Child Sleep Outcomes Research Articles

Telehealth-delivered behavioral sleep interventions for Autistic children: An evaluation of an enhanced stepped-care approach

BackgroundSleep problems are common among Autistic children and can have adverse effects on their development, well-being and quality of life. Telehealth offers a cost-effective and accessible model of delivering evidence-based sleep support. This study used a single-case design to evaluate the efficacy of telehealth-delivered behavioral sleep intervention (TDBSI), with intervention phases designed based according to a stepped-care approach. MethodFourteen Autistic children (3–17 years) and their parents participated in a 12-week program consisting of three sequential intervention phases: 1) self-directed online parent education supplemented with individualized intervention tip sheets, 2) group parent coaching via video conferencing, and 3) individualized parent coaching via video conferencing. The appropriateness of parent strategy selection and implementation fidelity was rated throughout. Sleep problem severity (SPS) scores are reported for each child as a measure of effect across intervention phases. The Children's Sleep Habits Questionnaire (CSHQ) and CSHQ-Autism are reported as measures of change from baseline to post-intervention. ResultsOnline parent education and tip sheets facilitated early success in parent strategy selection and implementation fidelity. SPS scores demonstrated large and statistically significant improvements in child sleep following the self-directed phase. Parent implementation fidelity and child sleep outcomes were further improved with group and individualized coaching. Post-intervention, the CSHQ and CSHQ-Autism revealed large and statistically significant improvements across subscales and participants compared to baseline. ConclusionsOnline parent education supplemented with individualized tip sheets demonstrates potential for addressing sleep problems in Autistic children. Therapist-led group and individualized parent coaching via videoconferencing show promise as higher intensity support for parents who do not achieve satisfactory results initially.

Infantile atopic dermatitis – increasing severity predicts negative impacts on maternal and infant sleep: a mixed methods study

BackgroundWhile the impacts of atopic dermatitis (AD) on maternal and child sleep outcomes have been previously explored, less is known about the associations between infantile AD and sleep quality and quantity.ObjectiveTo describe the perceived causes of AD-associated maternal sleep disturbances and the association between AD severity and infant sleep outcomes.MethodsMothers with infants aged < 19 months old with a diagnosis of AD were recruited from social media and medical clinics in Winnipeg, Canada between October 2021 and May 2022. Infant AD severity was classified using maternal-reported data on the Patient-Oriented Scoring Atopic Dermatitis tool (PO-SCORAD). Quantitative data were collected via a series of questionnaires with a subset of mothers subsequently completing semi-structured interviews. Quantitative and qualitative data were integrated in the discussion.ResultsMothers of infants with moderate/severe AD (6/12) were more likely to report their infant suffering from a higher degree of sleeplessness (i.e., ≥ 5 on a scale of 0–10) over the past 48 h compared to mothers of infants with mild AD (0/18). This was supported by qualitative findings where mothers described how their infant’s sleep quality and quantity worsened with AD severity. Additionally, 7/32 mothers reported that their child’s AD, regardless of severity, disturbed their sleep. Maternal sleep loss was most commonly attributed to infant itching (6/7), followed by worry (4/7).ConclusionInfantile AD severity was associated with worse sleep outcomes for both mothers and infants. We propose that maternal and infantile sleep quality and quantity can be improved by reducing AD severity through adherence to topical treatments.

An evaluation of a stepped-care telehealth program for improving the sleep of autistic children

