bluuebunny/crossref_metadata_2025_split huggingface dataset:
0492 FAmily Burden and KIDs' Sleep (FAB-KIDS); Pediatric Sleep Disorders Impact on Family: A retrospective study
Authors: Blaty Justin , Chen Maida 
Published: May 2022

Abstract

Introduction
Little is known about the far-reaching impacts of pediatric sleep difficulties on family function, though widely thought to be a common reason to seek care, few pediatric sleep centers have adequate support resources for families. Valid, reliable instruments, including the Revised Impact On Family Scale (RIOFS), exist which can be used to reflect the psychological and social impact chronic childhood illness have on family life. We aim to assess the relationship between impact on life related to pediatric sleep disorders.

Methods
Retrospective chart review. Data from medical records, sleep study reports, and RIOFS results were extracted from children undergoing clinically ordered polysomnography at a tertiary pediatric sleep center. IRB approval was obtained. Preliminary data from 91 children were analyzed with descriptive and correlational statistics. The RIOFS is a 15 item Likert scale questionnaire with possible scores of 15-60; higher scores equate higher family stress.

Results
Of the 91 subjects, 44% were girls. Average age at time of study was 8.9 (+/-5.4) years. Study types were 85% PSG, 15% titration. Average BMI percentile was 74%. Mean RIOFS score =28 (+/-9.8, 15-60). Initial correlation of RIOFS total score to PSG metrics did not show a significant correlation between hypothesized factors such as oAHI and RIOFS score (r 0.009, CI [-0.163, 0.182], p=0.927) or Sleep Efficiency (r 0.054, CI [-0.152, 0.256], p=0.609). Preliminary review suggests that the specific question on fatigue has the strongest correlation with increased AHI (r -0.171, CI [-0.047, 0.005], p=0.11).

Conclusion
In a cohort of patients referred to pediatric sleep lab, mean RIOFS total score was 28. For reference, mean total score for children with Autism Spectrum Disorder =31; with rare metabolic disorders =36.5; at home with tracheostomy and ventilator =40. Our data and published comparisons suggest high levels of family stress in patients referred for sleep studies. Supporting families with clinical social work, psychologists, therapists is key to delivery of effective family-centered care models. With ongoing study, identifiable sleep factors which may predict the highest RIOFS score may be identified. Future research is needed to investigate the best delivery of these services to this high-risk population

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0493 Daytime Sleepiness in Children with Asthma: Is it really the lungs?
Authors: Strang Abigail , Gao David , Rani Seema , Pasquale Frances , Covington Lauren , Patterson Freda , Chidekel Aaron 
Published: May 2022

Abstract

Introduction
Insufficient nocturnal sleep is the most common reason of excessive daytime sleepiness. Children with asthma are at increased risk for sleep disruption secondary to nocturnal respiratory symptoms and medication effects, as well as more common behavioral pediatric sleep challenges. Not yet clear is the relative contribution of asthma severity versus behavioral factors to daytime sleepiness in a sample of children (8-17 years) with asthma.

Methods
This survey-based study was conducted in the outpatient pulmonology clinic at Nemours Children’s Hospital, Delaware between 2018-2021. Children with asthma were eligible if they had a diagnosis of asthma, spoke English, and did not have a developmental disorder. Participants completed four surveys: Pediatric Daytime Sleepiness Scale (PDSS, higher scores=more sleepiness), Pediatric Quality of Life Inventory (PEDS-QL, higher scores=better quality of life), PROMIS Pediatric Anxiety short form (higher scores=more anxiety symptoms), and an investigator-designed survey assessing sleep-related technology use. Asthma factors (e.g., asthma severity, lung function [FEV1], number of prescribed asthma medications) were obtained from the electronic medical record. Descriptives and multiple regression analyses were conducted to identify asthma severity and behavioral predictors of daytime sleepiness, controlling for demographics.

