Sleep Initiation Research Articles

Decreasing Sudden Unexpected Infant Death

Background: Sleep-related sudden unexpected infant death (SUID) is an alarming, potentially preventable event with over 3,500 annual occurrences in the United States (US). In response to sleep-related SUIDs, the American Academy of Pediatrics and National Institutes of Health advocate for safe sleep practices to promote establishment of safe sleep environments for infants through the Safe to Sleep initiative. However, research evidence shows that lack of knowledge in hospital staff and community members (parents/caregivers) and cultural barriers/biases are factors associated with the inability or resistance to adopting safe sleep practices for infants.

Divergent Neural Activity in the VLPO During Anesthesia and Sleep.

The invention of general anesthesia (GA) represents a significant advance in modern clinical practices. However, the exact mechanisms of GA are not entirely understood. Because of the multitude of similarities between GA and sleep, one intriguing hypothesis is that anesthesia may engage the sleep-wake regulation circuits. Here, using fiber photometry and micro-endoscopic imaging of Ca2+ signals at both population and single-cell levels, it investigates how various anesthetics modulate the neural activity in the ventrolateral preoptic nucleus (vLPO), a brain region essential for the initiation of sleep. It is found that different anesthetics primarily induced suppression of neural activity and tended to recruit a similar group of vLPO neurons; however, each anesthetic caused comparable modulations of both wake-active and sleep-active neurons. These results demonstrate that anesthesia creates a different state of neural activity in the vLPO than during natural sleep, suggesting that anesthesia may not engage the same vLPO circuits for sleep generation.

Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life.

Anxiety and sleep disturbance are frequent symptoms during chemotherapy. Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups. Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles. Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life. More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms. Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

Objective Diagnosis of Circadian Rhythm Disorders.

Circadian sleep-wake disorders are common. Because they represent conflict between the timing of the patient's endogenous rhythms and desired timing of sleep, the presenting complaints may include both difficulty of sleep initiation or maintenance and undesired or unplanned daytime or early evening sleepiness. Therefore, circadian disorders may be misdiagnosed as either a primary insomnia or a hypersomnia disorder, depending on which complaint is more troublesome for the patient. Objective information about sleep and wake patterns over long periods is crucial for accurate diagnosis. Actigraphy provides long-term information about the rest/activity pattern about an individual. However, caution should be applied in interpretation of the results because the information provided only includes information of movements, and activity is only an indirect circadian phase marker. Timing of light and melatonin therapy is critical for successful treatment of circadian rhythm disorders. Therefore, results of actigraphy are useful and should be used in conjunction with additional measurements, including 24 hours sleep-wake history, sleep log, and melatonin measurements.

P035 Understanding cosleeping arrangements, motivations and satisfaction with sleep location in cosleeping mothers

Abstract Introduction Nighttime infant care practices differ across the globe. In western cultures, where independent solitary sleep is the norm, there is an expectation that parental presence at bedtime is minimized in favour of teaching children independent sleep initiation, maintenance, and resumption skills. In non-western cultures, parental presence at bedtime and overnight is the accepted norm. Despite and against current safe-sleep recommendations, rates of co-sleeping and bed-sharing are increasing in western countries. The purpose of this study was to understand motivations and satisfaction with mother’s choice to engage in co-sleeping. Methods Using an internet-based survey, this cross-sectional study aimed to understand mothers’ (n=3298) motivations to engage in co-sleeping (includes room-sharing and bed-sharing), and the satisfaction with their sleep arrangements. Results Quantitative analysis reported on the variability in co-sleeping arrangements, intentions, preference and satisfaction with the child (under 12 years) current sleep location. Qualitative analysis reported on parent’s motivation to engage in cosleeping and reasons for dissatisfaction with the sleeping arrangement. Discussion and Conclusion The results of the study overwhelmingly highlights the need for education and information for parents who want to engage in overnight proximal sleeping arrangements with their children. The study lends support to adopt risk minimization approach when providing safe sleep related information to parents. Findings will help inform clinical delivery of culturally appropriate and safe practices to ensure safe sleeping, and enable parents to make informed choices in relation to their children sleep location.

