bluuebunny/crossref_metadata_2025_split huggingface dataset:
0780 Pediatric OSA Assessment Tool to Predict Severity of Sleep Disordered Breathing
Authors: Bertschy Calli , Abdallah Tarek , Majid Ruckshanda , Sargsyan Lilit , Mathew Reeba 
Published: April 2024

Abstract

Introduction
In the general pediatric population, the prevalence of obstructive sleep apnea (OSA) varies between 2% and 5% with several well-established consequences, including learning disability and behavioral difficulties. Resources for evaluation are limited often with long wait times. The STOP-BANG questionnaire has facilitated OSA screening (in adults) and can also predict OSA severity. We developed a pediatric “Severe OSA Score” (SOS), for patients referred for polysomnography to predict severity of the OSA, hence facilitating appropriate triaging of available sleep studies.

Methods
An 8-item (10-point) SOS questionnaire was developed consisting of: snoring (+1), witnessed apneas (+2), restless sleep (+1), speech/developmental delay (+1), tonsillar hypertrophy (+1), craniofacial abnormality (+2), and body mass index (BMI) percentile &lt; 5% or &gt;95% (+1). This was administered prospectively to parents of consecutive patients between 2–12 years, scheduled for a polysomnography (PSG), at the Memorial Hermann Sleep Disorders Center - Texas Medical Center, between December 2022 to February 2023. The obstructive apnea hypopnea index (OAHI) was calculated on PSG (using the American Academy Sleep Medicine scoring manual version 3.0). An OAHI cut-off of 1.5 events/hour was used as diagnostic for OSA. A comparison was made between SOS severity (Group 1: &gt;5 and Group 2: ≤5) and the mean OAHI.

Results
45 subjects were included with a M:F gender distribution of 2:1, a mean age of 6.5 years (SD +/- 2.9), and a mean BMI percentile of 74.8 (SD +/- 28.3). All patients were diagnosed with OSA. The mean OAHI was 19.6 events/hour (SD +/- 20.1) with an average SOS score of 4.6 (SD +/- 1.2). When comparing Groups 1 and 2, the difference in the mean OAHI was statistically significant with a mean of OAHI 29.9 versus 14.3 events/hour respectively (p-value of 0.01).

Conclusion
We were able to prospectively show a strong correlation between a score of &gt;5 on the SOS risk tool and the mean OAHI in this pediatric cohort. This tool hence may be used to identify those children at higher risk for more severe OSA, thereby allowing us to select those patients for more urgent referral when resources are limited.

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0781 Perioperative Delta Weight and Pediatric Obstructive Sleep Apnea Resolution After Adenotonsillectomy
Authors: Dang Quynh-Chi , Johnson Romaine , Mitchell Ron , Ulualp Seckin 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) affects 1-5% of pediatric patients and has detrimental effects on childhood growth and development. Adenotonsillectomy (AT) is the most effective treatment for pediatric OSA but is correlated with postoperative weight gain in children. We hypothesized that higher perioperative weight gain correlates with lower rates of OSA resolution in pediatric patients.

Methods
We conducted a retrospective cohort study at a tertiary academic medical center analyzing demographic, weight, and polysomnography (PSG) data for 250 patients from 2-17 years of age between January 2021 and December 2022. We performed univariate and multivariate logistical regression analyses.

Results
Following AT, 27.7% (n=68/250) of patients had residual OSA (AHI&gt;5). Compared to patients without residual OSA, those with residual OSA were predominately male (77.9% vs 60.2%, p=0.007), had a higher median age (7.5 years vs 6.2 years; p=0.04), a higher median weight (41.8 vs 27.7 kg; p=0.01), and a higher median preoperative BMI (27.7 vs 20.9; p=0.001). Logistic regression showed that for every one-unit (1 kg) increase in perioperative weight, the odds of residual OSA increase by 6.0% (OR=1.06, 95% CI=1.02-1.10). For every one unit increase in baseline AHI correlated to 2% increase in the odds of residual OSA (OR=1.02, 95% CI=1.01-1.03, P=0.001). The odds of having residual OSA increased by 92% for Black or African American patients (OR=1.92, 95% CI=1.04-3.55, P=0.037).

Conclusion
Perioperative weight gain around the time of AT is correlated to higher rates of residual severe OSA in children. Weight loss and/or control is an important adjunctive treatment to ensure OSA resolution.

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0788 Effect of Sleep State and Position on Obstructive Respiratory Events in 12 - 24-month-old Toddlers
Authors: Shah Charmi , Sivaram Ganeshraj , El-Kersh Karim , Kluthe Theresa , Betz Kelly , Senthilvel Egambaram 
Published: April 2024

Abstract

Introduction
As per our knowledge, very limited number of studies have investigated the effect of sleep states and body positions on respiratory events distribution in toddlers aged 12-24 months. We aimed to investigate this relationship in this specific age group.