Results
Study participants (N=100) were mean age 12.1 years [SD=2.6], 54% male, and 45% Black. Persistent asthma was common (87%), with a mean of 4.2 (SD=2.5) prescribed asthma medications, and mean FEV1 of 97% (SD=17.8). On behavioral surveys patients scored: PDSS (M=14.13; range=0-31; SD=6.7), PEDS-QL (M=77.38; range=15.6-100; SD=18.6), and PROMIS (M=14.92; range=8-35; SD=7.2). 74% reported cell phone usage within 1 hour of bedtime. Multiple regression models showed that an increased number of prescribed medications (beta=0.168, p=0.042), lower patient-reported quality of life (beta=-0.310, p=0.004), increased anxiety symptoms (beta=0.203, p=0.05) and bedtime cellphone use (beta=0.290, p=0.003) were significantly associated with daytime sleepiness in children with asthma.

Conclusion
A greater number of behavioral than asthma severity factors related to daytime sleepiness in children with asthma. Strategies to reduce anxiety and bedtime cellphone use may be plausible behavioral targets to improve sleep in children with asthma. Further research to examine these associations longitudinally, and in children with more severe asthma, is warranted.

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None
0497 Associations between Sleep Problems and ADHD Symptoms in Early Childhood: A Longitudinal, Primary-Care Based Study
Authors: Davis Naomi , Lunsford-Avery Jessica , Compton Scott , Dawson Geraldine 
Published: May 2022

Abstract

Introduction
Sleep problems are common, impairing correlates of ADHD. These associations may emerge as early as toddlerhood, suggesting sleep-focused interventions in early development may improve ADHD-related outcomes. However, previous research has been limited by cross-sectional methodology and small, clinically-referred samples. Thus, relationships between sleep and ADHD symptoms over time and in non-clinical samples remain unknown. The current study evaluated concurrent and longitudinal relationships between sleep problems and ADHD symptoms in early childhood in a large, non-clinical sample.

Methods
Children were recruited from primary care clinics at an academic medical center and assessed at two time points: T1 (n=1806, mean age: 20 months) and T2 (n=646, mean age: 37 months). Sleep problems and ADHD symptoms were evaluated via the caregiver-reported Child Behavior Checklist (CBCL) Sleep and DSM-Oriented ADHD scales, respectively. At T2, caregivers also completed the ADHD Rating Scale (ADHD-RS), which includes inattention and hyperactive/impulsive subscales. Associations between sleep and ADHD were examined using Pearson correlations at each time point. Stability of and longitudinal relationships between sleep and ADHD symptoms were also examined.

Results
Greater sleep problems were correlated with elevated CBCL ADHD at T1 (r=.40, p&lt;.001) and T2 (r=.49, p&lt;.001). At T2, greater sleep problems were also related to increased ADHD-RS scores (r=.44, p&lt;.001), with similar relationships for inattention (r=.41) and hyperactivity/impulsivity (r=.43). Sleep problems (r=.51, p&lt;.001) and CBCL ADHD (r=.52, p&lt;.001) were moderately stable over time. Using the CBCL, partial correlations indicated that T1 sleep was associated with T2 ADHD after controlling for T1 ADHD (r=.11, p&lt;.01); T1 ADHD was associated with T2 sleep problems after controlling for T1 sleep problems (r=.17, p&lt;.001).

Conclusion
Sleep disturbances and ADHD symptoms were bi-directionally associated in a non-clinical sample of young children recruited in primary care. Results are consistent with conceptualization of ADHD as a 24-hour disorder and suggest that incorporating behavioral sleep techniques into empirically-based ADHD treatments may improve clinical outcomes for young children displaying ADHD symptoms. Future research may focus on 1) optimizing identification of toddlers and preschoolers at risk for sleep problems and ADHD and 2) developing interventions that can be delivered in primary care settings.

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P50HD093074 , K23MH108704
0509 Behavioral Topography of Bedtime Resistance in Younger and Older Toddlers
Authors: Leichman Erin , Rotella Katie , Mindell Jodi 
Published: May 2022

Abstract

Introduction
Sleep issues in young children are common, however little is known about bedtime resistance across development in toddlers. Thus, the aims of this study were to (1) assess the prevalence of bedtime resistance in younger and older toddlers and (2) examine differences in behavioral topography across groups.

Methods
318 mothers of toddlers (12-36 mos; M =23.1 mos) completed an online questionnaire addressing bedtime resistance, as well as the Brief Infant Sleep Questionnaire–Revised (BISQ-R). The sample included both younger (n=162, 12-23mos) and older (n=156, 24-36mos) toddlers.

