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This paper describes the longitudinal change in sleep, functional, and behavioural characteristics in a cohort of children with Down syndrome, including the effect of sleep interventions in a subset. A prospective longitudinal cohort study was undertaken in children with Down syndrome aged 3-16 years comparing (1) children referred to a tertiary sleep medicine clinic who received sleep hygiene advice and an additional sleep treatment (DSref_I) with (2) children attending the same clinic who only received sleep hygiene advice (DSref_N) and (3) children recruited from the community who, were not receiving any treatment (DScomm). Data collected included demographic and medical history information, Child Sleep Habits Questionnaire-Abbreviated (CSHQ-A), Life-Habits Questionnaire (Life-H) and Child Behaviour Checklist (CBCL) at baseline and then 6-monthly for a total of 18 months. Any sleep interventions during this time were recorded. A total of 57 children were included (DSref_I, n = 16; DSref_N, n = 25; DScomm, n = 16). At recruitment, the median CSHQ-A total score was high (>41) in all three subgroups, but highest in the DSref_I subgroup (median [interquartile range] Dsref_I score 58 [53-66] versus DSref_N score 49 [43-53], p = 0.019). Although improved, 80% of participants in the DSref_I subgroup still had a CSHQ-A total score >41 at the last assessment point. The median total Life-H and total CBCL scores were not significantly different between groups at baseline and there was no significant time, group, or interaction effect seen through the study. Over an 18-month period, sleep problems were seen to persist in children with Down syndrome. Treatment resulted in only modest improvements in sleep., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Rett syndrome is an X-linked neurodevelopmental disorder caused by mutation of Mecp2 gene and primarily affects females. Glial cell dysfunction has been implicated in in Rett syndrome (RTT) both in patients and in mouse models of this disorder and can affect synaptogenesis, glial metabolism and inflammation. Here we assessed whether treatment of adult (5–6 months old) symptomatic Mecp2- heterozygous female mice with N-acetyl cysteine conjugated to dendrimer (D-NAC), which is known to target glia and modulate inflammation and oxidative injury, results in improved behavioral phenotype, sleep and glial inflammatory profile. We show that unbiased global metabolomic analysis of the hippocampus and striatum in adult Mecp2-heterozygous mice demonstrates significant differences in lipid metabolism associated with neuroinflammation, providing the rationale for targeting glial inflammation in this model. Our results demonstrate that treatment with D-NAC (10 mg/kg NAC) once weekly is more efficacious than equivalently dosed free NAC in improving the gross neurobehavioral phenotype in symptomatic Mecp2-heterozygous female mice. We also show that D-NAC therapy is significantly better than saline in ameliorating several aspects of the abnormal phenotype including paw clench, mobility, fear memory, REM sleep and epileptiform activity burden. Systemic D-NAC significantly improves microglial proinflammatory cytokine production and is associated with improvements in several aspects of the phenotype including paw clench, mobility, fear memory, and REM sleep, and epileptiform activity burden in comparison to saline-treated Mecp2-hetereozygous mice. Systemic glial-targeted delivery of D-NAC after symptom onset in an older clinically relevant Rett syndrome model shows promise in improving neurobehavioral impairments along with sleep pattern and epileptiform activity burden. These findings argue for the translational value of this approach for treatment of patients with Rett Syndrome. [ABSTRACT FROM AUTHOR]

The aim of our study was to investigate the psychometric properties of the Turkish adaptation of the Epworth Sleepiness Scale for children and adolescents (ESS-CHAD). We evaluated internal consistency, test−retest reliability, construct validity, and criterion validity of the ESS-CHAD in the sample of 145 children with a mean age of 14.58 (±1.44), consisting of 53.1% females. Confirmatory factor analysis showed an 8-item unidimensional structure of the scale. Cronbach's alpha was 0.74; the correlation coefficients for test−retest reliability and criterion validity were 0.96 and 0.85, respectively (p's<.05). Our study presented the first evidence to establish the validity and reliability of the ESS-CHAD for Turkish children aged 12 − 18 years. [ABSTRACT FROM AUTHOR]

