bluuebunny/crossref_metadata_2025_split huggingface dataset:
0766 Qualitative Development of the Pediatric Narcolepsy Patient-Reported Outcomes (PNPROS) Questionnaire
Authors: Meltzer Lisa , Heckler Gillian , Revette Anna , Worhach Jennifer , Maski Kiran 
Published: May 2023

Abstract

Introduction
There is a significant need to reflect patient needs and values in healthcare outcome measures. In pediatric narcolepsy, there are no patient-reported outcome measures to assess disease burden, determine treatment efficacy, and guide future drug development. The aim of this study was to develop items for pediatric narcolepsy patient-reported outcomes (PNPROS) measure.

Methods
A standardized approach for the development of patient-reported outcome measures was used to develop the PNPROS items, including domain and facet definitions; a systematic, comprehensive literature review; in-depth interviews with pediatric narcolepsy experts (n=3); and qualitative interviews with children and adolescents with narcolepsy ages 9-17 years (n=15) and parents of children/adolescents with narcolepsy (n=15). Once the preliminary item bank was created, iterative refinement was completed through another round of qualitative interviews with children/adolescents (n=11) and parents (n=11), as well as experts in pediatric sleep, narcolepsy, and measure development.

Results
The literature review and expert interviews contributed to the final conceptual framework, which included two domains. The first, Narcolepsy Symptoms, included 13 facets (behavior, brain fog, cataplexy, cognitive difficulties, difficulty waking, disrupted nighttime sleep, daytime sleepiness, hallucinations, mood, nightmares, parasomnias, sleep paralysis, and tired/fatigue). The second, Functioning Impairment, included 11 facets (bothered, brain fog, emotional/mood, home/family, lack of understanding, life satisfaction, safety, school/academic, social, weight gain, work/extracurriculars). The literature review identified 714 items from 27 measures; after redundancies or irrelevant items were removed, the 337 remaining items were assigned a domain and facet through team consensus. Qualitative interviews resulted in a further reduction of items due to lack of clarity or redundancy, resulting in the final 55 items to be included in field testing.

Conclusion
This rigorous qualitative approach to the development and evaluation of content validity for the PNPROS item pool resulted in 25 items that assess Narcolepsy Symptoms and 35 items that capture Functional Impairment. Once the psychometric properties are established, through field testing in a diverse, national sample of pediatric patients ages 9-17 years with narcolepsy, the measure will be useful for evaluating disease burden and treatment efficacy in both clinical and research settings.

Support (if any)
American Academy of Sleep Medicine Foundation
0770 The Effect of In-Home Sleep Extension on Insulin Sensitivity for Habitually Short-Sleeping Adolescents
Authors: Simon Stacey , Cooper Emily , Brinton John , Bowen Anne , Cree-Green Melanie , Nadeau Kristen , Wright Kenneth 
Published: May 2023

Abstract

Introduction
The interplay of physiological and behavioral factors of adolescence that result in dramatically insufficient sleep may confer a notable cardiometabolic risk. Increasing sleep duration reverses the negative metabolic consequences of insufficient sleep in adults, but this has not been examined in youth. Thus, the current study aimed to evaluate the impact of in-home sleep extension on insulin sensitivity (Si) in habitually short-sleeping adolescents.

Methods
Twenty-six healthy adolescents obtaining ≤7h sleep on school nights (age=16.6±1.1, 69% female, 73% non-Hispanic White) completed a randomized crossover trial consisting of one week each of Typical Sleep (usual school schedule) and Sleep Extension (≥1h additional time in bed) during the academic year. Sleep was estimated via actigraphy, and an intravenous glucose tolerance test (IVGTT) measured Si following each condition. Spearman and Kendall correlations assessed associations and paired samples t-tests and Wilcoxon signed-rank tests examined change in variables from Typical Sleep to Sleep Extension.

