bluuebunny/crossref_metadata_2025_split huggingface dataset:
0733 The Association of Nocturia and Napping with Obstructive Sleep Apnea Among Older Adults with Insomnia and/or Daytime Sleepiness
Authors: Polisetty Lakshmi , Pan Yulu , Iannone Lynne , Knauert Melissa , Yaggi Klar , Gill Thomas , Miner Brienne 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is underdiagnosed in older adults (OAs) due to the poor performance of screening questionnaires. Symptoms of nocturia and napping may improve the identification of OSA in this population. We examined the association of these symptoms with OSA in OAs, and whether the association differed by gender.

Methods
In a prospective, observational study among 39 community-living adults ≥ 65 years reporting symptoms of insomnia and/or daytime sleepiness ≥once/week, we evaluated the association of nocturia and napping with OSA. Nocturia was assessed by the self-reported average number of times getting up to urinate at night. Napping was evaluated by self-reported number of naps/week, average nap duration (in minutes), and napping minutes/week (naps/week x minutes/nap). OSA was assessed by the Apnea Hypopnea Index (AHI) from home-based polysomnography. We used Pearson correlation coefficients to examine the strength of the association of nocturia and napping with AHI among all subjects, and separately in men and women.

Results
In all participants, the mean age was 74+/- 6.8 years, 72% were women, and the mean AHI was 19+/- 15.9 events/hr. When compared to women, men reported more nocturia (1.6 vs.1.3 episodes/night), more napping (including naps/week [3 vs. 2], nap duration [31 vs.17 minutes], and napping minutes/week [150vs. 55 minutes]). In addition, they had higher AHIs (25 vs.16 events/hr). Among all participants, nocturia was not significantly correlated with AHI, while nap duration and napping minutes/week were significantly correlated with AHI (p values &lt; 0.02). Among 11 men, nap duration and minutes per week were correlated with AHI (correlations 0.74 [p=0.009] and 0.56 [p=0.07], respectively). Among women, no napping characteristics were significantly correlated with AHI.

Conclusion
Among community-dwelling OAs with insomnia and daytime sleepiness, napping, and not nocturia, was associated with OSA. This association was driven by the strong correlation among men, particularly for nap duration. Napping may be a good screening question for OSA in older men, but examination of other symptoms is warranted in older women.

Support (if any)
Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342), the Robert E. Leet and Clara Guthrie Patterson Trust, and the National Institute on Aging (R03AG073991, K76AG074905).
0738 Association of socio-demographic determinants, smoking, and obesity with sleep trouble among women of reproductive age
Authors: Park Ariel , Thakur Bhaskar , Khan Safia 
Published: May 2023

Abstract

Introduction
While sleep quality in women is well known to be affected by hormonal factors such as menstrual cycle, pregnancy, and postpartum period, the connections between their sleep and socio-demographic characteristics are not widely studied. Our study objective was to examine the self-reported sleep problems among women of reproductive age in the US and their association with socio-demographic determinants of health as well as other health-related factors using the National Health and Nutrition Examination Survey (NHANES).

Methods
We analyzed a secondary data with 5,610 female participants aged 15 to 49 years who participated in the NHANES conducted during 2013 – 2018 to examine for the prevalence of self-reported sleep trouble as well as socio-demographic determinants (age, ethnicity, marital status, education, and income) and the presence of smoking and obesity. A design-based F-test and survey-based generalized linear model with Poisson family and log link function were performed to estimate the adjusted and unadjusted prevalence ratio (PR) with statistical significance of associated factors.

Results
The likelihood of trouble sleeping for those in the age group of 41 to 49 were significantly higher than those in the age group of 15 to 20 (PR 1.77 [95% CI 1.14-2.77]). Significantly more minority women including non-Hispanic Asian (PR 0.46 [95% CI 0.32-0.67]), Hispanic (PR 0.63 [95% CI 0.46-0.86]), and non-Hispanic black (PR 0.73 [95% CI 0.54-0.99]) reported less likely to have trouble sleeping than non-Hispanic multiracial group. When looking at marital status, married individuals reported less trouble sleeping (PR 0.83 [95% CI 0.80-0.99]) as compared to those who never married. Smoking was also associated with more trouble sleeping (PR 1.43 [95% CI 1.27-1.61]). Prevalence of reporting trouble sleeping was significantly higher for obese women compared to those with normal weight (PR 1.25 [95% CI 1.07-1.46]). There were no statistically significant differences in reported sleep trouble based on education status and income.

