bluuebunny/crossref_metadata_2025_split huggingface dataset:
0839 Parental Perspectives on the Effectiveness of a Sleep Intervention for Preschoolers: A Preliminary Assessment
Authors: Pétrin Rachel , Bérubé Annie , Pennestri Marie-Hélène , Touchette Evelyne , Forest Geneviève 
Published: April 2024

Abstract

Introduction
Healthy sleep is essential to a child's development, particularly during preschool. However, interventions that address sleep difficulties among children in this age group are scarce. This preliminary study explored parental perspectives on the effectiveness and barriers of a short sleep intervention for preschool children.

Methods
Twenty-nine families (either one or both parents) and their 3 to 5-year-olds participated in a two-hour sleep intervention and one-hour follow-up meeting to address children's sleep difficulties. Parents were taught about children’s optimal sleep habits. They were given tips on maintaining a consistent bedtime routine, managing their child's anxiety at bedtime and during the night, helping their child fall asleep independently, and reducing the occurrence of nightmares and night terrors. Parents were asked open-ended questions two months later to assess its success and barriers. Responses were analyzed using NVivo 14.23.2 to identify common themes.

Results
Numerous parents reported that their child's sleep improved in at least one aspect after the intervention. The most reported improvements were reduced nighttime awakenings, improved sleep independence, reduced sleep onset latency, a consistent sleep schedule and routine, and reduced conflicts at bedtime. More than half of parents noted that at least one aspect of their own sleep had improved, the most common being reduced sleep fragmentation. Almost all parents denoted other positive outcomes, such as better moods and reduced fatigue in children, increased patience, more personal time, improved mood and heightened energy levels in parents. A few parents indicated having a better relationship with their child. Sleep difficulties persisted in some children, such as trouble falling asleep, autonomous sleep and nighttime awakenings. Among parents who identified obstacles in implementing sleep strategies, conflicts at bedtime, changing sleep schedules, separation anxiety, and screens before bedtime were the most frequent.

Conclusion
Parents found the brief intervention effective and well-suited to their specific needs. Reducing children's sleep difficulties contributed to improving parents' sleep quality and the overall health and well-being of the family. This research highlights the need for tailored interventions that address preschoolers' sleep issues.

Support (if any)
This study was funded by the Social Sciences and Humanities Research Council of Canada (SSHRC).
0840 Center-based Childcare Attendance and Sleep in Children Under Six Years Old: A Systematic Review
Authors: O'Hagan Belinda , von Ash Tayla 
Published: April 2024

Abstract

Introduction
Many children within and outside of the United States spend a considerable amount of time in childcare settings during early childhood. The early childhood period is also marked with significant transitions in sleep, and many young children rely on a combination of daytime and nighttime sleep to meet their sleep needs. Thus, childcare settings may impact children’s sleep outcomes. The current systematic review aims to summarize findings of past research examining center-based childcare attendance and sleep outcomes.

Methods
We followed the steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Keywords related to sleep and childcare were entered into PubMed and PsycINFO on November 13, 2023, yielding 2,355 articles. Articles were reviewed using the following inclusion criteria: population included children ages 0-6 years old, intervention included formal center-based childcare attendance, control or comparison included between-subject (i.e., center-based childcare vs. no center-based childcare; half-day vs. full-day) and within-subject (i.e., weekdays vs. weekends) designs, outcomes included sleep duration and timing, and study designs included observational and experimental research. Methods were critically assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS).

Results
Nine studies were included in the final data extraction process. Studies were conducted in five countries: Japan (n=5), United States (n=1), Malaysia (n=1), France (n=1), and Australia (n=1). Evidence indicated that center-based childcare attendance is associated with decreased sleep duration, though findings were mixed. Four studies found that attendance was associated with shorter nighttime sleep duration whereas one study found null association. Two studies found positive association between attendance and daytime sleep (i.e., weekends/weekdays, half/full day) whereas one study found a negative association when comparing childcare type (i.e., relative/non-relative). Two studies found no association between attendance and total sleep duration. Most studies reported nighttime sleep and did not use an objective measure of sleep. Classifications of childcare type varied, making comparisons across studies challenging.

Conclusion
More research is needed to examine how center-based childcare attendance may impact sleep outcomes in young children. Future research should use objective measures of sleep when possible and describe details about childcare consistently to facilitate comparison or generalization.

Support (if any)
0841 TigerCHAT: Sleep and Cellphone Access in Rural Elementary School Children
Authors: Feeley Christine , Gibson-Young Linda 
Published: April 2024

Abstract

Introduction
There is increasing awareness of the importance of sleep for health and wellness in children, and the impact technology has on sleep. However, many children are not getting the necessary sleep for optimal school functioning. The purpose of this project is to describe cellphone access, placement at night, and bedtime in 8–9-year-olds attending an elementary school in a rural area.

