Delayed Sleep Onset Research Articles

Bioavailability of Melatonin after Administration of an Oral Prolonged-Release Tablet and an Immediate-Release Sublingual Spray in Healthy Male Volunteers.

The benefit of exogenous melatonin is based on its bioavailability, which depends on the galenic form, the route of administration, the dosage, and the individual absorption and rate of hepatic metabolism. The objective of this study is to investigate the bioavailability of melatonin after administration of an oral prolonged-release tablet (PR form) and an immediate-release sublingual spray (IR form). The main metabolite of melatonin, 6-sulfatoxymelatonin (6-SMT), was also measured, which has not been done in previous studies. Its determination is important as an index of the hepatic transformation of melatonin. In this single-center, open-label, randomized, crossover study, 14 healthy male volunteers received one tablet of the PR form (1.9 mg melatonin) or two sprays of the IR form (1 mg melatonin) during two visits separated by a washout period. Blood samples were collected over 7 and 9h for the IR and PR form, respectively, to determine the main pharmacokinetic parameters. The observed kinetics were consistent with those expected for immediate and prolonged-release forms. Pulverization of the spray resulted in an early, high plasma melatonin peak (Cmax: 2332±950 pg/mL; Tmax: 23.3±6.5min), whereas tablet intake produced a lower peak (Cmax: 1151±565pg/mL; Tmax: 64.2±44.2min; p<0.001 for comparison of Cmax and Tmax) followed by a plasma melatonin plateau and a more prolonged decay over time. Plasma melatonin/6-SMT AUC0-540/420 ratio was 0.09 for the PR form and 0.16 for the IR form. Both galenic forms were well tolerated. The results suggest that the galenic forms containing melatonin assessed in this study are suitable for the treatment of certain sleep disorders such as sleep onset delay and transient nocturnal awakenings for the IR form and insomnia for the PR form. Registration number: NCT04574141.

Children sleep habits and their knowledge during COVID-19: the impact on quality of life

BackgroundAmid the coronavirus crisis, many aspects of children's lives had been compromised, among which were their sleep habits. The current study aimed to examine children's sleep habits and the children's knowledge of the pandemic and its impact on their quality of life during the COVID-19 pandemic. Using observational cross-sectional analysis based on web-based questionnaires and face-to-face interviews, Parents completed the children's sleep habits questionnaire (CSHQ) and the pediatric quality of life inventory (PedsQL-P), and the questionnaire regarding their children's knowledge about COVID-19.ResultsAmong the total sample (n = 259), Children below the age of 6 (n = 52) showed statistically significant higher scores in the bedtime resistance, delayed sleep onset, and sleep anxiety subscales, while those older than the age of 12 (n = 50) showed a higher score in the sleep duration problem subscale and lower scores of physical, emotional and psychological functions. Finally, (71.4%) of the study population showed a high level of knowledge about the infectivity of the coronavirus and the fact that it is a pandemic.ConclusionsSleep problems are common among Egyptian children during the COVID-19 pandemic and have a significant impact on their quality of life.

Serdexmethylphenidate/dexmethylphenidate effects on sleep in children with attention-deficit/hyperactivity disorder.

Sleep-related problems are common in children with attention-deficit/hyperactivity disorder (ADHD). Sleep disorders are also side effects of all stimulant ADHD medications. Serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH) is a once-daily treatment approved for patients age 6 years and older with ADHD. In this analysis, sleep behavior was assessed during SDX/d-MPH treatment in children with ADHD. In a 12-month, dose-optimized, open-label safety study in 6- to 12-year-old participants (NCT03460652), a secondary endpoint was assessment of sleep behavior based on the Children's Sleep Habits Questionnaire (CSHQ) consisting of 8 sleep domains (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing, and daytime sleepiness). This post hoc analysis examined the individual sleep domains in the 12-month safety study. Of 282 participants enrolled, 238 were included in the sleep analysis. At baseline, mean (SD) CSHQ total sleep disturbance score was 53.4 (5.9). After 1 month of treatment, the mean (SD) CSHQ total score significantly decreased to 50.5 (5.4); least-squares mean change from baseline was -2.9 (95% CI: -3.5 to -2.4; p < 0.0001) and remained decreased up to 12 months. Mean sleep-score improvements from baseline to 12 months were statistically significant (p < 0.0001) for 5 of 8 sleep domains, including bedtime resistance, sleep anxiety, night wakings, parasomnias, and daytime sleepiness. Parasomnias and daytime sleepiness sleep domains showed the greatest mean improvement from baseline to 12 months. Sleep onset delay and sleep duration scores increased from baseline to 12 months. No statistically significant worsening occurred from baseline in sleep duration and sleep-disordered breathing domains; however, worsening of sleep onset delay was statistically significant. In this analysis of children taking SDX/d-MPH for ADHD, sleep problems did not worsen based on the mean CSHQ total sleep disturbance score. Statistically significant improvements in most CSHQ sleep domains were observed after 1 month and lasted for up to 12 months of treatment.

