bluuebunny/crossref_metadata_2025_split huggingface dataset:
0750 Earlier bedtimes mediate the effect of a brief behavioral intervention on children’s BMIz
Authors: Hart Chantelle , Coffman Donna , Carskadon Mary , Raynor Hollie , Jelalian Elissa , Owens Judith A , Hawley Nicola , Wing Rena 
Published: May 2023

Abstract

Introduction
We demonstrated that a brief behavioral intervention enhanced children’s sleep; those with clinically meaningful improvements in sleep (&gt; 30 m/night), had improvements in body mass index (BMI) and BMI z-scores (BMIz). Given emerging evidence regarding the potential importance of not only sleep duration but sleep timing (i.e., bedtimes) for obesity risk reduction, we explored whether sleep duration and/or sleep timing mediated effects of intervention on BMI and BMIz. We hypothesized that the effect of the intervention on 8-week BMI/BMIz would be mediated by earlier bedtimes and longer sleep duration at 2 weeks post-randomization.

Methods
Participants were 71 children 8-11 years old (mean (SD) age = 9.72 (1.00); 69% female; mean (SD) BMIz = 0.91 (0.935)) who slept &lt; 9.5 h/night and were randomized to a 4-session behavioral intervention to increase nocturnal sleep duration (primarily via advancing bedtimes) or to a control (4 sessions; continue with sleep as usual). Sleep was assessed via 7-day actigraphy; height and weight were measured to calculate BMI/BMIz at baseline, 2- and 8-weeks post randomization. We assessed mediation using the medflex R package. Models predicting 8-week BMIz and BMI controlled for baseline BMIz and BMI, respectively. Duration (mean actigraph sleep period) and bedtime (mean actigraph sleep onset) were entered as continuous variables in models.

Results
Relative to control, the behavioral intervention decreased children’s 8-week BMIz by -0.027 (SE = 0.013) via its effect on week 2 bedtimes (z = -2.066, p = 0.039). There was no direct effect of intervention on 8-week BMIz (z = 1.584, p = 0.113), and although of marginal significance, week 2 sleep duration did not mediate effects of intervention on 8-week BMIz (z = -1.937, p = 0.053). Findings focused on BMI, although consistent, did not reach statistical significance.

Conclusion
A behavioral intervention designed to enhance school-aged children’s nocturnal sleep had a positive impact on children’s weight status via its effect on bedtimes, and to a lesser degree, sleep duration. Findings add to emerging work supporting the potential importance of sleep timing in weight regulation.

Support (if any)
R01HL092910; P20GM139743
0762 Early life sleep characteristics and their associations with 1 to 5.5 years old respiratory and allergic multi-trajectories
Authors: Saade Danielle , Delvert Rosalie , Raherison-Semjen Chantal , Dumas Orianne , Sedki Mohammed , de Lauzon-Guillain Blandine , Leynaert Bénédicte , Nadif Rachel , Bédard Annabelle , Plancoulaine Sabine 
Published: May 2023

Abstract

Introduction
Sleep troubles have been associated with respiratory and allergic health problems in children, however the time line of their association is overlooked. The current study examined the associations between: (1) sleep patterns at age 1 year and respiratory and allergic multi-trajectories between 1 and 5.5 years; (2) respiratory and allergic multi-trajectories between 1 and 5.5 years and sleep patterns at age 5.5 years in a French birth cohort.

Methods
Clusters of sleep characteristics at age 1 year (nocturnal sleep duration (NSD), day sleep duration (DSD), sleep onset difficulties (SOD), night awakenings (NA)) and at age 5.5 years (NSD, SOD, NA) and respiratory and allergic symptoms multi-trajectory groups between 1 and 5.5 years (wheezing, asthma medication, eczema, allergic conjunctivitis) were identified using unsupervised methods. Associations between sleep clusters at each age and multi-trajectory groups were assessed using multinomial regressions adjusted for potential confounding factors among 9,577 children.

Results
Two sleep clusters were identified at both age 1 and 5.5 years: C1a (79.9%, age 1 year) and C1b (83.1%, age 5.5 years) characterized by adequate sleep duration and good sleep quality; C2a (20.1%, age 1 year) and C2b (16.9%, age 5.5 years) characterized by shorter sleep duration and poorer sleep quality. Four multi-trajectory groups were also identified: G1 (no/few symptoms, 44.4%), G2 (persistent non-respiratory allergic symptoms, 23.1%), G3 (transient early respiratory symptoms, 25.2%), G4 (persistent respiratory and allergic symptoms, 7.3%). Belonging to cluster C2a was associated with an increased odds of belonging to G3 (adjusted odds ratio [95% interval confidence]; 1.14 [0.99-1.31]) and G4 (1.29 [1.05-1.59]). After accounting for sleep clusters at age 1 year, belonging to G4 was associated with an increased odds of belonging to cluster C2b (1.21 [0.98-1.5]).