Results
A significant association between sleep and insulin sensitivity was observed during Typical Sleep, with poorer Si associated with longer sleep onset latency (rho=-0.29, p=0.04), and greater variability in waketime (rho=-0.44, p=0.02) and sleep duration (rho=-0.43, p=0.03). During Sleep Extension, participants significantly increased sleep duration by 1.4±0.7h (Typical Sleep=5.59±0.82, Sleep Extension=6.95±0.83 h; p&lt; 0.001) by shifting bedtimes to an earlier clock hour (Typical Sleep=00:34±01:12; Sleep Extension=23:10±00:57; p&lt; 0.001). Si did not significantly change between conditions (p=0.52). However, a trend was observed for a decrease in fasting glucose during Sleep Extension compared to Typical Sleep (Typical Sleep=92.5±8.87; Sleep Extension=88.48±12.06 mg/dL; p=0.055).

Conclusion
Habitually short-sleeping adolescents were successful at increasing sleep duration during an in-home intervention, but Si did not change compared to Typical Sleep. Notably, sleep duration during Sleep Extension was still less than the 8-10 h of sleep per night recommended for adolescents. A sufficiently early bedtime that supports adequate sleep is a biological challenge for adolescents when wake times are fixed due to early school start times. Future research is recommended examining whether combining sleep extension with a circadian health intervention can have a larger impact on sleep and cardiometabolic outcomes in adolescents.

Support (if any)
NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1TR002535
0772 Associations of Sleep Duration and Maternal Postnatal Depression in Infants with Autistic Siblings
Authors: Foster Miranda , Bradshaw Jessica 
Published: May 2023

Abstract

Introduction
Evidence suggests sleep differences emerge in the first three years of life for autistic individuals (MacDuffie et al., 2020) and may be a possible endophenotype in unaffected siblings (Naeem et al., 2021). In neurotypical samples, postnatal depression has also emerged as a potential contributor to infant sleep challenges (Dias & Figueiredo, 2021). Questions remain on the associations between infant sleep duration, maternal postnatal depression, and family history of ASD as well as how these variables interact to predict future autistic traits.

Methods
Participants (N=74) were enrolled in a prospective longitudinal study on early autistic traits and included infants with an autistic sibling (n=33, EL) and with no familial history of ASD (n=41, LL). At 6 months, caregivers completed the Edinburgh Postnatal Depression Scale (EPDS) and a 24-hour retrospective sleep log. At 12 months, clinicians administered a standardized observation of autistic traits (SORF) the includes scores related to deficits in social communication (SCD) and restrictive and repetitive behaviors (RRBs).

Results
At 6 months, EL infants spent significantly more time asleep during the day than LL infants, (t(45)=2.89, p&lt;.01). There were not significant differences in nighttime sleep duration or EPDS scores between groups. In examining the influence of self-ratings of maternal depression and likelihood status on sleep duration, the model was significant for daytime sleep (F(2, 36)=4.27, p=.02), but not nighttime sleep. Likelihood status, not EPDS score, predicted more hours spent asleep in the daytime. When assessing the role of status and sleep-related variables on future autistic traits, only decreased nighttime sleep duration at 6 months was related to greater RRBs at 12 months (F(3, 10)=15.26, p=.02), regardless of likelihood status.

Conclusion
The results of this study suggest that EL infants may sleep more in the daytime at 6 months. Reduced nighttime sleep at 6 months possibly signal future autistic traits, regardless of likelihood status. Future research should examine actigraphy data and its relationship to the etiology of ASD in larger samples.

Support (if any)
Funded by K23-MH120476, R21-DC071252, and T32GM081740.
0774 Characterization of sleep spindles and sleep architecture in adolescents with functional abdominal pain
Authors: Zyniewicz Olivia , Parikh Riya , Santucci Neha , Dye Thomas 
Published: May 2023

Abstract

Introduction
Functional abdominal pain disorder (FAPD) is a common disorder in adolescents with an estimated prevalence of 13.5 % worldwide. It is characterized by nearly-continuous or recurrent pain localized in the abdomen but poorly related to gut function. A greater incidence of sleep disorders has been described in pediatric populations with FAPD, but no studies have characterized differences in sleep continuity and quality that may be experienced by this population. This study examines differences in sleep spindles experienced by adolescents with FAPD due to the role of sleep spindles in sleep stabilization as it relates to pain.

