bluuebunny/crossref_metadata_2025_split huggingface dataset:
0793 Sleep Disordered Breathing in Children with Craniofacial Syndromes
Authors: Sivaram Ganeshraj , Jawad Kahir , El-Kersh Karim , Chariker Mark , Betz Kelly , Senthilvel Egambaram 
Published: April 2024

Abstract

Introduction
Children with Craniofacial Syndrome (CFS) are known to have a higher risk for Obstructive Sleep Apnea (OSA) due to various craniofacial abnormalities. We aim to assess OSA prevalence in a single cohort of children suffering from CFS and to stratify them by degree of OSA (mild, moderate, severe) and the overall management of OSA in CFS.

Methods
This was a single-center retrospective study that included children with confirmed CFS who underwent overnight polysomnography (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as normal (&lt; 1 event/hr), mild (1–4.9 events/h), moderate (5–9.9 events/h), and severe (≥ 10 events/h).

Results
PSG data were available for 46 children; 58.7% were male, with a mean age of 4.8 years. The average BMI was 18.2 (SD + 5.4 kg/m2) with an average z-score of 1.1 (SD + 4.0), and 76.1% of patients were Caucasian. Common referring symptoms were snoring (38.1%), witnessed apneas (29.1%), gasping/choking (17.4%), and oxygen desaturation (15.1%). The most common CFS was Pierre Robin Sequence (PRS) in 34.8%. OSA prevalence was 68.2% (23.3% mild, 20% moderate, 56.7% severe). The mean polysomnographic variables were total sleep time 346.2 min (± 120.0), AHI 22.2 (± 32.4), SaO2 nadir 83.8% (± 12.1), maximum CO2 level 54 mmHg (± 9.9), and arousal index 22.2 (± 23.4). The overall treatments consisted of mandibular distraction in 26.5%, continuous positive airway pressure therapy in 12.2%, tracheostomy in 6.1%, oxygen supplement in 2%, and lip-tongue adhesion in 2%.

Conclusion
In our cohort of children with CFS had a high prevalence of OSA with severe degree as the prevalent severity. PRS was the most common CFS and mandibular distraction was the most commonly performed procedure in infants with PRS.

Support (if any)
0794 Normative Transcutaneous Carbon Dioxide (TCCO2) Values in Older Children
Authors: Kalra Maninder , Deutsch Gabrielle , Karhoff Iris , Malerba Paola 
Published: April 2024

Abstract

Introduction
Transcutaneous carbon dioxide monitoring (TCCO2) is being increasingly used in pediatric sleep studies to assess for hypoventilation. However, consensus is lacking on a pediatric definition for hypoventilation. This study evaluates the applicability of adult hypoventilation definitions to healthy older children.

Methods
Subjects, 10 years to 18 years of age, participating in a study on sleep EEG dynamics in typical developing children were included. All participants underwent an in-lab nocturnal polysomnography with Natus Sleepworks TM system and following American Academy of Sleep Medicine (AASM) guidelines. Sentec monitor (Therwil, Switzerland) was used for TCCO2 recording. Studies were scored according to the AASM pediatric criteria. Nocturnal hypoventilation was evaluated according to the following definitions: – Over 25 percent of sleep time with a TCCO2&gt;50 mmHg [AASM], – A peak of TCCO2&gt;50 mmHg [S Ward, 2005], – A percentage of nighttime with a TCCO2&gt;50 mmHg&gt;2 % [R Paiva, 2009], – A TCCO2&gt;10 mmHg above the morning awake minimal TCCO2 level [FJ O’Donoghue, 2003].

Results
Preliminary results on 7 subjects of which 71 % were females are presented. The mean age was 14.7 years (SD 2.6 years) and mean BMI was 22.2kg/m2 (SD 2.3). All subjects had an obstructive AHI of &lt; 1; Mean awake TCCO2 was less than 45; Mean asleep TCCO2 was less than 50. There were no subjects with TCCO2 values &gt;50 for over 25 % time or with delta TCO2 sleep to awake of &gt;10 mmHg. There was one subject with peak TCCO2 values&gt;50 and one subject withTCCO2 values &gt;50 for 15 % time.

Conclusion
Our results, with no healthy child having &gt;25 % of sleep time with TCCO2 over 50 mmHg, support the use of AASM hypoventilation definition in older children. When validity of AASH hypoventilation criteria is questionable due to sleep time &lt; 4 hours or low REM sleep fraction, then an increase of sleep CO2 of 10 units as compared to awake values may also be used to identify hypoventilation.