Objective  The aim of the study is to investigate factors affecting total sleep time (TST) during infant polysomnography (PSG) and assess if <4 hours of TST is sufficient for accurate interpretation. Study Design  Overall, 242 PSGs performed in 194 infants <6 months of chronological age between March 2013 and December 2015 were reviewed to identify factors that affect TST, including age of infant, location and timing of study, presence of medical complexity, and presence of nasal tubes. A continuum of apnea-hypopnea index (AHI) in relation to TST was reviewed. Data were examined in infants who had TST <4 hours and low AHI. Results  Greater TST (p  < 0.001) was noted among infants during nocturnal PSGs, at older chronological and post-menstrual ages, and without medical complexity. The presence of nasogastric/impedance probes reduced TST (p  = 0.002). Elevated AHIs were identified even in PSGs with TST <4 hours. Short TST may have affected interpretation and delayed initial management in one infant without any inadvertent complications. Conclusion  Clinical factors such as PMA and medical complexity, and potentially modifiable factors such as time of day and location of study appeared to affect TST during infant PSGs. TST < 4 hours can be sufficient to identify high AHI allowing physician interpretation. Key Points Less than 4 hours of TST is enough for interpretation of infant polysomnography. Shorter TST appears related to infant age, medical complexity, and higher apnea-hypopnea index. Modifiable factors seen with higher TST were time of day, environment, and presence of nasal tubes. [ABSTRACT FROM AUTHOR]

Background: Tumors of the central nervous system (CNS) are the most common solid childhood malignancy. Over the last decades, treatment developments have strongly contributed to the improved overall 5-year survival rate, which is now approaching 75%. However, children now face significant long-term morbidity with late-effects including sleep disorders that may have detrimental impact on everyday functioning and quality of life. The aims of this study were to (1) describe the symptoms that lead to polysomnographic evaluation; (2) describe the nature of sleep disorders diagnosed in survivors of childhood CNS tumor using polysomnography (PSG); and (3) explore the association between tumor location and diagnosed sleep disorder. Methods: An extensive literature search following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) was conducted. Inclusion criteria were children and adolescents diagnosed with a CNS tumor age <20 years having a PSG performed after end of tumor treatment. The primary outcome was sleep disorder confirmed by PSG. Results: Of the 1,658 studies identified, 11 met the inclusion criteria. All the included articles were appraised for quality and included in the analysis. Analyses indicated that sleep disorders commonly occur among childhood CNS tumor survivors. Symptoms prior to referral for PSG were excessive daytime sleepiness (EDS), fatigue, irregular breathing during sleep and snoring. The most common sleep disorders diagnosed were sleep-related breathing disorders (i.e., obstructive sleep apnea) and central disorders of hypersomnolence (i.e., narcolepsy). Conclusion: Our findings point to the potential benefit of systematically registering sleep disorder symptoms among CNS tumor patients together with tumor type and treatment information, so that at-risk patients can be identified early. Moreover, future rigorous and larger scale controlled observational studies that include possible modifiable confounders of sleep disorders such as fatigue and obesity are warranted. Clinical Trial Registration: https://www.crd.york.ac.uk/prospero/display%5frecord.php?ID=CRD42021243866, identifier [CRD42021243866]. [ABSTRACT FROM AUTHOR]

Research finds a lack of sleep during adolescence is associated with a variety of negative outcomes and suggests that early school start times contribute to this problem. Criminologists have largely overlooked the relevance of school start times for adolescent delinquency and substance use, precluding multidisciplinary collaborations between criminologists and other social and health scientists that might further elucidate emerging policy initiatives. We provide a theoretically informed criminological perspective explicating the mechanisms through which delaying school start times may reduce delinquency and substance use. Two pathways are proposed: one focused on self-control and another on unstructured socializing with peers. After discussing evidence supporting the pathways, this article outlines a research agenda for criminologists to contribute to understudied portions of the model. [ABSTRACT FROM AUTHOR]