Methods
Subjects ages 11-18 years with FAPD and age/gender matched controls were recruited and underwent prospective polysomnography (PSG). PSGs were conducted according to AASM accredited standards, scored by a registered PSG technician, and interpreted by a boarded sleep physician. Using only artifact free epochs, sleep spindles were identified and characterized using the YASA python package / A7 algorithm with selections confirmed against gold standard (manual scoring). Comparisons of FAPD and control groups were performed using t-test or Wilcoxon rank sum tests for normal and non-normally distributed data, respectively. The PSG scorers and those preforming spindle analysis were blinded to control vs study group throughout the study.

Results
The study included 21 adolescents with FAPD and 20 controls. When compared to controls, the FAPD group had an elevated arousal index (FAPD: 10.08/hr ±4.89/hr, control: 7.32/hr ±3.61/hr, p = 0.046) and a lower percentage of NREM 3 sleep (FAPD: 20.13% ±5.47%, control: 24.77% ±6.94%, p = 0.023). During NREM 2 sleep, the FAPD group had significantly greater spindle density over frontal head regions than controls (FAPD: 2.80/min ±1.39/min, control: 1.86/min ±1.35/min, p = 0.040).

Conclusion
This study demonstrated that adolescents with FAPD have greater sleep spindle density, higher arousal indices, and lower proportions of slow wave sleep when compared to their peers. This may reflect an underlying difference in physiology which predisposes one to FAPD, or alternatively, may be secondary to pain symptoms themselves. Further investigation is warranted.

Support (if any)
This research is supported by the Cincinnati Children’s Research Foundation.
0777 Feasibility and Acceptability of Personalized Sleep Health Education as Part of Bed Provision for Families Living in Poverty
Authors: Carson Mikayla , Dunnewald Maja , Lamanna Erin , Fay Kate , Kyck Fiona , Mindell Jodi , Williamson Ariel 
Published: May 2023

Abstract

Introduction
Socioeconomic sleep health disparities begin in childhood but there are few feasible and scalable community-based approaches to promote pediatric sleep health. This study aimed to determine community provider and family acceptability of community provider-delivered sleep health education.

Methods
Forty-four families (90% mothers) of children ages 8-12 years (Mage=9.9; 64% girls; 64% African American/Black; 23% Hispanic/Latinx) participating in an intervention condition of a randomized trial completed two personalized, telephone-based sleep health education sessions with a community provider. This intervention and the providers were part of a non-profit bed provision program for children without beds and living at or below 100% of the US poverty level. Data on feasibility from the community providers and treatment acceptability from the families were collected.

Results
Thirty-eight families (86%) completed both intervention sessions. The first session (n=38) averaged 15 minutes (SD=4 mins), while the second session (n=36) averaged 8 minutes (SD = 2.5 mins). Community providers indicated that the sleep health education delivery was feasible to implement, citing the easy integration into their typical program workflow (e.g., session 1 occurred during calls to schedule bed deliveries) as a key determinant of future sustainability. Providers also highlighted many positive experiences, noting that the sleep health discussions helped them to get to know program participants better. In terms of intervention acceptability, 87% of families agreed/strongly agreed that “overall, [they had] a positive reaction to these strategies,” and 81% agreed/strongly agreed that “[they] found these strategies to be an acceptable way of helping [their] child sleep.” In addition, 87% agreed/strongly agreed they would use the sleep strategies if they wanted to change their child sleep habits in the future, 84% liked the strategies they learned, 84% believed the strategies were effective, and 90% reported the strategies were likely to result in permanent sleep improvements.

Conclusion
Overall, a community provider-delivered sleep health education was highly feasible for providers, with strong intervention retention and excellent caregiver acceptability ratings. Training community providers to deliver sleep health education is a promising strategy for disseminating evidence-based sleep health information on a larger scale and promoting pediatric sleep health equity.

Support (if any)
American Academy of Sleep Medicine Foundation
0780 Iron Sucrose Infusions for Pediatric Sleep Related Movement Disorders
Authors: Rashid Iqbal , Bseikri Mustafa 
Published: May 2023

Abstract

Introduction
Sleep related movement disorders (SRMD) such as restless leg syndrome (RLS), periodic limb movement disorder (PLMD), and restless sleep disorder (RSD) are common diagnoses among children referred to pediatric sleep clinics, particularly among children with neurodevelopmental disorders such as ASD. These disorders have been associated with low iron status, and evidence demonstrates clinical response to iron supplementation. Oral iron supplementation is often used as a first step in management, although some children do not manifest an adequate response in serum ferritin levels, or do not tolerate oral iron due to side effects or taste. For these children, iron infusions may be an attractive therapeutic strategy.