Methods
TigerCHAT is a school-based health education outreach program for children K-6th grades. It focuses on 45-minute sessions addressing various health topics, including sleep. Data are collected after IRB approval. In fall of 2022, nursing students led small groups of students in a sleep educational module during their gym period. Before education began, 50 3rd- grade students filled in a questionnaire regarding phone usage (do they have one, location during bedtime, bedtime and wake time).

Results
Frequencies, percentages, and ANOVA were run on the data to describe sleep and phone placement during the nighttime. Children ages 8-9 years (n = 50, 49% female, 51% male, 91.2% White, 8.4% Black, 46.4% classified as economically disadvantaged, 41% receive free or reduced lunch). Over half reported having a cellphone (n=31, 62% yes; n=19, 38% no). Of those with a cellphone, eleven (22%) reported having it under or by pillow, 11 (22%) reported having it on the bedside table, and 9 (18%) reported it not in their room at night. There was no significant difference in bedtime between those with a phone or without (F=.696, p=.402,) or where cellphone was located (in vs outside room) (F=1.55, p=.277). Children self-reported an average bedtime of 9:12pm (range 7:30pm-1am), and an average wake time of 5:15am (range 4:30am-6:30am), with an average total sleep time of 8.3 hours (range 4-10 hours).

Conclusion
The majority of students in this sample reported having access to a cellphone, and also reported having the cellphone close to them at night. While there was no significant difference in bedtime based on location or having a phone in this sample, it is still an important aspect of the sleep environment. Future studies should examine the significance of nighttime cellphone placement for school age and adolescent populations.

Support (if any)
0847 The Role of Pulse Wave Amplitude in Detecting Arousals in Children with Hypersomnia
Authors: Al-Shawwa Baha , Ingram David 
Published: April 2024

Abstract

Introduction
Changes in pulse wave amplitude (PWA) are a sensitive marker for both cortical and autonomic arousals, and are readily available in conventional polysomnogram recordings. The aim of the current study was to examine electrocortical versus PWA-based arousals in pediatric patients being evaluation for disorders of central hypersomnolence.

Methods
Polysomnograms for thirty consecutive patients who underwent multiple sleep latency test (MSLT) were identified. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify arousals. Arousals on overnight polysomnogram were rescored based on PWA drop. Patients were classified based on MSLT results into 3 groups: Narcolepsy group if mean sleep latency &lt; 8 minutes and the presence of 2 or more sleep onset rapid eye movement periods (SOREMP); idiopathic hypersomnia (IH) group if mean sleep latency &lt; 8 minutes and less than 2 SOREM periods; or normal if they did not meet criteria for narcolepsy or IH. Group differences in electrocortical arousal index (AI) vs PWA-based arousal index were examined via ANOVA.

Results
Out of the 30 patients included, there were 19 patients with normal MSLT, 7 patients with narcolepsy, and 4 patients with IH. There were no significant between-group differences for age, total sleep time (TST), sleep efficiency (SE), sleep latency (SL), REM latency, N1, N2, N3 or REM percentages, apnea hypopnea index (AHI), or periodic limb movement index (PLMI). There was were no significant differences between electrocortical AI in normal (9.4+/-4.4), IH (9.1/hr+/-4.9), and narcolepsy (10.6+/-6.6) groups (F(2,27)=[0.156], p=0.857). In contrast, there statistically significant between-group differences in PWA-based AI (F(2,27=[3.765], p=0.036). Post-hoc analysis demonstrated higher PWA-based AI in narcolepsy vs normal (24.2+/-10.4 vs 16.2+/-5.3, p=0.017), a trend for higher levels in IH vs normal (22.3+/-8.5 vs 16.2+/-5.3, p=0.131), and no difference between narcolepsy and hypersomnia groups (24.2+/-10.4 vs 22.3+/-8.5, p=0.674).

Conclusion
Pulse wave amplitude may hold promise as a scoring tool to help identify arousals and sleep disruption in patients with central disorders of hypersomnolence. Further studies are needed to verify these preliminary results and explore the utility of PWA-based AI in other sleep disorders.

Support (if any)
0848 The Utility of Pulse Wave Amplitude to Improve Interscorer Reliability
Authors: Al-Shawwa Baha , Fields Kerri , Ingram David 
Published: April 2024

Abstract

Introduction
While accurate scoring of arousals is crucial for identification of disrupted sleep architecture and hypopnea scoring, achieving acceptable interscorer reliability represents a major challenge. The drop in pulse wave amplitude (PWA) signal is a sensitive marker for arousals and is readily available in most conventional polysomnogram software. The aim of the current study was to examine interscorer agreement in scoring cortical arousals using EEG alone versus utilizing PWA drop signal as surrogate marker.

