Showing papers by "Carole L. Marcus published in 2018"

Development and validation of the PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment item banks.

Abstract: Study objectives To develop and evaluate the measurement properties of child-report and parent-proxy versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Sleep Disturbance and Sleep-Related Impairment item banks. Methods A national sample of 1104 children (8-17 years old) and 1477 parents of children 5-17 years old was recruited from an internet panel to evaluate the psychometric properties of 43 sleep health items. A convenience sample of children and parents recruited from a pediatric sleep clinic was obtained to provide evidence of the measures' validity; polysomnography data were collected from a subgroup of these children. Results Factor analyses suggested two dimensions: sleep disturbance and daytime sleep-related impairment. The final item banks included 15 items for Sleep Disturbance and 13 for Sleep-Related Impairment. Items were calibrated using the graded response model from item-response theory. Of the 28 items, 16 are included in the parallel PROMIS adult sleep health measures. Reliability of the measures exceeded 0.90. Validity was supported by correlations with existing measures of pediatric sleep health and higher sleep disturbance and sleep-related impairment scores for children with sleep problems and those with chronic and neurodevelopmental disorders. The sleep health measures were not correlated with results from polysomnography. Conclusions The PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment item banks provide subjective assessments of child's difficulty falling and staying asleep as well as daytime sleepiness and its impact on functioning. They may prove useful in the future for clinical research and practice. Future research should evaluate their responsiveness to clinical change in diverse patient populations.

Depressive symptomatology in school-aged children with obstructive sleep apnea syndrome: incidence, demographic factors, and changes following a randomized controlled trial of adenotonsillectomy

Abstract: Study Objectives Depressive symptoms following adenotonsillectomy (AT) relative to controls were examined in children with obstructive sleep apnea syndrome (OSAS). Methods The Childhood Adenotonsillectomy Trial (CHAT) multisite study examined the impact of AT in 453 children aged 5 to 9.9 years with polysomnographic evidence of OSAS without prolonged desaturation, randomized to early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). One hundred seventy-six children (eAT n = 83; WWSC n = 93) with complete evaluations for depressive symptomatology between baseline and after a 7-month intervention period were included in this secondary analysis. Results Exact binomial test assessed proportion of depressive symptomatology relative to norms, while effects of AT and OSAS resolution were assessed through linear quantile mixed-models. Treatment group assignment did not significantly impact depression symptoms, although self-reported depression symptoms improved over time (p < 0.001). Resolution of OSAS symptoms demonstrated a small interaction effect in an unexpected direction, with more improvement in parent ratings of anxious/depressed symptoms for children without resolution (p = 0.030). Black children reported more severe depressive symptoms (p = 0.026) and parents of overweight/obese children reported more withdrawn/depressed symptoms (p = 0.004). Desaturation nadir during sleep was associated with self-report depressed (r = -0.17, p = 0.028), parent-reported anxious/depressed (r = -0.15, p = 0.049), and withdrawn/depressed (r = -0.24, p = 0.002) symptoms. Conclusions Increased risk for depressed and withdrawn/depressed symptoms was detected among children with OSAS, and different demographic variables contributed to risk in self-reported and parent-reported depression symptoms. Arterial oxygen desaturation nadir during sleep was strongly associated with depressed symptoms. However, despite improvements in child-reported depressed symptoms over time, changes were unrelated to either treatment group or OSAS resolution status. Trials Registration Childhood Adenotonsillectomy Study for Children with OSAS (CHAT), https://clinicaltrials.gov/show/NCT00560859, NCT00560859.

Sleep and Executive Functioning Among Young Children Presenting to Urban Primary Care Clinics

Abstract: Purpose: Early childhood is a period of rapid cognitive and behavioral development. Poor quality sleep and obstructive sleep apnea (OSA) are associated with worse executive functioning (EF) skills during childhood and adolescence. However, few studies have examined these associations among socio-demographically diverse preschool-aged children. Thus, this study examined sleep patterns and problems and their association with EF …

Non-High Frequency Heart Rate Chaos: A Noninvasive Marker of REM Sleep and Obstructive Sleep Apnea Syndrome in Children

Abstract: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent condition associated with considerable metabolic, cardiovascular, and neurocognitive morbidity. Childhood OSAS is underdiagnosed due to a limited number of sleep laboratories and the lack of a screening test, and the subtlety of daytime symptoms in children compared to adults. A potential marker of OSAS is apnea-induced sympathoexcitation, which is likely to be exacerbated during rapid eye movement (REM) sleep. However, traditional methods of assessing sympathetic activity are either too invasive or insensitive/nonspecific for clinical use, particularly as a screening test. Study population comprised pediatric patients with OSAS (16 moderate/severe, 18 mild) and 18 normal non-snoring controls. We show that the chaotic dynamics of heart rate variability (HRV) as assessed by a sensitive noise titration assay is significantly increased during REM compared to non-REM sleep in children, particularly those with OSAS. The increase in heart rate chaos prevails in the face of decreased parasympathetic-mediated high-frequency component of the HRV power spectrum, indicating that the chaos was correlated to sympathetic instead of parasympathetic activity. Receiver operating characteristic analysis shows that such non-high frequency chaos reveals changing sympathetic-parasympathetic activities that are not discernible by conventional HRV metrics such as low- to high-frequency power ratio or sample entropy, with sensitivity and specificity sufficient to detect even mild OSAS in children. Results suggest a possible role for non-high frequency heart rate chaos as a selective noninvasive marker of sympathoexcitation in REM sleep, OSAS and potentially other cardiovascular abnormalities such as congestive heart failure.