Lavender essential oil fractions alleviate sleep disorders induced by the combination of anxiety and caffeine in mice

Ethnopharmacological relevanceLavender (Lavandula angustifolia Mill.) essential oil is renowned for its use in the treatment of insomnia and mental disorder diseases in folk medicine. Previous pharmacological studies have also shown that lavender essential oil displays sedative and hypnotic activities. However, the active ingredients and mechanism of lavender essential oil for sleep-improving effect remain unclear. Aim of the studyThis study investigates whether inhalation of different fractions of lavender essential oil can attenuate the sleep disturbances induced by combined anxiety and caffeine and explores the underlying mechanisms. Materials and methodsMolecular distillation was applied to separate lavender essential oil into fractions containing different chemical components, and GC-MS was used to analyze the volatile compounds of lavender essential oil and its fractions. The elevated plus maze test, pentobarbital-induced sleep test, and neurotransmitters enzyme-linked immunosorbent assay were conducted to evaluate the anxiolytic and hypnotic effects of lavender essential oil and its fractions on mice suffering from sleep disorders. ResultsThe results of behavioral tests indicated that lavender essential oil and its fractions (3%, v/v) exerted an ameliorating effect on sleep disturbances induced by anxiety and caffeine. The light fraction and heavy fractions exhibited complementary chemical composition, with the former enriched in linalool and trans-β-ocimene and the latter in linalyl acetate, lavandulyl acetate, trans-caryophyllene, etc. The light fraction contributed more to sleep maintenance, and the heavy fraction performed better at sleep initiation. The neurobiological parameters elucidated that the mechanism of lavender essential oil for sleep-improving was multifaceted, related to the GABAergic system, cholinergic system, histaminergic system, and monoamines in the limbic system. The heavy fraction shared a similar mechanism with the lavender essential oil, while the light fraction did not actively participate in the cholinergic system, histaminergic system, and dopaminergic system. ConclusionTaken together, our results demonstrated that different fractions of lavender essential oil played different roles in ameliorating sleep disorders, and this may be credited to their compositional differences and the complicated interactions with the central nervous system. The results are informative for future investigations on the molecular level mechanisms and provide guidance for appropriate applications of lavender essential oil.

Association between night sleep latency and hypertension: A cross-sectional study.

Sleep disorders have been shown to increase the risk of hypertension, while the relationship between night sleep latency and hypertension is less well-known. We aimed to investigate the association between night sleep latency and hypertension, as well as related sleep factors by gender in the Chinese population. We conducted a cross-sectional study of the relationship between night sleep latency and hypertension. The sample size included 619 consecutive hospitalized patients (M/F: 302/317, 64.01 ± 12.27 years). T test, Chi-square test, and ANOVA were performed to analyze baseline data and intergroup comparisons. Spearman correlation analysis was performed to find the interrelationships. Multivariate logistic regression analysis was performed to adjust for covariables. The findings showed hypertension patients had longer night sleep latency (P < .001). After adjusting for confounding factors, night sleep latency was positively correlated with hypertension in both men and women (odds ratio: 1.065, 95% confidence interval: 1.044–1.087). Spearman correlation analysis suggested that night sleep latency was positively correlated with systolic blood pressure (r = 0.186, P < .001), diastolic blood pressure (r = 0.136, P < .001), sleep initiation time (r = 0.091, P = .023), and global Pittsburg Sleep Quality Index score (r = 0.371, P < .001), was negatively correlated with sleep duration (r = −0.186, P < .001), sleep time on weekdays (r = −0.183, P < .001), and sleep time on weekends (r = −0.179, P < .001). Longer night sleep latency was associated with an increased risk of hypertension in men and women, which might involve the pathological progression of hypertension along with other sleep factors.