Support (if any)
Research Institute, Nationwide Children's Hospital
0796 Implementation of the San Diego Sleep Survey (SDSS) in Children with down Syndrome
Authors: Bhattacharjee Rakesh , Wu F , Warner M , Inkelis S , Mung K , Stauffer Jacy 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is highly prevalent in children with Down syndrome (CWDS). Polysomnography is advised in all CWDS under four years, but at all ages, OSA prevalence remains as high as 75%. Polysomnography in CWDS requires skilled pediatric sleep labs, which are scarce. Implementation of comprehensive sleep questionnaires to identify sleep disorders could lead to earlier recognition and treatment however validated sleep questionnaires in CWDS are not widely available.

Methods
Caregivers of patients aged 1 to 21 years referred to Rady Children’s Hospital Sleep Center, San Diego, CA, completed the San Diego Sleep Survey (SDSS) via the Epic® EMR system. CWDS were identified using diagnostic codes (ICD-9/10). Additionally, surveys were collected from children without sleep complaints (control) at San Ysidro Children’s Dental Center and Chula Vista Medical Plaza. The SDSS, a 51-item scale, employed a 4-item Likert-type scale (Never, Sometimes, Usually, Do Not Know) for finely graded insights into sleep problems. Five domain scores assessed pediatric sleep problems: insomnia, sleep-disordered breathing (SDB), sleep disorder (e.g., parasomnia), sleep hygiene, and daytime symptoms (DS). A subset also completed the Pediatric Sleep Questionnaire (PSQ) and Children’s Habit Sleep Questionnaire (CSHQ) for comparative purposes.

Results
2103 patients completed SDSS (age 8.6±4.8) at the Sleep Center. Of these, 134 CWDS were identified (age 8.1±5.1; 58 females [43%]). Compared to controls (n=135, age 9.4±2.4), CWDS had significantly better hygiene scores (8.8±2.0 vs 9.9±2.3, p&lt; 0.01), and significantly higher insomnia scores (14.4±3.8 vs 12.9±3.3, p&lt; 0.01), SDB scores (17.3±5.2 vs 13.8±6.1, p&lt; 0.01) and DS scores (23.6±6.7 vs 19.5±5.9, p&lt; 0.01). Sixty-five CWDS completed the PSQ, which identified 27 children (43%) with a positive SDB score (PSQ Total Score ≥8), compared to 104 children (63%) with a positive SDB score on SDSS. Thirty-eight CWDS completed the CSHQ; all had a positive score (CSHQ Total Score ≥41).

Conclusion
The SDSS is a feasible method for evaluating sleep disturbance in CWDS, recognizing abnormalities in various domains including SDB. Future analyses will compare SDSS to PSQ and CSHQ to assess convergent validity for screening for sleep disorders. Sensitivity and specificity of SDSS to identify OSA compared to polysomnography will be explored.

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0797 Afraid to Sleep Alone: Characteristics of Parents and School-age Children Who Cannot Sleep Independently
Authors: O'Grady David 
Published: April 2024

Abstract

Introduction
A surprising number of school-age children (5 - 12) do not sleep independently. Every night, the child sleeps in the parent's bed, or a parent sleeps in the child’s bed. This habit eventually becomes very frustrating for parents. But when they try to get their child to sleep alone, the child becomes intensely anxious and vigorously resists. The ensuing struggle can bring chaos to family routines and distress to everyone. The problem is surprisingly common, occurring in up to 10% of school-age children. Nevertheless, it has received little systematic attention.

Methods
1,630 parents completed an online survey. All the parents had a school-age child (5 to 14 years) who routinely co-slept with a parent (in the parents’ bed or the child’s bed). The parents identified the habit as a problem. Parents accessed the survey alongside an accompanying online article about this sleep habit.

Results
The overwhelming majority of children (&gt;67%) had never learned to sleep alone. Most parents reported that the problem was very distressing to them, disrupted their sleep, disrupted family routines, and interfered with sexual intimacy. When parents tried to get their child to sleep alone, the child displayed extremely elevated anxiety and protest, even panic. Parents’ efforts were unsuccessful and left them frustrated and worried about their child’s psychological health. Yet 81% of these children had never received any mental health treatment. Among mothers, about 63% reported they had a history of anxiety disorder themselves, twice the rate of the general population. Among fathers, the rate of reported anxiety disorder was about the same as in the general population. These findings imply that clinical interventions with this population need to specifically address mothers' challenges with anxiety.