Methods
Arousals were scored using the same data on duplicate studies by the sleep laboratory medical director and education coordinator who is registered polysomnographic technologist (RPSGT). The first study was scored according to the American Academy of Sleep Medicine (AASM) arousal rule only. The second study used the drop in PWA as a marker for a possible cortical arousal in conjunction with the AASM arousal rule. A drop in PWA signal of at least 30% that lasted for 3 seconds was needed to identify possible arousals. Interscorer agreement and Cohen’s Kappa were calculated as measures of reliability.

Results
When scored using conventional EEG arousal criteria alone, there was an overall 90.3% agreement for all epochs with a corresponding Cohen’s Kappa of 0.642 (95% CI: 0.580-0.704), representing substantial agreement. When PWA assistance was utilized, agreement was significantly improved to 96.5% overall with a corresponding Cohen’s Kappa of 0.878 (95% CI: 0.840-0.917), representing almost perfect agreement.

Conclusion
Pulse wave amplitude may hold promise as a surrogate tool for identifying cortical arousals and improving interscorer reliability.

Support (if any)
0853 The Importance of Actigraphy in Assessment of Hypersomnia in Children
Authors: Snow Ayelet , Balog Matthew , Loghmanee Darius , Donskoy Innessa 
Published: April 2024

Abstract

Introduction
Daytime sleepiness is a significant pediatric health problem, with prevalence ranging from 4% in preadolescents to almost 20% in high school seniors (1,2,3). When hypersomnia is present both subjective and objective means of assessment is required. Subjective measures range from parent interview to self-report questionnaires and a daily diary filled over the course of days or months. Objective data is mostly acquired using actigraph devices. A systemic review by the American Academy of Sleep Medicine (AASM) found a single study examining nightly sleep duration using both actigraphy and sleep logs over the course of 2 weeks among adult sleep patients with excessive daytime sleepiness. It found self-reported daily total sleep time (TST) overestimated sleep by an average of 86 minutes (4). To the best of our knowledge there was no such comparison published in the pediatric population. We estimate that the same clinically significant difference exists in the pediatric population when comparing subjective report of daily total sleep time to an objective actigraphy measurement.

Methods
This retrospective cohort study used a convenience sample of 17 children aged between 6 to 20 years, presenting with hypersomnia to the sleep clinic between August 2022 and May 2023. Reported daily total sleep time was collected during their initial clinic visit and all children were given an actigraph for 2 weeks and were instructed to wear it continuously.

Results
Actigraph adherence was 91% with an average usage of 13 days. Self-reported daily TST was overestimated by 3.1 hours on average as compared to actigraph data. This was a statistically significant, t(16)=2.1199, p&lt; 0.01.

Conclusion
Interviews, questionnaires, and diaries are subjective and tend to describe the perception of sleep. When evaluating hypersomnia an objective tool is essential. sleep insufficiency in hypersomnia patients may be overlooked when the daily total sleep time is assessed using the subjective patient’s report. The simultaneous use of actigraphy may be preferable in this assessment to avoid misdiagnosis and treatment errors.

Support (if any)
0858 A Predictive Model of Composite Sleep Health for Cardiovascular Disease Based on the RU-SATED Framework
Authors: Zhang Nan , Sun Mei , Tang Siyuan 
Published: April 2024

Abstract

Introduction
Sleep health is a multidimensional construct. Previous studies have focused on single dimensions of sleep health and their association with cardiovascular disease (CVD). This study aimed to generate a composite multidimensional sleep health (MSH) score by combining subjective and objective measurements of sleep based on the RU-SATED framework, which consisted of Regularity, Satisfaction, Alertness, Timing, Efficiency, and Duration, and examine the association between the composite MSH score and the prevalence of CVD.

Methods
This was a secondary analysis using data from the multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL). A total of 1,912 participants with complete baseline and actigraphy data were included in the analysis. The primary outcome was the prevalence of CVD, defined as self-reported coronary heart disease or stroke. Covariates included demographics (age, gender, education, and income) and major CVD risk factors (hypertension, dyslipidemia, diabetes, obesity, and smoking). Each domain in RU-SATED framework was measured using both self-reported questions and actigraphy, and converted to binary values with unfavorable conditions coded as 1. Receiver operating characteristic (ROC) curve was used to select the measurements with higher predictive accuracy for each domain. The composite MSH score was obtained by summing the scores from each single domain. Logistic regression analyses were performed to analyze the relationship between the composite MSH score and CVD prevalence.

Results
Subjectively measured sleep efficiency, timing, alertness, and satisfaction showed higher predictive values for CVD, and actigraphy-measured sleep duration and regularity were associated with better predictive performance. The odds ratio of the composite MSH associated with CVD was 1.261-fold (95% CI 1.060-1.500, p=0.009) after adjusting for covariates. Neither standalone subjective measures nor actigraphy measures of MSH were able to uncover this relationship (OR=1.161, 95% CI 0.978-1.378; OR=1.152, 95% CI 0.966-1.374).

