bluuebunny/crossref_metadata_2025_split huggingface dataset:
0765 Enlarged perivascular spaces in infancy: associations with autism diagnosis, cerebrospinal fluid volume, and later sleep problems
Authors: Garic Dea , McKinstry Robert , Rutsohn Joshua , Slomowitz Rebecca , MacIntyre Leigh , Pandey Juhi , Schultz Robert , St. John Tanya , Estes Annette , Dager Stephen , Botteron Kelly , Hazlett Heather , Styner Martin , Piven Joseph , Shen Mark 
Published: May 2023

Abstract

Introduction
Since the re-discovery of the glymphatic system, there has been an increased interest in perivascular spaces (PVS) and cerebrospinal fluid (CSF) characteristics in relation to sleep. Enlarged PVS (ePVS) are associated with neurological disorders and sleep problems, and excessive extra-axial CSF (EA-CSF) volume is associated with autism spectrum disorder (ASD). However, ePVS has not been studied in infancy in relation to autism, EA-CSF volume, or sleep problems. The objectives of this study, therefore, are to examine whether ePVS is 1) more prevalent in infants who later develop ASD, 2) related to EA-CSF volume, and 3) associated with later sleep problems.

Methods
The study was conducted on a prospective, longitudinal cohort from the Infant Brain Imaging Study (IBIS). Participants underwent neuroimaging at 6-, 12-, and 24-months of age, and parent-reported Children’s Sleep Habits Questionnaires (CSHQ) were collected at a follow-up visit at school age (age range = 7-12 years, M = 10.0). A total of 311 participants were included: 47 infants at high familial likelihood for ASD who were later diagnosed with ASD (HL+), 180 high likelihood infants not diagnosed with ASD (HL-), and 84 low likelihood control infants (LL-). The CSHQ was available on a subset of 109 participants.

Results
Significant group differences in ePVS rates were found at 24 months of age (p=0.041), with 44.7% of the HL+ group having ePVS, compared to 26.7% in the HL- group (p=0.017) and 26.2% in the LL- group (p=0.031). ePVS at 24 months was associated with greater EA-CSF volume from 6-24 months (p=0.002) and greater sleep disturbances at school-age (p=0.006), regardless of ASD diagnosis.

Conclusion
The presence of ePVS during infancy was associated with ASD diagnosis, elevated EA-CSF volume, and more frequent sleep disturbances. Results suggest that infants with ePVS should be monitored for early signs of ASD and potential long-term sleep problems, particularly sleep disturbances. Further examination is needed to establish whether early ePVS is ASD-specific or an indication of early glymphatic system dysfunction that can put infants and children at risk for atypical brain development and later sleep problems.

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0767 INSIGHT Responsive Infant Parenting Intervention and Child Sleep at Age 6 Years
Authors: Hohman Emily , Hernandez Erika , Dadzie Adwoa , Master Lindsay , Anzman-Frasca Stephanie , Savage Jennifer , Buxton Orfeu , Paul Ian 
Published: May 2023

Abstract

Introduction
The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers resulted in more responsive bedtime parenting and longer infant sleep duration in the first year after birth. The current analysis evaluates intervention effects on parent-reported sleep behaviors and objectively-measured sleep at child age 6 years.

Methods
Mothers (n=279) were randomized to the RP or control intervention, delivered by nurses at home and clinic visits through child age 2.5 years. Sleep content focused on establishing bedtime routines, age-appropriate bedtimes, and promoting self-soothing at bedtime and after night wakings. At 6 years, children completed wrist actigraphy (Spectrum Plus) for 7 days during the school year. Children with ≥3 valid days were included in analyses (n=162). Mothers (n=173) completed the Children’s Sleep Wake Scale and Children’s Sleep Hygiene Scale. Study group differences for 10 sleep actigraphy variables (M/SD of onset, offset, and midpoint of sleep timing, sleep maintenance efficiency, and total sleep time), as well as survey scores, were examined.

