aim: To examine the relationship of sleep disturbance with adherence and glycemic control in adolescents with Type 1 diabetes mellitus. materials & methods: Participants included 72 adolescents in poor metabolic control. Parents reported on the frequency of the following sleep disturbances: sleeping too much, not sleeping enough, trouble sleeping and being overtired. Adherence was assessed via self-report and frequency of blood glucose monitoring. Glycemic control was assessed via hemoglobin A1c and continuous glucose monitoring data. results: Sleeping more was associated with lower adherence and higher HbA1c. Sleeping more and trouble sleeping were associated with hyperglycemia as measured by continuous glucose monitoring. Conclusion: Sleep disturbance may negatively impact adherence and glycemic control. Additional research is needed to determine directionality of relationships. Practice points• Adherence to diabetes care is particularly problematic during adolescence for young people with Type 1 diabetes mellitus (T1D).• Difficulties with sleep have a known impact on cognitive and executive functioning, which is important for adherence. However, research has not yet examined relationships between sleep disturbance and adherence for adolescents with T1D.• The current study aimed to examine relationships of sleep disturbance with adherence and glycemic control in adolescents with T1D.• Participants included 72 adolescents between the ages of 10 and 18 years, who had poor diabetes control.• Parents reported on adolescent sleep disturbance, self-report and frequency of blood glucose monitoring were used to assess adherence, and HbA1c and results of continuous glucose monitoring were used to assess glycemic control.• Sleeping too much and trouble sleeping were associated with hyperglycemia. Sleeping too much was also associated with lower adherence and higher HbA1c.• Sleep variables collectively explained 16% of the variance in adherence and 15% of the variance in average CGM glucose levels.• Associations of sleep disturbance with adherence suggests the importance of assessing sleep and also highlights the need for future research on methods to improve sleep for adolescents with T1D.For reprint orders, please contact: reprints@futuremedicine.com

Study Objectives The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children. Methods A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1-18 years-old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims. Results Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g., noise, staff interruptions), most interventions targeted the child-level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components. Conclusions Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as a main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.

Background Youth with asthma commonly have suboptimal adherence to inhaled corticosteroids (ICS). It is critical to systematically evaluate the effectiveness of ICS adherence promotion interventions and discern which techniques are most effective. Objective This study aims to (1) quantify the extent to which interventions improve ICS adherence in pediatric asthma, (2) explore differences in effect size estimates based on intervention and study characteristics, and (3) characterize the risk of bias across interventions. Methods We conducted literature searches across five databases. Included studies quantitatively measured ICS adherence as an intervention outcome among youth (<18 years old) diagnosed with asthma and were published after 1997. We analyzed aggregate effect sizes and moderator variables using random-effects models and characterized risk of bias using the Cochrane Collaboration tool. Results Thirty-three unique studies met inclusion criteria. At post-intervention, the aggregate effect size for pediatric ICS adherence promotion interventions was small but significant (n = 33, g = 0.39, 95% confidence interval [CI] = 0.24–0.54); however, the aggregate effect size at follow-up was not statistically significant (n = 6, g = 0.38, 95% CI = −0.08 to 0.83). Method of adherence measurement and intervention format were significant moderators. Most interventions had a high risk of performance bias and an unclear risk of bias in one or more domains. Conclusions ICS adherence promotion interventions are effective among youth with asthma. Additional longitudinal research is needed to quantify a more precise measure of intervention effectiveness over time, and moderators of intervention effectiveness should be reassessed as the literature base expands.

Objective: Adolescents with asthma are at increased risk for poor sleep quality, anxiety, and worse asthma control. Given associations between sleep and anxiety among youth and between asthma control and anxiety in the adult literature, this cross-sectional study aims to examine whether (1) asthma control and anxiety are related among adolescents with asthma and (2) sleep quality accounts for unique variance in symptoms of anxiety beyond asthma control. Methods: Forty-one adolescents with persistent asthma (Mage = 14.83, SD = 1.28) completed the Adolescent Sleep Wake Scale, the Multidimensional Anxiety Scale for Children 2, and the Asthma Control Test. Hierarchical linear regressions were conducted to assess whether sleep quality accounted for unique variance in anxiety above asthma control. Results: Asthma control was not related to overall anxiety, p > .05, but was associated with greater endorsement of Generalized Anxiety Disorder (GAD) and physical anxiety symptoms. Together, asthma control and sleep quality explained 32.3% of the variance in overall anxiety, F(3, 34) = 5.41, p = .004. Adding sleep quality to the model accounted for 15.8% of the variance, with worse sleep quality being associated with higher anxiety, β = −.43, p = .008. Controlling for asthma control, sleep quality also explained additional variance in GAD and physical anxiety symptoms. Asthma control and sleep quality were not related to harm avoidance, p > .05. Conclusions: Our results emphasize the importance of screening for anxiety and sleep difficulties when working with adolescents with asthma, particularly those with poor asthma control.

Background Asthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ≥9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions. Objective We propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app. Methods Participants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses. Results This study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019. Conclusions Outcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users. International Registered Report Identifier (IRRID) DERR1-10.2196/13549

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Introduction Pediatric patients undergoing stem cell transplant (SCT) often experience extended hospitalizations. Inappropriate lighting during admissions is known to disrupt sleep and circadian health, which can result in worse health outcomes. This study aimed to describe patterns of light across 24-hour periods in two inpatient rooms of children undergoing SCT. Methods Wall-mounted light meters (Extech SDL400) continuously tracked noise and light levels at one-minute intervals in two patient rooms over six months. We determined the percent of time that patients were exposed to non-optimal light levels (< 448 lux during the daytime, >18 lux in the evening, >2 lux at night); thresholds were based on converting recent consensus-based melanopic equivalent daylight illuminance guidelines to vertically measured illuminance thresholds. We assessed the frequency that light exceeded thresholds associated with night wakings (>150 lux). Wilcoxon rank-sum tests compared light levels between the two rooms. Room A had a single northwest-facing window overlooking a narrow courtyard. Room B had an unobstructed window facing north. Results On average, hospitalized pediatric SCT patients spent 50% of their time in inappropriate light conditions. They were exposed to light spikes >150 lux on 2% of nights, with overnight light peaking at 513 lux. When comparing average daytime and nighttime light levels between the two rooms, Room A was significantly dimmer than Room B, p <.001. In the dimmer room, light levels never reached the recommended threshold during the daytime, and the light was too bright for 19% of the evening and 17% of the nighttime. In the brighter room, light levels were too dim during 97% of the daytime and too bright during 59% of the evening and 30% of the nighttime. Conclusion During the day, pediatric SCT patients are rarely exposed to light bright enough to preserve a healthy circadian rhythm. Hospitals have an opportunity to significantly improve the sleep and circadian health for children already at elevated risk for health morbidities during transplant. Support (if any) This research was generously supported by grant funding from Pedals for Pediatrics (PI: Zhou) and an institutional research training grant (T32DK063929).

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