MANAGEMENT OF STRESS INDUCED INSOMNIA THROUGH AYURVEDA

Urbanization and modernization together are the contributors to lifestyle diseases. This lifestyle impacts on health and well-being. Sleep is one among the best elixir and tonic of life. It is a natural rejuvenator to refresh every living being in the earth. Any alterations in the quantity, quality as well as the patterns of the sleep, contributes to various disorders of sleep. Sleep disturbances occur in many of the psychiatric illnesses and is also as a component of the diagnostic criteria for specific disorders. According to National institute of health, the prevalence of sleep disorders in America is approximately among 14.71 % of the population. A higher prevalence of sleep disorders related to initiation and maintenance of sleep (28%) was reported in an urban population from India. Among these sleep disorders, insomnia is the commonest clinical presentation which is 40% more common in women than in men. Severe insomnia is sleeping less than 3.5 hours in females and 4.5 hours in males, may lead to a reduced life span.

Neuronal gating of tactile input and sleep in 10-month-old infants at typical and elevated likelihood for autism spectrum disorder

Sleep problems in Autism Spectrum Disorder (ASD) emerge early in development, yet the origin remains unclear. Here, we characterise developmental trajectories in sleep onset latency (SOL) and night awakenings in infants at elevated likelihood (EL) for ASD (who have an older sibling with ASD) and infants at typical likelihood (TL) for ASD. Further, we test whether the ability to gate tactile input, using an EEG tactile suppression index (TSI), associates with variation in SOL and night awakenings. Parent-reported night awakenings and SOL from 124 infants (97 at EL for ASD) at 5, 10 and 14 months were analyzed using generalized estimating equations. Compared to TL infants, infants at EL had significantly more awakenings and longer SOL at 10 and 14 months. The TSI predicted SOL concurrently at 10 months, independent of ASD likelihood status, but not longitudinally at 14 months. The TSI did not predict night awakenings concurrently or longitudinally. These results imply that infants at EL for ASD wake up more frequently during the night and take longer to fall asleep from 10 months of age. At 10 months, sensory gating predicts SOL, but not night awakenings, suggesting sensory gating differentially affects neural mechanisms of sleep initiation and maintenance.

Features of the EEG Pattern of Sleep Spindles and Its Diagnostic Significance in Ontogeny.

Analysis of the microstructure of sleep using extended EEG monitoring can provide deep understanding of the neuronal activity of the brain. Sleep spindles (SS) are one of the main EEG patterns occurring during the non-rapid eye movement sleep. SS reflect the process of synchronization and provide sleep initiation and maintenance by suppressing sensory information. SS are associated with a wide range of brain functions, such as memory and neuroplasticity, general intelligence and cognitive performance, which undergo various changes throughout the life. In this review we discuss the features of the formation and regression of SS in humans during ontogeny on the basis of published data of the last 5-6 years and fundamental results of previous studies at the Scientific Centre for Family Health and Human Reproduction Problems that formed the basis of the modern study of neurophysiological phenomena of the wakefulness and sleep. The search for diagnostic patterns and prognostic markers of the pathology of higher nervous activity remains a priority in fundamental studies and medical practice. Modern methods for studying sleep and its EEG patterns are the next step in understanding the neurophysiological aspects of the sleep-wake cycle. This will open prospects for predicting postnatal maturation, understanding the mechanisms of brain neuroplasticity in the "sleep-wakefulness" continuum, which is one of the tasks of modern somnology and neurophysiology.

Sleep Disturbances in Patients with Alcohol Dependence with and without Tobacco Use