Conclusion
Challenges in transitioning from co-sleeping to sleeping alone occur commonly, disrupt routines, and cause marked distress. These dynamics can be understood as involving sleep associations, parental accommodation, ineffective limit setting, and anxiety escalation. Behavioral interventions can be very effective. This presentation will describe one such approach that typically resolves the problem in less than two weeks and can be implemented by parents acting on their own as they follow a treatment guideline.

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0798 Feasibility & Acceptability of SAFE: A Brief Trauma-Informed Behavioral Sleep Intervention for Youth in Foster Care
Authors: Rech Megan , Harmouch Sirine , Myers Annika , Kim Jinu , Cifre Anthony , Vieira Alyssa , Andre Theo , Alfano Candice 
Published: April 2024

Abstract

Introduction
Children who have spent time in foster care unsurprisingly experience high rates of sleep problems and disorders, which negatively impacts well-being. Sleep and Adjustment in Foster Environments (SAFE) is a brief, telehealth-delivered behavioral sleep intervention for caregivers of young children in or adopted from foster/kinship care. Building upon existing evidence-based behavioral sleep strategies by using a trauma-informed approach, SAFE promotes children’s self-regulation, felt safety, and connection with foster caregivers to improve sleep. Using data from a randomized controlled pilot study, we explored the feasibility and acceptability of SAFE compared to an active control condition (Sleep Education Support; SES), which provided families with a mailed informational booklet about young children’s healthy sleep.

Methods
Foster/kinship caregivers and adoptive foster parents of children ages 2-5 years were recruited across Texas. Children with organic sleep disorders (e.g., OSA), major medical conditions/disorders, and/or autism were ineligible. Beliefs about treatment were assessed pre-treatment with the Credibility/Expectancy Questionnaire; perceived intervention utility and acceptability were assessed post-treatment with the Client Satisfaction Questionnaire and via qualitative interviews.

Results
Over an 18-month period, N=127 families inquired about the study, 78 were screened, and 67 were eligible. Of these, 22/67 (33%) did not move forward due to scheduling difficulties (n=9), no longer being interested (n=8), or loss of contact (n=5). The remaining 45 eligible families were randomized to SAFE (n=22) or SES (n=23). Among SAFE families, 21/22 (95%) completed all three intervention sessions and the post-treatment assessment. Among SES families, 20/23 (87%) completed the post-intervention assessment. Primary factors influencing study withdrawal included the child leaving the home and scheduling difficulties. Results of independent-samples t-tests revealed significantly higher treatment satisfaction in the SAFE group (M=29.57, SD=4.78) compared to the SES group (M=23.95, SD=7.00; t=-2.988, p=.005). Groups did not significantly differ in treatment credibility or expectancy.

Conclusion
SAFE appears feasible and acceptable to foster/adoptive caregivers. While both groups reported similar baseline beliefs about treatment and shared positive post-treatment feedback, satisfaction was greater for the SAFE group. Results underscore a need for sleep health interventions tailored to this population.

Support (if any)
This study was funded by the Grant to Enhance and Advance Research (GEAR) from the University of Houston.
0799 Do Weighted Blankets Improve Sleep Among Children with a History of Trauma? A Randomized Controlled Crossover Trial
Authors: Vieira Alyssa , Cifre Anthony , Baker Carter , Myers Annika , Rech Megan , Kim Jinu , Crabb Katherine , Zhang Yuexin , Alfano Candice 
Published: April 2024

Abstract

Introduction
Sleep problems (e.g., trouble falling asleep, nighttime awakenings) are highly prevalent and persistent among children with a history of trauma/ maltreatment and elevate their risk for a range of deleterious outcomes. Weighted blankets have gained popularity in recent years as a potential non-pharmacological intervention for improving sleep in clinical populations of children, but their efficacy has not been examined among children with a history of trauma and/or maltreatment. Therefore, this study explores whether the use of a weighted blanket for sleep improves objective and subjective sleep outcomes among a group of children adopted from foster care (i.e., with a history of trauma/ maltreatment).

Methods
The current study used a randomized, within-subjects, crossover design where participants used a weighted blanket for two weeks and their usual blanket for two weeks in a counterbalanced order. Participants were N=30 children (63% female), ages 6 to 15 years (M = 9.7, SD = 2.9), adopted from foster care in Texas. Sleep outcomes were measured using actigraphy and subjective sleep diaries.

Results
Results indicated no meaningful differences in the type of blanket used in either actigraphy-based estimates of total sleep time (t(27) = 0.10, p = .91, d = 0.02), sleep onset latency (t(27) = 0.14512, p = .88, d = 0.03), or wake minutes after sleep onset (t(27) = -0.44, p = .65, d = -0.08), or subjective total sleep time (t(27) = 0.75, p = .45, d = 0.14), sleep onset latency (t(25) = 0.28, p = .78, d = 0.06), or sleep quality ratings (t(26) = 1.97, p = 0.06, d = 0.38). Period effects were also examined for each variable; however, results were all also non-significant with small effect sizes. Child age, biological sex, and timing of participation (school year versus summer months) did not impact outcomes.

Conclusion
While this study did not find significant differences in sleep outcomes based on type of blanket used, controlled studies using larger samples of children with a history of maltreatment are needed.

Support (if any)
We thank Luna Blankets (www.lunablanket.com) for donating the weighted blankets used in this study.
0800 Evaluation of the Sleep Profile in Children with Cri Du Chat Syndrome: A Pilot Study
Authors: Xavier Sandra , Moysés-Oliveira Mariana , Kloster Anna Karoliny , Balbueno Bianca , Tufik Sergio , Andersen Monica 
Published: April 2024

Abstract

Introduction
Cri du Chat (CDC) syndrome is a rare genetic condition caused by the deletion of the short arm of chromosome 5, and it affects 1:50,000 live births. It is characterized by global delay in neuropsychomotor development, frequent behavioral alterations, and complaints of sleep fragmentation. The prevalence of sleep problems in CDC syndrome varies from 12 to 64%. So far, it is not completely established whether there is a higher prevalence of sleep disorders in individuals with this syndrome compared to the 20-30% prevalence in neurotypical (NT) children.

Methods
This is a pilot study in which the Sleep Disturbance Scale for Children questionnaire was applied to parents (or caregivers) of 11 patients with CDC syndrome and 11 age-matched NT individuals (controls) to determine the profile of sleep quality in the cohort. In the CDC group, inclusion criteria involved the availability of the molecular array exam, confirming the diagnosis of CDC syndrome.

Results
Sixty eight percent of the sample was male, and the age of participants ranged from 2 to 31 years. Daytime sleepiness, difficulty in falling asleep again after waking up during the night and awakenings during the night were significantly more frequent in the CDC group (p=0.025, 0.0004 and 0.027, Chi-squared test, respectively). No significant differences between groups were observed in relation to total sleep time, sleep latency and bed resistance. Our preliminary data showed that wake after sleep onset is 2.5x more frequent in CDC patients than in NT.

Conclusion
Our pilot study showed that CDC group presented worse sleep parameters in comparison to NT controls. Awakenings during the night and the presence of daytime sleepiness in the CDC group may be a manifestation of non-restorative sleep in this population. Better documenting the prevalence and profile of sleep disorders in this syndrome will allow the improvement of the challenging behavioral issues frequently observed in this condition. The increase in the number of participants in this study will certainly deeper characterize the sleep disturbances in these patients. Further clinical trials will be critical to develop more individualized treatment strategies to individuals with CDC syndrome.

Support (if any)
AFIP, CNPq, FAPESP.
0801 The Relationship of Objectively Measured Sleep to Puberty in School-Age Children with Familial Autism
Authors: Davis Emma , Botteron Kelly , Dager Stephen , Hazlett Heather , Marrus Natasha , Munson Jeff , Pandey Juhi , Pruett John , Schultz Robert , John Tanya St , Zwaigenbaum Lonnie , Piven Joseph , Estes Annette 
Published: April 2024

Abstract

Introduction
The onset of puberty brings changes in sleep patterns in neurotypical school-aged children, shifting circadian timing and decreasing total sleep time. Sleep problems affect over 80% of school-aged autistic children. The predominant autism sleep phenotype involves longer sleep onset latency, night wakings, and early morning waking—defining features of insomnia. Research on the relationship of puberty to sleep problems, sleep duration, and sleep onset timing in autistic children is limited.

Methods
232 school-aged children (age 6-13 years; Male n=142, Female n=90) participated in a sleep study through the longitudinal, multisite Infant Brain Imaging Study (IBIS) network. Participants were ascertained at 6-months-old for having an older autistic sibling (high-likelihood; HL) or no family history of autism (lower-likelihood; LL). The HL group included 47 diagnosed with autism (HL+), 104 without autism (HL-), and an LL comparison group of 81. The participants with actigraphy were categorized as Pre-puberty (n=89) or In-puberty (n=38) based on Tanner Staging. Measures include sleep problems (Children's Sleep Habits Questionnaire, CSHQ), sleep duration and sleep onset time (via 10 days actigraphy and sleep diary).

Results
Sleep problems were significantly increased in the HL+ group compared to HL- and LL groups (CSHQ; p&lt; 0.01; χ2=23.736). Sleep onset times were later for the In-Puberty versus Pre-Puberty HL- group by 52.2 minutes (Kruskal-Wallis; p=0.01), and later, but not statistically significant, for the HL+ group by 43.2 minutes and LL group by 6.6 minutes. Sleep duration was lower, but not statistically significant, for the In-Puberty versus Pre-Puberty HL+ group by 36.6 minutes and HL- group by 37.2 minutes, and higher for the LL group by 3 minutes (ns).

Conclusion
Overall, parent-reported sleep problems were increased in school-age HL autistic children compared with HL- and LL children. Objective measures revealed In-Puberty HL+ and HL- had notably later sleep onset times and decreased sleep duration compared with Pre-Puberty. However, only HL- sleep onset time was significantly later. This pattern suggests sleep characteristics could be associated with familial autism and puberty. Future studies with a larger sample are needed to further evaluate the effect of puberty on sleep in autism.

Support (if any)
R01 HD101578
0808 Nighttime Distribution of Periodic Limb Movements of Sleep After Surgical OSA Treatment in Pediatric Population
Authors: Chang Audrey , Ignatiuk Daniel , Nakamura Aisaku , Hossain Md Monir , Simakajornboon Narong 
Published: April 2024

Abstract

Introduction
Increased periodic limb movements of sleep (PLMS) can occur in patients with sleep disordered breathing. Changes in PLMS following treatment for obstructive sleep apnea (OSA) are observed, but poorly understood. In adults, PLMS are typically seen in the first portion of the night whereas OSA events occur most frequently during the latter portion. To better understand the link between pediatric PLMS and OSA, we investigated whether nighttime distribution of pediatric PLMS could predict resolution of PLMS following surgical management of OSA.

Methods
A retrospective study was performed in children and adolescents aged 1-18-year-olds who had pre-operative PSG showing OSA (OAHI ≥1.5/hr) and significant PLMS (PLM index [PLMI] ≥5/hr) before undergoing surgical treatment for OSA and subsequent post-operative PSG. The cohort was divided into 2 groups based on post-operative PSGs; (1) sustained PLMS with PLMI index &gt;5/hr post-operatively and (2) resolved PLMS with PLM index &lt; 5/hr postoperatively. PLMS distribution was qualified by calculating PLMI during each third of the night of pre-operative PSG. The age, PSG parameters and PLMS distribution were compared between patients with sustained PLMS and resolved PLMS.

Results
Twenty-seven subjects met the criteria for entry into analysis; 14 patients with sustained PLMS and 13 patients with resolved PLMS. Sustained PLMS had higher overall PLMI compared to resolved PLMS (15.13±8.02/hr vs. 9.77±5.88/hr, p=0.03). Sustained PLMS had a higher PLMI during the first third of the night on pre-operative PSG compared to resolved PLMS (15.99±10.37/hr vs. 6.05±8.02/hr, p=0.01). There were no significant differences in PLMS in the middle and last thirds of the night, BMI, age (6.37±4.20 vs. 5.07±4.10 years) at sleep study, AHI, or OAHI (8.11 vs. 6.04).

Conclusion
Children with PLMS that resolved after surgical treatment for OSA have less frequent PLMS in the early part of the night and a lower overall PLMI compared to children with sustained PLMS. This suggests that PLMS occurring in the first third of the night are independent of sleep disordered breathing and are likely associated with other conditions such as sleep related movement disorders. The distribution of PLMS may help prioritize children with OSA and PLMS who require further evaluation of RLS/PLMD post-operatively.

Support (if any)