Relationship between child sleep problems in autism spectrum disorder and parent mental health and well-being

Sleep problems are a common comorbidity in children and adolescents with autism spectrum disorder (ASD). The aim of this study is to determine how sleep problems affect not only the child with ASD, but parents also. Parents of 409 children and adolescents with ASD completed the Children's Sleep Habits Questionnaire, Pittsburgh Sleep Quality Index, Parenting Stress Index-Short Form, World Health Organization Quality of Life Abbreviated Version (WHOQOL-BREF), Hospital Anxiety and Depression Scale, and the Multidimensional Scale of Perceived Social Support. The majority (86.6%) of parents presented with poor sleep. The majority (95.3%; n = 387) of children presented with sleep problems, while 4.7% (n = 22) did not have sleep problems. A cross-sectional within-subjects research design was utilised, with the following analyses conducted: Pearson correlations, chi-square tests, t-tests, and MANOVAs. Relationships were found between child sleep problems and parent sleep problems, specifically child parasomnias, sleep duration, night wakings, and sleep onset delay. Parents of children with sleep problems experienced more parenting stress, specifically on the Difficult Child and Parent-Child Dysfunctional Interaction subscales of the Parenting Stress Index-Short Form. Parents of children and adolescents with sleep problems had significantly higher levels of anxiety and depression than parents of children and adolescents who did not have sleep problems. A relationship between sleep problems and lower quality of life was found. Parents of children with sleep problems received significantly lower scores on the WHOQOL-BREF domains of Physical Health, Psychological and Environment than parents of children without sleep problems. There was no significant difference found between parents of children with or without sleep problems on perceived social support. The current study demonstrated how child sleep affects parental well-being. While sleep problems are one comorbid condition in ASD, future research is needed to determine the impact of other comorbidities in parents of children and adolescents with ASD.

0758 Initial Efficacy of a Brief, Trauma-Informed Sleep Intervention for Children in Foster Care

Abstract Introduction Children in foster care experience impairing sleep problems that contribute to greater attachment, emotional and behavioral problems concurrently and over time. Sleep nonetheless remains a critically neglected aspect of health among this vulnerable group. To address the unique sleep needed of this population, we developed a brief, telehealth-delivered behavioral sleep intervention for caregivers of young children currently or formerly in foster care, called Sleep and Adjustment in Foster Environments for Toddlers and Preschoolers (SAFE-T). The current study examined the initial efficacy of SAFE-T. Methods N = 25 foster or adoptive foster parents with a 2- to 5-year-old child (M = 3.9; SD = 1.7) were recruited from the state of Texas. After a baseline assessment including the Children’s Sleep Habits Questionnaire (CSHQ) and Parenting Stress Index (PSI), families were randomized to SAFE-T or an active control group. SAFE-T families (n = 14) received 3 telehealth-delivered sessions with a therapist who provided information about healthy sleep and trauma-informed suggestions for reducing child sleep problems. Control families (n = 11) were sent an informational booklet about sleep to keep. A post-treatment assessment was completed approximately one month after he initial assessment. Results Compared to the control group, the SAFE-T group evidenced greater reductions in total CSHQ sleep problem scores (η2 = .14), including Sleep Anxiety (partial eta squatted = .16), Sleep Onset Delay (η2 = .08), Bedtime Resistance (η2 = .09) and Daytime Sleepiness (η2 = .07) scores at post treatment. Based on the PSI, caregivers in the SAFE-T group reported greater reductions in Difficult Child scores (η2 = .35), Parent-Child Dysfunctional Interactions (η2 = .31) and Parenting Stress (η2 = .16) compared to the control group. Conclusion Medium to very large effects were found for reductions in caregiver-reported child sleep problems as well as parenting stress following intervention with SAFE-T. These promising results suggest that a brief, trauma-informed sleep intervention may be effective in improving child sleep health and caregiver well-being in foster families. Support (if any) This study was funded by the Grant to Enhance and Advance Research (GEAR) from the University of Houston.