Conclusion
Sleep disturbances at 1 year were associated with poorer respiratory and allergic health between 1 and 5.5 years and respiratory and allergic problems between age 1 and 5.5 years were associated with sleep troubles at 5.5 years suggesting bidirectionality. Further research is needed to explore potential coevolution of sleep and allergic and respiratory troubles during early childhood.

Support (if any)
ANR-21-CE36-0001-01
0763 EFFECT OF RACIAL AND SOCIOECONOMIC DISPARITIES ON SLEEP DURATION IN CHILDREN
Authors: Rao Harish 
Published: May 2023

Abstract

Introduction
National Survey of Children’s Health is a population-based, nationally representative online and paper survey of primary caregivers of noninstitutionalized U.S. persons aged ≤17 years. Data from 2016-2018 survey (MMWR 2021) published by the Center for Disease Control (CDC) highlighted the racial and economic disparities in sleep duration among children. Children from Black and Hispanic ethnicities had significantly lower sleep duration compared to their white counterparts. Short sleep duration was also more prevalent among families with lower income or lower parental educational attainment. We analyzed the data from questionnaires administered to parents of children presenting for polysomnogram.

Methods
We analyzed a consecutive sample of caregiver completed questionnaires (n=252) of patients between 4- 18 years referred for polysomnogram to our Pediatric Sleep Program. Questions ranged from demographic information to sleep wake times, sleep duration, sleep environment and parental knowledge of age-appropriate sleep requirement. Regression analysis was performed to study the effect of parental education and ethnicity on sleep duration and parental knowledge of sleep requirement.

Results
Children born to mothers with college education or higher had significantly longer duration of sleep (p&lt; 0.05). Mothers with college education or higher were also more aware of age-appropriate sleep requirements. (p&lt; 0.05). Children of Asian, White, and Mixed ethnicity were more likely to have age-appropriate sleep duration compared to Black and Hispanic (p&lt; 0.05). Parents of Asian and White ethnicity were more aware of age-appropriate sleep requirement (p&lt; 0.05). Parental marital status or father’s education status did not show similar effects on sleep duration or knowledge about sleep requirement.

Conclusion
Maternal education and family ethnicity had a significant effect on sleep duration as well as awareness of age-appropriate sleep requirement. Children from families with lower parental educational attainment and Black and Hispanic ethnicities have shorter sleep duration. Findings from our small community-based study mirrored data from large population-based data collected by CDC. Sleep disparity associated with various social determinants of health can increase family stress resulting in environmental and psychological factors that negatively affect sleep duration. Targeted education regarding age-appropriate sleep duration should be provided for ethnic minorities and families with lower income and lower parental education attainment.

Support (if any)
0790 Sleep, Early Solid Introduction, and Allergic Disease in Infancy
Authors: Mindell Jodi , Carson Mikayla , Leichman Erin S , Gould Russell , Alunkal Linda , Mack Catherine , Walters Russel 
Published: May 2023

Abstract

Introduction
Early complementary (solid) food introduction (&lt; 6 months) is at times recommended to reduce the risk of allergic disease, specifically food allergy. However, little is known about solid food introduction and allergic disease as they relate to sleep problems during infancy. Thus, the purpose of this study was to assess the association of sleep problems with early solid food introduction and allergic disease during the first year of life.

Methods
Mothers of 300 infants (0-11.9 mos, M=5.87) completed an online questionnaire about infant sleep, solid food introduction (non-milk, -juice, -formula), and allergic disease (including atopic dermatitis, itchy/dry skin, food allergies). Prevalence of sleep problems was compared in the context of presence or absence of early solid food introduction and allergic disease, using chi-square.

Results
Overall, 29.3% of infants were reported to have a sleep problem, 29.0% atopic dermatitis and/or itchy/dry/flaky (AD/IDF) skin, and 10.7% food allergies. Of infants who were 6 months or older at the time of the study, 24.4% were introduced to solids early (&lt; 6 months). Those infants with early solid food introduction were less likely to have a reported sleep problem (19.5%) compared to those introduced to solids starting at 6 months or later (37.8%), p &lt; .05. For all infants, sleep problems were more likely to be reported in association with AD/IDF than those without those skin conditions (39.1% vs 25.4%), p &lt; .05. No statistically significant differences were found in sleep problem rates between those with a food allergy (40.1%) and those without a food allergy (28.0%), p &gt; .05.