Adolescents with obesity and obstructive sleep apnea syndrome (OSAS) are at high risk of poor physical and cognitive health consequences. The purpose of this study was to explore executive function (EF) in adolescents with obesity and OSAS, describe physical activity and sleep duration, and explore the relationships between EF and physical activity and sleep duration. Participants comprised 20 adolescents (ages 11–17 years) with obesity (body mass index [BMI] ≥ 95th percentile) and OSAS (apnea–hypopnea index [AHI] ≥ 1.5 events/hr) participated in this observational pilot study with a prospective 1-week measurement protocol. Outcome measures included EF by the Behavior Rating Inventory of Executive Function-2, physical activity by Previous Day Physical Activity Recall, and sleep by Consensus Sleep Diary and actigraphy. Adolescents with obesity and OSAS had significantly worse EF by self- and parent-report than the normative sample (p ≤.003), 45% had impaired EF and up to 30% had clinically significant impairments. Participants spent approximately 14.3 hr/day in light-intensity activity, and 33% did not engage in moderate-to-vigorous-intensity activity for at least 60 min on any days of data collection. Adolescents had insufficient sleep duration, averaging 6.9 hr/night. No significant relationships were identified between physical activity or sleep duration and EF. Providers should have a heightened awareness for EF impairments in obese adolescents with OSAS and consider how EF deficits may affect uptake and adherence to complex lifestyle and/or medical interventions among these patients. [ABSTRACT FROM AUTHOR]

In typically developing (TD) children, sleep problems have been associated with day-time attentional difficulties. Children with developmental disabilities often suffer with sleep and attention problems, yet their relationship is poorly understood. The present study investigated this association in school-aged children with Down syndrome (DS) and Williams syndrome (WS). Actigraphy and pulse oximetry assessed sleep and sleep-disordered breathing respectively, and attention was tested using a novel visual Continuous Performance Task (CPT).Attentional deficits were evident in both disorder groups. In the TD group, higher scores on the CPT were related to better sleep quality, higher oxyhemoglobin saturation (SpO2), and fewer desaturation events. Sleep quality, duration, and SpO2variables were not related to CPT performance for children with DS and WS. [ABSTRACT FROM PUBLISHER]

Aim: The purpose of this study was to evaluate whether there was a difference between the reports of parents and primary school children in the age group of 9-10 and 11 years in terms of sleep characteristics or not. Methods: This research was a descriptive-cross sectional study. Total 615 students and their families constituted study group of research. In the evaluation of data, spearman correlation and wilcoxon, chi-square analysis and Phi coefficient calculation was utilized. Results:The difference between the statements of students and their parents regarding the sleeping and wakeup times and leep problems / characteristics was found to be significant and the consistency between the statements was low in this study Conclusion: It could be recommended for school nurses to be more careful and questioning while evaluating the sleep characteristics of especially younger students. [ABSTRACT FROM AUTHOR]

The aim of this research is to investigate the prevalence of excessive daytime sleepiness (EDS) in primary school children in Hong Kong and to explore the interrelationship between EDS, unhealthy sleep behavior, and depression. 911 primary 4-6 students were recruited to a cross-sectional study. They completed a pack of questionnaires measuring sleepiness, depression, unhealthy sleep behaviors, and some socio-demographic information. Univariate logistic regression was performed to identify the potential risk factors of UBS on EDS and depression. A multivariate logistic regression was performed to examine the mediation role of EDS between UBS and depression. An EDS prevalence rate of 25.1 % was observed. Staying up late to study was significantly associated with both EDS and depression, eating before sleep was strongly associated with EDS and an inconsistent sleep time was strongly associated with depression. EDS only partially mediated the relationship between staying up late to study and depression. Unhealthy sleep behaviors are common among children and which may be due to heavy homework, poor time management, lack of house rule regarding snack time. They will increase the risk of depression and excessive sleepiness. [ABSTRACT FROM AUTHOR]