Results
Overall, 61.3% endorsed bedtime stalling/fighting/resisting, with no age difference (57.4% younger vs 65.4% older), p &gt; .05. Bedtime resistance commonly occurred after lights out (60% of those who resisted). Resistance also occurred during the bedtime routine (55.9%) and with announcement of bedtime (36.9%). Older toddlers were more likely to resist at announcement of bedtime (51.0% vs. 21.5%, p&lt; .001), with no other age differences for resistance timing. Of the 21 resistant behaviors assessed, younger toddlers were most likely to cry/tantrum (68.8% vs 48.0%) and climb (or attempt) out of the crib (28.0% vs 12.7%), p &lt; .01. Older toddlers were more likely to engage in 16 behaviors, including these most common: wanting a snack/drink (19.4% vs. 57.8%), adult to hug/snuggle/lie down (23.7% vs 53.9%), more time doing a bedtime activity (19.4% vs 49.0%), or a specific item (19.4% vs. 46.1%), getting out of bed (25.8% vs 46.1%), or watching electronics (24.7% vs 42.2%), p &lt; .01.

Conclusion
Most mothers (61%) reported that their toddler resisted in some way at bedtime. No differences in the prevalence of bedtime resistance were found between younger and older toddlers, however the behavioral presentation of resistance differed. Whereas younger toddlers were more likely to cry and attempt climbing out of the crib, older toddlers were more likely to make specific verbal requests and requesting specific activities. These differences likely stem from developing language, motor, and cognitive skills. Ways to help caregivers manage these common bedtime behaviors need to be age and developmentally-based, aligning with presenting behavioral difficulties.

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Johnson & Johnson Consumer Inc., Skillman, NJ, USA
0516 Characterizing Sleep and Mood during COVID for Youth with Allergic Disease
Authors: Booster Genery , Jump Stephanie , Meltzer Lisa 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic significantly disrupted the daily lives of children and adolescents. This study aimed to characterize sleep and mood during COVID in youth with asthma and/or eczema at two times: shortly after the lifting of stay at home orders (Summer 2020 [T1]) and after youth returned to school (Winter 2021 [T2]).

Methods
Pediatric PROMIS measures (Sleep Disturbances, Sleep-Related Impairment, Anxiety, Depressive Symptoms) and the Pediatric Sleep Practices Questionnaire were administered through REDCap. Parents of younger children (YC, 5-7 years, n=16) completed proxy measures for their children, while older children (OC, 8-12 years, n=16) and adolescents (ADOL, 13-17 years, n=17) completed self-report measures.

Results
For YC, mean Sleep Disturbances T-scores significantly decreased between T1 and T2 (62.0 vs. 56.4, p=.02), with no significant changes in the other variables. For OC, there were no significant changes in mean T-scores for any of the outcomes. For ADOL, there was a significant increase in Sleep-Related Impairment between T1 and T2 (52.0 vs. 57.7, p=.003), as well as a significant increase in Depressive Symptoms (48.2 vs. 52.5, p=.04). At T1, technology use prior to bedtime was more common in ADOL (YC=37.5%, OC=37.5%, ADOL=88.2%). At T2, technology use was also more common in ADOL (YC=50.0%, OC=37.5%, ADOL=64.7%), with an increase in YC technology use and a decrease in ADOL technology use observed. Parental presence while falling asleep was greatest in YC at both time points, with no noted changes in any group across time (T1: YC=56.3%, OC=18.8%, ADOL=17.6%; T2: YC=50.0%, OC=25.0%, ADOL=11.8%).

Conclusion
This study was limited by a small sample size, but provides some insights into the sleep and mood of children and adolescents with allergic disease during the first year of the COVID-19 pandemic. Although YC had fewer sleep disturbances at T2, there was an increase in technology use prior to bedtime. For ADOL, some of the changes in sleep, technology use, and depressive symptoms were likely due to the return to school at T2. Finally, it was notable that multiple OC and ADOL required parental presence to fall asleep. Additional research is needed to understand how the ongoing pandemic is impacting children and adolescents.