0684 Effects of Transcranial Magnetic Stimulation (TMS) on Treatment of Intrusive Thinking in Insomniac Populations

Abstract Introduction Patients with clinical insomnia commonly report intrusive thinking (IT) as a common contributor to delayed sleep onset. Evidence suggests that the default mode network (DMN) may contribute to this intrusive thinking. Therefore, we employed continuous theta burst (cTBS) repetitive transcranial magnetic stimulation (rTMS) to modulate DMN activation, and thus reduce IT before sleep. Methods In a counterbalanced cross-over design, active or sham cTBS was administered to 20 participants with clinical insomnia, 8 males (Mage=31.63, SD=6.74) and 12 females (Mage=23.75, SD=4.29), with sessions separated by at least 5 days. To assess intrusive thoughts prior to sleep, participants took the Glasgow Content of Thoughts Inventory (GCTI). We utilized the subscale of the GCTI measuring sleep and wakefulness. Higher scores indicate more persistent intrusive thoughts. We conducted a mixed ANOVA to examine effects of sham and active cTBS conditions on intrusive thoughts. Results There was a medium effect size (ηp2 =.087) but no significant variance (p&amp;gt;.05) in average IT scores between participants sham cTBS (M=19.100, SD=5.349) and active cTBS (M=18.200, SD=4.502) Post-TMS sessions. There was a significant interaction between sex, TMS, and administration (F(1,18)= 4.697; ηp2=.207; p=.044). We then conducted a simple effects analysis between males and females. There was no significant effect of cTBS condition on reported intrusive thinking post-TMS administration (F(1,7)= .628; ηp2=.082; p=.454). However, there was a significant interaction of cTBS condition on intrusive thoughts post-TMS administration for females (F(1,11)= 5.894; ηp2=.349; p=.034). Post-hoc pairwise comparison revealed that females reported significantly greater intrusive thinking post-TMS administration (M=20.167, SD=5.68) compared to pre-TMS administration (M=17.5, SD=5.73) during their sham cTBS session (p=.042). This was not present post-TMS administration during active cTBS (p&amp;gt;.05). Conclusion There was a decrease in intrusive thoughts relating to sleep and wakefulness in females, but not males, following active TMS. Interestingly, we also observed an increase in intrusive thoughts for the sham condition, suggesting that participants may have developed expectations of improvement and been sensitized to these cognitions when sleep was not improved. These findings are encouraging suggesting that cTBS may improve IT, although preliminary data suggest this may differ between males and females. Support (if any) W81XWH2010173

0035 Melanopsin genetic variants and delayed sleep phenotype – whole genome sequencing analysis

Abstract Introduction Melanopsin (OPN4) is a blue light-sensitive opsin-type G-protein coupled receptor. It is highly expressed in photosensitive retinal ganglion cells which mediate responses to light, including regulation of sleep, circadian photoentrainment, and pupillary light response. Mutations in OPN4 were shown to affect responses to light, ultimately affecting the regulation of circadian rhythms and sleep. Previously, we describe a male carrier of the OPN4 missense variant diagnosed with delayed sleep-wake phase disorder (DSWPD), with a consistent recurrent pattern of delayed sleep onset The rs143641898 [NM_033282.4:c.502C&amp;gt;T p.(Arg168Cys)] variant in the OPN4 gene that was shown in a functional study to render the OPN4 protein non-functional. Methods The analysis was conducted on whole genome sequencing samples obtained from patients with a clinical diagnosis of DSWPD. Age and sex-matched samples were used as controls. Results Here we report an enrichment of OPN4 rare coding variants, MAF&amp;lt; 1, in a set of 117 DSWPD samples as compared to 315 healthy controls. This significant enrichment likely implies that other rare pLOFs can similarly contribute to the delayed sleep phenotype. Moreover, we report a significant association of rs rs1079610, a common variant in OPN4 – with delayed bedtime in DSWPD patients. This variant has been previously reported in association with altered pupillary responses. This effect is not seen in a large set of healthy controls without DSWPD diagnosis. Conclusion The OPN4 discussed rare OPN4 variants likely increase the risk of DSWPD via its direct effect on the pathophysiology along the melanopsin axis. This study offers useful insights for the differential diagnosis and ultimately treatment of DSWPD risk in which patients carry pathogenic variants in the OPN4 gene. Support (if any)

The association between evening social media use and delayed sleep may be causal: Suggestive evidence from 120 million Reddit timestamps

Public health officials and clinicians routinely advise social media users to avoid nighttime social media use due to the perception that this delays the onset of sleep and predisposes to the health risks of insufficient sleep. With some exceptions, the evidence behind this advice mostly derives from surveys identifying an association between self-reported social media usage and self-reported sleep patterns. In principle, these associations could alternatively be explained by users turning to social media to pass the time when they are otherwise having difficulty sleeping, or by individual differences that draw some people to frequent social media use, or by offline activities that overlap with both social media use and delayed sleep. To attempt to distinguish among these explanations, we leveraged estimated bedtimes from 44,000 Reddit users reported in a recent study and their 120 million posts to test whether the relationship between sleep and social media has properties suggestive of a causal relationship. We find that users are especially likely to be active on Reddit after their bedtime (and therefore awake) on nights that they posted to Reddit shortly before bedtime, especially if they posted multiple times or in high-engagement forums that night. Overall, this study lends additional support to the notion that there likely is some causal effect of evening social media use on delayed sleep onset.

0683 Sleep disturbance, social functioning, and suicidal ideation among preadolescent children admitted to intensive psychiatric care

Abstract Introduction Research on preadolescent childhood suicidality is sparse, with recent population-based studies providing support for sociodemographic and diagnostic correlates of preadolescent suicidal ideation. Sleep disturbance is of particular interest in the examination of preadolescent suicidal ideation because sleep health is interlinked with childhood psychosocial functioning; further, there are changes in preadolescent homeostatic regulation of sleep-wake and intrinsic circadian rhythm (i.e., delayed sleep onset), and psychosocial pressures in preadolescence, such as bedtime autonomy, that are increasingly manifested. There is a need to test models that begin to delineate associations between sleep disturbance and childhood suicidal ideation, specifically among youth with early-onset psychopathology. One possible explanatory factor in the association between sleep disturbance and suicidal ideation, grounded in existing theoretical frameworks of suicide, is social functioning (e.g., developmentally appropriate peer interactions and connectedness). The current study tested an indirect effects model in which sleep disturbance is associated with suicidal ideation via social functioning. Methods 223 children (ages 7–12) with severe psychopathology who presented for intensive hospital-based treatment and their caregivers completed an assessment battery at admission, including the parent-reported sleep disturbances via the Children’s Sleep Habits Questionnaire, and child-reported dysregulated negative affect, social functioning, and suicidal ideation. Indirect effects were examined via the PROCESS macro for SPSS Version 4.0. Binary logistic regression was used when suicidality served as the dependent variable. All models controlled for youth age and dysregulated negative affect. Results Higher levels of parent-reported youth sleep disturbances were related to lower levels of youth-report social functioning. Further, lower levels of social functioning and higher levels of sleep disturbances were associated with higher odds of endorsing suicidal ideation. Indirect effects analyses indicated that higher levels of sleep disturbances was associated with increased odds of reporting suicidal ideation via the detrimental impact of sleep disturbances on social functioning. Conclusion The findings support the novel extension of explanatory models of suicide to children and highlight the possible role of sleep disturbance in the etiology of early suicidality. Documenting these associations provides the impetus for fine-grained examination of sleep health and social functioning among children who experience suicidal ideation and severe psychopathology. Support (if any)

Sandman Send Me a Dream: Case of Non-24-Hour Sleep-Wake Disorder in a Sighted Pediatric Patient (P11-9.005)

<h3>Objective:</h3> Non-24-hour sleep-wake disorder (N24SWD) is a circadian rhythm disorder that leads to the inability to consistently sync the sleep wake (SW) pattern to the 24 hour day night cycle. Patients with N24SWD have progressively delayed SW patterns that occur in a cyclic fashion leading to significant interruptions to daily life. N24SWD is most commonly observed in non-sighted individuals impacting an estimated 50% of that population. It is exceedingly rare in patients with sight, with the first published case in 1971. Furthermore, this is even rarer, if ever, previously described in the pediatric population. <h3>Background:</h3> A 12-year-old male was referred for excessive daytime sleepiness and abnormal sleeping patterns. His bedtime is progressively more delayed each day. During periods of unrestricted sleep, sleep onset delays 2–3 hours each night, with a sleep latency of about 30 minutes and 8–10 hours of sleep duration. Return to a normal bedtime of 9:00pm occurs every 7–10 days. There was no other significant sleep history. He denies sleep paralysis, hypnogogic and hypnopompic hallucinations, and snoring. Melatonin had inconsistent success and adverse effects. The patient’s neurological examination was unremarkable. <h3>Design/Methods:</h3> NA <h3>Results:</h3> Actigraphy confirmed the diagnosis of N24SWD demonstrating cycling of SW when allowed a free sleep schedule. Brain MRI without contrast was unremarkable. The patient was initiated on tasimelteon which led to significant improvements in his ability to maintain a consistent bedtime. <h3>Conclusions:</h3> This case demonstrates that not only can N24SWD occur in sighted individuals, but it can certainly be present in the sighted pediatric population. If not identified, it can lead to long term effects on a child’s life, affecting their development and education. This case also demonstrated the benefits of selective melatonin agonists in the treatment of this condition. <b>Disclosure:</b> Dr. Hart has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Jazz Pharmaceuticals. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Avadel. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz Pharmaceuticals. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Jazz Pharmaceuticals. Dr. Morse has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Hayes solicitors. The institution of Dr. Morse has received research support from NIH.

Consensus recommendations on sleeping problems in Phelan-McDermid syndrome

Early onset sleep problems and disorders are very common in individuals with Phelan-McDermid Syndrome (PMS) with rates of up to 90%. These sleep problems and disorders cannot be taken lightly. Not only do they have a major impact on the health, behaviour, functioning and learning opportunities of affected individuals, they can also have detrimental effects on the well-being and resilience of parents and caregivers, ultimately affecting the physical health, mental health and well-being of the whole social system.In this review we aim to understand the types and frequencies of sleeping problems in PMS as the basis for recommendations on their management and treatment and to provide general guidelines for clinicians and practitioners. We conducted an in-depth literature search, summarised findings, and participated in a series of consensus meetings with other consortium members - experts on PMS and stakeholders - to agree on guidelines and recommendations. In parallel, a world-wide survey was created and distributed amongst parents to include their perspective.Our literature search found only four articles specifically focused on sleeping problems in PMS, although some other articles mentioned prevalence and associated factors. Country-specific prevalence rates ranged between 24% and 46%, whereas our parental survey reported 59%. The main problems reported involved difficulty falling asleep and numerous night awakenings, with being restless in sleep, night-time incontinence, and tooth grinding also commonly reported. Only a small number of individuals had undergone a sleep study monitored by a specialist. Bedtime resistance normally decreases with age, but sleep-onset delay, sleep anxiety, parasomnias, problems falling and remaining asleep remain throughout lifespan, with total sleep time improving during adulthood. However, this improvement was also accompanied by a substantial increase in parasomnias. Ultimately, an increase in sleep disorders in children correlates with increased sleep disorders and daytime sleepiness in parents/caregivers.No study to date has focused on the underlying causes of sleeping problems in PMS, but comorbid mental health conditions, somatic causes, or (poly)pharmacy have been proposed as triggers for sleeping disturbances. Currently there is no PMS-specific treatment for sleeping problems, and current recommendations are mostly based on individuals with intellectual disability and/or neurodevelopmental conditions.

The clinical and sleep manifestations in children with FOXG1 syndrome

FOXG1 syndrome is a rare neurodevelopmental disorder associated with severe cognitive dysfunction, autistic behavior, and early-onset hyperkinetic movement disorders. Patients have also been reported to experience sleep disturbances. However, these findings are mainly based on subjective caregivers' reports, and limited by small case numbers. Moreover, no studies using objective evaluation tools, such as actigraphy, have been reported. We analyzed the clinical and sleep manifestations of children with FOXG1 syndrome registered in the FOXG1 Research Foundation Patient Registry database. A total of 258 individuals with FOXG1 syndrome were included in this research. 132 (51.16%) had sleep disturbances. The more impaired of language acquisitions (absence of speech, OR: 3.99, 95%CI = 1.69-9.42, p = 0.002), hyperkinetic movement disorders (OR: 2.64, 95%CI = 1.34-5.20 p =0.005) and feeding difficulties (OR: 2.81, 95% CI = 1.52-5.19, p = 0.001) were significantly associated with an increase in odds of sleep disturbance after adjusting for age, sex, and antiepileptic drugs. We also performed sleep studies on six individuals with FOXG1 syndrome using The Children's Sleep Habits Questionnaire (CSHQ), the Sleep Disturbance Scale for Children (SDSC), and 7-day data from Actiwatch. The Pittsburgh Sleep Quality Index (PSQI) and 7-day data from Actiwatch were also used to evaluate the sleep condition of their parents. The CSHQ scores revealed bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night-waking, and parasomnia. Sleep-wake transition disorders and disorders of initiating and maintaining sleep were also suggested by the SDSC scores. The children's actigraphy revealed short sleep durations, impaired sleep efficiency, longer wake after sleep onset, and frequent night-waking. All caregivers reported significantly higher PSQI scores, mildly declined sleep efficiency, and shorter total sleep duration. Sleep disturbances, especially in initiating and maintaining sleep, are common in individuals with FOXG1 syndrome and their caregivers. Sleep disorders in patients with FOXG1 syndrome and their caregivers should be investigated.

Prevalence of sleep problems and habits among children in Saudi Arabia: A cross-sectional study.

To investigate children's sleep problems, habits, and lifestyle changes. A cross-sectional study was carried out in Riyadh, Saudi Arabia, over a period of 2 months, from August through September 2022, with parents of children aged 2-14 years after reviewing the literature and formulating a validated Google questionnaire containing 30 questions related to sleep habits, problems, and disorders. In total, 585 questionnaires were included in the analysis. The sample comprised 345 (59%) males and 240 (41%) females. The mean age of patients was 7 (range: 2-14) years. Bed-time resistance was the most prevalent sleep problem (70.3%), followed by sleep-onset delay (58.1%), difficulty waking up in the morning on weekdays (41.3%), weekends (38%), and interrupted sleep (31%). An alarmingly high prevalence of hyperactivity (41.8%) and aggressive behaviour (42.2%) was noted. Co-sleeping with parents was reported in 41% of children. Night terror was reported in 20.6% and 26.5% in nightmares. Statistically significant associations were noted between screen time, snoring, and witnessed apnoea with sleep problems. Sleep problems are common among children in Saudi Arabia. The study sheds some light on sleep habits and practices in this age group in Saudi Arabia, such as the high prevalence of bed-time resistance and sleep-onset delay, hyperactivity, and sleep-affecting culprits such as screen time, snoring, and witnessed apnoea.

Sleep Disturbances in Children With Atopic Dermatitis: A Scoping Review.

Atopic dermatitis (AD) is associated with various quality of life concerns including poor sleep. Sleep impairments in children with AD are associated with increased risk of short stature, metabolic syndrome, mental illness and neurocognitive dysfunction. Although the association between AD and sleep disturbance is well established, the specific types of sleep disturbance in pediatric AD patients and their underlying mechanisms are not fully understood. A scoping literature review was performed to characterize and summarize the types of sleep disturbance in children (less than 18 years of age) with AD. 31 papers met inclusion criteria and extracted data were analyzed in an iterative manner. Two types of sleep disturbances were found to be more prevalent in pediatric AD patients in comparison to controls. One category was related to loss of sleep (increased frequency or duration of awakenings, increased sleep fragmentation, delayed sleep onset, decreased total sleep duration, and decreased sleep efficiency). Another category was associated with unusual behaviors during sleep (restlessness/limb movement/scratching, sleep-disordered breathing including obstructive sleep apnea and snoring, nightmares, nocturnal enuresis and nocturnal hyperhidrosis). Some mechanisms underlying these sleep disturbances include pruritus and induced scratching and increased proinflammatory markers induced by sleep loss. Sleep disturbance appears to be associated with AD. We recommend clinicians to consider interventions that may reduce sleep disturbances in children with AD. Further investigation of these sleep disturbances is needed to elucidate pathophysiology, develop additional treatments, and reduce negative impacts on the health outcomes and quality of life in pediatric AD patients.

Sleep Habits of Turkish Preschool Children

Purpose: This study aims to a) provide a detailed description of sleep habits and problems, b) to compare sleep habits and problems among 4-6-year-old typically developing Turkish children, c) to find out parental views on problem sleep behavior. Methods: Participants consisted of 702 parents. Children’s age ranged from 4 to 6 years. Demographics Information Survey and the Children’s Sleep Habits Questionnaire (CSHQ) were administered to parents. Results: Across different age groups bedtime was not different for weekdays. Bedtime during weekends, however, differed across different age groups. Older children were going to bed later. Wake-up time and bedtime for weekdays differed for children who attend preschool. Children attending preschool woke up earlier and went to bed earlier. Sleep duration did not differ for both weekdays and weekends. There was no gender difference in terms of bedtime, wake-up time, and sleep duration for both weekdays and weekends. However, girls’ daytime sleepiness scores and sleep onset delay scores were higher. Conclusions: Sleep problems are prevalent among young Turkish children. Comparing the CSHQ overall and subscale scores of this study with other studies, the most important differences were seen in the bedtime resistance and the sleep anxiety subscales. These discrepancies indicate a cultural difference in bedtime resistance and sleep anxiety of Turkish preschool children. Future research should investigate the effects of parenting and discipline on sleep behavior and problems. Effective intervention programs are needed in order to reduce problems related to bedtime resistance and sleep anxiety of Turkish preschoolers.

An exploratory study of sleep habits in school-aged survivors of retinoblastoma

Objective/BackgroundRetinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits. Patients/methodsSixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data. ResultsGreater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent. ConclusionsSurvivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.

Pre-sleep arousal induced by suspenseful series and cliffhangers have only minor effects on sleep: A sleep laboratory study

Pre-sleep arousal impairs sleep. Therefore, watching suspenseful TV series before sleep is not recommended as they increase arousal. In particular, the consumption of multiple episodes of the same suspenseful TV series in one sitting – termed binge-watching – could lead to large increases in physiological arousal delaying sleep onset. Furthermore, abrupt endings during critical scenes – termed cliffhangers – result in unfinished story lines, which further increase cognitive arousal and could negatively impact sleep architecture and the number of awakenings. However, the effects of binge-watching and cliffhangers on objective sleep parameters are still unknown.Here we tested in a controlled sleep-laboratory setting whether pre-sleep arousal induced by watching 3–4 episodes of a suspenseful TV series has negative effects on sleep in 50 healthy young participants (39 females, mean age = 22.62 ± 2.60 (SD)). Watching a neutral TV series served as a control condition, according to a within-subject design. In one group of participants, the suspenseful TV series ended with a cliffhanger. In the other group, the same TV series ended where no ongoing action was interrupted. Pre-sleep arousal was measured both subjectively with the self-reported level of stress and objectively with the mean heart rate and cortisol level. As expected, suspenseful TV series induced higher cognitive and physiological pre-sleep arousal than neutral control TV series, with highest values for TV series with cliffhangers. In spite of the high pre-sleep arousal, participants fell asleep faster after watching the suspenseful compared with the neutral TV series (F(1,48) = 4.89, p = 0.032, η2 = 0.09). Sleep architecture and the number of awakenings remained unaffected. However, in the first two sleep cycles, heart rate was still higher after watching suspenseful TV series (F(1,48) = 6.76, p = 0.012, η2 = 0.12). And only after cliffhangers, objective sleep quality – measured as the ratio between slow-wave and beta activity during sleep – was lower than in the other conditions (interaction effect, F(1,48) = 5.05, p = 0.029, η2 = 0.10).Our results speak against large impairments of pre-sleep watching of multiple episodes of suspenseful TV series and cliffhangers on sleep quality and architecture. However, unfinished narratives might induce more subtle changes in oscillatory power during sleep, possibly reflecting ongoing cognitive processing during sleep.

Effects of Benson relaxation technique on sleep quality of patients with cardiovascular diseases: A narrative review

Cardiovascular disease (CVD) counts at the forefront of death causes and has become a significant global issue due to its high prevalence rate. The Benson technique can benefit general health conditions in CVD patients. However, there is still controversy over the efficacy of BRT on sleep quality improvement. This narrative review aims to summarize the evaluation of the effects of Benson relaxation technique on sleep quality of patients with cardiovascular diseases. This narrative review was conducted via online databases, such as PubMed, Web of Science, Embase, and Scopus and Google Scholar search engine. Published articles were included in the search from the first until September 10, 2023. Additionally, the bibliographies of pertinent publications were looked up. These databases were searched using a strategy string that combined free text keywords with Medical Subject Heading (MeSH) phrases. The search terms for "Cardiovascular Disease" with synonyms AND "Quality of Sleep" with synonyms were combined with search terms for "Benson Relaxation Technique". English-language published articles that matched the inclusion criteria were evaluated and included. Inclusion criteria included review and all descriptive studies evaluating moral distress and resilience in nurses during COVID-19. Grey literature and letters were excluded from the search results. The study results showed Benson's relaxation technique can increase the sleep quality of patients in terms of mental sleep quality, sleep onset delay, useful sleep, sleep disorders and overall sleep quality. To further increase the sleep of patients after open heart surgery, the Benson relaxation technique is recommended as a complementary method in addition to drug therapy. Benson relaxation technique increases sleep quality in patients with cardiovascular diseases. Therefore, this method can be used as a suitable complementary treatment to improve the sleep quality of these patients.

