Continuous positive airway pressure care for pediatric obstructive sleep apnea: A long-term quality improvement initiative.

Successful treatment of pediatric obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) is challenging due to behavioral, technical, medical, and systems factors. We undertook a quality improvement (QI) initiative involving physicians, nurses, psychologists, and respiratory therapists to improve CPAP outpatient care and processes. We aimed to: (1) increase the proportion of patients with a follow-up visit within 4 months of initiation of CPAP, (2) reduce the median time to first follow-up visit to under 4 months, and (3) increase the proportion of patients obtaining a post-initiation polysomnogram within 1 year to >50%.

Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers.

Study Objectives: Community-based research indicates that Black preschoolers tend to have more bedtime difficulties and are at higher risk for obstructive sleep apnea (OSA) compared to White preschoolers. This study examined differences in sleep patterns and problems by race among a clinical sample of Black and White preschoolers at an outpatient sleep clinic.

Methods: Data were collected from electronic medical records for 125 children ages 2-5 years (mean = 3.

Individual and socio-demographic factors related to presenting problem and diagnostic impressions at a pediatric sleep clinic.

Objective: Individual and socio-demographic factors have been found to be associated with sleep disturbances in children. Few studies have examined these factors among children presenting for care at pediatric sleep clinics. This study examined individual and socio-demographic factors in association with presenting problems and diagnostic impressions for new patients at an interdisciplinary pediatric sleep clinic.

Pacifier Use, Finger Sucking, and Infant Sleep.

Few studies to date have investigated the relationship between pacifier use or finger sucking and infant sleep. One hundred and four mothers of infants (ages 0-11 months) completed the Brief Infant Sleep Questionnaire (BISQ). Infants who engaged in finger sucking had fewer night wakings and longer stretches of nighttime sleep, although less daytime sleep.

Comorbid symptoms of sleep-disordered breathing and behavioral sleep problems from 18-57 months of age: a population-based study.

Research suggests that in clinical samples, almost 1/2 of children with obstructive sleep apnea have a behavioral sleep problem, and of those, most do not receive behavioral recommendations. This study extends previous research via a longitudinal investigation of the presence and comorbidity of symptoms of sleep-disordered breathing (SDB) and behavioral sleep problems in a non-clinical sample. Findings were that the prevalence of symptoms of SDB and behavioral sleep problems at each of the 4 time points was nearly identical, with a peak age of 30 months, and that 25% to 40% of children with symptoms of SDB had behavioral sleep problems.

Behavioral sleep problems in children and adolescents.

Sleep problems in children and adolescents are common, and they impact multiple domains of child and family functioning. Psychologists have a critical role in the assessment and treatment of sleep problems and are integral to interdisciplinary sleep teams. Certain sleep problems may be related to co-morbid psychological or developmental conditions, and others are considered to be primarily medical, yet behavioral approaches may be applicable.

Heritability of insomnia symptoms in youth and their relationship to depression and anxiety.

Study Objectives: Insomnia is a highly prevalent sleep disorder yet little is known about the role of genetic factors in its pathophysiology. The aim of this study was to examine the relative contributions of genetic and environmental factors in explaining variability in insomnia symptoms.

Design: Traditional twin design.

Correlates of adolescent sleep time and variability in sleep time: the role of individual and health related characteristics.

Objectives: Adolescents are predisposed to short sleep duration and irregular sleep patterns due to certain host characteristics (e.g., age, pubertal status, gender, ethnicity, socioeconomic class, and neighborhood distress) and health-related variables (e.

Bedtime problems and night wakings: treatment of behavioral insomnia of childhood.

Bedtime problems and frequent night wakings are common sleep problems in infants and toddlers, affecting 20 to 30% of young children. Such problems, categorized as behavioral insomnia of childhood (BIC), lead to insufficient sleep, which contributes to multiple domains of child dysfunction. Behavioral treatments of BIC, such as extinction and positive routines are introduced, and supporting evidence is reviewed.

Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future.