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0522 Level II Home Sleep Apnea Testing Compared to In-Lab Polysomnography for the Evaluation of Obstructive Sleep Apnea in Youth with Down Syndrome
Authors: Cielo Christopher , Kelly Andrea , Ward Michelle , Falvo Jennifer , Arputhan Ahtish , Walega Rachel , Xanthopoulos Melissa , Tapia Ignacio 
Published: May 2022

Abstract

Introduction
In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA) diagnosis in children. However, cost, insufficient facilities, and disruption to families challenge PSG completion, particularly for youth with disabilities such as Down syndrome (DS) in whom OSA is common. By providing sleep architecture and arousal-associated hypopnea data, level II home sleep apnea testing (HSAT) with EEG has the potential to be accessible and accurate. We hypothesized that compared to PSG, HSAT would be accurate in detecting moderate-severe OSA in youth with DS and preferred by families.

Methods
Prospective comparative effectiveness study. Youth &lt;18 years old with DS underwent in-laboratory PSG and level II HSAT at home. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored using AASM criteria blinded to PSG result, were compared to reference PSG. OSA was defined as obstructive apnea hypopnea index (OAHI) greater than 5 events per hour on either test.

Results
Thirty-five (17 female) youth aged [median (IQR)] 10.0 (6.1, 16.9) years completed testing. Total sleep time for HSAT was 7.9 (6.9, 8.9) hours versus 6.8 (5.9, 7.0) hours for PSG (p=0.002). PSG OAHI was 12.7/hr (5.3, 21.5). Twenty-six (74.3%) participants had OSA by PSG, 20 of whom were correctly identified by HSAT; one participant with OSA diagnosed by HSAT (OAHI=6.2/hr) was not identified by PSG (OAHI=3.9/hr). Accuracy of HSAT for identifying OSA was 80.0%, sensitivity 76.9%, and specificity 88.9% compared to PSG. Signal quality was good except for pulse oximetry, with median (IQR) adequate signal for 79.5% (57.5%, 86.3%) of the study. Compared to PSG, 83.3% of parents reported that youth had a more normal night’s sleep with HSAT, 70.0% of parents found HSAT easier, and 90.0% of youth preferred HSAT.

Conclusion
In youth with DS, HSAT has good accuracy for detecting moderate-severe OSA. Limitations may include night-to-night variability, differences in environment, or loss of oximetry signal. Youth slept more during HSAT than in-lab PSG and the majority of families preferred level II HSAT. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with DS.

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NIH R21HD101003 (Tapia/Kelly)
0527 Reasons for Early Polysomnography Termination in Pediatric Patients with Sleep-Disordered Breathing
Authors: Luong Shan , Culp Marilyn , Caraballo Michelle , Wani Anna 
Published: May 2022

Abstract

Introduction
Many children with possible obstructive sleep apnea remain unidentified due to low referral rate. Out of the patients who successfully get referred, scheduled, and show up to their polysomnography (PSG), a proportion fail to complete the study. Our focus is to explore what factors can lead to early PSG termination in hopes of proactively identifying the at-risk groups and implementing strategies in the future to help bridge the gap between scheduled and completed studies.

Methods
The sleep lab at the Pediatric Sleep Center at UT Southwestern Medical Center includes 20 pediatric beds across two sites, with &gt;4000 pediatric sleep studies run per year. We retrospectively reviewed all studies from January 1, 2017 through December 31, 2019 that were terminated before study completion. We investigated reasons for early termination in each case and gathered patient characteristics such as age, gender, presence of neurocognitive impairment, payor status to identify predictors of unsuccessful studies. We also looked at variability in time of year and testing sites in early study termination.

Results
From the data review of 138 patients, we identified the 3 main reasons for termination to be intolerance to equipment (n=65), acute illness (n=45), or refusal by parent (n=28). There was a greater proportion of patients who terminated due to illness, relative to the other two reasons, in the winter (p = 0.01 refusal by parent; p = 0.02 intolerance to equipment) and a lesser percentage in the summer (p = 0.003 refusal by parent; p &lt; 0.001 intolerance to equipment). There was a greater proportion of subjects who were neurocognitively impaired that terminated due to intolerance to equipment relative to those that terminated due to illness (p = 0.002).

Conclusion
In our retrospective analysis of the three main reasons for early PSG termination, we did not notice any difference between location sites, age groups, or payor status. In the future, efforts to prevent underutilization of the lab should focus on illness screening especially in the summer and winter as well as development of tools to assess tolerance especially in the neurologically impaired.