Methods
This was a single center, retrospective study that included normal toddlers between the ages of 12 and 24 months diagnosed with OSA with overnight polysomnography. Toddlers with obstructive apnea hypopnea index (OAHI) of 2 or greater were included. Patients with Down syndrome, neuromuscular disease were excluded. REM, NREM and different body positions AHI were collected, in addition to REM and NREM mean end-tidal carbon dioxide level (EtCO2) and mean oxygen saturation (SaO2).

Results
A total of 95 toddlers (68 males, 27 females) between 12 and 24 months old met the criteria. 48.4% of patients were Caucasian, 37.9% were African American and 4.2% were Hispanic. Median times (%) spent in REM and NREM were 21 and 79.1, respectively. Median time (minutes) in different body positions were supine 147, right side 53.4, left side 58.5, and prone 42.35. Median REM AHI was 8.45, higher than median NREM AHI of 1.1 (p&lt; 0.001, IQR: 3.475-24.875 and IQR: 0.3-4.5, respectively). Median REM SaO2 was 98% (IQR: 97-99) and median NREM SaO2 was 98 %( IQR: 97-99), with no statistical difference. REM EtCO2 median was 41 (IQR: 40-44) and median NREM was 42 (IQR: 40-44), with no statistical difference. Median AHI while supine was 2.15 (IQR: 0.4-9.1), on right side was 0.8 (IQR: 0-7.25), on left side was 1.1(IQR: 0-8.8), and while prone was 0 (IQR: 0-5.2). The median supine AHI compared to off-supine AHI showed no significant difference (p=0.6252).

Conclusion
Toddlers suffering from OSA have worsening AHI during REM sleep, however their SaO2 and EtCO2 does not significantly change compared to NREM sleep. Additionally, sleep position does not affect AHI distribution this population.

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0790 Polysomnographic Insights into the ADHD and OSA Connection in Children
Authors: Lacki Olga , Slaven James , Bandyopadhyay Anuja 
Published: April 2024

Abstract

Introduction
Attention-deficit/hyperactivity disorder (ADHD) is closely linked to sleep disorders, particularly obstructive sleep apnea (OSA), but their relationship remains poorly understood. Polysomnographic studies on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated versus non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA.

Methods
Medical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019-2022. ADHD diagnosis was determined by ICD code F90, and moderate to severe OSA was defined by apnea-hypopnea indices (AHI) ≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA-alone, children with ADHD-alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest.

Results
4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA-alone (29.8%), 333 with ADHD-alone (8.3%), and 111 with ADHD+OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD-alone. However, they exhibited significantly better sleep efficiency, a polysomnographic proxy for insomnia, than children with OSA-alone, and sleep efficiency did not significantly differ from the other groups. No significant difference in periodic limb movements (PLMs) was found across all groups. Children with ADHD+OSA had higher BMIs than those with OSA-alone and ADHD-alone. The above results held true even after correcting for stimulant usage.

Conclusion
The polysomnographic marker of sleep efficiency falls short in explaining the frequency of insomnia diagnoses in children with ADHD. Enhanced subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with ADHD+OSA, polysomnogram results do not reveal any unique sleep parameters that cannot be better explained by OSA alone. Those with ADHD+OSA exhibit higher BMIs than those with ADHD alone, underscoring the importance of screening for OSA in children with ADHD symptoms, especially those with above-average BMIs.

Support (if any)
Morris Green Physician-Scientist Development Program and Joyce Victoria McRobbie Pediatric Fellowship
0795 Quantifying Guideline Adherence: Sleep Testing in the Pediatric down Syndrome Population
Authors: Balog Matthew , Loghmanee Darius , Donskoy Innessa , Snow Ayelet 
Published: April 2024

Abstract

Introduction
Down Syndrome (DS) is the most common chromosomal disorder, occurring in 1 in every 700 births. Clinically reported symptoms of obstructive sleep apnea (OSA), such as snoring, have been shown to be unreliable for predicting the presence of OSA in the DS population. With the prevalence of OSA in this vulnerable population estimated between 50-79%, and the lack of guidance that the traditional symptoms provide in clinical decision making, the American Academy of Pediatrics (AAP) recommends all children with DS be screened for OSA with polysomnography (PSG) before their 4th birthday. Previous studies conducted shortly after the publishing of these guidelines showed suboptimal adherence. Both DS and OSA impact medical costs over time, with OSA leading to a doubling of medical expenses (cite) and DS increasing it twelve-fold. Early diagnosis and treatment of OSA in children with Down Syndrome is imperative to improving morbidity in this patient population and lowering overall healthcare cost and utilization.