Conclusion
Overall, lower sleep problem rates were associated with early introduction (before 6 months) of solid foods. Presence of sleep problems was associated with reports of atopic dermatitis and itchy/dry/flaky skin. Sleep problems were unrelated to food allergies, although overall rates of food allergies were low in this study.

Support (if any)
Johnson & Johnson Consumer Inc., Skillman, NJ, USA
0830 Novel OSA-driven metric predicts incident dementia in sleep apnea in two different community-based cohort studies
Authors: Trucios Gonzalo Labarca , Esmaeili Neda , Hu Wen-Hsin , Gell Laura , Messineo Ludovico , Vena Daniel , Stone Katie , Yaffe Kristine , Ensrud Kris , Michos Erin , Kwon Younghoon , Redline Susan , White David , Wellman Andrew , Azarbarzin Ali 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with intermittent hypoxemia and sleep fragmentation. In OSA, sleep fragmentation is often measured by the number of electroencephalographic arousals per hour of sleep without considering their intensity. In this study, we sought to determine the association of “arousal intensity” with increased risk of dementia in two independent community-based cohorts: the Osteoporotic Fractures in Men Study (MrOS) and the Multiethnic Study of Atherosclerosis (MESA).

Methods
Arousal intensity was calculated from the baseline polysomnogram of the MrOS and MESA cohorts. We included participants with available data from baseline study to Visit 4 (median follow-up 10.7 [IQR: 10.3 – 11.1] years) in MrOS and from Mesa Sleep to 2018 in MESA (median follow-up 6.8 [IQR:6.2 – 7.3] years). Dementia at baseline or those who reported positive airway pressure therapy were excluded. The primary analysis assessed the association of arousal intensity with incident dementia (primary outcome). Dementia was defined as a significant change in the Teng Mini Mental Test plus self-report of medical diagnosis during the follow-up visit in MrOS and based on the ICD-9 codes from hospital discharge data in MESA. Multiple logistic regression analyses were used to obtain the adjusted odds ratio per 1 standard deviation increase in arousal intensity after adjusting for anthropometric/demographic variables, depression, alcohol, tobacco, and AHI.

Results
A total of 1,136 MrOS and 1,923 MESA participants with complete data were included, with a median age of 76 [IQR 72 – 80] years, (100% Male) and 67 [IQR: 61 - 75] years, (46.3% Male), respectively. In MrOS, 11.4% of men had events and every 1SD increase in arousal intensity was associated with a 23% [95%CI: 0 to 50; p&lt; 0.05] increased risk of incident dementia. In MESA, 3.5% of men had events and every 1SD increase in arousal intensity was associated with a 29% [95%CI: 1 to 65; p&lt; 0.05] increased risk of incident dementia.

Conclusion
In two independent cohorts, high arousal intensity was associated with an increased risk of incident dementia after adjusting for relevant confounders. Quantifying arousal intensity may provide added value for cognitive risk stratification in sleep apnea.

Support (if any)
AASM Foundation (grant number: 254-FP-21).
0842 Feasibility of daytime bright light exposure and urinary 6-sulfatoxymelatonin profiling in the medical ICU: A pilot study
Authors: Intihar Taylor , Doyle Margaret , Lukas Molly , Wright Kenneth , Redeker Nancy , Pisani Margaret , Yaggi H , Knauert Melissa 
Published: May 2023

Abstract

Introduction
Bright daytime light, dim evening light, and near darkness during sleep are optimal lighting conditions to support circadian physiology, wakefulness, and sleep. Such light patterns are absent in the medical intensive care unit (MICU) and are considered one factor contributing to the delayed circadian timing observed in MICU patients. We, therefore, conducted a pilot trial assessing the use of daytime bright light (DBL) in the MICU and tested the feasibility of using urinary 6-sulfatoxymelatonin (aMT6s) as a marker of circadian phase and amplitude.

Methods
We enrolled patients aged &gt;50 years admitted to the MICU without pre-existing circadian disruption. Urine samples were collected every 4 hours starting on study day 1 (D1). Patients were randomized to receive bright light (&gt;1200lux at the angle of gaze, 5000K) for 4 hours or 8 hours starting at 09:00 on D2. Circadian metrics of aMT6s amplitude and acrophase were calculated via gamma distribution cosinor analysis.