Background: sleep disorder is one of the important factors that may lead to an increase in the risk of relapse for people in the early phases of recovery from alcohol addiction. Despite the relevance of this problem, little is known about the sleep features in people with co-occurring alcohol and nicotine use. The aim of study was to investigate the inuence of the smoking factor on the dynamics of sleep characteristics in patients with alcohol dependence . Patients and methods: the 24-week prospective cohort study in 67 smokers (mean age 41 ± 9.2; 23.9% women) and 33 non-smokers (mean age 44 ± 8.2; 21.2% women) admitted to the addiction clinics to receive alcohol withdrawal treatment (ICD-10 code F10.2, dependence syndrome; F10.30, withdrawal syndrome). Sleep characteristics were assessed by self-report (Insomnia Severity Index, Pittsburgh Questionnaire) and by actigraphy watch. Results: a group of smokers experienced greater difculty in sleep initiation compared to non-smokers (61.2% vs 39.4%) ( p ≤ 0.05). The duration and the quality of sleep increased over time of observation in both study groups ( p &lt; 0.001). Throughout the study sleep quality was poorer in smokers compared to non-smokers (17.3 vs 15.9 scores on the Insomnia Severity Index at the rst measurement and 2.6 vs 0.5 scores at the last assessment) ( p &lt; 0.001). The multivariate regression analysis revealed that the smoking was signicantly associated with poor sleep quality (F = 5.348, p = 0.021). Conclusion: smoking can predict poorer sleep quality during early remission in patients with alcohol dependence.

Longitudinal associations of DNA methylation and sleep in children: a meta-analysis

BackgroundSleep is important for healthy functioning in children. Numerous genetic and environmental factors, from conception onwards, may influence this phenotype. Epigenetic mechanisms such as DNA methylation have been proposed to underlie variation in sleep or may be an early-life marker of sleep disturbances. We examined if DNA methylation at birth or in school age is associated with parent-reported and actigraphy-estimated sleep outcomes in children.MethodsWe meta-analysed epigenome-wide association study results. DNA methylation was measured from cord blood at birth in 11 cohorts and from peripheral blood in children (4–13 years) in 8 cohorts. Outcomes included parent-reported sleep duration, sleep initiation and fragmentation problems, and actigraphy-estimated sleep duration, sleep onset latency and wake-after-sleep-onset duration.ResultsWe found no associations between DNA methylation at birth and parent-reported sleep duration (n = 3658), initiation problems (n = 2504), or fragmentation (n = 1681) (p values above cut-off 4.0 × 10–8). Lower methylation at cg24815001 and cg02753354 at birth was associated with longer actigraphy-estimated sleep duration (p = 3.31 × 10–8, n = 577) and sleep onset latency (p = 8.8 × 10–9, n = 580), respectively. DNA methylation in childhood was not cross-sectionally associated with any sleep outcomes (n = 716–2539).ConclusionDNA methylation, at birth or in childhood, was not associated with parent-reported sleep. Associations observed with objectively measured sleep outcomes could be studied further if additional data sets become available.

Infant Safe Sleep Initiative in a Small Volume Maternity Service.

Despite the 2016 American Academy of Pediatrics recommendations for preventing sudden unexpected infant death, there are approximately 3,400 sudden unexpected infant deaths annually in the United States. Modeling of safe sleep practices by nurses in the hospital influences parents' practice at home; however, safe sleep practices are not consistently modeled during the childbirth hospitalization. A quality improvement project was conducted to implement a safe sleep initiative based on the 2016 American Academy of Pediatrics recommendations for nurses caring for hospitalized infants after birth. Evaluation included testing of nurses' knowledge, infant crib audits, and nurses' evaluation of the intervention. A significant improvement was found in overall nurse education scores. Crib audits demonstrated a significant improvement in the following elements: use of multiple blankets, swaddling of the infant, and parent teaching. Nursing surveys reported an increase in confidence to practice safe sleep recommendations and educate and redirect parents. Implementing a safe sleep initiative can increase nurses' knowledge, improve adherence to recommendations with modeling safe sleep practices, and increase parent awareness of safe sleep recommendations, potentially positively affecting adherence after discharge.

