bluuebunny/crossref_metadata_2025_split huggingface dataset:
0826 Sleep in Parents and Children with Overweight and Obesity
Authors: Tsai Shao-Yu , Tung Yi-Ching , Huang Chuen-Min , Gordon Christopher , Cayanan Elizabeth , Lee Chien-Chang 
Published: April 2024

Abstract

Introduction
Sleep is fundamental for overall health and well-being. Nevertheless, a substantial portion of school-age children, ranging from 30.0% to 43.7%, experience sleep disturbances as reported by their parents. Children who are overweight or obese have increased sleep disturbances than their normal-weight peers. Research on children and parent’s sleep shows that parental sleep and health characteristics may serve as a risk or protective factor for children's sleep. This study aims to investigate the sleep patterns of parents and their school-age children with overweight and obesity.

Methods
Children (6-9 years) with overweight and obesity wore a wrist-worn actigraph for 7 days. Children’s sleep disturbance was assessed using the parent-report Children's Sleep Habits Questionnaire (CSHQ). Parental subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with parental depressive symptoms measured using the Epidemiologic Studies-Depression Scale (CES-D). General linear models were used to examine the association between parental and child sleep.

Results
Overall, 246 children and parents participated in this study, with 208 (84.6%) children experiencing clinically significant sleep disturbances and 123 (50%) parents reporting poor sleep quality. Higher children's sleep disturbance scores significantly predicted poorer parental sleep quality (b = 0.11, p &lt; .01). Poorer parental sleep quality was associated with more severe sleep disturbances in children (b = 0.46, p &lt; .01). This association was unaffected by children’s actigraphic sleep (all p &gt; .05) and remained significant after adjusting for parental depressive symptoms (b = 0.14, p &lt; .01).

Conclusion
Sleep disturbances are prevalent in both parents and their school-age children who are overweight or obese, with a significant bi-directional association between the two. Healthcare professionals working in school settings should screen for sleep disturbances in parent-child dyads of children with overweight and obesity.

Support (if any)
This work was supported by the Ministry of Science and Technology, Taiwan, MOST 107-2314-B-002-025-MY3.
0829 Effects of Sex on Sleep EEG in Typical and Atypical Neurodevelopment
Authors: Kozhemiako Nataliia , Purcell Shaun M · 
Published: April 2024

Abstract

Introduction
Sleep electroencephalography (EEG) patterns exhibit intricate variations influenced by multiple factors, including sex-specific disparities. While sex effects in sleep neurophysiology are relatively well-described in adults, information is more limited in pediatric samples, even less so in specific cohorts such as neurodevelopmental disorders (NDD). In this study we aimed to describe sex differences in a comprehensive set of EEG-derived sleep features in non-NDD individuals and compare those to the NDD cohorts including autism spectrum disorder(ASD), attention deficit hyperactivity disorder(ADHD), and intellectual disabilities(ID).

Methods
We used whole-night polysomnography data from a large National Sleep Research Resource sample, spanning from 2.5 to 17.5 years and Nationwide Children’s Hospital Sleep Databank, a pediatric sleep clinic cohort. Using ICD codes, we have defined the NDD subsets for ASD (N=196), ADHD (N=525), intellectual disabilities (N=167), and no-NDD sample (N=1523). The open-source package Luna was used to derive multiple sleep features including sleep spindles, slow oscillations (SOs) and spectral power across standard frequency bands. Linear regression models controlling for age were used to investigate sex effects with standardized b-coefficients (bstd) and p-values reported.

Results
Almost half of sleep EEG features expressed nominally significant sex differences in the no-NDD cohort (165 out of 351 tested EEG metrics), although their effect sizes were rather small. The strongest sex differences were observed in fast spindle density across all channels (largest effect at C4, bstd=-0.22,p=7x10-6 at C3, higher in girls), SO duration across all channels (largest effect at F3, bstd=0.24,p=1x10-5, longer in boys), occipital spectral power in alpha and sigma bands during REM sleep (bstd=-0.23,p=7x10-6 at O1, higher in girls). Generally, the NDD groups expressed similar pattern of sex differences evidenced by significant correlation between the standardized beta coefficients of each disorder and no-NDD group across all metrics (Pearson’s r=0.32 in ASD, 0.34 in ADHD and 0.27 in ID) although we also found evidence of disorder-specific sex differences.