Results
Eight (6 males, 2 females) out of 14 pilot participants produced sufficient urine for sampling; one was subsequently excluded due to exogenous melatonin use. Of the seven patients in the analysis, one did not have significant cosinor fit. Mean (SD) age was 74 (9) years and APACHE II illness severity score was 24 (4). D1 median (IQR) aMT6s amplitude was 29,389ng (447-125,874ng) and acrophase was 12:42 (8:30-13:54). D2 (after DBL start), median amplitude was 847,381ng (372-1,694,391ng) and acrophase was 04:36 (03:06-06:06). Six patients received 4-hours and two patients received 8-hours of DBL. Sample size was inadequate for testing differences in circadian outcomes between light assignments and study days.

Conclusion
DBL may promote earlier circadian timing and greater circadian amplitude in critically ill patients. Findings support feasibility of aMT6s in assessing circadian phase and amplitude in MICU patients who produce urine; however, a significant proportion of MICU patients are anuric. Consequently, sample size limitations, potential for masking, and infrequent urine sampling warrant further investigation. These pilot findings have influenced the frequency of aMT6s sampling (e.g., change to hourly) in an ongoing RCT evaluating the impact of DBL versus usual light exposure on circadian rhythms in critical illness.

Support (if any)
K23HL138229, AASM Foundation
0866 Geographic Insufficient Sleep Duration and Cardiometabolic Risk Among Adolescents and Adults in the T1D Exchange Clinic Registry
Authors: Griggs Stephanie , Howard Quiana , Bolton Pamela , Motairek Issam , Al-Kindi Sadeer , Still Carolyn Harmon , Hickman Ronald 
Published: May 2023

Abstract

Introduction
Individuals with type 1 diabetes (T1D) are at a heightened risk for cardiometabolic disease and associated risk factors. Insufficient sleep duration (&lt; 7 hours) may accentuate this risk, but little is known about its geographic distribution. Insufficient sleep is disproportionately distributed across the United States. We sought to determine whether the geographic distribution of insufficient sleep was associated with individual cardiometabolic risk among 18,620 adolescents and adults ages 13-90 years in the T1D Exchange Clinic Registry.

Methods
We linked residence zip codes with prevalence of insufficient sleep generated from the Population Level Analysis and Community Estimates (PLACES) dataset. We examined associations between geographic patterns of sleep duration (area-level) and individual cardiometabolic risk factors (hemoglobin A1c, low-density lipoprotein, blood pressure, body mass index) using multivariable linear regression adjusting for age, sex at birth, T1D duration, and race/ethnicity.

Results
Geographic areas with shorter sleep duration experienced multiple individual cardiometabolic risk factors. Specifically, shorter geographic level sleep duration was associated with higher glycemia (□= .156, p &lt; .001, R2 = .144), higher body mass index (□ = .037, p &lt; .001, R2 = .125), higher low density lipoprotein cholesterol (□ = .022, p &lt; .001, R2 = .031), and higher systolic blood pressure (□ = .021, p &lt; .001, R2 = .142), even after adjusting for covariates (age, sex, type 1 diabetes duration, and race/ethnicity). There were significant differences in age, race/ethnicity, and sex. The association between shorter area-level sleep duration and diastolic blood pressure was no longer significant after adjusting for covariates.

Conclusion
Adolescents and adults with T1D living in areas with a higher prevalence of insufficient sleep had higher cardiometabolic risk even after considering covariates. Future studies are warranted to unravel underlying mechanisms contributing to cardiometabolic risk at the individual level (e.g., sympathetic dysregulation, discrimination, insulin insensitivity, and inflammation) as well as other geographic contributions (e.g., air, light noise pollution, redlining). Understanding the determinants of geographic variability would enhance the utility of these data for public health campaigns.

Support (if any)
This research is supported by the National Institute of Nursing Research (R00NR018886).
0898 Title: Test - Retest Reliability of the Multiple Sleep Latency Test in Non-cataplectic Central Hypersomnia Disorders
Authors: Mora-Munoz Laura , Araujo Matheus , Andrews Noah , Wang Lu , Foldvary-Schaefer Nancy 
Published: May 2023

Abstract

Introduction
Differentiation of narcolepsy type II (NT2) and idiopathic hypersomnia (IH) is challenging in clinical practice. Diagnostic criteria rely on the multiple sleep latency test (MSLT), previously shown to have poor reproducibility in these disorders. We leveraged a large polysomnographic database to study test-retest reliability in non-cataplectic central hypersomnia disorders.

Methods
Patients evaluated at Cleveland Clinic Sleep Disorders Center from 2008-2021 with suspected central hypersomnia disorders excluding narcolepsy type I with &gt;1 PSG/MSLT were included. Studies not meeting validity criteria (&lt; 7hr sleep time on PSG, &lt; 5 MSLT trials, use of REM suppressants/alerting medications within 14 days) were excluded. Diagnostic groupings included NT2, IH and Normal/Indeterminate based on ICSD-3. Reliability and correlation between tests was performed using intra-class and Spearman’s correlations, respectively. Data is presented as mean+SD or median [25th,75th percentiles] for continuous variables and N(%) for categorical variables.