While mounting evidence suggests that sleep plays an important role in the etiology of obesity, the underlying pathogenic pathways are complex and unresolved. Experimental sleep deprivation studies demonstrate sympathovagal imbalance, indicative of diminished parasympathetic activity and/or heightened sympathetic activity, is consequent to poor sleep. Further, obese children exhibit sympathovagal imbalance, particularly during the night, compared to non-obese children. The question remains whether sympathovagal imbalance is one potential pathophysiological pathway underlying the association between sleep and obesity. The aim of the present study was to examine whether sympathovagal imbalance contributed to the association between sleep and obesity in children. Participants included 564 children aged 10 to 12 years (M = 11.67, SD = 0.95; 43.5 % girls) from the QUALITY Cohort, a longitudinal study of children at-risk for the development of obesity. While children were at-risk due to confirmed parental obesity status, 57.7 % of children were of normal body mass index (5-85th percentile). Sleep duration, sleep timing, and sleep disturbances were based on child- and parent-report. Anthropometrics were measured for central adiposity (waist circumference) and body composition (body mass index, fat mass index). Sympathovagal imbalance was derived from heart rate variability spectral analyses. Estimated path coefficients revealed that sympathovagal imbalance partially contributed to the association between poor sleep (later bedtimes, sleep-disordered breathing) and obesity. These findings highlight the importance of better understanding sympathovagal imbalance and its role in the etiology and maintenance of obesity. Future research should consider investigating nocturnal sympathovagal balance in youth. [ABSTRACT FROM AUTHOR]

This study examined sleep, sleepiness, and daytime performance in 68 children with autism, 57 children with intellectual disability (ID), and 69 typically developing preschool children. Children in the autism and ID groups had poorer daytime performance and behaviors than the typically developing children. Children in the ID group also were significantly sleepier than children in both the autism and typically developing groups. These significant differences persisted over 6 months. Actigraph-defined sleep behaviors and problems did not relate to daytime sleepiness or daytime performance and behaviors for the children with autism or the typically developing group. For the ID group, longer night awakenings and lower sleep efficiency predicted more daytime sleepiness. For each group, parent-report sleep problems were associated with more daytime sleepiness and more behavior problems. [ABSTRACT FROM AUTHOR]

There is enormous value in advancing the knowledge of lifestyle habits in young children. Parental reports capable of capturing sedentary behavior patterns and sleep habits of young Hong Kong children would undoubtedly be a useful assessment tool. To test the validity and reliability of the Sedentary Behavior and Sleep Scale, we assessed sedentary time and sleep duration in 66 Chinese children (27 boys and 39 girls; 6.7 ± 0.5 yrs) for 4 days with an RT3 accelerometer. Parents completed the SBSS within 8 days of accelerometer collection and at 1 -week intervals to assess reliability. We assessed agreement between RT3 accelerometer parental reported total sedentary time and wake time and bedtime for a weekday and weekend day, respectively. Interdass correlation coefficients were utilized to assess test-retest reliability Adequate test-retest reliability was noted for all questions with the exception of screen time during the weekend (ICC 0.59-0.89). When compared with the RT3, the SBSS underestimated sedentary time; the reported wake time and bedtime was slightly earlier and later than the SBSS for both weekday and weekend. These findings suggest that the SBSS may be useful as a supplement when using objective measure of sedentary habits and sleep duration. [ABSTRACT FROM AUTHOR]

Arousal from sleep is associated with transient and abrupt cardiorespiratory changes, and elevated arousals associated with sleep disorders may trigger adverse cardiovascular sequela. In this paper, we provide the first data in children on cardiorespiratory responses to cortical arousal. Heart rate and ventilatory responses to arousal from stage 2 and rapid eye movement (REM) sleep were investigated in 40 normal, healthy Caucasian children (age: 7.7 ± 2.6 years; body mass index z-score: 0.30 ± 0.8). All children underwent overnight polysomnography studies. Cortical arousals were scored according to standard criteria. Heart rate changes were assessed over 30 s, starting 15 s prior to cortical arousal onset. Breathing rates were quantified three breaths before and after arousal onset. Arousals from stage 2 as well as REM sleep resulted in an R–R interval shortening of about 15%, independent of age and gender. The R–R interval shortening initiated at least 3 s before the cortical arousal onset. The breathing interval immediately after cortical arousal onset was significantly shortened ( P < 0.001). In conclusion, cortical arousals in children are associated with an increase in breathing rate and significant heart rate accelerations, which typically precede the cortical arousal onset. [ABSTRACT FROM AUTHOR]