Results
Children (mean age 6.7 years, 96% non-Hispanic White) slept on average 8.8 hours ± 33 minutes per night, with 40% meeting the minimum recommendation of 9 hours. The mean sleep onset time was 9:14 pm ± 50 minutes. There were no significant study group differences in any actigraphy variables. RP mothers reported higher scores for Total Sleep Quality (4.6 ± 0.5 vs. 4.4 ± 0.6, p=0.03), ‘Going to Bed’ subscale (4.3 ± 0.8 vs. 4.0 ± 0.9, p=0.03), which captures child compliance with bedtime, and ‘Reinitiating Sleep’ subscale (4.6 ± 0.9 vs. 4.2 ± 1.1, p=0.005), which captures the child’s ability to go back to sleep on their own after waking. Total Sleep Hygiene score did not differ between groups.

Conclusion
The INSIGHT intervention targeting sleep in infancy was associated with improved parental perception of bedtime stalling and self-soothing behaviors at age 6 years. However, this did not translate into differences in sleep duration, timing, or quality measured by actigraphy. Future research should examine strategies to maintain the impacts of the RP intervention on infant sleep into middle childhood.

Support (if any)
R01DK088244, KL2TR002015
0768 Melatonin use for sleep disturbance in school-aged children and adolescents: An Australian pharmacy perspective
Authors: Lee Samantha , Yeung Kingston , Bin Yu Sun , Cheung Janet 
Published: May 2023

Abstract

Introduction
Melatonin is a widely used pediatric sleep aid. While readily available internationally, regulatory changes in Australia have only recently allowed over-the-counter access for patients aged over 55, triggering renewed public interest in melatonin. However, melatonin access for younger patients with sleep disturbances remains a prescription-only medicine. Furthermore, pharmacist opinions about the use of melatonin in pediatric patients remain unexplored. This study aimed to investigate Australian community pharmacists’ perspectives toward melatonin use in school-aged children and adolescents.

Methods
A qualitative study was conducted in a convenience sample of community pharmacists/interns practicing in metropolitan Sydney. Participants completed an online questionnaire capturing demographic information and practice context. Participants subsequently indicated their interest in participating in an in-depth semi-structured interview. Interviews were guided by a schedule of questions exploring pharmacists’ knowledge, beliefs, and attitudes toward melatonin use in pediatric patients. The interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach to identify emergent themes. Recruitment continued until thematic saturation was reached.

Results
Twenty-four interviews were conducted with pharmacists (n=19) and interns (n=5). Participants were mostly female (67%) with a mean age of 29.8 (range: 22-56) years. Pharmacists managed 25.3 (1-300) sleep-related inquiries per day on average and received direct product requests for melatonin 15.9 (2-100) times per week. Preliminary analyses identified three key themes: Conflicting Opinions on Safety, Product Cost and Formulation Availability, and Gaps in Clinical Education. Pharmacists’ involvement in pediatric melatonin use has largely been within the domains of dispensing or compounding prescriptions. While melatonin was perceived as a “better choice over other sedatives” for children, pharmacists expressed uncertainty about the evidence base concerning long-term use in younger age groups, relying heavily on physicians for prescribing discretion and patient supervision. The need for affordable proprietary products with flexible dosing options and targeted education around melatonin and circadian sleep health was also expressed by participants.

Conclusion
Findings allude to the need for greater availability and accessibility of pediatric-specific melatonin formulations, as well as refinement of clinical education resources that specifically address the use of melatonin among school-aged children and adolescents.

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0769 Multidimensional Sleep Health in Adolescents from the General Population: Definition, Thresholds and Construct Validity
Authors: Nyhuis Casandra , Ell Johanna , Calhoun Susan , He Fan , Liao Jason , Spiegelhalder Kai , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio 
Published: May 2023

Abstract

Introduction
The RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measures.

Methods
We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Each MSH domain was categorized as “good” or “poor” using cut-offs informed by prior studies and expert consensus. Good cut-offs, assigned a score of 1, that were derived from actigraphy-measured data included: the standard deviation of sleep midpoint ≤1-h (RU), mean of sleep midpoint 2:00-4:00 (T), mean value of sleep efficiency ≥85% (E), and mean total sleep time ≥7.5-h (D). Good cut-offs derived from self-reported rating scales included the absence of insomnia symptoms (S) or excessive daytime sleepiness (A). Values considered poor based on these cut-offs were assigned a score of 0. Scores were summed across all domains to obtain a composite score ranging from 0 to 6, with higher scores indicating better MSH. Morningness and Tanner staging were self-reported, while Sleep and Arousal clusters scores on the Pediatric Behavior Scale were parent-reported.

