bluuebunny/crossref_metadata_2025_split huggingface dataset:
0782 Sleep and Its Disturbance in Parents of Children and Adolescents with Epilepsy: A Systematic Review and Meta-Analysis
Authors: Tsai Shao-Yu , Tsai Han-Yi , Lin Ying-Ying , Chen Su-Ru , Kuo Shu-Yu , Lou Meei-Fang 
Published: May 2023

Abstract

Introduction
Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in parents of children and adolescents with epilepsy is lacking. A greater understanding of the characteristics of sleep patterns and sleep problems in parents of children with epilepsy is needed because when the sleep of the parents is compromised, the parents’ ability to provide quality care for the child may be hampered. The purpose of this systematic review and meta-analysis was to synthesize published studies examining sleep and its disturbance in parents of children and adolescents with epilepsy.

Methods
Five electronic databases, PubMed, Medline, Embase, PsychINFO, and CINAHL, were systematically searched from inception to September 2021. Studies examining parents or caregivers of pediatric patients aged &lt; 18 years with epilepsy using a quantitative measure of sleep duration, sleep quality, or sleep disturbance were included. Available data were pooled using random-effects or fixed-effects models on the basis of heterogeneity between studies.

Results
Eleven observational studies with a total of 934 parents of children and adolescents with epilepsy were reviewed. The pooled nocturnal sleep duration was only 5.93 hours (95% CI: 4.64 to 7.21 hours). Overall sleep quality as estimated by the bias-adjusted pooled Pittsburgh Sleep Quality Index total score was 6.65 (95% CI: 5.98 to 7.33). Parents of children with epilepsy had significantly higher Pittsburgh Sleep Quality Index total scores in comparison to parents of healthy children (differences in means: 1.84, 95% CI: 1.29 to 2.39). The pooled estimated prevalence of parental sleep disturbances was 58.1% (95% CI: 45.7% to 69.6%).

Conclusion
Our findings demonstrate a high prevalence of sleep disturbances with poor sleep quality and substantial reductions in sleep time in parents of children and adolescents with epilepsy. Healthcare professionals in pediatric neurology clinics should initiate screening of sleep disturbances in parents and refer parents to a sleep specialist when necessary.

Support (if any)
This work was supported by Ministry of Science and Technology, Taiwan, MOST 110-2628-B-002-039.
0785 Sleep Habits and Sleep Hygiene Practices of South African Primary School-Aged Children: An Exploratory Study
Authors: Wood Tanya , Rampf Nadine 
Published: May 2023

Abstract

Introduction
Insufficient sleep adversely affects the physiological and psychological well-being of children and their families. Reports indicate that children's sleep health is declining; however, comparable data on the South African pediatric population is lacking. To this end, the current study aimed to explore the sleep quality and sleep hygiene practices of South African primary school-aged children.

Methods
The current study was exploratory and employed convenience sampling. Parents/legal guardians of South African children (6 – 11 years) attending primary school were recruited through social media platforms and asked to complete an online survey. The survey captured basic biographical information on their child's sleep habits (Children’s Sleep Health Questionnaire, CSHQ) and sleep hygiene practices (Children’s Sleep Hygiene Scale, CSHS). Survey responses were collected from May–August 2022.

Results
Of the 448 responses, 208 were included in the data analysis. Responses were received from eight South African provinces; the highest response was from the Western Cape (38.5%), followed by Gauteng (30.3%). The mean age of the study population was 8.0 ± 1.7 years (mean ± SD) and 51% were female. Of the children surveyed, 49.5% attended government schools. The mean parental report of sleep duration was 9.31 ± 0.45 hrs. The mean total sleep disturbance score based on the CSHQ was 47 ± 8.4, with 76% of children scoring greater than or equal to 41, indicating the presence of a possible sleep disturbance. The mean sleep hygiene index was 28.0 ± 3.4. Linear regression analysis revealed a significant correlation between total sleep disturbance and sleep hygiene scores (R2 = 0.32, p &lt; 0.001); low sleep hygiene index scores were associated with a higher total sleep disturbance score. Multiple quantile regression models revealed that home-schooling and increased age were also significantly associated with sleep disturbance scores.

Conclusion
While the reported total sleep time for South African primary school-aged children was within the recommended range (9 – 11 hrs) for this age group, the overall presence of possible sleep disturbances was high, which could be attributed to poor sleep hygiene practices.