0032 Objective and Subjective Measures of Sleep Initiation are Differentially Associated with DNA Methylation in Adolescents

Abstract Introduction The onset of puberty is associated with a shift in the circadian timing of sleep leading to delayed sleep initiation [i.e., later sleep onset time (SOT)] driven by later bedtimes and/or longer sleep onset latency (SOL). Subjective sleep initiation, as per self-reports, and objective sleep initiation, as per actigraphy (ACT) or polysomnography (PSG), assess equally relevant but different domains of the same physiological process. Several GWAS have identified genes associated with sleep and circadian phenotypes; however, little is known regarding the epigenetic basis and significance of delayed sleep initiation in adolescence, a critical developmental period. Methods We analyzed data from 263 adolescents from the Penn State Child Cohort follow-up study who had complete subjective (self-reported questionnaires), at-home 7-night ACT, and in-lab 9-hour PSG data for bedtime, SOL and SOT. Epigenome-wide single-nucleotide resolution of DNA methylation in cytosine-phosphate-guanine (CpG) sites and surrounding regions were obtained from peripheral leukocytes. Linear regression assessed the association between bedtime, SOL and SOT with site-specific methylation levels, adjusting for sex, age, race/ethnicity, body mass index, and psychotropic medication use. P-values were adjusted using the Benjamini &amp; Hochberg method to correct for false discovery rate and, thus, q-values are reported. Results Exome-wide analysis showed differential methylation in 1450 unique genes across the 9 sleep measurements, while GWAS-informed analysis yielded 57 genes. Gene hits were identified for bedtime (PSG), SOL (subjective, ACT and PSG) and SOT (subjective and PSG): 14 genes were associated with both subjective and PSG-measured SOL, 34 with both ACT- and PSG-measured SOL, and one (TBC1D22A) with subjective, ACT- and PSG-measured SOL. One gene (ABTB2) was associated with subjective and PSG-measured SOT. Conclusion Objective and subjective sleep initiation in adolescents is associated with altered DNA methylation in genes previously identified in adult GWAS of sleep and circadian phenotypes. Our data provides evidence for a potential epigenetic link between habitual (subjective and ACT) SOL and in-lab SOT and DNAm in genes involved in circadian regulation (i.e., RASD1, RAI1), metabolism (i.e., FADS1, WNK1, SLC5A6), and neuropsychiatric disorders (i.e., PRR7, SDK1, FAM172A). Support (If Any) National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)

0596 Sleep Disturbances in Cystic Fibrosis and Primary Ciliary Dyskinesia Over Time, Before and After Modulator Therapy

Abstract Introduction Prior studies have shown that cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are associated with sleep disturbances affecting quality of life (QOL).Our aim was to analyze changes in sleep complaints over time in patients with CF and pancreatic insufficiency (CF-PI), pancreatic sufficiency (CF-PS) and PCD, and explore the effect of CFTR modulators. Methods Patients completed age-appropriate sleep quality questionnaires (SDSC, PSQI), quality of life questionnaires (PedQL, QOL-BE) and the Epworth sleepiness scale (ESS). They repeated the same questionnaires 3 years later. In addition, medical records were reviewed for clinical data. Results Of a total of 50 patients, 27 were children and 23 were adults: 33 CF-PI, 8 CF-PS and 9 PCD. On the 3-year follow up questionnaires the PSQI revealed reduced sleep quality in 11 adult patients (47%), and the SDSC score was pathological, in 5 children (18.5%), suggestive of high rates of disturbed sleep. In children the mean SDSC score had not changed from baseline (41.1±11.5) to follow up (42.5±12.35; p=0.778). In adults the PSQI increased from 3.7±2.5 to 4.5±2.8 (p=0.075), most pronounced in adults that were not on modulators (3.9±2.7 to 4.8±3.4; p=0.027). This effect was driven primarily by changes in sleep initiation and maintenance domains. There were no other differences in the sleep complaints between CF-PI, CF-PS and PCD patients, or between patients on and off modulator therapy during the study period. Conclusion Over time, quality of sleep worsened in patients with CF and PCD, particularly the ability to initiate and maintain sleep. Our results may suggest that modulator treatment attenuates the worsening of sleep complaints, however, larger studies are needed to clarify this. Support (If Any) None