Results
The mean composite score was 3.03 ± 1.30 and domains A and D were most commonly rated as poor (64.5% and 65.3%, respectively). Younger age (r=-0.13, p&lt; 0.05) and identifying as non-Hispanic white (r=-0.14, p&lt; 0.01) were significantly associated with higher MSH scores, while sex (r=-0.04, p=0.40), Tanner staging (r=-0.06, p=0.29) or BMI percentile (r=-0.07, p=0.15) were not. Greater morningness (r=-0.29, p&lt; 0.01), less disturbed sleep (r=-0.28, p&lt; 0.01) and higher arousal (r=-0.21, p&lt; 0.01) scores were associated with higher MSH scores.

Conclusion
Our data-driven approach can be used to assess MSH in the adolescent population. Our definition captures previously identified health disparities in MSH in adults and shows optimal construct validity against self-reports of circadian preference and parent observations of adolescents’ degree of sleep disturbance and arousal. Improving sleep duration and daytime alertness appear to continue to be the most relevant domains impacting overall MSH in adolescents.

Support (if any)
NIH (R01HL136587,UL1TR000127)
0771 An Innovative Intervention on Parental Sleep Beliefs and Practices: Its Effects on Children's Short-Term Sleep
Authors: Pétrin Rachel , Bérubé Annie , Pennestri Marie-Hélène , Touchette Evelyne , Forest Geneviève 
Published: May 2023

Abstract

Introduction
Inadequate parental sleep beliefs and practices have been associated with the development and maintenance of sleep difficulties in children. Disrupted sleep at a young age leads to adverse child outcomes and affects parents' sleep and family functioning. Our goal was to evaluate the effects of improved parental sleep beliefs and practices on child and parent sleep in the short term. Hence, we designed an innovative intervention for developing parenting skills in children's sleep management.

Methods
15 caregiver-child dyads with preschool-age children were recruited through daycare centers and placed in small groups for a two-hour intervention and a follow-up. Children's and parents' sleep were respectively measured using the Children’s Sleep Habits Questionnaire (CSHQ) and the Pittsburgh Sleep Quality Index (PSQI). Parental beliefs were assessed by three subscales (Setting Limits, Anger, Doubt) of the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ). Parental practices were measured by two factors (Sleep Conflict, Sleep Dependence) of the Parent-Child Sleep Interactions Scale (PSIS). Data were collected before the intervention and two weeks later. Paired-sample t-tests were used to measure changes in each variable.

Results
Significant improvements were observed in scores on CSHQ subscales measuring Bedtime Resistance (t(14)=3.15, p=.004; M=11.3 vs M=9.47), Sleep Onset Delay (t(14)=3.21, p=.003; M=2.40 vs M=1.67), Parasomnias (t(14)=2.35, p=.017; M=10.9 vs M=9.87), and Daytime Sleepiness (t(14)=2.90, p=.006; M=13.0 vs M=11.3). Accordingly, total CSHQ scores were significantly lower (t(14)=4.70, p&lt;.001; M= 55.7 vs M=49.5) reflecting less sleep disturbance in children. Parents' sleep was of superior quality, with global PSQI scores marginally decreased (t(14)=1.75, p=.051; M=6.93 vs M=6.20). Lower Sleep Conflict scores (t(14)=3.44, p=.002; M=7.67 vs M=4.8) and total PSIS scores (t(14)=3.59, p=.001; M=13.3 vs M=9.00) indicated better parental sleep practices.

Conclusion
These preliminary results show that parental interventions on children’s sleep management can improve child sleep and parental sleep practices. These results also highlight that parental practices about their child’s sleep can change independently of their beliefs. Long-term measures will help verify the course of changes in parents' sleep and beliefs regarding their child’s sleep.

Support (if any)
This project was funded by the Social Sciences and Humanities Research Council of Canada (SSHRC).
0773 Behavioral sleep characteristics may differ in toddlers with epilepsy compared to children without epilepsy
Authors: Gupta Gita , Saylam Ezgi , Patel Anup , Dang Louis , O'Brien Louise , Ibadat Shewar , Sturza Julie , Neff Katherine , Shellhaas Renée 
Published: May 2023

Abstract

Introduction
Sleep is cited as a prominent concern by many caregivers of children with epilepsy. Few studies have examined this issue systematically.