Sleep problems in adolescents with epilepsy and their caregivers: associations with behavioural difficulties.

The aim of this study was to investigate the frequency of sleep problems in adolescents with epilepsy and their caregivers. We also examined the behavioural difficulties in adolescents with epilepsy and compared these behaviors with healthy controls. This observational case-control study included 37 adolescents with epilepsy and their caregivers, and 43 healthy age-matched adolescents and their caregivers. The Children`s Sleep Habits Questionnaire (CSHQ), DSM-5 Level 2 Sleep Disorders Scale for Children, and Strengths & Difficulties Questionnaire (SDQ) were used to evaluate sleep habits, sleep problems, and behavioural difficulties in adolescents. The DSM-5 sleep disorder scale for adults was used to evaluate the caregivers` sleep problems. Adolescents with epilepsy had higher sleep problem scores such as daytime sleepiness and overall sleep problems compared with healthy controls. The psychopathological symptoms such as conduct problems, hyperactivity/inattention, and total behavior were also more frequent in adolescents with epilepsy. There was a nonsignificant increase in DSM-5 sleep disturbance score in caregivers of adolescents with epilepsy. Sleep onset delay had a significant negative correlation with total behavioral difficulties (r = -0.44, p < 0.01), and emotional problems (r = -0.47, p < 0.05) in adolescents with epilepsy. Sleep duration was negatively correlated with conduct problems (r = -0.33, p < 0.05), but positively correlated with prosocial score (r = 0.46, p < 0.01) in adolescents with epilepsy. Night waking was positively correlated with total behavioral difficulties (r = 0.35, p < 0.05) and hyperactivity score (r = 0.38, p < 0.05) in adolescents with epilepsy. Adolescents with epilepsy have more frequent sleep disturbances and maladaptive behaviors such as hyperactivity/inattention, and conduct problems compared with healthy controls, and their caregivers are more vulnerable to sleep problems. Moreover, we also demonstrated a strong association between sleep disturbances and behavioral problems in adolescents with epilepsy.

Non-alcoholic fatty liver disease and sleep quality: a single center cross-sectional survey study

Sleep-wake disorders are probably a part of Nonalcoholic Fatty Liver Disease (NAFLD) etiology. This study aimed to evaluate the relationship between NAFLD and the Pittsburgh Sleep Quality Index (PSQI) components. Sleep quality was assessed by the PSQI, which comprised seven components. Participants diagnosed with hepatic steatosis using ultrasonographic imaging and healthy volunteers were given the questionnaire. The percentage of subjects with poor sleep quality was noticeably higher in the NAFLD patients than in the non-NAFLD control group (OR: 4.58, 95% CI: 2.67-7.85) (p&lt;0.001). Compared to the control group, the NAFLD group reported shorter sleep duration (p=0.044), a longer sleep onset delay (p&lt;0.001), worse subjective sleep quality (p&lt;0.001), a higher percentage of subjects with sleep disturbances (p&lt;0.001), a higher percentage of subjects using hypnotic drugs (p=0.009), and a higher percentage of subjects with daytime dysfunction (p&lt;0.001). When the subjects were split into two groups based on gender, global PSQI sleep quality and subjective sleep quality were significantly worse in both genders with NAFLD than in the non-NAFLD group (p&lt;0.001). The sleep onset delay of the NAFLD group was substantially longer in males (p=0.002) and females (p&lt;0.001) compared to controls. Sleep disturbances were significantly higher in both sexes with NAFLD compared to controls (p&lt;0.001). The rate of those with daytime dysfunction in the NAFLD group was considerably higher in both genders compared to the non-NAFLD group (p=0.001). Only among the male patients in the NAFLD group the prevalence of hypnotic drug use was substantially greater (p=0.033) than in the non-NAFLD group. Poor sleep was associated with NAFLD in both genders.