Conclusion
Using the large-scale population-based cross-sectional survey analysis, we identified that the problem of sleep disturbance was independently and positively associated with the higher age, unmarried, smokers and obese women in the reproductive age group.

Support (if any)
0751 Early Childhood Sleep Associated with Adolescent Sleep Physiology among Youth with ADHD
Authors: Lunsford-Avery Jessica , Kollins Scott , Krystal Andrew 
Published: May 2023

Abstract

Introduction
Sleep complaints are prevalent and impairing symptoms among adolescents with ADHD. Our recent work has shown that key aspects of sleep physiology differentiate adolescents with ADHD from healthy controls (HC), including reduced slow-wave sleep percentage (SWS%) and relative delta power (rDelta) and increased stage 2 percentage (N2%) and relative sigma power (rSigma) after accounting for sleep duration. ADHD-related sleep problems may emerge as early as toddlerhood, yet little is known about the trajectory of sleep disturbances over time in ADHD. The current study examines relationships between early childhood sleep problems and adolescent sleep physiology in ADHD and HC.

Methods
Sixty-two medication-free adolescents (31 with ADHD, mean age=15.3, 50% female) completed a diagnostic interview (Mini International Neuropsychiatric Interview) and 3 nights of at-home polysomnography. Spectral analysis was conducted on a single O1-C3 channel. Caregivers reported on participants’ sleep problems during toddlerhood and preschool (Child Behavior Questionnaire; CBQ). Linear regressions controlling for age, sex, and pubertal status examined relationships between early childhood sleep problems and aspects of sleep physiology implicated in adolescent ADHD (SWS%, rDelta, N2%, rSigma) and whether associations differed between groups.

Results
Adolescents with ADHD had greater caregiver-reported early childhood sleep problems compared to HC (t(60)=3.71, p&lt;.001). In the full sample, greater caregiver-reported sleep problems in early childhood were associated with reduced SWS% (β=-.28, p=.04) and rDelta (β=-.27, p=.04), and increased rSigma (β=.33, p=.02), in adolescence. An early childhood sleep by group interaction was observed for rDelta (β=1.09, p=.04), such that the association was significantly stronger for adolescents with ADHD than HC.

Conclusion
The current study found that sleep problems in early development were associated with disruptions in sleep physiology in adolescents, including relatively less time spent in SWS, reduced delta power, and increased sigma power. Results suggest that ADHD-related sleep problems may begin early in life and persist into adolescence. Screening for and treating sleep problems during early development may be important for supporting sleep health among adolescents with ADHD, and future studies should assess this possibility. Future studies employing longitudinal designs may clarify the contribution of sleep disturbances to the onset and persistence of ADHD symptoms across development.

Support (if any)
K23MH108704; R34MH128440
0755 The Relationships Between Sleep Duration, Sleep Efficiency, and Blood Pressure During Late Adolescence
Authors: Phillips Shameka , Li Peng , Ward Teresa , Chandler-Laney Paula , Bowen Pamela , Affuso Olivia , Rice Marti 
Published: May 2023

Abstract

Introduction
Elevated blood pressure (BP) is an important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the world. Elevated BP in adolescence increases the risk for CVD in adulthood. Unfortunately, 1.3 million adolescents (ages 12 to 19) have extremely elevated blood pressure or hypertension (HTN). Evidence suggests that sleep duration is associated with HTN in adults, but less is known about these relationships during adolescence. Furthermore, there is limited research focused on specific developmental stages, particularly late adolescence, which is the last age group before adulthood. Also, there is a paucity of research on BP including other sleep variables like sleep efficiency. Therefore, the purpose of this secondary data analysis was to determine if sleep duration and sleep efficiency were associated with BP during late adolescence.