Support (if any)
0786 Sleep Problems and Associations with Mental Health Among Children Recently Adopted from Foster Care
Authors: Rusin Karolina , Cifre Anthony , Alfano Candice 
Published: May 2023

Abstract

Introduction
Trauma and early adversity are known to increase risk for both sleep and psychological disturbances, placing children who spend time in foster care at a higher risk for these problems than other populations of youth. Recent research has shown most children in foster care experience impairing sleep problems, but little is known of whether and how these problems relate to longer-term mental health. Thus, among a large sample of children recently adopted from foster care, we examined the prevalence of sleep-related problems when children were first placed in the foster home and their associations with current mental health problems.

Methods
N=234 parents of children, 4–11 years (M=5.94, SD=1.97) adopted from foster care in the U.S. within the past two years completed an online survey about their children’s sleep and mental health. Participants were recruited through private social media groups for foster, kinship, and/or adoptive caregivers. Parents were asked to report the specific types of sleep-related problems children exhibited at time of first arrival in home and completed validated measures of child anxiety and depressive symptoms regarding their child’s current functioning.

Results
After first arriving in the home, 82.9% of children were reported to experience at least one sleep-related problem. Further, 58.5% were reported to experience nighttime awakenings, 37.2% exhibited fear of the dark, and 32.1% had trouble sleeping alone. Approximately one quarter of children wet the bed (27.8%), struggled with staying in bed (27.8%), experienced nightmares (26.1%), and/or had night terrors (22.6%). Total number of sleep-related problems was significantly positively correlated with child age (r (234) = .30, p &lt; .001), as well as current separation anxiety (r (234) = .16, p &lt; .05), generalized anxiety (r (234) = .33, p &lt; .001), and depressive symptoms (r(234) = .23, p &lt; .001).

Conclusion
Our findings align with previous reports indicating high rates of sleep-related problems among youth in foster care and further suggest that these early problems may be a harbinger for mental health problems even after children achieve permanence. Findings call for greater attention toward sleep health among children in foster care and other alternative care settings.

Support (if any)
0791 The Association of Sleep with Developmental and Behavioral Factors in Premature Infants
Authors: Dunnewald Majalisa , Lamanna Erin , Williamson Ariel , Moore Melisa , Mindell Jodi 
Published: May 2023

Abstract

Introduction
Children with neurodevelopmental conditions often experience sleep problems. Whereas sleep is a predictor of behavioral outcomes in children, there is limited evidence regarding sleep as an indicator of neurodevelopmental concerns. This study examined the prevalence of sleep issues and neurodevelopmental conditions in children with a history of prematurity, as well as the role of sleep as a potential indicator for future developmental and behavioral concerns.

Methods
Electronic health records of 57 young children (M = 31.9 gestational weeks, range = 23 to 40 weeks; 35.1% girls) presenting to a neonatal follow-up clinic were reviewed. Caregivers completed the Brief Infant Sleep Questionnaire (BISQ-R) between 6-16 corrected months (Mage = 11.6 mos) and then completed the Modified Checklist for Autism in Toddlers (M-CHAT) between 16-26 corrected months (Mage = 20.9 mos). Caregivers also completed the Survey of Wellbeing of Young Children (SWYC; n = 56; Mage = 20.9 mos) and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA; n = 32; Mage = 17.4 mos).

Results
Approximately one-quarter (26.3%) of subjects had a caregiver-perceived child sleep problem at ages 6-16 corrected months. A total of 40.4% of children had clinically significant autism concerns on the M-CHAT and 67.9% had clinically significant concerns on the SWYC. Subsequent caregiver ratings showed that 25.0% of children exhibited challenging behaviors and 34.4% lower social-emotional competency on the BITSEA. Children who demonstrated clinically significant autism risk on the M-CHAT were more likely to have a prior caregiver-identified child sleep problem. Those who later failed the M-CHAT also had increased night waking frequency (2.43 vs 1.82 wakings) earlier in development. Logistic regression indicated that caregiver-identified sleep problems significantly predicted subsequent challenging behaviors on the BITSEA but not later neurodevelopmental concerns on the SWYC or social-emotional competencies on the BITSEA.