Conclusion
Our findings indicate that multiple sleep EEG metrics express significant sex differences in childhood which are also observed in NDD populations. Such sex differences could potentially relate to disorder-relevant factors such as the differential prevalence of sleep issues in boys and girls or symptom manifestation.

Support (if any)
0844 Improving the Care of Pediatric Patients with Narcolepsy
Authors: Castner Lauren , Grekowicz Megan , Samphere Suzanne , Walden Krista , Flint Korina , Da Gambrell-Sanders 'Jhnae , Anderson Deb , Willis Rebecca , Malsch Thomasien , Bandla Hari 
Published: April 2024

Abstract

Introduction
Narcolepsy is a rare disorder characterized by disabling excessive daytime sleepiness and signs of REM-sleep dissociation. Pediatric narcolepsy has a different clinical presentation and may be difficult assess, but still can lead to severe impairments. Due to the importance of narcolepsy and the effects on quality of life we aimed to analyze and adjust our processes for caring for pediatric patients with narcolepsy to reach 90% compliance or greater with recommended quality measures.

Methods
Utilizing the AASM Quality Measures, medical records were reviewed from the Children’s Wisconsin Sleep Disorders Center with a diagnosis of narcolepsy from January 2018 until May 2023. Baseline compliance with recommended quality metrics were established. Those with a compliance rate of 80% or less were selected for the four step Plan-Do-Study-Act cycle. Data was continuously collected and analyzed quarterly to track compliance and address deficiencies in current processes.

Results
Pre-intervention data collection from 2017-2018 had compliance of 52% in documentation of the sleepiness assessment. Practice adjustments included educating clinical staff and distributing clinic questionnaires which improved compliance to 100%. With telehealth, compliance decreased to 90% and required an adjustment to clinical providers performing the assessment. Additional changes included developing an EMR Narcolepsy template to include safety counseling and education. Utilization of telehealth allowed annual follow up to remain &gt;90%, even if patients delayed or cancelled an annual visit. For the small population of new patients compliance fluctuated between 0-100% for initiating treatment in part due to parent scheduling and clinic availability.

Conclusion
It is essential to ensure proper diagnosis, prompt treatment initiation, regular follow up of symptoms and response to treatment, and safety practices for those with Narcolepsy. With simple adjustments, compliance improved, but due the COVID-19 pandemic care delivery changed. The plan was to temporarily shift to a telehealth model, telehealth enabled us more flexibility to discuss results and manage treatments when necessary. Utilization of online questionnaires through patient portals can update the EMR. Work is ongoing to further explore how technology can be used to reach patients and maintain consistent follow up.

Support (if any)
Internal funding provided by the Children’s Wisconsin Department of Pediatrics
0849 Characterization of Patient Referrals to ED/Inpatient Admission from an Outpatient Pediatric Sleep Center
Authors: hiranrattana Anunya , Fitzgerald Rebecca , Kehoe Anna , Heckler Gillian , Gilbert Christianna , Katwa Umakanth , Maski Kiran 
Published: April 2024

Abstract

Introduction
The medical complexity of patients referred to our pediatric laboratory has been increasing. These children are at higher risk of severe sleep disordered breathing and/or risk of emergent medical issues during the study. As a result, patients may need to be referred directly to emergency room or inpatient admission from the ambulatory sleep lab. In this single site pediatric sleep lab quality improvement project, we identify the frequency of ED/inpatient referrals from attended, in-lab sleep studies, reasons for referrals, and contributing factors for referral.

Methods
This is a cohort study of patients who had in-lab ambulatory polysomnogram at Boston Children’s Hospital between March 2017 to May 2022 identified through chart review search terms (ED or inpatient diagnostic codes within 24 hours of polysomnogram billing code). We performed chart review for demographics, past medical history, sleep study variables, medications, and disposition. We used chi-square tests to compare age and medical complexity categories.