0433 Does Social Media Use Before Bed Lead to Sleep Continuity Disturbance?

IntroductionResearch shows that the use of electronics before bed can negatively impact the circadian rhythm and sleep. Less is known, however, about social media use in relation to sleep continuity disturbance (i.e., insomnia). In the early months of the COVID-19 pandemic, social media use increased and updates about the pandemic were easily accessible online. It is possible that social media use before bed could introduce additional psychological stressors due to availability of negative content online and known correlations to depression and anxiety. Thus, the aim of this research was to examine how social media use before bed influenced different subtypes of insomnia during the initial months of the pandemic.Methods4,138 adults (mean age = 45.8 years; 79% women) completed a national online survey during April – June 2020. Social media use before bed was measured using the first item on the Social Media Engagement questionnaire (i.e., “How often do you use social media in the 15 minutes before you go to sleep?”). Participants responded to this item based on how many days per week (range = 1-7). Sleep disturbance was assessed using a retrospective sleep diary and the Insomnia Severity Index (ISI). The sleep diary asked about sleep continuity (e.g., sleep latency, wake after sleep onset, total sleep time) during the past month.ResultsResults from separate regression analyses supported that social media use before bed was positively related to greater ISI scores, b = 0.25, t = 8.0, p < 0.001. For example, those who use social media before bed every day reported greater mean ISI scores and sleep latency times (mean ISI = 9.5; SL = 37.5 minutes) compared to those who reported never using social media before bed (mean ISI = 7.7; SL = 27.9 minutes). In contrast, social media use before bed was not related to other sleep continuity variables.ConclusionThe present data supports that social media use before bed is related to insomnia symptoms, specifically difficulty with sleep initiation. These findings are significant as they may help us understand which aspects of insomnia are most vulnerable to the negative impact of online social interactions, especially during a highly stressful period, such as the COVID-19 pandemic.Support (If Any)K23HL141581 (PI: Vargas); R25HL10544 (PI: Jean-Louis); K24AG055602 (PI: Perlis)

0817 Conquering Two Sleep Birds with One Iron stone: The Case of Resolved Restless Sleep Disorder and Parasomnia with Iron Therapy

Abstract Introduction Restless Sleep Disorder (RSD) is characterized by frequent nocturnal movements of large muscle groups or a complaint of restless sleep by observers with associated daytime dysfunction.1 RSD, like other movement disorders of sleep, is associated with low iron stores.2 Children with RSD have increased NREM sleep instability and a propensity for parasomnia.2 No reports to date have demonstrated the use of iron therapy for parasomnia in patients with RSD. Furthermore, studies are limited in very young children with this disorder as they currently fall outside proposed diagnostic criteria.1 Report of Cases: A 2 year-old male presented to the sleep clinic with parental complaints of nightly sleep initiation and maintenance difficulty, mild snoring, restless sleep, episodes of sleepwalking and night terrors multiple times per week. Symptoms worsened over 6 months and were associated with daytime irritability and behavioral problems. Sleep quality measures assessed progress between visits: the PROMIS Sleep Disturbance (PROMIS SD) and Sleep Related Impairment (PROMIS SRI). Serum ferritin was initially 20ug/L. Polysmnogram demonstrated no significant sleep related breathing disorder, a large muscle group movement index of 14, periodic limb movement index of 3. Initial treatment included oral iron therapy, scheduled awakenings, and hypnotic dose melatonin. The sleep psychologist addressed limit setting and negative sleep associations with improved insomnia symptoms but parasomnia and restless sleep continued. The parent noted reduction in both movements and parasomnia frequency after one month of iron therapy. After a 3 month period on treatment, the parent reported complete cessation of the parasomnia, drastic reduction in restlessness, and near resolution of insomnia. Sleep quality measure PROMIS SD improved by 11, demonstrating reduced sleep disturbance. PROMIS SRI did not change. Ferritin level increased to 47ug/L. Conclusion RSD in a very young child with NREM parasomnia responded to oral iron therapy improving overall sleep quality. This case demonstrates the relationship between relative iron deficiency, RSD and associated parasomnia. Support (If Any) 1. DelRosso LM, Ferri R, Allen RP, et al. Consensus diagnostic criteria for a newly defined pediatric sleep disorder: restless sleep disorder(RSD).SleepMed.2020;75:335-340. 2. Leung W, Singh I, McWilliams S, Stockler S, Ipsiroglu OS. Iron deficiency and sleep - A scoping review. SleepMedRev.2020;51:101274