Conclusion
These pilot data suggest that a caregiver-identified child sleep problem at age 6-16 months corrected is linked to more frequent challenging child behaviors in toddlerhood (16-26 corrected months). Caregiver-identified child sleep problems and more night wakings also predicted later neurodevelopmental concerns. Sleep problems in premature infants may thus be an early indication of later behavioral and neurodevelopmental issues.

Support (if any)
0792 TigerCHAT: A School-Based Health Education Program Promoting Wellness and Sleep Health in a Rural Community
Authors: Feeley Christine , Gibson-Young Linda 
Published: May 2023

Abstract

Introduction
There is increasing awareness of the importance of sleep for overall health and wellness in children. However, many children are still not getting the recommended hours of sleep necessary for optimal school functioning. The purpose of this project is to describe a school-based health education program (TigerCHAT) and identify common barriers to sleep in 10-11 year old students.

Methods
TigerCHAT is a school-based health education program for children K-6th grades. It focuses on 45-minute sessions addressing various health topics, including sleep. Data are collected after parental consent approved. It was implemented in a rural elementary school in Alabama in the fall of 2018. Eighty-two nursing students over 10 weeks led small groups of students in brief educational modules, including one on sleep, during their scheduled gym period. Before education began, 5th and 6th grade students (10-11 years old) filled out a 22 question “What Keeps Me From Sleeping Well” Questionnaire modified for children from the Sleep Environment Inventory that asked students to circle yes/no/NA.

Results
Frequencies and percentages were run on the data to determine common reasons for disrupted sleep. Children ages 10-11 years in 5th and 6th grade (n=363, 47% female, 53% male, 45.3% Black, 50.8% White, 0.4% Hispanic, 1.5% Asian or Pacific Islander, 68% classified as economically disadvantaged) in a rural elementary school filled out questionnaires. The most frequently cited reasons for not sleeping well included: Noise inside the house (55%, n=198); Room too hot or cold (50%, n=181); Phone calls or text messages during the night (49%, n=176); Needed to go to the bathroom (49%, n=177); The TV, radio, or computer was on (44%, n=160); and Worried about my family (41%, n=149).

Conclusion
Students in this sample overwhelmingly endorsed environmental disrupters as reasons for not sleeping well (temperature of room, presence of noise, phone/technology in room), rather than other stressors on the questionnaire (worry about grades, worry about friends) or physical factors (stomach ache). Environmental factors such as the use of phones and social media should be examined further in this population, as it may be a significant, and potentially modifiable, reason for poor sleep in school age children.

Support (if any)
0794 Effect of Surgical OSA Treatment on Periodic Limb Movements of Sleep in Pediatric Patients
Authors: Ignatiuk Daniel , Nakamura Aisaku , Hossain Md Monir , Simakajornboon Narong 
Published: May 2023

Abstract

Introduction
The relationship between obstructive sleep apnea (OSA) and periodic limb movements of sleep (PLMS) is not completely understood, especially among pediatric patients. Previous research describes varied changes in PLMS following OSA treatment, including increased, decreased, or unchanged PLMS frequency. This study aimed to evaluate the effect of surgical OSA treatment on the periodic limb movement index (PLMI) in pediatric patients with OSA and significant PLMS.

Methods
Retrospective chart review was performed to identify pediatric patients who had polysomnography demonstrating significant PLMS (PLMI ≥ 5/hour) and OSA (obstructive apnea-hypopnea index (OAHI) ≥ 1.5/hour) that was treated with upper airway surgery. Patients aged 1-18 years were included if significant PLMS was present on either pre-treatment or post-treatment polysomnograms between 1/1/2010 and 7/31/2022. Patients were evaluated for changes in PLMI and OAHI between a pre- and post-treatment polysomnogram, each obtained within 12 months of OSA treatment. Patients with inadequate sleep time (&lt; 2 hours) were excluded. Data are reported as mean ± standard deviation and results from mixed effect linear models.

Results
Medical record review identified 198 patients. The average age was 5.3±3.8 years (range 1.1-16.9 years) at pre-treatment polysomnogram, including 129 (65.2%) male patients. Adenotonsillectomy was the most common OSA treatment (n=136). For the whole group, the OAHI decreased from 12.3±15.3 to 5.3±8.1/hour and the PLMI increased from 5.5±8.5 to 7.0±8.7/hour after treatment, for an average PLMI increase of 1.5/hour (SE=0.7, p=0.04). Sub-group analysis of patients with decreased OAHI following treatment (n=152) showed an average PLMI increase of 2.3/hour (SE=0.8, p=0.004), while patients with increased OAHI following treatment (n=44) did not show a significant change in PLMI. There were 74 patients (37.4%) who developed significant PLMS following treatment and 36 patients (18.2%) with significant PLMS before and after treatment.