Results
Of 6724 PSG studies conducted, 95 (1.4%) patients were referred to ED or inpatient admission within 24 hours from the sleep study. Demographics: Patients ranged in age from 1 month to 20 years [mean age 5.5(6) years] and the cohort was 38% female, 53% Caucasian, 12% Black, 2% Asian, 13% Hispanic, 6% other, 14% race/ethnicity not reported. Of the 95 patients referred to ED/inpatient hospitalization, 64% needed continued medical assistance in the morning due to various problems including persistent hypoxia, hypercarbia, altered mental status, difficulty tolerating oral intake, or need for assistance ambulating. Features such as age and patient triage level assigned prior to sleep study did not predict whether patient returned to baseline upon wakening. The reason for referral for ED or admission included severe sleep disordered breathing (e.g. obstructive sleep apnea or central sleep apnea; 33.8%), persistent hypoxia/hypercarbia (23.1%), cardiac (e.g. arrhythmias, worsening heart disease; 10.8%), vomiting/diarrhea (10.8%), neurologic (e.g. seizures, paroxysmal events, altered mental status; 7.7%), infection (e.g. fever/infection concern; 3.1%), allergy/anaphylaxis (1.5%), behavioral/psychiatric (1.5%), and metabolic derangements (e.g. hypoglycemia; 1%).

Conclusion
This quality improvement project informs sleep lab policies and procedures regarding staffing, training and management of urgent medical issues that arise during pediatric sleep studies.

Support (if any)
None
0850 Implementation of the San Diego Sleep Survey (SDSS) in Children with Autism
Authors: Warner M , Wu F , Inkelis S , Mung K , Stauffer Jacy , Linke A , Bhattacharjee R 
Published: April 2024

Abstract

Introduction
Children with autism (CWA) experience a high frequency of sleep disorders, which impact their well-being and development. Polysomnography faces challenges due to sensory sensitivities and communication difficulties in CWA. Therefore, sleep questionnaires play a critical role in gathering comprehensive information about sleep patterns and disturbances, potentially aiding in the identification of sleep disorders. The diagnostic potential of questionnaires could facilitate earlier access to tailored interventions for CWA, promoting enhanced sleep quality and better overall health outcomes.

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. CWA 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 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 Sleep Habits Questionnaire (CSHQ) for comparative purposes.

Results
2103 patients completed SDSS (age 8.6±4.8). Of these, 241 CWA were identified (age 8.2±4.7; 64 females [27%]). Compared to controls (n=135, age 9.4±2.4), CWA had significantly better hygiene scores (9.3±2.3 vs 9.9±2.3, p=0.03), higher insomnia scores (17.1±4.4 vs 12.9±3.3, p&lt; 0.01), higher SDB scores (18.4±6.2 vs 13.8±6.1, p&lt; 0.01) and higher DS scores (31.5±7.0 vs 19.5±5.9, p&lt; 0.01). 89 CWA completed the PSQ which identified 71 children (81%) with a positive SDB score (PSQ Total Score ≥8) compared to 189 children (65%) with a positive SBD score on SDSS. Forty-eight CWA completed the CSHQ; and all patients had a positive score (CSHQ Total Score ≥41).

Conclusion
The SDSS is a viable method for evaluating sleep disturbance in CWA, recognizing abnormalities in various domains. Future analyses will compare SDSS to PSQ and CSHQ to assess convergent validity for screening for sleep disorders. Additionally, sensitivity/specificity analyses of SDSS compared to the gold-standard of polysomnography will be explored.

Support (if any)
0852 Self-help Strategies for Sleep in Children and Adolescents with Epilepsy
Authors: Wu Pei-Yu , Weng Wen-Chin , Tsai Shao-Yu 
Published: April 2024

Abstract

Introduction
Children and adolescents with epilepsy have more sleep problems compared to their healthy peers. These sleep problems not only negatively impact development and quality of life, but also pose challenges in managing epilepsy effectively. The purpose of this cross-sectional study was to explore the use of self-help strategies for sleep among children and adolescents with epilepsy and examine the association between these strategies and sleep.

Methods
Seventy-five children and adolescents with epilepsy aged 1 to 17 years (mean age: 10.29 years) were recruited from a university-affiliated hospital between July 2022 and November 2023 in Taipei, Taiwan. They wore an actigraph on their wrist for a week, while their parents concurrently completed a sleep diary to document the utilization of any self-help strategies for sleep during the same period. Parent-reported sleep in children and adolescents was obtained using the Children's Sleep Habits Questionnaire (CSHQ). Data were analyzed using independent samples t-test.

