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Background: Healthy adults awaken between each sleep cycle approximately 5 times each night but generally do not remember all of these awakenings in the morning. A rule of thumb has arisen in the sleep field that approximately 5 min of continuous wakefulness are required to form a memory for an awakening. However, few studies have examined memory for these sleep-wake transitions and none have done so in the home, while participants follow their normal routine., Methods: Self-report and actigraphy were used in the participant's home environment to determine the minimum duration of an awakening necessary for morning recall for each of the 39 healthy adults., Results: Recall thresholds ranged from 30 to 600 s with a mean of 259 s (4 min 19 s) and were negatively associated with sleep efficiency but not significantly associated with total sleep time, age, income, or education. There also was a sex by cohabitation interaction, with single men having lower thresholds than single women and cohabiting participants, which was explained by higher sleep efficiency in noncohabitating men. Large individual differences suggest that many factors may influence recall threshold., Conclusions: Our preliminary study is the first to calculate the duration of wakefulness necessary for morning recall of nocturnal awakenings and the first to use a field-based design, allowing for the study of habitual sleep patterns at the participant's home. Further study is needed to explore if recall thresholds calculated using actigraphy can be validated against polysomnography (PSG) or be used to guide potential treatments., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objectives: The aims for this study were to determine the prevalence of sleep-bruxism among young children, explore child behavior problems that may be associated with sleep-bruxism, and identify relations among sleep-bruxism, health problems, and neurocognitive performance., Methods: The current study was a retrospective analysis of parent report surveys, and behavioral and neurocognitive assessments. Parents of 1953 preschool and 2888 first grade children indicated their child's frequency of bruxism during sleep. A subsample of preschool children (n=249) had additional behavioral, as well as neurocognitive assessments. Among the subsample, parents also reported on their child's health, and completed the Child Behavioral Checklist; children were administered the Differential Ability Scales, and Pre-Reading Abilities subtests of the Developmental Neuropsychological Assessment., Results: 36.8% of preschoolers and 49.6% of first graders were reported to brux ⩾1time per week. Among the preschool subsample, bruxing was independently associated with increased internalizing behaviors (β=.17). Bruxism was also associated with increased health problems (β=.19), and increased health problems were associated with decreased neurocognitive performance (β=.22)., Conclusions: The prevalence of sleep-bruxism was high. A dynamic and potentially clinically relevant relation exists among sleep-bruxism, internalizing behaviors, health, and neurocognition. Pediatric sleep-bruxism may serve as a sentinel marker for possible adverse health conditions, and signal a need for early intervention. These results support the need for an interdisciplinary approach to pediatric sleep medicine, dentistry, and psychology., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: Although psychostimulants have been shown to affect sleep in experimental studies, the relation between nonmedical psychostimulant use and sleep has not been examined. Our goal was to describe the sleep quality and characteristics of college students who use psychostimulant medications nonmedically., Methods: We surveyed 492 college students about their sleep quality and psychostimulant use characteristics. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); psychostimulant use and characteristics were measured via a survey developed for this study., Results: College students who self-reported current or a history of nonmedical psychostimulant use reported worse subjective sleep quality, sleep disturbance, and global PSQI scores than nonusers. The most commonly reported reason for nonmedical psychostimulant use was to improve work performance and concentration., Conclusions: These data demonstrate worse sleep quality among nonmedical psychostimulant users. The likely consequence of increased daytime sleepiness helps to confirm the known public health concern of nonmedical prescription psychostimulant use among college students., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Children who were born prematurely are at higher risk for sleep-disordered breathing (SDB) compared to their same-age peers who were born fullterm., Objective: The objective of the present study was to assess the frequency of SDB symptoms and effects on growth among preterm infants while they are still infants, with a goal of identifying risk factors to facilitate prevention and early intervention., Methods: The Louisville pediatric SDB risk survey was administered to the primary caretakers of prematurely born infants attending the Neonatal Follow-Up Clinic at West Virginia University Children's Hospital., Results: Participation was 100% among 173 consecutive patients invited to participate in the study. At 9.13 months corrected age, 8.1% of infants born at a mean of 31.6 weeks gestation were reported to snore > or = 3 days/week, a rate consistent with diagnosis of sleep-disordered breathing among older children. A composite of nine parent-reported symptoms was created based on factor analysis. Birth weight and size for gestational age at birth did not differ between snoring groups or correlate with the composite score. But a significant negative correlation between the composite risk for SDB score and current weight for adjusted age percentile score indicate that infants with higher SDB symptom profiles have lower weight for age (r=-.18, p=.028)., Conclusions: SDB symptoms are detectable among infants born preterm, while they are still infants. Because of their preferential risk for SDB and its somatic consequences, a primary research goal should be description of the natural history of SDB and identification of modifiable risk factors and treatment options., (Copyright 2009 Elsevier B.V. All rights reserved.)

Study Objectives: Few commercially available brands of actigraphs (ACT) have been subjected to rigorous validation with infant participants. The purpose of this study was to examine the agreement between concurrent polysomnography (PSG) and one brand of ACT (AW-64, Mitter Co. Inc.) using appropriate statistical techniques among a sample of healthy infants., Methods: Twenty-two healthy infants (14.1+/-0.6 months) had one night of ankle ACT recording during research PSG at Kosair Children's Hospital Sleep Research Center in Louisville, Kentucky. Macroanalyses were conducted using the Bland-Altman concordance technique to assess agreement between total sleep time (TST) and wake after sleep onset (WASO) simultaneously measured by PSG and ACT, using two ACT algorithm settings. Microanalyses were also calculated to examine sensitivity, specificity, and accuracy of ACT within each PSG-identified sleep state. Correlations were calculated between PSG-identified arousals and the discrepancies between ACT and PSG., Results: The Bland-Altman concordance technique revealed that ACT underestimated TST by 72.25 (SD=61.48) minutes and by > or = 60 min among 54.55% of infants. Furthermore, ACT overestimated WASO by 13.85 (SD=30.94) minutes and by > or = 30 min among 40.91% of infants. Sensitivity, specificity, and accuracy analyses revealed that ACT adequately identified sleep, but poorly identified wake. PSG and ACT discrepancies were positively associated with PSG-identified arousals (r=.45)., Conclusions: Improved device and/or software development is needed before the AW-64 can be considered a valid method for identifying infant sleep and wake., (2009 Elsevier B.V. All rights reserved.)