Methods
We performed a retrospective chart review of children referred for iron infusion between January 2021 to November 2022 at Kaiser Permanente Northern California Pediatric Sleep Clinics. Children carried a diagnosis of RLS, PLMD, or RSD. Iron sucrose was used, with a target dose of 6-7mg/kg, with a maximum dose of 200mg per infusion. We reviewed the number of infusions, pre- and post-infusion ferritin levels, and clinical response based on clinic notes and/or secure message communication after infusion.

Results
A total of 11 children were identified who received at least one iron infusion. Mean age at time of first infusion was 7.2 (4.5) years, 63.6% were male, and 45.5% were diagnosed with ASD. The most common diagnosis was PLMD (54.5%), followed by RLS (27.3%), and RSD (18.2%). Mean infusion dose of iron sucrose was 130.5mg (41.6) and children received an average of 2.0 (1.1) infusions. Mean ferritin prior to infusion was 30.1 (20.1) and 62.6ng/mL (41.1) post infusion. Based on chart review, 63.6% of families reported symptomatic improvement following iron infusions. No children were reported to have worsening of sleep or significant side effects following iron sucrose infusion.

Conclusion
Iron infusions are an effective strategy for management of sleep related movement disorders who are recalcitrant to oral iron. This can be an especially attractive therapeutic option in children with neurodevelopmental disorders such as ASD. Further research exploring optimal dosing and formulation of iron is warranted.

Support (if any)
0781 Relationship between Bedtime Routines with Sleep, Development, and Parenting Stress in Toddlers
Authors: Lam Joey , Salih Zainab , Carson Mikayla , Dunnewald Maja , Waisfeld Agostina , Randazzo Isabel , Heere Megan , Williamson Ariel , Mindell Jodi 
Published: May 2023

Abstract

Introduction
Institution of a nightly bedtime routine is a key component of sleep health and is likely to foster positive early childhood development. The current study investigated the longitudinal and concurrent relationships between a bedtime routine and sleep, social-emotional development, and parenting stress in toddlers living in lower income homes and/or neighborhoods.

Methods
Caregivers of 78 toddlers (56.4% female; M=12.87 mos; 67.9% Black; 73.1% WIC) reported on their child’s bedtime routine at their 12-month well-child visit. At their child’s 15- and 24-month well visit, caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R SF), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Parenting Stress Index (PSI-SF). Results were considered significant at p&lt;.05.

Results
Toddlers with a consistent bedtime routine (5+ nights per week) at 12 months had significantly earlier bedtimes (20:54 vs 21:24) and waketimes (7:21 vs 8:48) at 24 months compared to those without a consistent routine. At 15 months, a more frequent bedtime routine was associated with fewer concurrent social-emotional problems (r = -.32) and decreased bedtime difficulty (r = -.34). At 24 months, toddlers with a consistent bedtime routine (33.3%) were less likely to exhibit concurrent BITSEA social-emotional competency concerns (66.7%). Caregivers also reported better nighttime sleep in toddlers with a consistent routine at 24 months. Additionally, caregivers whose child had a consistent routine at 15 and 24 months perceived their child as less difficult (PSI) at 24 months. However, no associations emerged between bedtime routine frequency and consistency at 12, 15, and 24 months with ASQ communication and personal-social concerns.

Conclusion
Bedtime routine frequency and consistency in toddlers was associated with better caregiver-perceived sleep, social-emotional development, and lower parental stress regarding their child being perceived as difficult, but not communication and personal-social concerns. A bedtime routine may be a cost-effective strategy to promote toddlers’ sleep, overall development, and family’s functioning.

Support (if any)
This study was partially funded by the Simms/Mann Institute
0783 Sleep Continuity and Quality in Adolescents with Functional Abdominal Pain
Authors: Parikh Riya , Zyniewicz Olivia , Santucci Neha , Dye Thomas 
Published: May 2023

Abstract

Introduction
Functional Abdominal Pain Disorders (FAPD), in which chronic abdominal pain occurs independently of organic pathology, are common in adolescents. FAPD can lead to significant impairment in daytime function and may overlap with sleep disorders. Though several studies have explored the nature of sleep disturbances experienced by adolescents with FAPD, none have characterized differences in sleep architecture in this population.