Results
Of all the participants, only 17 (22.7%) children and adolescents had a nighttime sleep efficiency greater than 85%. The average total score of the CSHQ was 52.31±7.46, indicating moderate to severe sleep disturbance. Thirty-one (41.3%) parents reported using self-help strategies to help their children and adolescents sleep. These strategies included listening to music or stories (n = 14, 18.7%), reading books (n = 13, 17.3%), accompany (n = 6, 8%), using relaxation techniques (n = 2, 2.7%), feeding (n = 2, 2.7%), and giving teething toys (n = 2, 2.7%). There were no statistically significant differences (p &gt; 0.05) in sleep efficiency and CSHQ scores between children and adolescents who used self-help strategies for sleep and those who did not.

Conclusion
Many children and adolescents with epilepsy experience sleep disturbance and poor sleep quality, with a significant proportion attempting to use self-help strategies to improve their sleep. Our findings highlight the importance of managing sleep in this population and suggest the need for further exploration into the effectiveness of specific self-help strategies for sleep in children and adolescents with epilepsy.

Support (if any)
This work was supported by the National Science and Technology Council, Taiwan, NSTC 112-2628-B-002-003.
0868 Cardiac Remodeling: Apnea-Hypopnea Index as a Predictor for Changes in Left Atrial Volume
Authors: Chung Steve , Kokinda Sussan , Nguyen-Phan Andy , Chervin Ronald , Schuetz Sonja 
Published: April 2024

Abstract

Introduction
Left atrial (LA) size and volume are of interest in sleep-disordered breathing (SDB) as they are associated with cardiac arrhythmias. However, whether the apnea-hypopnea index (AHI) predicts LA longitudinal changes over time remains unknown.

Methods
This retrospective cohort study includes adults (≥18 years) without congestive heart failure (CHF) who were referred for a diagnostic in-laboratory polysomnogram (PSG) between January 2019 and March 2020; a baseline echocardiogram within one year of the PSG; and a follow-up echocardiogram more than one year after the initial studies. Clinical, PSG and echocardiographic variables, including LA volume and LA size, were abstracted from the medical record. SDB was classified as absent, mild, moderate, or severe (AHI ≤4.9/h, 5.0-14.9/h, 15.0-29.9/h, and ≥30/h, respectively). Regression models were used to assess the baseline cross-sectional relationships between AHI and LA measures, and the association of baseline AHI with LA changes over time.

Results
We identified 103 patients (58.8% male, median age 66 years (interquartile range, IQR 52-71)) with and without SDB (AHI median 19.9, IQR 7.3 – 35.6). The median time between baseline and follow-up echocardiograms was 3.2 years (IQR 2.3-4.1). AHI was associated with larger LA volume (β=0.64, p=0.0002) and LA size (β=0.08, p=0.04) at baseline. AHI also predicted changes in LA volume over time (β=0.57, p=0.02), but not changes in LA size. A dose-dependent relationship between SDB severity and changes in LA volume was noted: Individuals without OSA demonstrated a slight decrease in LA volume over time (median -7, IQR -36 - -5) whereas those with severe SDB demonstrated an increase in LV volume (median 13, IQR -9 – +18). Individuals with mild/moderate SDB fell between those groups.

Conclusion
Many patients with SDB are at risk for cardiac arrhythmias. Our results indicate that SDB severity at baseline predicts changes in LA volume over time. These findings may help identify patients at risk for LA enlargement and associated arrhythmias, and suggest a potential opportunity for early intervention to decrease cardiovascular risk.

Support (if any)
NIH R25NS088248
0874 Impact of Physical Activity on Subsequent Night's Sleep in Patients After Cardiac Surgery
Authors: Lee Sueyeon , Park Chang 
Published: April 2024

Abstract

Introduction
After cardiac surgery, patients often experience sleep disturbances, including poor sleep quality and increased awakenings. Sleep benefits postoperative physical function and overall recovery and has been related to physical activity. Physical activity and sleep have daily variations, but no study has examined their relationships on a daily basis after cardiac surgery. To address this gap, we investigated the effects of daily physical activity on daily sleep in postsurgical cardiac patients.