Background: Pediatric sleep-disordered breathing is known to negatively impact cognitive development. While a theoretical basis has been proposed for the developmental effect of pediatric sleep-disordered breathing on executive function specifically, this had not been directly examined among preschool-age children. This population may be particularly vulnerable if school-readiness is compromised. The purpose of the current study was to use a multi-dimensional approach to assessing executive function among preschool-age children at risk for sleep-disordered breathing., Methods: Thirty-nine preschool children were administered executive function tasks assessing the dimensions of inhibition, working memory, and planning as part of a larger study. A parent or guardian completed a validated questionnaire concerning the child's snoring and other behaviors indicating risk for sleep-disordered breathing., Results: After controlling for age in a series of regressions, higher parent-reported risk for sleep-disordered breathing was associated with substantially lower performance on each executive function dimension. In comparing the group means of children at high and low risk for sleep-disordered breathing, the single snoring frequency item also showed that children who snored frequently or almost always had lower performance on each executive function dimension., Conclusions: The results suggest that sleep-disordered breathing may be associated with impaired executive function in preschoolers, with its strongest impact on the inhibition dimension, further emphasizing the importance of early intervention for sleep-disordered breathing in this early age group.

Introduction: Snoring affects biobehavioral development among preschool and early school-age children. The goals of the present study were to survey the parents of a large community sample of infants and young toddlers to evaluate (a) naturalistic sleep duration and location; (b) snoring prevalence; and (c) demographic measures and sleep behaviors related to the presence of snoring either 2 or >or=3 days/week., Methods: Questionnaires were completed by parents of children ages 2 weeks to 2 years attending well-baby checkups and were also mailed to the homes of six-month-old infants., Results: Data from 944 children were available for analyses. No age differences were reported for total sleep duration, co-sleeping, or snoring. Average daily sleep duration was 12.5+/-1.8h (standard deviation (SD)), with daytime naps accounting for an increased proportion of total sleep duration among younger infants. Co-sleeping was reported by 15% of families. Snoring 2 days/week was reported in 11.8% and> days/week in 5.3% of participants. Survey items indicating risk for sleep-disordered breathing (SDB) clustered into factors related to the child, their environment, and their family; restless sleep was exclusively related to snoring 2 days/week and ethnicity, sweating during sleep, and noisy breathing exclusive to snoring >or=3 days/week., Conclusions: Young infants appear to sleep less than currently recommended. Co-sleeping is relatively common and not age-dependent through the first 2 years of life. Items relating to the child's sleep behaviors, environment, and parents' perceptions were predictive of positive report of snoring, with snoring rates consistent with a significant risk for SDB being similar to those reported for older children.

Background and Purpose: This study was designed to assess potential relationships of race and socioeconomic status (SES) to bedtime behavior from a community sample of 2- to 7-year-old children., Patients and Methods: A previously validated sleep questionnaire was administered to parents of children enrolled in the Jefferson County, Kentucky school system. The sleep behavior of African-American (n=973) and Caucasian (n=2398) children was analyzed. Median annual income of residential zip codes was used as a proxy for SES., Results: Mean age was 4.8+/-1.1 years. Two composite 'sleep behavior scores' were generated related to excessive daytime sleepiness and sleep-related behavior. Children in the lower SES group had significantly more impaired 'sleep behavior scores' than those in the higher SES group, regardless of race or age. African-American children had later bedtimes than Caucasian children with similar rise times, resulting in significantly shorter sleep duration and more excessive daytime sleepiness, independent of SES and age., Conclusions: Cultural variables impact sleep-related behavior in children. Race and SES have independent relationships with sleep behavior. Independent of SES, African-American children sleep less due to later bedtimes. SES does play a role, however, in parentally reported sleep-related behavior problems. Thus, cultural variables such as race and SES are important modifiers of sleep behaviors in children and should be addressed in sleep education programs.

Background: Periodic limb movement disorder (PLMD) has recently emerged as a relatively frequent and markedly underdiagnosed condition in children that induces arousals and sleep fragmentation and leads to poor learning and behavioral problems. Because a cost-effective and widely available alternative to pediatric polysomnography is needed for diagnosis of limb movement disorders, this study sought to examine whether periodic leg movements in children could be reliably identified using recently developed actigraphy software., Methods: Bilateral actigraphs were worn around the feet by 99 children ages 4-12 years during standard clinical overnight polysomnography, which included bilateral anterior tibial electromyogram (EMG). Left and right leg movements were scored independently for comparison purposes., Results: Agreement between tibial EMG and actigraphy-derived events were initially low, with movement indices being overestimated by actigraphy. This agreement was improved when a correction factor based on the average number of movements during arousals as measured by EMG was applied. However, the correction factor itself was found to differ substantially for patients who were diagnosed with PLMD compared to other patients., Conclusions: A novel actigraphic approach currently used for detection of PLM events during sleep in adults is insufficiently accurate to permit reliable estimates in children.