs. FCM is superior to iron sucrose both in terms of improvement in ferritin level as well as decreased need for repeated infusions.

Support (if any)
None.
0820 Challenges to Pediatric Patients Sleeping Well in the Hospital: Environmental and Practice Considerations
Authors: Fidler Andrea , Chang Ellen , Dandoy Christopher , Beebe Dean , Smith David , Dye Thomas , Wang YunZu Michele 
Published: April 2024

Abstract

Introduction
Pediatric oncology and bone marrow transplant (BMT) patients frequently experience poor sleep during their extended hospital stays due to various sleep disruptors. This study aimed to identify specific factors affecting the sleep of our hospitalized patients.

Methods
Hospitalized BMT / oncology patients aged ≥5 years old (n=25) and their parents completed a survey designed for this study, which involved describing the extent to which factors identified in prior studies / extant literature were barriers or facilitators to patient sleep. Over 5 consecutive days / nights, we measured the light that patients were exposed to and how frequently staff entered patient rooms during the night. Light intensity (lux) was collected via Condor ActTrust actigraphs installed at eye-level by the patient’s bed. Room entries were tracked via paper / pencil logs affixed to the door.

Results
Participants (median age of 11.2 years) most frequently endorsed barriers related to vital sign checks, room entries, loud sounds, bright lights, medical procedures, and pain. Top sleep facilitators included reducing light in the room, pain / sleep medications, and having family nearby. Average light exposure varied over the course of the day: morning (median = 2.34 lux, range = 0.09-22.17), daytime (median = 15.55 lux, range = 3.49-125.63), evening (median = 10.48 lux, range = 2.64-64.82), and overnight (median = 1.03 lux, range = 0.28-9.44). Staff-recorded room entries averaged 5 per night, with one patient experiencing 18 room entries in a single night.

Conclusion
Participants endorsed numerous barriers to getting good quality sleep while hospitalized. Based on both patient / family-report as well as objective measurements, it is evident that staff room entries and bright lights at night are not conducive to sleep. Light levels in patient rooms were routinely too dim during the day to optimally support circadian rhythm entrainment. Given that sleep plays a crucial role in health maintenance and recovery, hospitals should strive to reduce staff-related sleep disturbances where possible and optimize lighting in patient rooms. These efforts would create a more “sleep friendly” environment for both patients and their resident family members.

Support (if any)
AF is supported by an institutional training grant (National Institutes of Health T32DK063929).
0821 GPS-derived Green Space Exposure and Sleep Among 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
Exposure to greenspace has been linked to improved well-being among children such as cognitive restoration and reduced stress. Greenspace is also associated with increased exposure to light, a zeitgeber of the circadian system. Studies examining the association between greenspace exposure and sleep, however, have been equivocal, largely due to methodology related to static measures of environmental context. We address this issue by using GPS-derived measures of greenspace that move beyond static residential contexts, and examine multiple measures of access to greenspace.

Methods
Schoolchildren 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. GPS was used to identify stay points if participants spent 15 minutes in a space. We extracted and averaged Normalized Difference Vegetation Index (NDVI) values in 100m, 200m, 300m, 500m, and 1,000m circular buffers surrounding each participant's stay points to calculate greenspace exposure. Sleep measures were derived using actigraphy, and potential association with greenspace exposure was analyzed using a series of linear regression models.

Results
Forty-nine participants had 398 valid days of wear-time. On average, participants wore devices for 6.2 days (SD=1.72). The mean sleep values included: Time in Bed, 9.63 hours; Total Sleep Time, 9.17 hours; Sleep Efficiency, 88.78%, and Wake After Sleep Onset (WASO), 37 minutes). Both TIB (hours) (100m β:1.98, p=0.01; 200m β: 1.87, p=0.01; and 300m β: 1.65, p=0.05) and TST (hours) (100m β: 1.94, p=0.01; 200m β:1.67, p=0.01; and 300m β: 1.37, p=0.05) showed positive associations with mean NDVI across smaller buffer distances. However, associations between Sleep Efficiency, WASO and greenspace exposure were not significant.