Methods
Employing a longitudinal pilot study design, 33 adults aged 18 to 80 who had undergone cardiac surgery were recruited from one hospital in Chicago and using an online recruitment site. Daily physical activity and sleep were measured in participants’ homes using a wrist-worn ActiGraph over 7 days and nights. Sociodemographic and psychosocial factors were assessed through self-reported online questionnaires. Mixed-effects model analyses were applied to examine the effects of daily physical activity on five sleep variables; covariates were selected from bivariate correlational and regression analyses as well as previous research evidence.

Results
Participants were mostly male (57.6%), non-Hispanic whites (63.6%) and had a mean age of 60.8 ± 10.1 years. Their mean body mass index (BMI) indicated overweight (28.4 ± 5.2 kg/m2), and 54.6% had undergone coronary artery bypass graft surgery 85.7 ± 91.2 months earlier. In mixed-effects model analyses, higher moderate-to-vigorous physical activity was significantly associated with lower next-day sleep latency (b=-1.32, p&lt;.05). Among covariates, lower depression (b=2.72, p&lt;.05), higher companionship (b=0.37, p&lt;.05), and higher instrumental support (b=2.40, p&lt;.05) were associated with lower daily wake after sleep onset, increased daily sleep efficiency, and longer total sleep time, respectively. In addition, older age, higher BMI, and a higher comorbidity index predicted more daily sleep disturbances.

Conclusion
In postsurgical cardiac patients, daily physical activity should be assessed and managed as a means to enhance daily sleep. Tailoring sleep interventions to individuals based on their comorbidities and psychosocial factors is also important. Future research should explore interactions between daily physical activity and sleep in a larger sample of postsurgical cardiac patients during varying time periods after surgery and should comprehensively assess sleep status, including sleep disorders, daytime napping, and daytime sleepiness.

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0877 Sleep Quality and Dyslipidemia Among Young and Midlife Women
Authors: Ajmani Mallika , Holzman Claudia , Tauman Riva , Lyu Xiru , Catov Janet , Dunietz Galit Levi 
Published: April 2024

Abstract

Introduction
Sleep quality is associated with poor cardiometabolic health in women and men. However, these associations have been infrequently reported among young and midlife women. Therefore, we examined the influence of poor sleep quality on dyslipidemia in a cohort of women from Michigan.

Methods
We utilized the POUCHmoms Study, a large and socioeconomically diverse community-based cohort of 648 young and midlife women from five Michigan communities. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), a widely used self-report questionnaire with 19 dimensions of sleep. A score &gt;5 on the PSQI was considered indicative of poor sleep quality. Fasting lipids levels were assessed in plasma for all women. Based on clinical guidelines for dyslipidemia, we classified women by high and low lipid levels; High-density lipoprotein &lt; 40 mg/dl, Low-density lipoprotein&gt;160 mg/dl, Total Cholesterol &gt;240mg/dl, Triglycerides&gt;200mg/dl. Health, sociodemographic and lifestyle information was collected through questionnaires. Next, we grouped women by low and elevated (borderline/high) lipids levels and examined associations with poor sleep quality. Bivariate analysis was used for determining the association between the lipid levels with covariates of interest. Logistic regression models, adjusting for sociodemographic, health and lifestyle characteristics, were utilized to assess the association between poor sleep quality and dyslipidemia.

Results
Women in this cohort had a mean age of 38y and 68% were white. More than half (60%) reported poor sleep quality. The prevalence of low HDL and high total cholesterol was 41% and 30% respectively. Women with poor sleep quality were more likely to have low HDL (adjusted OR=3.17, 95% CI: 1.78, 6.96) than women with good sleep quality. Associations of poor sleep quality with high levels of triglycerides, LDL, and total cholesterol were not statistically significant. However, when we grouped women by elevated/high levels, we found that high triglycerides and low HDL levels were associated with poor sleep quality (adjusted OR=1.94, 95% CI: 1.06, 3.54) and (adjusted OR=2.65, 95% CI: 1.71, 4.12), respectively.

Conclusion
In this cohort of young and midlife women, we found significant associations between poor sleep quality, high triglycerides, and low HDL. These findings highlight the potential influence of sleep quality on cardiovascular function among women.

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