Methods
This secondary data analysis included older adolescents (16-18 years) who participated in the Cleveland Children’s Sleep and Health Study, a cohort study examining sleep disturbances and health outcomes. Height, weight, and BP (systolic (SBP) and diastolic (DBP)) were measured using standard clinical procedures. Objective sleep duration and sleep efficiency were measured by at least five days of actigraphy. Subjective sleep duration was averaged from daily self-report. The association was evaluated using Pearson correlations and multiple linear regressions.

Results
This sample included 259 adolescents (age 17.7±0.4, 63.3% White, 55.6% female). Pearson correlation analysis indicated a negative relationship between sleep efficiency and SBP (r = -0.210, p &lt; 0.001) with a small-medium effect size (95% CI [-0.316, 0.098]). However, the negative correlation between sleep efficiency and SBP was no longer significant after controlling for assigned sex, race, and body mass index percentiles in a multiple linear regression model.

Conclusion
This secondary data analysis did not provide sufficient evidence on the associations between sleep duration and sleep efficiency with BP in older adolescents, possibly due to the homogenous sample with small variations in BP, sleep duration, and sleep efficiency. Therefore, there is a need for future studies including more heterogenous samples to evaluate the relationships between sleep and BP in this age group.

Support (if any)
1st author - NHLBI T32HL105349 & NICHD 5T32HD101397-03
0758 Initial Efficacy of a Brief, Trauma-Informed Sleep Intervention for Children in Foster Care
Authors: Alfano Candice , Rech Megan , Harmouch Sirine 
Published: May 2023

Abstract

Introduction
Children in foster care experience impairing sleep problems that contribute to greater attachment, emotional and behavioral problems concurrently and over time. Sleep nonetheless remains a critically neglected aspect of health among this vulnerable group. To address the unique sleep needed of this population, we developed a brief, telehealth-delivered behavioral sleep intervention for caregivers of young children currently or formerly in foster care, called Sleep and Adjustment in Foster Environments for Toddlers and Preschoolers (SAFE-T). The current study examined the initial efficacy of SAFE-T.

Methods
N = 25 foster or adoptive foster parents with a 2- to 5-year-old child (M = 3.9; SD = 1.7) were recruited from the state of Texas. After a baseline assessment including the Children’s Sleep Habits Questionnaire (CSHQ) and Parenting Stress Index (PSI), families were randomized to SAFE-T or an active control group. SAFE-T families (n = 14) received 3 telehealth-delivered sessions with a therapist who provided information about healthy sleep and trauma-informed suggestions for reducing child sleep problems. Control families (n = 11) were sent an informational booklet about sleep to keep. A post-treatment assessment was completed approximately one month after he initial assessment.

Results
Compared to the control group, the SAFE-T group evidenced greater reductions in total CSHQ sleep problem scores (η2 = .14), including Sleep Anxiety (partial eta squatted = .16), Sleep Onset Delay (η2 = .08), Bedtime Resistance (η2 = .09) and Daytime Sleepiness (η2 = .07) scores at post treatment. Based on the PSI, caregivers in the SAFE-T group reported greater reductions in Difficult Child scores (η2 = .35), Parent-Child Dysfunctional Interactions (η2 = .31) and Parenting Stress (η2 = .16) compared to the control group.

Conclusion
Medium to very large effects were found for reductions in caregiver-reported child sleep problems as well as parenting stress following intervention with SAFE-T. These promising results suggest that a brief, trauma-informed sleep intervention may be effective in improving child sleep health and caregiver well-being in foster families.

Support (if any)
This study was funded by the Grant to Enhance and Advance Research (GEAR) from the University of Houston.
0760 Applying machine learning to examine settling down period for children with and without sensory hypersensitivities
Authors: Hartman Amy , Kocanaogullari Deniz , Soehner Adriane , Bendixen Roxanna , Akcakaya Murat 
Published: May 2023

Abstract

Introduction
Children with sensory hypersensitivities have poorer subjective sleep health than their peers. However, traditional actigraphy variables (e.g., sleep efficiency, sleep duration) do not adequately capture these sleep deficits. In qualitative interviews, caregivers of children with sensory hypersensitivities identified the settling down period prior to sleep as a major family stressor, potentially indicating a novel target for intervention. We applied machine learning techniques to thoroughly characterize and discriminate differences in the settling down period for children with and without sensory hypersensitivities.