Results
A total of 58 patients (62.1% female, age 31.9 yr [18.5, 48.6]) were included. Interval between MSLTs was 3.6 + 3.18 yr (same diagnosis on both tests: 3.24 + 3.15; changed diagnosis: 3.98 + 3.22). Diagnosis based on MSLT 1 was NT2 8(13.8%), IH 20(34.5%) and Normal/Indeterminate 30(51.7%). Overall, 33(56.9%) patients remained in the same diagnostic category including 3(5.2%) NT2, 12(20.7%) IH and 18(31.0 %) Normal/Indeterminate. Of 25(43.1%) cases changing diagnosis, 3(5.2%) changed from NT2 to IH and 2(3.4%) to Normal/Indeterminate; 4(6.9%) changed from IH to NT2 and 4(6.9%) to Normal/Indeterminate; 5(8.6%) changed from Normal/Indeterminate to NT2 and 7(12.1%) to IH. Median MSL on tests 1 and 2 were 10.8 [4.6,12.9] and 9.0 [4.5,13.1], respectively. Correlation was moderate MSL [0.59 (0.39, 0.73), p&lt; 0.001] and fair for SOREMPs [0.32 (0.07, 0.53), p=0.015]. Intra-class correlation showed moderate reliability in test-retest for MSL [0.56 (0.36, 0.72)] and SOREMPs [0.54 (0.33, 0.70)].

Conclusion
MSLT test-retest reproducibility in non-cataplectic central hypersomnias was moderate in a tertiary care clinic population. While more favorable than prior studies, these findings underscore diagnostic challenges that may contribute to misdiagnosis of patients with hypersomnia.

Support (if any)
0931 App-Supported Sleep Coaching: Implications for Sleep Duration and Sleep Quality
Authors: Grandner Michael , Gorovoy Suzanne 
Published: May 2023

Abstract

Introduction
Sleep coaching programs have emerged to address sleep health needs for subclinical populations. Yet, few such programs have been formally evaluated.

Methods
Data were obtained from N=51 consecutive users who completed the 12-week Sleep Reset program. Sleep Reset (Simple Habit, Inc.) includes ongoing text-based communication with trained coaches and a mobile app that includes a sleep diary, educational modules, mindfulness exercises, and progress-tracking. Potential users with a contraindicated medical/psychiatric problem or a likely sleep disorder (including Insomnia Disorder) are referred for additional care/support. The coaching included information about sleep and circadian principles (e.g., sleep hygiene, behavioral scheduling, light exposure, relaxation) and techniques based on CBTI (e.g., stimulus control). T-tests examined change scores for diary-derived sleep latency (SL), wake after sleep onset (WASO), total sleep time (TST), number of awakenings (NWAK), and sleep efficiency (SE). N=3 had uninterpretable baseline TST. Post-hoc analyses examined those who reported at least one sleep continuity disturbance (SL&gt;=30, WASO&gt;=30, SE&lt; 0.85; N=44) vs none (N=7) and short sleepers (TST&lt; 360 min; N=19) vs 6+ hours (N=32).

Results
Those who participated in the program saw a mean increase in SE of 6.4% (95%CI [2.7%,10.2%], t(50)=3.4, p=0.001) and TST of 57.8 mins (95%CI [33.8,81.8], t(47)=4.9, p&lt; 0.0005), and a mean decrease in SL of 12.2 mins (95%CI [-20.0,-4.4], t(50)=-3.1, p=0.003), WASO of 32.4 mins (95%CI [-52.7,-12.0]. t(50)=-3.2, p=0.002), and NWAK of 0.3 awakenings (95%CI [-0.7,-0.01], t(50)=-2.1, p=0.046). Those who reported a problem were more likely to show an improvement in SE (+7.9% vs -0.3%, p=0.001), SL (-14.8 vs +4.0 mins, p=0.0008), and WASO (-40.5 vs +15.8 mins, p=0.0001), but groups did not differ in terms of change in NWAK and TST. Short sleepers saw a relative improvement in SE (+12.2% vs +3.0%, p=0.037) and TST (+109.8 vs +23.7 mins, p=0.0001), but no differences in change to SL, WASO, and NWAK.

Conclusion
The sleep coaching program improved sleep quality and duration for participants without sleep disorders. Those with baseline sleep continuity problems received the most benefit to SL and WASO, and short sleepers saw a nearly 2-hour average increase in TST. Future studies need to extend this work with control groups.

Support (if any)