Methods
In this retrospective chart review, an electronic medical record (EMR) query for all patients aged 3-8 years, with a diagnosis of DS, and who live in Illinois was performed. The query included if any sleep clinic or PSG orders were placed and when these orders were completed. The query yielded a convenience sample of 582 children.

Results
Only 26% (117) of the subjects had a sleep medicine clinic or PSG order in their chart with 21% (124) having completed a PSG, and 11% (62) completed a sleep medicine visit. Only 23% (111) of patients between 4-8 years old were compliant with AAP sleep testing guidelines.

Conclusion
There is opportunity to strengthen the process of screening DS patients for OSA. The low adherence to AAP guidelines shown in this, and previous studies, highlight the need for dedicated quality assurance and improvement programs aimed at closing this practice gap, especially within institutions who care for sizable Down Syndrome populations.

Support (if any)
none
0802 Adolescents’ In-game Purchase, Problem Gaming, Gambling Game Playing Associated with Poor Sleep Quality
Authors: Chang Fong-Ching , Chuang Wei-Chun 
Published: April 2024

Abstract

Introduction
Problem gaming and sleep deprivation among adolescents represent critical issues in public health. Online gaming frequently incorporates monetary features, like microtransactions, blurring the line between gaming and gambling. More than half of parents are worried that their children feel pressured to make in-game purchases (Ofcom, 2023). Research has shown an association between problem gaming and heightened psychological distress as well as reduced sleep quality in adolescents. In Taiwan, there has been a notable increase in online game and gambling game advertisements across both offline and online platforms in recent decades. This study aims to explore the relationships between adolescents' exposure to marketing, parental involvement, in-game purchases, problem gaming, engagement in gambling games, psychological distress, and sleep problems in Taiwan.

Methods
Data were gathered from a sample of 2595 seventh-grade students across 30 middle schools in both urban and rural areas of Taiwan. A self-administered questionnaire was conducted in 2020. A panel of 8 experts was invited to assess the content validity of the questionnaire. The questionnaires were distributed to students in their classrooms by trained interviewers. Approval was obtained from the Institutional Review Board at National Taiwan Normal University.

Results
The findings revealed that 94% of adolescents engaged in online gaming, with 38% making in-game purchases, 9% participating in online gambling games, and 32% reporting poor sleep quality. The multiple regression results showed that adolescents exposed to higher levels of gaming marketing, involved in in-game purchases, and experiencing lower levels of active parental mediation were more likely to have problem gaming. Furthermore, adolescents with increased exposure to gambling game marketing, influenced by advertising effects, involved in in-game purchases, and experiencing problem gaming, were more likely to engage in online gambling games and purchase tokens. Additionally, adolescents involved in in-game purchases, problem gaming, and playing online gambling games were more likely to experience higher psychological distress and poor sleep quality.

Conclusion
Adolescents' engagement in in-game purchases, problem gaming behaviors, and playing online gambling games has been linked to increased risks of psychological distress and poor sleep quality.

Support (if any)
This research was supported by a research grant from the Taiwan Ministry of Science and Technology.
0805 Melatonin Use Among Children in Foster Care: Associations with Sleep and Daytime Behavior
Authors: Baker Carter , Vieira Alyssa , Cifre Anthony , Wolfson Amy , Ripple Carol , McGlinchey Eleanor , Alfano Candice 
Published: April 2024

Abstract

Introduction
In recent years, melatonin use has risen steeply in children of all ages. It is also the most commonly recommended intervention for sleep problems among children in foster care (Alfano et al., 2022) despite a lack of evidence of its safety and efficacy for children with a history of maltreatment/trauma. This study therefore investigated and compared aspects of sleep and daytime emotional/behavioral problems among children in foster care who have and have not been administered melatonin.

Methods
Survey data from N=454 caregivers from across the U.S. who were currently fostering children between the ages of 4- and 11-years-old (M=6.39, SD=2.20) were examined (McGlinchey et al., 2023). Caregivers were recruited for an anonymous online survey via private Facebook groups for foster families. Questions included whether or not they had ever administered melatonin to the foster child, aspects of the child’s sleep, and emotional/behavioral problems. Children included in the sample were relatively diverse, with 17% Black/African American and 11% Hispanic children from 46 U.S. states.

Results
Forty-eight percent (48%; n = 221) of foster caregivers reported administering melatonin to their child currently or in the past. ANCOVAs controlling for level of foster care (i.e., children with special needs) revealed melatonin use was associated with poorer sleep quality, F(1, 423)=25.118, p&lt;.001, partial η²=.056, and increased severity of daytime behavioral problems, F(1, 410)=21.843, p&lt;.001, partial η²=.051, based on medium effects. However, melatonin use was not associated with child depressive, F(1, 441)=2.151, p=.143, partial η²=.005, or anxiety symptoms, F(1, 422)=1.198, p=.274, partial η²=.003.