Methods
Children (ages 6-10) with sensory hypersensitivities (n=20) and children without sensory hypersensitivities (n=29) wore the GT9X Actigraph continuously for 2 weeks and caregivers completed daily sleep diaries. Settling down period (caregiver reported start of settling down until actigraphy indicated sleep onset) was isolated for each night and 7 features were extracted from the activity data (mean magnitude, maximum magnitude, kurtosis, skewness, Shannon entropy, standard deviation, interquantile range). Ten-fold cross-validation with random forests were used to determine the accuracy, sensitivity, and specificity of differentiating groups.

Results
We achieved an 83% accuracy in classifying children with sensory hypersensitivities versus those without hypersensitivities (sensitivity = 84%; specificity = 82%). Feature importance maps showed that the most important feature for differentiating groups was maximum activity count magnitude during the settling down period; children with sensory hypersensitivity had higher maximum bouts of activity during settling down. The hypersensitive group also showed a higher variance in activity during settling down, as demonstrated by greater interquartile range (variance within the time window), standard deviation of activity, and Shannon entropy (the amount of uncertainty in the time window).

Conclusion
Our novel machine learning analysis successfully uncovered objective features within the settling down period that differentiate children with sensory hypersensitivity from their peers. Our data highlights exciting new potential targets for intervention: children with sensory hypersensitivities have larger and sporadic bouts of activity during their settling down period that clearly set them apart from their peers without hypersensitivities.

Support (if any)
T32 HL082610, University of Pittsburgh School of Rehabilitation Science Doctoral Award (PI Hartman), Sensory Integration Education PhD Student Grant (PI Hartman).
0764 End of daylight saving and sleep children 4-24 months
Authors: Lucchini Maristella , Thakur Shambhavi , Barnett Natalie , Anders Thomas 
Published: May 2023

Abstract

Introduction
Daylight saving time (DST) imposes a twice yearly 1h change in local clock time. Although it may seem a small adjustment, there is increasing awareness of the potential acute and long term effects at the individual and population level. Several studies have shown detrimental effects on sleep patterns, but mostly focusing on adults. Only one study has looked at the effect in infants’ sleep of change from standard time (ST) to DST, reporting negative effects. One study limitation was the reliance on parental reports of infant sleep. In addition, effects of the change from DST to ST are unknown. We hypothesize that the change from DST to ST would lead to earlier rise times, leading to sleep loss in the week following the change.

Methods
Caregivers of 510 children ages 3-24 mos (M=9.8 mos) tracked their child’s sleep using Nanit baby-monitor. Sleep metrics analyzed were: Nighttime sleep duration (NSD) and midpoint, number of night-wakings and sleep efficiency. Wilcoxon rank sum tests compared the average of each sleep metric for the week preceding the time change (Oct 31st-Nov 4th 2022, Baseline) with sleep metrics for each night of the following week (Nov 7-11 2022, post-DST week). Analyses were repeated stratifying by age group (4-6,7-12 and 13-24 months).

Results
After the time change, there was no change in NSD or sleep efficiency. There was a significant decrease in the number of night-wakings for infants 3-6 months, with an average of 0.5 fewer wakings per night compared to Baseline (Baseline mean=5 wakings). Midpoint was significantly earlier for all ages by an average of 10min, every day of the post-DST week.

Conclusion
The return to ST affected infants’ sleep midpoint. Observed effects were minor compared to those reported in previous literature for the ST to DST change, in line with other fields like cardiovascular health. This easier adjustment could be attributed to the fact that during DST there is an increased mismatch between body clock and social clock time, thus infants more readily adjust to a return to ST which minimizes this mismatch.

Support (if any)
This research was supported by Nanit
0787 Sleep Problems and Sleep Disorders in Children with Rubinstein-Taybi Syndrome
Authors: Srisinghasongkram Pornchada , Simakajornboon Narong 
Published: May 2023

Abstract

Introduction
Rubinstein-Taybi syndrome (RSTS) is a genetic condition which characterized by distinctive facial features, broad and angulated thumbs and halluces, short stature, and moderate-to-severe intellectual disability. Sleep problems have been reported in children with RSTS. However, most studies were case reports in adult population. There is limited information on details about sleep problems in children with RSTS. The purpose of this study was to: (1.) Describe the demographics, clinical presentation of children with RSTS; (2.) Describe polysomnographic findings, sleep diagnoses and treatments of children with RSTS.

