Parenting bedtime behaviors and sleep among toddlers living with socioeconomic adversity

Purpose: Sleep problems are very prevalent during the first year of life with 20-30% of infants reported to have a sleep problem. Families most commonly seek support from pediatric health care clinicians regarding their infant and toddler s bedtime resistance and frequent and prolonged night wakening. While much has been published describing sleep patterns and sleep interventions to assist parents in helping their children initiate and maintain sleep, the majority of this literature included children living with middle to high incomes. Consistent with other health disparities, sleep disparities occur in children living in socioeconomically disadvantaged homes and emerging literature suggests that this disparity begins at 12 months. Hence, there is a need to develop interventions to support families living with socioeconomic adversity. The first step, however, is to determine if the significant associations between parenting bedtime interactions and sleep patterns of infants and toddlers commonly reported among families living in families of middle to high incomes is also observed among families living with socioeconomic disadvantage. This presentation will report findings of a study conducted with toddlers (12-15 months old) and their parents living in socioeconomically disadvantaged homes. Because one of the most commonly reported sleep problems among toddlers is night wakening, the focus of our presentation will be the relationships between parenting interactive bedtime behaviors and disrupted sleep and night wakening. Methods: The sample includes 33 healthy toddlers and a parent who live with socioeconomic adversity. Data was collected during two data collection visits. Demographic information collected from the caregiver included their own gender, age, race/ethnicity, marital status, family housing, family income, education level, federal and state assistance, and number and age of children. Data was also collected on the toddler s race/ethnicity, age, gender, birth and medical history. Data on sleep characteristics included subjective and objective measures of sleep duration and efficiency, obtained with questionnaires, diaries, and nine days/nights of actigraphy. In addition to caregiver education collected with the demographics, income to needs ratio was collected as a measure of adversity. Income-to-needs ratio is a standard measure of a family s economic situation. The self-report Parental Interactive Bedtime Behavior Scale (PIBBS) is a 19-item Likert-type parent questionnaire that measures the interactive behaviors caregivers use with their children at bedtime. Five subscales and a total score are calculated: 1. Active physical comforting, 2. Encourage autonomy, 3. Settle by movement, 4. Passive physical comforting, 5. Social comforting. Associations of parenting bedtime interactions and sleep characteristics were examined using Spearman correlation coefficient. Results: Sleep duration among the toddlers was just over 8 hours - much below the 10-13 hours of sleep recommended for this age group by the United States based National Sleep Foundation. Disrupted sleep (sleep fragmentation) and wakening after sleep onset (WASO) between the toddlers were not associated with any of the parenting bedtime interactive bedtime behavior. However, there were significant associations between total parenting interactive behaviors and passive physical comforting and WASO (r=.37, p=.05 and r=.52, p=.002, respectively) within toddlers over the course of their week-long monitored sleep. Similarly, a significant association was found between total parenting interactions and sleep disruption within toddlers (r=.36, p=.05). Conclusion: As described in the extant literature, the findings of this study support the connection between parenting interactions and toddler sleep patterns based on the variability of sleep disruption and night wakening within the toddlers week-long monitored sleep. While active physical comforting (e.g. rocking to sleep, patting or rubbing child s back, etc.) is most commonly associated with sleep patterns in infancy and toddlerhood, findings from this study suggest that passive physical comforting (presence of the parent in the room to fall asleep) was the strongest association with individual variability of the toddler s disrupted sleep and night wakening. Future directions for this work include adding biomarkers of stress response to determine how characteristics of sleep in toddlers are associated with their stress response system as well as additional parenting variables to identify the characteristics of parenting linked to toddler sleep patterns in this populations. These results will then be used to inform the development of future health promotion interventions focused on improving sleep early in life

0847 Sleep Disordered Breathing in a case series of 4 children with Trisomy 18

Abstract Introduction Trisomy 18 (Edwards syndrome) is the second-most-common viable autosomal trisomy syndrome after trisomy 21, occurring in 1 in 2500 pregnancies. Obstructive Sleep Apnea (OSA) in Trisomy 21 has been well described in the literature. Even though trisomy 18 patients have upper airway obstructive (UAO) features overlapping with trisomy 21 that could predispose them to develop SDB, there is a dearth of data published about it. Report of Cases: We present a case series of four patients with trisomy 18 who were evaluated for SDB aged 17mo-3yrs at the time of the reported polysomnographies (PSGs). Two patients had multiple prior studies. Moderate OSA was noted in two patients, and one was noted to have severe OSA, while the fourth patient had resolution of their severe OSA post adenotonsillectomy (T&amp;A). Reduced sleep efficiency was noted in 2 patients. All but one patient had abnormal EEGs, consistent with known underlying seizure disorders. While all patients desaturated during sleep, only two patients fulfilled the criteria for hypoxemia (SpO2 below 90% for more than 5 minutes). One of these had resolution of hypoxemia with a trial of positive airway pressure therapy (PAP) of 5 cmH2O on a titration study. While capnography showed hypoventilation in two patients, one of the patients was treated with supplemental oxygen and the recommendation for titration PSG study to evaluate the need for PAP. Conclusion With aggressive interventions, children with trisomy 18 have seen a higher survival over the recent years. These children often have micrognathia or retrognathia, midface hypoplasia, glossoptosis, and hypotonia, predisposing them to have UAO. Endoscopic assessments reveal laryngomalacia and/or tracheomalacia, tonsillar and adenoid hypertrophy. In a previously reported study by Kettler et al. (2020), a prevalence of SDB of 44.68% was noted compared to the 1-4% average prevalence in non-syndromic children, hence clinicians should have a low threshold to screen them. In our small case series, all 4 patients had moderate-to-severe OSA, to begin with. Our results show that both surgery and PAP therapy may be successful in the treatment of OSA. More longitudinal data is needed to understand the pathology and management of SDB in these children. Support (If Any)   </jats:sec

Consumer sleep technology for children: A scoping review

This is a scoping review protocol for a project evaluating the evidence base for consumer sleep technology in children

Childhood Trauma and Stressful Life Events Are Independently Associated with Sleep Disturbances in Adolescents

Adolescence is a critical developmental period associated with an increase in stress, the appearance of anxiety and depressive symptoms, and changes in sleep patterns. Even though the disruption of sleep patterns in stress and anxiety and depressive disorders is well known, the independent effects of childhood trauma and stressful life events on sleep patterns are less understood. We tested the independent effects of stress (childhood trauma and stressful life events) while controlling for anxiety and depression on adolescent sleep patterns. Seven hundred fifty-two adolescents completed self-report questionnaires about childhood trauma, stressful life events, anxiety, and depression. Four sleep factors identifying movement during sleep, sleep regularity, sleep disturbances and sleep pressure were extracted in the principal component analysis of sleep questions. Both childhood trauma and recent stressful life events were significantly associated with sleep disturbances before and after controlling for anxiety and depression.</jats:p