BackgroundSleep problems are prevalent in Autistic children, adversely affecting their development, well-being and quality of life. Traditional face-to-face behavioral interventions are hindered by accessibility. Using a single-case design, this study evaluated the efficacy of a stepped-care telehealth-delivered behavioral sleep intervention (TDBSI). MethodSeven Autistic children (aged 4–8) and their parents participated in a 12-week program consisting of baseline plus three sequential intervention phases: (1) self-directed online parent psychoeducation, (2) small group parent coaching via video conferencing, and (3) individualized parent coaching via video conferencing. Parent strategy selection and implementation fidelity were closely monitored and rated across intervention phases. Child sleep outcomes were assessed through daily parent-reported sleep diaries and the Children's Sleep Habits Questionnaire. ResultsFive of seven parents used online parent education to independently select antecedent strategies (e.g., sleep hygiene, stimulus control) and/or rewards that were appropriate for their child’s sleep and implemented them with high fidelity. This resulted in reductions in sleep onset latency, night wakings, early wakings, and bedsharing for their children. Parent implementation fidelity and child sleep outcomes were further improved for all participants with group or individualized coaching, and results were maintained at 12 weeks and six months post-intervention. ConclusionsTDBSIs show promise in addressing sleep difficulties in Autistic children, warranting further investigation and replication.

Social Capital and Sleep Outcomes Across Childhood in United States Families.

To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income. Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration. In our sample (N=35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime. Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes.

Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis.

Up to 50% of children and adolescents in the United States (U.S.) experience sleep problems. While existing research suggests that perceived stress in caregivers is associated with poorer sleep outcomes in children, research on this relationship is often limited to infant and early childhood populations; therefore, we investigated this association in school-age children and adolescents. We used cross-sectional caregiver-reported surveys and applied item response theory (IRT) followed by meta-analysis to assess the relationship between caregiver perceived stress and child sleep disturbance, and moderation of this relationship by child age and the presence of a child mental or physical health condition. We analyzed data from the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program, a collaboration of existing pediatric longitudinal cohort studies that collectively contribute a diverse and large sample size ideal for addressing questions related to children's health and consolidating results across population studies. Participants included caregivers of children ages 8 to 16 years from four ECHO cohorts. Caregiver perceived stress was measured using the Perceived Stress Scale (PSS), and child sleep disturbance was assessed using five sleep-related items from the School-Age version of the Child Behavior Checklist (CBCL). Increases in caregiver perceived stress and child mental or physical health condition were independently associated with greater sleep disturbance among children. The findings reinforce the importance of accounting for, and potentially intervening on, the broader family context and children's mental and physical health in the interest of improving sleep health.

Characterization of sleep in emerging adults with cystic fibrosis on elexacaftor/tezacaftor/ivacaftor

Characterization of sleep in emerging adults with cystic fibrosis on elexacaftor/tezacaftor/ivacaftor

Respiratory and sleep outcomes in children with SMA treated with nusinersen - real world experience

It is unclear how improvements in peripheral motor function in children with spinal muscular atrophy (SMA), treated with nusinersen, translate into clinically significant respiratory/sleep outcomes. A retrospective chart review of SMA children at the Sydney Children's Hospital Network was undertaken looking at 2 years before and after receiving their first dose of nusinersen. Polysomnography (PSG), spirometry and clinical data were collected and analysed using paired and unpaired t-tests for PSG parameters and generalised estimating equations for longitudinal lung function data. Forty-eight children (10 Type 1, 23 Type 2, 15 Type 3) at mean age 6.98 yrs (SD 5.25) for nusinersen initiation were included. There was a statistically significant improvement in oxygen nadir during sleep in individuals post nusinersen (mean of 87.9% to 92.3% (95%CI 1.24 – 7.63, p = 0.01)). Based on clinical and PSG findings, 6/21 patients (5 Type 2, 1 Type 3) ceased nocturnal NIV post nusinersen. Non-significant improvements were demonstrated in mean slope for FVC% predicted, FVC Z-score and mean FVC% predicted. Within 2 years of commencing nusinersen, stabilisation of respiratory outcomes occurred. Whilst some of the SMA type 2/3 cohort ceased NIV, there were no statistically significant improvements lung function and most PSG parameters.

Impact of Crisaborole on Sleep Outcomes in Pediatric Patients with Mild-to-Moderate Atopic Dermatitis.

Using data from three clinical trials, the effect of crisaborole treatment on sleep outcomes for pediatric patients with atopic dermatitis (AD) and their families was examined. This analysis comprised patients aged 2 to < 16years from the double-blind phase 3 CrisADe CORE 1 (NCT02118766) and CORE 2 (NCT02118792) studies, families of patients aged 2 to < 18years from CORE 1 and CORE 2, and patients aged 3months to < 2years from the open-label phase 4 CrisADe CARE 1 study (NCT03356977), all with mild-to-moderate AD who received crisaborole ointment 2% twice daily for 28days. Sleep outcomes were assessed via the Children's Dermatology Life Quality Index and Dermatitis Family Impact questionnaires in CORE 1 and CORE 2 and the Patient-Oriented Eczema Measure questionnaire in CARE 1. In CORE1 and CORE 2, a significantly lower proportion of crisaborole-treated patients than vehicle-treated patients reported sleep disruption at day 29 (48.5% versus 57.7%, p = 0.001). The proportion of families whose sleep was affected by their child's AD in the preceding week was also significantly lower in the crisaborole group (35.8% versus 43.1%, p = 0.02) at day 29. At day 29 in CARE 1, the proportion of crisaborole-treated patients who experienced ≥ 1 night of disturbed sleep in the previous week decreased by 32.1% from baseline. These results suggest that crisaborole improves sleep outcomes in pediatric patients with mild-to-moderate AD and their families.

Perinatal Physiological and Psychological Risk Factors and Childhood Sleep Outcomes: A Systematic Review and Meta-analysis.

The purpose of this study was to investigate the influence of maternal physiological and psychological factors during pregnancy and after birth on infant and children's sleep outcomes. Six databases were searched from inception to April 2021. Longitudinal studies that investigated the association of risk factors during and after pregnancy and children's sleep-related outcomes were included. Hedge's g and odds ratio were pooled as effect size with random effects model. A total of 32 articles were included. Both prenatal maternal alcohol use (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.04-3.28) and tobacco smoking (OR = 1.28, 95% CI: 1.01-1.62) were associated with shorter child sleep duration. Prenatal and postnatal maternal depression symptoms were associated with increased child sleep problems at age 6 months (OR = 1.97, 95% CI: 1.19-3.24, and 2.05, 95% CI: 1.37-3.07, respectively). Prenatal and postnatal maternal major depression disorders were associated with shorter sleep duration (Hedge's g = -0.97, 95% CI: -1.57 to -0.37) and lower sleep efficiency (Hedge's g = -1.44, 95% CI: -1.93 to -0.95). Prenatal anxiety had no impact on child sleep problems (OR = 1.34, 95% CI: 0.86-2.10). Maternal pregnancy and obstetric factors and psychological factors are potential risk factors of poor child sleep health. Future research is warranted to better understand the impact of these risk factors on long-term child sleep outcomes and their potential mediating mechanisms.

Examining the interactive association of family- and neighborhood-level socio-economic characteristics on children's sleep beyond the associations of residency and neighborhood violence

ObjectiveTo examine the interactive association of neighborhood and family socio-economic characteristics (SEC) on children's sleep. DesignSecondary data analyses were completed on the 2014 Ontario Child Health Study, a cross-sectional sample of 10,802 children aged 4-17. ParticipantsChildren (aged 4-11, 50% male; N = 6264) with available sleep outcome data. MethodsMultilevel modeling was used to assess the interactive relationship between family- and neighborhood-level poverty in relation to child sleep outcomes (problems falling asleep, problems staying asleep, weekday and weekend time in bed), above the associations of variables known to be related to sleep at the child (ie, child age, sex, internalizing problems, externalizing problems, chronic illness), family (ie, negative parenting behaviors, family structure, parent mental health, years lived in neighborhood, parent education level), and neighborhood levels (ie, neighborhood size, antisocial behavior). ResultsNeighborhood poverty (p < .01, ß = -0.001, 95% confidence interval [-0.007, -0.002]) was significantly related to shorter weekday time in bed and the interactive association of family and neighborhood poverty was significantly related to weekend time in bed (p < .05, ß = 0.012, 95% confidence interval [0.004, 0.021]). Children living in low poverty neighborhoods with families of higher SEC backgrounds, and children living in high poverty neighborhoods with families of lower SEC backgrounds had the shortest weekend time in bed (9.7 hours). ConclusionsThere is a compound relationship of family and neighborhood poverty on children's sleep above and beyond family- and child-level risk factors.

Examining the interactive effects of family- and neighbourhood-level socio-economic characteristics on child sleep outcomes

Examining the interactive effects of family- and neighbourhood-level socio-economic characteristics on child sleep outcomes

773-P: Impact of Six Months of Hybrid Closed-Loop Use on Sleep in Youth with Type 1 Diabetes and Their Parents

Many youth with T1D and their parents do not achieve sufficient sleep duration or quality. While HCL use improves nocturnal glycemic control, it is unclear whether sleep duration and quality are impacted. The objective of this study was to measure sleep outcomes in children with T1D and parents after HCL initiation. Youth with T1D starting the Tandem Control-IQ (CIQ) and a parent enrolled in an observational study. Actigraphy data (sleep duration, sleep efficiency, and wake after sleep onset (WASO)) and sleep surveys (Pittsburgh Sleep Quality Index (PSQI) , PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment) were collected at baseline and 3- and 6-months after CIQ initiation. Thirty-nine youth (11.1±3.6 yrs (range 3-17) , T1D duration 2.5±3.0 yrs, 54% male) and parents (42.5±6.7 yrs, 18% male) participated. Parents significantly improved WASO at 3- and 6-months (p=0.0 and 0.007) and sleep quality at 3-months (p=0.011) . No significant changes in subjective or objective sleep outcomes for children occurred other than a decrease in PROMIS Sleep-Related Impairment parent proxy at 3 months (p=0.041) . Youth with T1D and their parents experience insufficient sleep duration and poor sleep quality. Parent subjective sleep quality and WASO improved with CIQ use. Improving sleep quality is complex and further research is needed to identify causes of sleep disruptions and intervention methods. Disclosure E.C.Cobry: None. A.J.Karami: None. T.B.Vigers: None. L.Pyle: None. E.Jost: Other Relationship; Tandem Diabetes Care, Inc. L.J.Meltzer: None. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. Funding National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (K12DK094712)

Household chaos mediates the link between family resources and child sleep

PurposeThis study examined the mediational role of household chaos in the link between family resources and child sleep outcomes during the transition to kindergarten. ProceduresParticipants included 230 families of children entering kindergarten (50% female) who participated in an 8-day measurement burst at pre-kindergarten (July-August), early kindergarten (September/October), and mid-kindergarten (November/December). At pre-kindergarten, mothers completFed the Family Resources Scale-Revised (FRS-R), while at pre- and early-kindergarten, trained observers assessed household chaos using the Descriptive In-Home Survey of Chaos-Observer ReporteD (DISCORD). To better understand perturbations in child sleep during this transition, actiwatches (AW Spectrum Plus, Philips/Respironics, Murrysville, PA) were used to measure both child sleep duration and proportion of recommended sleep duration (9+ hours per night) at early- and mid-kindergarten. Main findingsResults found that family resources were more clearly predictive of child sleep outcomes than household income. Controlling for quality of coparenting and maternal depressive symptoms, household chaos mediated the link between family resources and child sleep duration at both early and mid-kindergarten, the link between family resources and the proportion of recommended sleep duration in mid-kindergarten, and the change in proportion of recommended sleep from pre-kindergarten to early-kindergarten. ConclusionsFindings highlight household chaos as a mechanism by which family resources, a metric of socioeconomic risk, influences child sleep during the transition to kindergarten.

Pilot Intervention Targeting Sugary Drink Intake Associated With Improvements in Adolescent Sleep Duration

ObjectiveTo examine temporal associations between participation in a community-based intervention targeting sugary drink intake and sleep outcomes among children. MethodsData are from an ethnically diverse sample of 100 children aged 9–12 years from 2 Massachusetts Boys and Girls Club (BGC) sites who participated in a pilot-site randomized trial (usual BGC programming plus H2GO! intervention vs usual BGC programming). Secondary outcomes of the trial (sleep duration and adequate sleep duration [≥ 9 h/night] were assessed via a self-report survey at baseline, 2 months, and 6 months. Generalized linear and logistic regression models estimated intervention effects associated with outcomes. ResultsThe intervention was associated with increased sleep duration (β = 0.74; 95% confidence interval, 0.03–1.45) and higher odds of adequate sleep (odds ratio, 2.47; 95% confidence interval, 1.06–5.74) at 2 months. Sleep did not differ by treatment condition at 6 months. Conclusions and ImplicationsThis community-based sugary drink intake intervention may be a potential avenue to improve child sleep outcomes in the short term.

613 Variation in Sleep Beliefs and Behaviors Among Caregiver-Child Dyads Participating in a Sleep Extension Intervention

Abstract Introduction Given the high prevalence and poor outcomes of insufficient child sleep, effective interventions for the pediatric primary care setting are needed. Collecting family perspectives on intervention strategies is critical to understand and enhance outcomes, particularly among children who do not experience improvements. This study examined variation in qualitative family sleep beliefs and behaviors by quantitative child sleep outcomes of a sleep extension intervention. Methods A total of 24 caregiver-child dyads (child age 9–12 years, M age 11.3 (SD:1.0) years; 46% male; 50% non-Latinx White; 29% Black) participated in a mobile health sleep extension intervention, between March-December 2019, and completed post-intervention semi-structured telephone interviews to solicit intervention perceptions. The intervention used a 25 factorial design consisting of sleep duration goals and weekly performance feedback, with random assignment to sleep health promotion messaging and financial incentive conditions. Sleep duration was assessed via Fitbit Flex 2 devices during 2-week baseline and 7-week intervention periods. We developed a codebook using a grounded theory approach and conducted coding in NVivo. We compared preliminary qualitative themes among children who showed a &amp;gt;=30-minute improvement in sleep duration (‘responders’) versus those who did not (‘non-responders’). Results Of the 24 dyads, 38% (N=9 dyads) were classified as non-responders. Preliminary qualitative themes included: family beliefs about sleep and electronics usage; the study impact on sleep behaviors; and an enhanced awareness of child sleep. Intervention responder and non-responder dyads similarly described family restrictions on evening electronics usage (e.g., electronic parental controls; physical removal of devices) to benefit child sleep. However, more children classified as intervention responders described the benefits of these restrictions and expressed beliefs about the negative impacts of electronics on sleep. Whereas caregivers of both responders and non-responders described efforts to remind their child to go to bed earlier during the intervention, caregivers in the responder group described being more focused on and active in child sleep extension strategies. These included setting bedtime reminders and adjusting family activities to ensure an extended sleep schedule. Conclusion Addressing caregiver-child beliefs about sleep behaviors and engagement in sleep extension strategies could augment sleep extension intervention outcomes in future research. Support (if any) K01HL123612 (JAM), CHOP (JAM), K23HD094905 (AAW)

Bedtime smart device usage and accelerometer-measured sleep outcomes in children and adolescents

PurposeWe analyzed the association between bedtime smart device usage habits and accelerometer-measured sleep outcomes (total sleeping time, sleep efficiency, and wake after sleep onset) in Hong Kong children and adolescents aged 8–14.MethodsA total of 467 students in Hong Kong participated in this study from 2016 to 2017. They self-reported their bedtime smart device usage habits. The primary caregiver of each participant was also invited to complete a self-administered questionnaire about the family’s social-economic status and bedtime smart device usage habits. An ActiGraph GT3X accelerometer was used to assess participants’ 7-day sleep outcomes.ResultsThe mean age of the participants was 10.3 (SD 1.9), and 54% were girls. Among the participants, 27% (n = 139) used a smart device before sleep, and 33% (n = 170) kept the smart device on before sleep. In total, 27% (n = 128) placed the smart device within reach before sleep, 23% (n = 107) would wake up when notifications were received, and 25% (n = 117) immediately checked the device after being awakened by a notification. Multiple regression controlling for age, sex, socio-economic status, and other confounders showed that those who woke up after receiving a notification had a statistically longer sleeping time (19.7 min, 95% CI: 0.3, 39.1, p = 0.046), lower sleep efficiency (− 0.71%, 95% CI − 1.40, − 0.02, p = 0.04), and a longer wake after sleep onset (2.6 min, 95% CI: 0.1, 5.1, p = 0.045) than those who did not. Nonetheless, all primary caregivers’ bedtime smart device habits were insignificantly associated with all sleep outcomes of their children.ConclusionThose who woke up after receiving smart device notifications had lower sleep efficiency and longer wake after sleep onset than those who did not, and they compensated for their sleep loss by lengthening their total sleep time.

Children who sustained traumatic brain injury take longer to fall asleep compared to children who sustained orthopedic injuries: actigraphy findings

ABSTRACT Objective: Primary: to examine objective sleep outcomes in children who sustained moderate to severe traumatic brain injury (TBI). Secondary: to examine the relation of objective sleep with subjective sleep, fatigue, and injury variables. Setting: A single tertiary brain injury unit. Participants: Children (5–15 years) with moderate to severe TBI (n = 23) or orthopedic injury (OI; n = 13). Design: Cohort study. Measures: Primary: objective sleep measure (actigraphy watch). Secondary: subjective sleep measure (questionnaire), fatigue questionnaire, and injury variables. Results: On actigraphy, children with TBI had longer sleep onset latency compared to children with OI. On the sleep questionnaire, children with TBI obtained higher scores for total sleep disturbance, initiating and maintaining sleep, and excessive somnolence. On the fatigue questionnaire, greater difficulties were found for total, sleep/rest, and cognitive fatigue for the TBI group. In the TBI group, actigraphy data did not correlate with sleep questionnaire, fatigue, or injury variables. Conclusion: Our study showed evidence of objective and subjective sleep disturbance in children with moderate to severe TBI, but these two types of sleep measures were not related. It is possible that distinct mechanisms underpin objective and subjective sleep disturbance, which may require different interventions.

Prenatal cannabis exposure and sleep outcomes in children 9–10 years of age in the adolescent brain cognitive development SM study

ObjectivesAnalyze the associations between prenatal cannabis exposure and child sleep outcomes. MethodsData from the Adolescent Brain Cognitive Development Study (ABCD Study®) was used to determine whether maternal reports of prenatal cannabis use were associated with child sleep outcomes among 11,875 children ages 9–10 controlling for covariates including prenatal substance exposure, mother's education, combined household income, parental marital status, race, child sex, and child age. ResultsEndorsement of any prenatal cannabis use was associated with symptoms of disorders of initiating and maintaining sleep, disorders of arousal, sleep wake disorders, disorders of excessive somnolence, and a summed sleep disorder score (all β > 0.10 and p < 0.03) while frequency of prenatal daily cannabis use was significantly associated with disorders of excessive somnolence (β = 0.29, p = 0.03). ConclusionsAlthough causality is not established, the results suggest potential long-term effects of prenatal cannabis exposure on sleep and the prudence of abstinence from cannabis use while pregnant.

0871 Air Pollution Exposure And Adverse Sleep Health Across The Life Course: A Systematic Review

Abstract Introduction An increasing number of epidemiologic studies have examined air pollution as a possible contributor to adverse sleep health, but the results were mixed. The aims of this systematic review are to investigate and summarize the associations between exposures to air pollutants and various sleep measures across the lifespan. Methods PubMed, CINAHL, Cochrane, Scopus, Web of Science, and PsycInfo were searched through October 2019 to identify original data-based research examining the direct epidemiological associations between air pollution exposures, both ambient and indoor, and various sleep health measures, including sleep quality, sleep duration, sleep disturbances, and daytime sleepiness. Results Twenty-two articles from 2010-2019 spanning a wide range of study populations (from early childhood to elderly) and locations (10 Asian, 4 North American, 3 European, 5 other) were selected for inclusion. Due to variation in both exposure and outcome assessments, conducting a meta-analysis was not plausible. Twenty-one reported a generally positive association between exposure and poor sleep quality. While most studies focused on ambient air pollutants, five assessed the specific effect of indoor exposure. Increased exposure to both ambient and indoor pollutants is associated with increased respiratory sleep problems and a variety of additional adverse sleep outcomes in children and adolescents. In adults, air pollution exposure was most notably related to sleep disordered breathing severity. Conclusion Existing literature generally show negative relationships between exposure to air pollution and sleep health across different ages, countries, and measures. While many associations between air pollution and sleep outcomes have been investigated, the mixed study methodologies and use of subjective air pollution and sleep measures result in a wide range of specific associations. Plausible toxicological mechanisms remain inconclusive. Future studies utilizing objective sleep measures and controlling for all air pollution exposures an individual encounters may help ameliorate variability in the results reported by current published literature. Support yes

0922 Nightly Associations Between Pre-Bedtime Activity, Actigraphic Light, and Sleep in Children With ASD and Insomnia

Abstract Introduction Approximately two thirds of children with Autism Spectrum Disorder (ASD) suffer from chronic insomnia. Current behavioral interventions for insomnia in children with ASD use sleep hygiene guidelines to educate parents and their children regarding sleep promoting habits. However, the relationship between pre-bedtime physical activity/light and sleep is understudied in ASD. The current study examined daily associations between pre-bedtime actigraphically assessed activity/light levels and objective/subjective sleep outcomes in children with ASD and insomnia. Methods Thirty children (Mage=8.5 yrs, SD=1.78 yrs) with comorbid ASD and insomnia completed 14 days of actigraphy measuring ambient white light intensity and activity levels every 30 seconds. Validated sleep scoring algorithms (in Actiware V. 6.0.9) estimated objective sleep onset latency (SOL), total sleep time (TST), wake time after sleep onset (WASO), and average activity/light levels 30, 60, and 120 mins prior to bedtime. Additionally, average activity/light levels 120-240, and 240-360 mins prior to bedtime were computed. Children also completed 14 daily sleep diaries (with parental assistance) measuring subjective reports of the same sleep parameters. Associations between daily estimations of pre-bedtime activity levels, light, and nighttime objective and subjective sleep were examined through multilevel modelling. Bonferroni corrections were performed to account for multiple comparisons. Results After Bonferroni corrections (p&amp;lt;.025 significance level), greater activity within 30 minutes (B=0.0465, p=.0093) and 60 minutes (B=0.0681, p=.0005) of bedtime were associated with longer subjective SOL. Pre-bedtime light exposure was not a significant predictor of sleep outcomes. Conclusion Results suggest that in general, variations in daily pre-bedtime activity, but not light, are associated with worse nightly subjective SOL in children with ASD and insomnia. Findings support that sleep hygiene recommendations in children with ASD include avoidance of higher levels of pre-sleep physical activity. Prospective studies examining temporal causal relationships between pre-bedtime activity and sleep in ASD are warranted. Support Research was supported by a University of Missouri Research Board award (McCrae, PI; Mazurek, Co-PI). Data collected as part of clinical trial NCT02755051 Targeting Sleep in Kids with Autism Spectrum Disorder at the University of Missouri (PI: McCrae).