Conclusion
Effective OSA treatment led to increased PLMI among a majority of children, highlighting the potential for unmasking of PLMS in some pediatric patients with OSA. Furthermore, over one third of patients developed polysomnographic criteria for significant PLMS after OSA management. This may suggest a sub-group of children with OSA who have a PLMD phenotype that may not become apparent until appropriate OSA treatment.

Support (if any)
0795 Implementation of the Pediatric Craniofacial Screening Tool for Sleep Disordered Breathing (PCSS): An Observational Pilot Study
Authors: Heckler Gillian , Gueye-Ndiaye Seyni , Owens Judith 
Published: May 2023

Abstract

Introduction
Pediatric sleep-disordered breathing (SDB) is highly prevalent and associated with craniofacial risk factors not routinely assessed. We developed the Pediatric Craniofacial Screening Tool for Sleep (PCSS) to assess which craniofacial risk factors are closely correlated with SDB symptoms in children.

Methods
Pilot study of children ages 5-12y recruited from eight dental sites across the country to participate in the PCSS screening by dental providers. The primary outcome was SDB measured by the validated PSQ-SRBD questionnaire (22 items, range 0-1, and &gt;0.33 signifying increased SDB risk). The predictors included PCSS total score and individual items comprising of 21 craniofacial features. Neighborhood socioeconomic status (NSES) was characterized by using the Area Deprivation Index (ADI). Correlation and regression analyses modeled the association between PSQ-SRBD and total PCSS score. To assess inter-rater reliability, a subset of subjects had a second PCSS screen by a second dental provider.

Results
The sample included 97 children (94%-Non-Hispanic-White, 4% Hispanic, 2% other; 49%-female), with a mean age of 8.6±2.2. PSQ-SRBD scores were elevated in 20 (20.6%) participants. Three children were reported to overweight (on item specific question of PSQ-SRBD scale). Children with elevated PSQ-SRBD (&gt;0.33) had lower NSES compared to children with PSQ-SRBD scores &lt; 0.33. PSQ-SRBD was associated with total PCSS score (OR=1.17 CI[1.01-1.36], p=0.033) and individual features including, narrow vaulted palate (OR=3.22, CI[0.94-10.93], p=0.03), forward head posture (OR=3.13, CI[1.11, 9.30], p=0.03), tongue thrust (OR=7.04, CI[1.20, 47.67], p=0.03), tongue tie (OR=7.58, CI[1.88, 33.58], p=0.005) and heart-shaped tongue (OR=11.21, CI[1.81, 98.11], p=0.01) after adjustment with age, sex, race and ethnicity. The correlation between total PCSS score and PSQ-SRBD was low (R=0.39, p= &lt; 0.01), however in subjects with at least one positive craniofacial feature, the correlation between significant PCSS features and PSQ-SRBD was moderate (R=0.54, p= &lt; 0.01). There was high inter-rater reliability (kappa=0.75) in a subset of 53 subjects with second PCSS screens.

Conclusion
Multiple craniofacial features assessed during routine dental visits were associated with increased risk for pediatric SDB. This study points to the utility of a craniofacial scale to assess SDB risk in children. This pilot study will be expanded to include a more diverse patient population.

Support (if any)
0797 Correlation between Obstructive Sleep Apnea and Echocardiography Parameters in Infants and Preschool Children with Down Syndrome
Authors: Bandyopadhyay Anuja , Rao Harish , Chmiel Michael , Slaven James , Jalou Hasnaa 
Published: May 2023

Abstract

Introduction
Down syndrome (DS) is one of the most common genetic disorders caused by the Trisomy of chromosome 21. Children with DS secondary to the unique airway anatomy and hypotonia, are at risk for obstructive sleep apnea (OSA). Untreated OSA in children can lead to serious complications because of chronic hypoxia leading to Pulmonary hypertension (PHTN) and Cor pulmonale. An overnight polysomnogram (PSG), the gold standard for diagnosing OSA in children, should be performed within 4 years per American Academy of Pediatrics recommendations. However, OSA in DS has been observed at a much younger age.