Methods
Caregivers of 11 toddlers (12-36 months old) were recruited from two academic Pediatric Neurology clinics and responses were compared to children without epilepsy (n=343). Caregivers responded to a novel questionnaire being developed for infants and toddlers. Two domains were analyzed (Caregiver/Child Behavior and Comfort Object/Bedtime Routine). The domain score equaled the sum of the scores for each item divided by the number of items answered. Items in the Caregiver/Child Behavior domain were: 1.“My child’s total sleep time and sleep routine are problematic for me”; 2.“I am frustrated by my child’s sleep problem”; 3.“I worry about my child’s health due to their sleep problem”; 4.“My child wakes up shortly after they have fallen asleep”; 5.“My child wakes up distressed in the middle of the night”; 6.“My child’s sleep is restless”; 7.“My child does not seem well rested during the day”; 8.“My child requires a parent/caregiver's presence to fall asleep (e.g. in the room, in the bed)”; 9.“My child moves their legs in a cycling pattern, or kicks and moves their legs excessively in the middle of the night”. Items in the Comfort Object/Bedtime Routine domain were: 1. My child requires a parent/caregiver's presence to fall asleep (e.g., in the room, in the bed)”; and 2.“My child requires the presence additional comfort measures (e.g., aromatherapy, noise machine, weighted blanket, music) to fall asleep”.

Results
The Caregiver/Child Behavior score was higher (worse) in toddlers with epilepsy (3.40; SD 0.72) compared with controls (1.94; SD 0.93) p&lt; 0.0001. Yet, toddlers with epilepsy had lower (better) scores in the Comfort Object/Bedtime Routine domain (2.23; SD 1.25) compared with controls (3.20; SD 1.25) p=0.01.

Conclusion
Sleep behavior is complex in toddlers with epilepsy and can lead to parental frustration and worry in comparison to toddlers without epilepsy. Further investigation into this relationship could provide opportunities for effective interventions to improve sleep and quality of life for children with epilepsy.

Support (if any)
NIH2T32HL110952-06
0775 Differences in subjective sleep measures in mothers and fathers of premature infants: A preliminary study
Authors: Socarras Laura Ramos , Lebel Valérie , Forest Geneviève 
Published: May 2023

Abstract

Introduction
It has been documented that newborn’s sleep is strongly associated with maternal and paternal sleep. However, mothers seem to be more affected by their infant’s sleep than fathers. These associations are not well known in families of premature newborns yet. This was the objective of the present study.

Methods
30 families of premature newborns (mothers, fathers and infants) participated in this study one month after discharge from the hospital. Parents completed, among other measures, sleep diaries during three consecutive weekdays for themselves and their child. Multiple linear regression analyses were computed to examine the association between sleep duration and nocturnal awakenings of the premature infant and their mothers’ and fathers’ sleep duration and number of awakenings during the night. Analyses were done separately for mothers and fathers.

Results
Regression models for parents’ sleep duration were significant and explained 31.7% of the variance in mothers’ sleep duration (p=.009) and 30.8% of the variance in fathers’ sleep duration (p=.01). Infants’ sleep duration was the only significant predictor in both models (□=.663, p=.005 and □=.670, p=.005, respectively for mothers and fathers). Thus, shorter sleep duration in premature infants predicted shorter sleep duration in mothers and fathers. Analyses of parents’ nocturnal awakenings showed that the model was significant for mothers (p&lt;.001), but not for fathers (p=.372). The variables explained 73.4% of the variance in mothers’ awakenings, and infants’ nocturnal awakenings was the only significant predictor (□=.801, p&lt;.001).

Conclusion
Our results suggest that premature infants’ sleep is strongly associated with mothers and fathers’ sleep. In addition, it seems that nocturnal awakenings are particularly associated with the mothers, but not the fathers’ awakenings during the night, which may be related to their involvement in feeding schedules during the night. Future studies should focus on sleep disturbances in families of preterm infants and on interventions targeted for both mothers and fathers that can be implemented to improve sleep in this population.