Conclusion
Children in foster care who are taking/have taken melatonin are reported to have worse quality sleep and more daytime emotional/behavioral problems than children in foster care not taking melatonin, but not more depressive or anxiety symptoms. The extent to which greater daytime problems might be a result of poorer nighttime sleep remains to be understood. Although our study has limitations, it is one of the first to examine behavioral correlates of melatonin use among children in foster care.

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0810 Impact of Schooling on the Measurement of Multidimensional Sleep 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) is an emerging concept in sleep and circadian science that aims to capture the 24-hour experience of sleep and identify individuals in the population with good sleep health. While schooling is one of the most important contextual variables impacting adolescent sleep, little is known about how it impacts the measurement of MSH. In the present study, we examined differences in adolescent MSH while they were either in-school or on-break.

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, with 63% of the sample (n=236) in-school when sleep data were collected. We used the MSH RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – to derive a composite score of sleep health using actigraphy and self-reports.

Results
Adolescents in-school had a marginally (p=0.07) higher MSH score (3.12±1.2) than those on-break (2.87±1.4). Adolescents on-break were more likely to have optimal alertness (37.8% vs 31.8%, p&lt; 0.05) and duration (37.2% vs 61.5%, p&lt; 0.05), but less likely to have optimal timing (30.8% vs 61.8%, p&lt; 0.001) and efficiency (34.6% vs 50.9%, p&lt; 0.001) compared to those assessed while in-school. The differences observed in the timing and duration domains were driven by on-break adolescents mean sleep midpoint being more than an hour later than those in-school (4:42 am vs 3:36 am, p&lt; 0.001) and having a mean sleep efficiency slightly below the cut-off of 85% (84.3% vs 85.9%, p&lt; 0.05).

Conclusion
Accounting for contextual factors in adolescents, specifically whether they are attending school or not, is important for the measurement of MSH. Future work should derive cut-offs for optimal sleep health specific to adolescents as well as potentially include other timing dimensions beyond average sleep midpoint, such as social jetlag.

Support (if any)
NIH Awards Number R01HL136587, UL1TR000127
0814 Light Regularity Associated with Cognitive Performance in Adolescents with ADHD
Authors: Lunsford-Avery Jessica , Krystal Andrew , Engelhard Matthew 
Published: April 2024

Abstract

Introduction
Regular light exposure may play a key role in cognitive performance via both direct (via arousal) and indirect (via circadian rhythm regulation) mechanisms. Adolescents with ADHD are at risk for both cognitive deficits and circadian dysregulation, including delayed and irregular sleep patterns, and light exposure has been proposed as a critical contributor to ADHD-related impairments via its influence on circadian rhythm regulation. However, whether light irregularity contributes to cognitive impairment in adolescents with ADHD, and whether such relationships are mediated by disrupted sleep patterns, is unknown.

Methods
Forty-six adolescents aged 13-17 (54% female) completed a diagnostic interview, &gt;5 days/nights of actigraphy, and a cognitive measure (Kaufman Brief Intelligence Test-Second Edition (KBIT-2): Verbal, Nonverbal, and Composite scores). Twenty were diagnosed with ADHD; 26 were healthy controls (HC). Partial Pearson correlations covarying for sex and age examined associations between the light regularity index (LRI: derived from actigraph-measured light exposure) and KBIT-2 performance in the full sample. We further explored whether LRI-cognition associations were specific to the ADHD group, and if so, whether such relationships were explained by shorter (total sleep time, TST), less regular (sleep regularity index, SRI), and delayed (sleep midpoint) sleep patterns.

Results
In the full sample, lower LRI correlated with poorer composite (r=.34, p=.03) and verbal (r=.42,p=.005), but not nonverbal (r=.08, p=.62), cognitive performance. Adolescents with ADHD displayed lower LRI than HC (β=-.31), and decreased LRI was related to lower SRI (r=.63) and later sleep midpoint (r=-.50) in this group (p’s&lt;.05). In the ADHD group, LRI was associated with composite (r=.67) and verbal (r=.70) cognitive performance (p’s&lt;.01), and these relationships remained significant in sensitivity analyses controlling for SRI, TST, and sleep midpoint (p’s&lt;.05). Associations between LRI and cognition were non-significant in HC (p’s&gt;.10).

Conclusion
Irregular light exposure is associated with cognitive deficits among adolescents with ADHD, which is not fully explained by disrupted actigraphy-measured sleep patterns. Future studies using additional behavioral and biological measures of circadian function (e.g., Dim Light Melatonin Onset) may elucidate the specific mechanisms by which light regularity supports cognitive performance among adolescents with ADHD and assess whether regularly-timed light exposure chronotherapy improves cognition in this population.

Support (if any)
K23MH108704, R34MH128440