Methods
A retrospective study was performed in patients with RSTS (ages 0-20 years) who underwent polysomnography at Cincinnati Children’s Hospital Medical Center from January 1, 2000 to October 31, 2022. Demographics, clinical presentation, polysomnographic findings, diagnoses and treatments were reviewed. Descriptive statistics were utilized.

Results
Thirteen children with RSTS were included, 69% were male (N=9). The median age was 6.3 years (range 13 days to 12.6 years). The most common presenting symptoms included snoring (N=9, 69.2%), pauses of breathing (N=6, 46.2%) and nighttime awakenings (N=5, 38.5%). The age of onset of sleep symptoms ranged from birth to 5 years. From polysomnographic findings, the most common diagnosis was obstructive sleep apnea (OSA) (N=11, 84.6%) with obstructive apnea-hypopnea index ranging from 2.8 to 72.7/h, (mild, N=3; moderate, N=3; severe; N=5). All children with mild OSA (N=3) were treated with medications, while children with moderate-to-severe OSA were managed with PAP therapies (N=4), supplemental oxygen (N=3), and surgeries (N=3). Other diagnoses included central sleep apnea (N=2) and periodic limb movement disorder (N=2), which were treated with supplemental oxygen and iron supplements, respectively.

Conclusion
The most common presenting sleep symptoms in children with RSTS were snoring, pauses of breathing and nighttime awakening. The age of onset of symptoms was variable, but usually occurred during infancy through childhood. OSA was the most common diagnosis in these populations. Physicians should recognize the early signs and symptoms of sleep problems in children with RSTS to allow early diagnosis and appropriate treatment.

Support (if any)
Cincinnati Children's Hospital Research Fund
0788 Sleep Profile of Adolescents Following Posterior Spinal Fusion
Authors: Cucchiaro Giovanni , Ortiz Luis , Fierstein Jamie , Gray Geoffrey , Ahumada Luis , Householder Kym , Tudor Brant , Rehman Mohamed 
Published: May 2023

Abstract

Introduction
Major musculoskeletal operations can have a prolonged impact on patients’ quality of life during the postoperative period. Sleep patterns can be affected by general anesthesia, complex and prolonged operations, and post-surgical care. Sleep disturbance can be considered a determinant of poor postsurgical outcomes. In this study, we examined the sleep profile of adolescents who underwent Posterior Spine Fusion (PSF) utilizing the FitBit Charge 4TM wearable device.

Methods
Patients were approached at the time of their evaluation in the orthopedic office once they had been scheduled for PSF. Patients received a Fitbit Charge 4TM at the time of enrollment. Total sleep time (TST), the duration of REM and Deep Sleep phases, and sleep efficiency were obtained from patients’ FitBit4 data and were calculated by averaging data recorded over a 2-4-day period during the week prior to surgery, during the hospital stay, one-two-three weeks, and 3 months after patients were discharged home. Patients were given a PROMIS sleep questionnaire delivered to their cellular phone using Qualtrics the week before the hospitalization, during hospitalization, and 3 months after surgery. Pain scores were obtained every 4-6 hours during the patient’s hospital stay using the self-reporting numeric scale.

Results
16 patients (10 female (62%)) completed the 3 months study period. Mean age was 16±1.9 years. The average length of hospitalization was 3 days. The average TST, REM, and DEEP sleep at baseline was 387±111, 74±28, 75±25 minutes respectively. TST, REM, and DEEP sleep decreased during the acute post-operative period and gradually increased during the follow-up period going to baseline values by the 3rd post-surgery week in 72% of the cases. Perception of sleep showed mild disturbance at baseline and worsened during the hospital stay based on PROMIS scores with improvement or return to baseline by the 3rd month post-operatively in 86% of patients.

Conclusion
Sleep phases of adolescents are affected after a major surgery. Similar to patients of other major surgeries, these changes are short-lived and returned to baseline by the 3rd post-operative week. There was a broad range of changes among subjects during the study period.

Support (if any)