Conclusion
GPS-derived greenspace exposures in close proximity to daily activities are associated with total sleep time among elementary school children, with the strength of the association diminishing with each widening radius from the stay point. Our results have implications for urban planning and greening of neighborhoods, but additional analyses are needed with larger sample sizes and control for sociodemographic factors.

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
0824 The Association Between Sleeping Arrangements and Breastfeeding Duration
Authors: Hershon Malka , Ly Michelle , Laganière Christine , Pokhvisneva Irina , Gaudreau Hélène , Pennestri Marie-Hélène 
Published: April 2024

Abstract

Introduction
The World Health Organization recommends that infants be exclusively breastfed for at least the first 6 months of life, and then partially breastfed until 2 years of age and onward, if preferred. However, the choice to breastfeed an infant is influenced by cultural, biological, and social factors. For instance, factors which may promote breastfeeding include bedsharing, but the current literature requires more longitudinal examinations and follow-ups. The current project aims to investigate the associations between bedsharing at 6 months and the duration of breastfeeding.

Methods
The analysis included data from 294 mother-infant dyads (52 bedshared) from the Maternal Adversity, Vulnerability and Neurodevelopment cohort. Maternal reports of their infant’s sleep location were reported at 6 months of infancy. Infants who shared a bed with their mother were considered to bedshare, whereas those who slept in the same room as their mother, in their own room alone, or in their own room with someone else where not considered to bedshare. A retroactive measure of breastfeeding was given to mothers (until infants were 24 months), in which they were asked how old the infant was when they stopped breastfeeding. An independent samples t-test was conducted to compare breastfeeding duration between infants who bedshare and those who do not.

Results
Bedsharing infants were breastfed for a longer period (in months; M=12.87, SD=5.21) than infants who did not bedshare (M=10.64, SD=3.97; t(292)=-3.48, p=&lt;.001).

Conclusion
These results show that infants who bedshare with their mother are likely to be breastfed for about 2 months more. These results provide support for the protective nature of bedsharing at 6 months on breastfeeding duration. Given these potential benefits, these results highlight the need for clear recommendations for parents to safely practice bed sharing if they are willing to use this sleeping arrangement.

Support (if any)
Malka Hershon holds a Canada Graduate Scholarship - Master’s program (SSHRC). Dr. Pennestri holds a Chercheur-Boursier Award from the Fonds de recherche du Québec – Santé and a William Dawson Award from McGill University.
0825 Sweet Dreams Are Made of This: Improving the Family Bond with Better Sleep for Children 6 Months to 6 Years Old
Authors: Vadasz-Chates Nataly , Chaung Matthew , Kaji Sanjay , Troester Matthew , Dorrity Renae 
Published: April 2024

Abstract

Introduction
This comprehensive review explores methods employed to improve pediatric sleep, emphasizing developmental trends, challenges, and health impacts. The narrative navigates through behavioral modification techniques, responsive parenting, and innovative digital therapeutic interventions, offering a holistic perspective on pediatric sleep dynamics. The primary objective is to evaluate the efficacy of responsive parenting techniques within the Batelle Sleep School program in improving pediatric sleep patterns and enhancing overall family well-being. This study aims to contribute evidence-based insights into the complex interplay between sleep quality, parenting styles, and child development.

Methods
The study involves a retrospective analysis of surveys from under 500 families with children aged six months to six years enrolled in the Batelle Sleep School program from October 2022 to March 2023. Quantitative and qualitative data will focus on sleep assessments, parental confidence, sleep latency, and awakening surveys. The intervention spans two weeks, during which parents follow the program's guidelines.

Results
Pre-program and post-program data will be analyzed to assess changes in sleep latency and the number of awakenings. Statistical methods, including paired t-tests, will be employed for quantitative analysis, while qualitative data will undergo thematic analysis to identify common themes related to family dynamics and program effectiveness.

Conclusion
This research aims to provide evidence-based recommendations for parents, healthcare professionals, and researchers by investigating the integration of responsive parenting techniques with a digital therapeutic in the context of the Batelle Sleep School program. Bridging the gap between pediatric sleep challenges and effective interventions, this study contributes to the evolving landscape of sleep medicine, recognizing the diverse needs of families and offering tailored solutions for improved pediatric sleep.

Support (if any)