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0778 Functional thalamo-cortical connectivity relates to sleep-onset problems in early infancy
Authors: Chiem Emily , Wagner Lauren , Ceballos Joshua , Dapretto Mirella 
Published: May 2023

Abstract

Introduction
Healthy sleep patterns are crucial for proper brain development in infancy. However, little is known about the relationship between early sleep disturbances and functional brain connectivity. The thalamus plays a critical role in the regulation of sleep and wakefulness, and undergoes rapid growth in the first year. Therefore, we examined how early thalamic connectivity relates to sleep-onset problems during the first 6 months of life.

Methods
All data were collected as part of the Baby Connectome Project (1U01MH110274). Forty-six infants (between 3-5 months old) underwent resting-state fMRI scans during natural sleep. The fMRI data were preprocessed and analyzed using FSL, and the bilateral thalamus was used in seed-based analyses. The Infant Behavior Questionnaire (IBQ) was used to create a measure of sleep initiation. Five IBQ items (21-25) were reverse-scored and averaged to generate the Infant Sleep-Onset Problems (ISOP) score, with higher scores indicating longer sleep latencies. ISOP scores across 3-6 months were used as regressors in whole-brain analyses.

Results
Preliminary results suggest a positive correlation between ISOP scores and connectivity between the thalamus and precuneus, such that greater sleep-onset problems were associated with stronger connectivity between the thalamus and precuneus. In contrast, there was a negative correlation between ISOP scores and connectivity between the thalamus and anterior cingulate cortex, such that fewer sleep-onset problems were associated with stronger connectivity between the thalamus and anterior cingulate cortex.

Conclusion
Our findings suggest that stronger thalamic connectivity with the precuneus, a region involved in the perception and integration of information, is related to greater sleep initiation difficulties. In contrast, stronger connectivity between the thalamus and anterior cingulate cortex, a region involved in attention allocation and emotional regulation, is associated with less sleep initiation problems. While these results are preliminary, they indicate that early sleep problems are associated with altered development of functional thalamo-cortical networks.

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0779 Impact of 8-h Time Limited Eating on Sleep in Adolescents with Obesity
Authors: Jayakumar Archana , Vidmar Alaina , Gillett Emily , Wei Choo Phei 
Published: May 2023

Abstract

Introduction
Time-based interventions, such as time-limited eating (TLE), have become a promising dietary strategy in adults with obesity. TLE involves shortening the daily eating window to a pre-specified number of hours and fasting for the remaining hours of the day without altering diet quality. No study to date has examined the impact of TLE on sleep quality in adolescents with obesity.

Methods
We conducted a secondary analysis of a 12-week pilot study that compared TLE (8-h eating window/16-h fasting window) to a prolonged window (12-h eating window/12-h fasting window) in adolescents with obesity (ages 14 to19, 72% female, 74% Hispanic). All youth completed the Pittsburgh Sleep Quality Index (PSQI) at baseline (n = 42), weeks 4 (n = 43), and 12 (n = 42). The seven component PSQI score, develops a global score that ranges from 0 to 21, where higher scores indicates worse sleep. Glycemic profiles were captured via continuous glucose monitors (CGM) worn for the duration of the study. Mixed effects generalized linear model in log scale and ordinal logistic regression models were utilized to (a) examine the change in PSQI total score and (b) assess the association between glycemic variability and PSQI total score overtime by intervention arm.

Results
Across all youth included in this analysis (n = 43), there was improvement in PSQI total score at week 12 compared to baseline that was marginally significant after adjusting for multiple testing (% change = -19.60, 95%CI = -31.83 to -5.18, p = 0.057). The median PSQI score for the TLE group (n = 29) was 6 at week 0 (5 to10) and 5 at week 12 (2.5 to 7), suggesting sleep quality improved. The changes in PSQI total score, sleep ratio, and sleep onset score over the course of study were not statistically different between groups (p &gt; 0.05). There was no significant association between glycemic variability and PSQI score between the groups.

Conclusion
Findings from this secondary analysis indicate that TLE does not negatively alter sleep quality or duration in adolescents with obesity. The potential effects of TLE on sleep should be further investigated in larger randomized trials.

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