Methods
Adolescents (age 11-18 years) with FAPD and age/gender-matched controls were prospectively recruited to undergo polysomnography (PSG). PSG was performed according to AASM guidelines, scored by a registered sleep technologist, and interpreted by a board-certified sleep physician. The first four hours of artifact-free NREM sleep were analyzed using fast Fourier transformation with Welch tapered windows of 1024 samples (and 50% overlap) averaged over 30-second epochs. Total power was calculated for very low (0.3 – 1 Hz), delta (1 – 4 Hz), theta (4 – 8 Hz), and alpha (8-12 Hz) frequencies. Comparisons between groups were made using Wilcoxon rank sum tests or t-tests for non-normal and normal data, respectively.

Results
A total of 41 subjects were recruited (FAPD n=21, control n=20). The FAPD group had a greater arousal index and a lower percentage of NREM 3 sleep when compared to the control group (FAPD arousals: mean=10.08/min ± 4.89 min, control arousals mean=7.31/min ± 3.61/min, p = 0.046), FAPD NREM 3: mean=20.13% ± 5.47%, control NREM 3: mean=24.77% ± 6.94%, p =0.023). Delta power was significantly lower in the FAPD group compared to controls (FAPD Delta mean=488.67 µV2 ± 282.82 µV2, control Delta mean=1193.14 µV2 ± 663.89 µV2, p &lt; 0.001).

Conclusion
This study demonstrates significant differences in sleep architecture of adolescents with FAPD compared to their peers. In particular, decreased proportions of NREM 3 sleep and lower Delta power are indicative of diminished slow wave sleep (SWS). Reductions in SWS may be indicative of common neurotransmitter pathways shared between sleep and chronic pain syndromes, or secondary to sleep disruption associated with pain. Further research is indicated.

Support (if any)
This research is supported by the Cincinnati Children’s Research Foundation and the Summer Medical Student Respiratory Research Fellowship program at Cincinnati Children’s.
0784 Sleep Disruptors on the Inpatient Pediatric Unit
Authors: Uribe Daniela , Rani Seema , Chidekel Aaron , Strang Abigail 
Published: May 2023

Abstract

Introduction
High quality sleep is crucial to health and development in children. Compared to healthy children, hospitalized children have a higher chance of experiencing disrupted and poor-quality sleep, which may thereby impede their recovery. There is lack of research around sleep disruptors in hospitalized children outside of the ICU setting.

Methods
This IRB approved, prospective, survey-based study was completed in 2022 and included children ages 8-17 years who were hospitalized □3 days on the inpatient (non-ICU) units at Nemours Children’s Hospital, Delaware. The study was comprised of four surveys: The Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD, higher scores= more sleepiness), Adolescent and Children’s Sleep Hygiene Scales based on age (ASHS and CSHS, Higher Scores= Better Sleep Hygiene), Consensus Sleep Diary, and the Nemours Sleep Disruptors Questionnaire (NSDQ) which evaluated contribution of various factors to sleep disruption. The EMR was reviewed for demographic and clinical information. Descriptive and comparative statistics were performed.

Results
Study participants (n=45) were 40% male, 57.8% white, with a mean age of 13.4 years. The mean number of nighttime awakenings was 2 (range=0-7). The average total sleep time was 8.2 hours (range=5-12). Vital signs were obtained between 10PM and 6AM for 87% of participants. On the administered surveys, participants scored: ESS-CHAD (M=8.6 SD=4.3), ASHS (M=2.9 SD=.8), CSHS (M=3.3 SD=.6). 54% of patients reported feeling like they needed more sleep. On the NSDQ, the most disruptive factors noted by patients (causing at least mild sleep disruption) were alarms on equipment (69%), vital signs (64%) and environmental noise (62%).

Conclusion
In this cohort of hospitalized children, sleep environment (specifically related to alarms, environmental noise, and vital signs) was a leading cause of sleep disruption. Further interventional studies are needed to examine the relationship between sleep quality and sleep-friendly hospital environments, with vital signs and physiologic monitoring as potential targets for intervention.

Support (if any)