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0530 A Study of Pediatric PAP Compliance in Longitudinal and Single-Visit Patients
Authors: Culp Marilyn , Luong Shan , Nguyen Emily , Wani Anna 
Published: May 2022

Abstract

Introduction
PAP compliance is difficult to attain and maintain, but important for treatment efficacy in obstructive sleep apnea. This study sought to identify patterns of compliance by age, stratified by gender and device type in patients who followed up only once after treatment initiation (single-visit patients) and those who were seen more than once (longitudinal patients).

Methods
Charts for approximately 10 months from 10/2018 to 7/2019 were retrospectively reviewed for 1177 patient visits, representing 521 patients with 246 single-visit and 275 longitudinal patients. Some longitudinal patients had visits dating back to 2002. Data analyzed included: age at visit versus compliance measured by percentage of days used and percentage of days used over 4 hours during their compliance period. Data was analyzed for single visit and longitudinal patients stratified by gender and device type. Age was categorized as 0 to 24 months, then years 3.0 to 5.9, 6.0 to 12.9, 13.0 to 18.9 and 19.0 to 21.9.

Results
Patient demographics: 47.2% single-visit, 52.8% longitudinal; 60% male; Approximately 80% between 6 and 18.9-years-old; 80.8% used CPAP. Statistically significant results:Seen for different age groups among females (p=0.012): Females 19 to 21.9-years-old had 45.8% lower compliance for percentage of days used over 4 hours compared to 3 to 18.9-years-old.Longitudinal patients showed 7.5% and 2.4% better compliance for percentage of days used (p=0.0006) and for days used over 4 hours (p=0.002), respectively, compared to single-visit patients after adjusting for sex and age group. Using a BPAP device was associated with 8.9% better compliance for use over 4 hours (p=0.002) compared to CPAP after adjusting for sex, age and visit groups. Longitudinal patients had 7.7% higher compliance for % days used over 4 hours compared to single visit patients (p=0.0016) after adjusting for sex, age group and device.

Conclusion
Statistically significant positive factors for compliance were longitudinal patients versus single-visit patients and those using BPAP.Among females, 19 to 21.9-year-olds were least compliant, otherwise no differences between age or gender were identified.

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0537 Symptom Improvement Reported with Some PAP Use in Non-adherent Pediatric Patients with OSA
Authors: Scribner April , White Jennifer , Pruss Kristi , Jambhekar Supriya , Spray Beverly 
Published: May 2022

Abstract

Introduction
Positive airway pressure (PAP) is commonly used in children to treat obstructive sleep apnea (OSA) when surgery is not an option or is ineffective1-3, but adherence is often poor. Observational studies suggest utilization of PAP improves symptoms, signs, and polysomnogram indices of OSA in at least 85% of children4-9. The Agency for Healthcare Research and Quality released the report “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea”10. Conclusions of this report determined that the published evidence reviewed does not support that PAP affects long term outcomes. No pediatric studies were included in this report. Objectives of this study were to determine if pediatric patients with OSA who are non-adherent to PAP therapy report an improvement in symptoms with some use of PAP.

Methods
A retrospective chart review was performed on patients with OSA on PAP seen in the pediatric sleep clinic. Patients were considered adherent to PAP if usage was longer than 4 hours/night for 70% of nights or more. Follow up visits occurred around 3 months, 6 months, 1 year, and 18 months-2 years. Adherence data and reported improvement in symptoms were documented at each visit, and demographical information was obtained.

Results
235 patients were included in the analysis (63.9% male, 32.3% female, 3.8% missing), with a mean age (SD) at PAP initiation of 12 years (4.5). The sample was predominately Caucasian (51.5%) or African American (38.3%), 85.9% were non-Hispanic, and 53.2% obese. The mean (SD) apnea-hypopnea index was 24.7(27.6)/hr. At first visit post-initiation, of the 138 patients that had adherence data available, 80.4% reported improvement in symptoms with PAP use. Of these patients, 55.86% were non-adherent but reported symptom improvement with some use of PAP. Visit 4 data was available for 74 patients. At visit 4, 91.9% reported improvement in symptoms. Of these, 48.53% were considered non-adherent but reported symptom improvement with some use of PAP.

Conclusion
Historically, PAP adherence in children has been relatively poor11. Utilizing PAP therapy to treat OSA may result in an improvement in symptoms when used in patients who are considered non-adherent to therapy.

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