Digital solutions for sleep problems in children: A pilot study.

Children with sleep difficulties have limited options for treatment. Advancements in technology allow for the digital delivery of evidence-based sleep strategies developed with a focus on cognitive behavioral therapy (CBT) approaches for insomnia. An initial survey study was conducted to assess the need and current management of sleep problems in pediatric populations. A secondary pilot study evaluated the effect of a digitally-delivered sleep strategy for the treatment of pediatric sleep problems. In the pilot study, participants had access to a mobile application which provided individualized CBT-focused sleep solutions delivered over 6-10 weeks. A total of 218 participants were surveyed to determine their need and approach for pediatric sleep problems. Approximately 74% reported sleep problems in children aged 0-1 (46%), 2-4 (67%), 5-12 (85%), and 13-17 (73%). In the pilot study, 11 families with pediatric sleep problems (children categorized as baby, toddler and school-aged) were enrolled and received the DrLullaby digital intervention. An improvement in key sleep behavior was observed including "time to fall asleep" (n = 8; 72.7%), "total time asleep" (n = 6; 54.5%) and "time awake" (n = 7; 63.6%). Within group analysis for time awake and time to fall asleep showed a mean change from baseline of 75.6% and 31.3%, respectively. Within group analysis for total time asleep showed a mean improvement of 1 h and 3 min compared to baseline. The collective distress scale score was decreased by 35%. These results suggest viability of the digital delivery of evidence-based sleep strategies for treatment of pediatric sleep problems.

Assessment of sympathetic neural activity in chronic insomnia: evidence for elevated cardiovascular risk.

Study Objectives: Chronic insomnia affects up to 15 per cent of adults. Recent cross-sectional and prospective epidemiological studies report an association between insomnia and hypertension, including incident hypertension, yet mechanisms underlying the association remain unknown. We hypothesized that participants with chronic insomnia would have elevated sympathetic neural outflow, blunted baroreflex sensitivity, and augmented sympathetic neural and cardiovascular reactivity to stress when compared with good-sleeper controls. Methods: Twelve participants with chronic insomnia (11 women, 1 man) and 12 controls (8 women, 4 men) underwent one night of laboratory polysomnography, two weeks of at-home wrist actigraphy, and one night of controlled laboratory sleep prior to a comprehensive morning autonomic function test. The autonomic function test consisted of simultaneous recordings of muscle sympathetic nerve activity (MSNA; microneurography), beat-to-beat blood pressure (finger plethysmography), and heart rate (electrocardiogram) during a 10 min supine baseline and a 2 min cold pressor test. Results: Baseline blood pressure, heart rate, and MSNA were not different between groups, but sympathetic baroreflex sensitivity was significantly blunted in participants with insomnia (-2.1 ± 1.0 vs. -4.3 ± 1.3 bursts/100 heartbeats/mm Hg; p < 0.001). During the cold pressor test, systolic arterial pressure reactivity (Δ21 ± 11 vs. Δ14 ± 8 mm Hg; time × group = 0.04) and total MSNA reactivity (Δ127%, 54%-208% vs. Δ52%, 30%-81%; time × group = 0.02) were augmented in chronic insomnia. Conclusions: Participants with chronic insomnia demonstrated impaired sympathetic baroreflex function and augmented neural cardiovascular responsiveness to stress, when compared with controls. These findings support growing evidence of cardiovascular risk and physiological hyperarousal in chronic insomnia. Clinical Trial Registration: NCT02048878. https://clinicaltrials.gov/ct2/show/NCT02048878.