Conclusion
In this study, actigraphy-measured or subjectively measured MSH did not predict the prevalence of CVD independently, whereas the composite MSH combined actigraphy-measured and subjective measurements could predict the prevalence of CVD. The results have inspired us to further explore standardized methods and reach a consensus in measuring MSH, using the RU-SATED framework as a guide.

Support (if any)
0862 Associations Between Daily Fluctuations in Sleep and Blood Pressure Among Those with and Without Insomnia
Authors: Egeler Mara , Phelps Claire , Vargas Ivan 
Published: April 2024

Abstract

Introduction
Hypertension is a major contributing factor for heart disease, with nearly half of US adults meeting criteria. While studies have begun to examine the relationship between insomnia and blood pressure (BP), little is still known regarding the relationship between daily fluctuations in sleep and BP. This study aimed to provide further clarification on the role insomnia plays in the development of hypertension, including the impact that daily fluctuations in sleep have on fluctuations in BP.

Methods
Participants included 61 adults from the greater Northwest Arkansas area (63.9% White, 67.2% Female, 30-79 y) who completed 10 consecutive days of sleep and blood pressure monitoring. Insomnia status was determined by an Insomnia Severity Index (ISI) score of 8 or higher. Sleep was assessed objectively through actigraphy and subjectively through sleep diaries. BP was measured during the morning and evening using an ambulatory BP monitor. Variables examined included actigraphy and diary based total sleep time (TST), total wake time (TWT), and sleep efficiency (SE), as well as morning, evening, and daily systolic and diastolic BP. A series of multiple regressions were used to examine differences in BP between those with and without insomnia. Mixed effects models were used to explore the relationship between deviations in sleep and BP.

Results
Insomnia status was not found to be associated with average systolic or diastolic BP in the morning (β = 0.09, p = 0.44, β = 0.07, p =0.51), evening (β = 0.15, p = 0.20, β = 0.13, p =0.25), or daily (β = 0.12, p =0.28, β = 0.10, p =0.35). Decreases in actigraphy derived TST were associated with increased next day morning systolic (β = -0.01, p &lt; 0.01) and diastolic (β = -0.01, p = 0.02) BP when controlling for TWT.

Conclusion
The results of this study did not show support for insomnia serving as a predictor for hypertension. However, a nightly increase of total sleep time significantly decreased morning BP on the following day. Additional analyses will further dissect the association between daily fluctuations in sleep and BP.

Support (if any)
Graduate-Professional Student Congress Tiffany Marcantonio Research Grant
0863 Sleep Regularity and Cardiovascular Health Among U.S. Adults
Authors: Yang Li , Wallen Gwenyth , Barb Jennifer , Maki Katherine , Farmer Nicole 
Published: April 2024

Abstract

Introduction
Connections between sleep and cardiovascular risk and health are reported in adults. The sleep regularity index (SRI), a measure of day-to-day variability in sleep-wake times, has been shown to be associated with cardiovascular risk in older adults. The connection between SRI and cardiovascular health, the American Heart Association (AHA) derived concept of positive health promotion across the lifespan, has yet to be reported. The aim of this work is to investigate associations between SRI and cardiovascular risk and health.

Methods
Using National Health and Nutrition Examination Survey (NHANES) 2011-2014 data in US adults aged 40-75 years of age who are free of cardiovascular disease, the SRI was calculated from actigraphy across seven days using the ActiGraph model GT3X+, manufactured by ActiGraph of Pensacola, FL. Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) scores were calculated based on AHA. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the pooled cohort equations defined by the American College of Cardiology/AHA guidelines. The four-year interview weight was used for all complex sample analyses. SPSS complex sample general linear models were used to assess the association between SRI, ASCVD score, LE8, LS7, and demographic variables.

Results
Among the NHANES sample (n=5589; 52.8 % female; mean age = 54.5, SE = 0.17), the mean SRI score was 63.0 (SE = 0.52), the average ASCVD score was 0.12 (SE = .003), the mean LE8 and LS7 scores were 57.1 (SE = 0.46) and 6.6 (SE = 0.04). SRI was not significantly related to ASCVD score (β = -0.001, p = .062). Individuals with higher SRI scores reported higher LE8 (β = 0.265, p &lt; .001) and LS7 (β = 0.035, p &lt; .001) scores. After controlling for gender, race ethnicity, household food security, and SNAP participation status, SRI remained as a significant predictor to LE8 (β = 0.219, p &lt; .001) and LS7 (β = 0.029, p &lt;.001

Conclusion
Among U.S. adults aged 40 to 75 years of age, sleep regularity is positively associated with cardiovascular health.

Support (if any)