0646 Sleep Disorders and Sleep Medication Use in Youth with Persistent Tic Disorders

Abstract Introduction Sleep disturbance is present in 80% of youth with persistent tic disorders (PTD). However, studies examining rates of sleep disorders in youth with PTD are limited, and reports on sleep medication use in this population are lacking. Such knowledge would inform understanding of assessment and treatment needs of youth with PTD. Therefore, the present study examined rates of sleep disorders and sleep medication use among youth with PTD, and their associations with tic severity and ADHD symptoms. Methods Participants were 52 parents of youth with PTD who responded to an internet survey evaluating sleep-wake patterns. Youth were predominantly male (n = 37, 72.5%); and 88.5% (n = 46) were reported to have Tourette’s disorder and 11.5% (n = 6) were reported to have persistent motor tic disorder. Parents provided demographics and medical history, including lifetime sleep disorder diagnosis by a health professional and current prescription or over-the-counter sleep medication use. Parents rated youth tic severity (Parent Tic Questionnaire) and ADHD symptom severity (Swanson, Nolan, and Pelham-IV Parent Rating Scale). Results Descriptive statistics and independent samples t-tests were performed. Per parent report, 39.2% (n = 20) of youth with PTD had one or more lifetime sleep disorders. Insomnia (n = 9, 17.3%), nightmares (n = 9, 15.7%), sleep walking (n = 5, 10.0%), bruxism (n = 5, 10.0%), and restless leg syndrome (n = 5, 10.0%) were most commonly endorsed. Fifty percent of parents of youth with PTD endorsed youth sleep medication use. The most commonly endorsed sleep medications were melatonin (n = 23, 44.2%), valerian (n = 6, 11.5%), and diphenhydramine (n = 5, 9.6%). There were no significant group differences in tic severity or ADHD symptom severity. Conclusion Findings highlight the presence of disorders of sleep initiation and maintenance, parasomnias, and sleep-related movement disorders in youth with PTD. Results indicate that sleep medication use, particularly melatonin, is common in this population. Future research is needed to test the efficacy of melatonin use for addressing sleep problems in youth with PTDs. Support (If Any) NIMH K23 MH113884 funding to Dr. Ricketts.

Potential eating disorder exhibited with daytime functional vulnerabilities associated with sleep problems in Japanese adolescents: A cross-sectional study.

ObjectivesEating disorders (ED) are serious psychiatric disorders that affect individuals, especially adolescents. It has been suggested that nonclinical ED‐like characteristics are related to sleep problems. We conducted a survey of Japanese adolescents to investigate this claim.MethodIn this cross‐sectional study, 398 adolescents aged 12–18 years responded to a self‐administered questionnaire survey. We used the Eating Attitudes Test‐26 (EAT‐26) and the Athens Insomnia Scale (AIS) to measure potential ED and sleep problems, respectively.ResultsAdolescents with potential ED had significantly higher daytime functional vulnerability potentially associated with sleep problems than those without ED. In particular, problems with a sense of well‐being and physical and mental functioning during the day were significant. In contrast, no significant associations were found between potential ED and sleep initiation, awakenings during the night, early morning awakening, total sleep duration, or overall quality of sleep. Finally, nocturnal and daytime sleep scores were significantly associated with dieting, bulimia, and oral control EAT‐26 subscores.DiscussionParticipants with possible ED experienced problems related to well‐being and mental and physical functioning, which are indicators of daytime functional vulnerability potentially associated with sleep problems. Further, adolescents with more severe ED characteristics are more likely to have a higher degree of daytime psychological vulnerability potentially attributable to sleep problems. The study suggested that professionals treating adolescent mental health issues need an approach that comprehensively integrates both sleep problems and potential ED.