Methods
In this single-center retrospective study, data was collected by reviewing the medical records and PSG REDCap database from 2019-2021. Patients with ICD code 10 diagnosis of DS between 0 to 4 years of age who underwent PSG and echocardiography were included. Our primary aim was to assess the severity of OSA in preschool children and describe echocardiogram parameters in DS patients with OSA. We hypothesized that there will be differences in polysomnogram parameters of DS children with and without PHTN.

Results
61 patients met the criteria for the study with the mean age being 11.3 months. 3 patients (5.4%) did not have OSA (apnea hypopnea index (AHI)&lt; 1/hr), 11 patients (19.6%) had mild OSA (AHI 1-4.9/hr), 12 patients (21.4%) had moderate OSA (AHI 5-10/hr), 30 patients had severe OSA (AHI &gt;10/hr). Five patients with missing AHI values were excluded for subsequent analyses. Echocardiogram parameters were compared using the described AHI cut offs to define severity of OSA. OSA was observed to be significantly higher in the group with elevated RV systolic pressure.

Conclusion
Although our study did not find any difference in PSG findings in young children with DS with and without PHTN, obstructive apnea index was significantly elevated in young children with elevated RV systolic pressure. OSA is a significant contributor to the development of PHTN in children with DS. Children with DS are at higher risk for PHTN due to their unique pulmonary vasculature. As PHTN is a significant comorbidity of DS, it is important to perform PSGs early during childhood to detect and treat OSA.

Support (if any)
0800 Pediatric PSG Flagging Etiologies and Impact on Clinical Timeline
Authors: Rani Seema , Schanz John , Gatta Victoria , Kolb August , Strang Abigail , Chidekel Aaron 
Published: May 2023

Abstract

Introduction
There is a paucity of literature regarding “flagged PSGs”, a term used to triage emergent PSGs for expedited scoring and reporting. Given the morbidity and multi organ-system dysfunction of untreated OSAS in children, it is extremely important to identify and treat expediently. The aim of this study was to review flagged PSGs at a tertiary level pediatric sleep center, including management and intervention timelines.

Methods
This is an IRB-approved retrospective chart review of flagged PSGs (N=266) over a three-year period (2019-2022) at a pediatric sleep center. PSGs were flagged based on laboratory protocols and provider discretion. Demographic, clinical, and PSG data were obtained from EMR.

Results
Patients with flagged studies were white (49.2%), non-Hispanic (87.2%), males (66.9%) with (mean ± SD) age (6.9 ± 6.0) years and BMI of (23.3 ± 11.6) kg/m2, respectively. Reasons for flagging studies were repetitive brief oxygen desaturations &lt; 80% (46.6%), sustained desaturations &lt; 85% (32.3%), sustained EtC02 &gt;60mmHg (5.6%), or other concerning events (15.5%). Most common comorbidity was pulmonary (41.4%), followed by genetic (30.5%), cardiac (23.3%), and neuromuscular (11.7%). 23.3% children were obese. 30.1% had prior airway surgeries; most commonly being adenotonsillectomy (70.0%). Mean Apnea-hypopnea index was 47.2 ± 36.1 events/hr. 35% children had hypoxemia and 36.8 % had hypoventilation. Time duration from flagging study to finalized report, surgical, or medical intervention was 4.3 ± 6.0, 78.2 ± 105 and 26.6 ± 93.0 days, respectively. Medical (40.6%) and surgical (37.9%) intervention were similar in frequency; however, children &lt; 8 were more likely to undergo surgery (p&lt; 0.001). Most frequent surgical intervention was adenotonsillectomy (82.1%). Patients with AHI&gt;30 had less time between PSG and surgical intervention (65.3 ± 96.7 days vs 112 ± 119 days, p=0.04).

Conclusion
Most frequent reason for flagging PSG was repetitive brief desaturations. Time to surgical intervention was longer than medical intervention; however, they occurred in similar frequency. Pandemic staffing shortages and PAP machine recalls impacted both interventions. Patients with higher disease severity experienced quicker scoring, report finalization, and surgical intervention. Future directions include establishing protocols between sleep laboratory and surgical teams, assess the impact of this and further streamline care.

Support (if any)