This review of the scientific literature examines the widely observed relationship between sleep duration and mortality. As early as 1964, data have shown that 7-h sleepers experience the lowest risks for all-cause mortality, whereas those at the shortest and longest sleep durations have significantly higher mortality risks. Numerous follow-up studies from around the world (e.

Relationships among sleepiness, sleep time, and psychological functioning in adolescents.

Objective: This study examined associations among adolescent sleepiness, sleep duration, variability in sleep duration, and psychological functioning (symptoms of anxiety, depression, externalizing behaviors, and perceived health).

Methods: This was a cross-sectional analysis of data from a community-based cohort study of sleep and health. Participants were 247 adolescents (48.

The need for interdisciplinary pediatric sleep clinics.

The purpose of this study was to describe the function and structure of an interdisciplinary outpatient pediatric sleep clinic. In addition, the frequency of individual and comorbid sleep diagnoses, the prevalence of comorbid medical or psychiatric disorders, and the types of treatment recommendations and referrals provided to patients at the end of their clinic visits was examined. Over a 4-month period, 265 consecutive patients were evaluated in the sleep clinic by trainees, nurses, and attendings in pulmonary medicine, neurology, and psychology.

Bedtime problems and night wakings in children.

Bedtime problems and night wakings in children are extremely common, and the treatment literature demonstrates strong empirical support for behavioral interventions. Empirically validated interventions for bedtime problems and night wakings include extinction, graduated extinction, positive routines, and parental education. Most children respond to behavioral interventions, resulting not only in better sleep for the child, but also better sleep and improved daytime functioning for the entire family.

The sleepy adolescent: causes and consequences of sleepiness in teens.

The majority of adolescents do not obtain the recommended amount of sleep, resulting in significant daytime sleepiness. For most adolescents, insufficient sleep results from the interaction between intrinsic factors such as puberty and extrinsic factors such as school start times. Insufficient sleep and sleepiness impact all areas of adolescent functioning, including academic, psychological and behavioural, which underscores the importance of evaluating sleepy adolescents.

Sleep disruptions in parents of children and adolescents with chronic illnesses: prevalence, causes, and consequences.

Objective: Provide a comprehensive review of the existing literature on the prevalence, causes, and consequences of sleep disruptions in parents of youth with chronic illnesses.

Methods: A comprehensive literature search of PsychInfo, MEDLINE, and CINAHL for articles related to sleep in parents of youth with chronic illnesses yielded 59 potential articles, with 19 meeting inclusion criteria.

Results: Parents of children with eczema were the most commonly studied group.

A review of pediatric nonrespiratory sleep disorders.

Sleep problems are extremely common during childhood, from infancy to adolescence. Despite the prevalence of sleep problems, childhood sleep disorders are often underrecognized and undiagnosed, despite being either preventable or treatable. Sleep impacts almost all aspects of a child's functioning, and thus the increased recognition and treatment of sleep disorders will positively affect a child's well-being.

Pretend play as a resource for children: implications for pediatricians and health professionals.

Pretend play relates to many areas of adaptive functioning in child development including creativity, coping, and emotion regulation. Though pretend play interventions have been employed in medical settings for decades, there are few empirical studies of such interventions in the literature. A review of literature involving pretend play in medical settings indicates that pretend play interventions are effective in inpatient and outpatient settings for preventing and reducing anxiety and distress.

A meta-analysis of the effects of psychological interventions in pediatric oncology on outcomes of psychological distress and adjustment.

Objective: To estimate the effectiveness of psychological interventions in pediatric oncology on decreasing psychological distress and increasing psychological adjustment using meta-analytic methods.

Methods: A meta-analysis was conducted on 12 psychological intervention studies in pediatric oncology using a weighted least squares (WLS) approach and random effect models.

Results: Effect sizes significantly different from zero were found for parent distress (mean = 0.

Longitudinal changes in family outcomes of very low birth weight.

Objectives: Although children with very low birth weight (VLBW, <1500 g) are at high risk for developmental impairments, we know little about the long-term effects of VLBW on families. This study examined long-term family outcomes and their stability over time.

Methods: Participants were the families of 64 children with <750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls.