0869 Black Children Report Greater Sleep-Related Impairment Independent of Objective Sleepiness and Sleep-Disordered Breathing

Abstract Introduction Daytime sleepiness and functional impairment are common among youth with sleep-disordered breathing (SDB). The Multiple Sleep Latency Test (MSLT) objectively measures sleepiness, while the PROMIS Sleep-Related Impairment (SRI) scale captures perceived impacts of sleep problems on daytime functioning from child and parent perspectives. However, the relationship between objective sleepiness and the PROMIS SRI scores remains poorly understood in pediatrics, particularly across racial groups. We evaluated whether objective sleepiness and impairments differed between Black and White children with and without SDB and examined associations between MSLT sleep latency and PROMIS SRI scores. Methods This cross-sectional study included Black and White children aged 8-12 years with SDB and healthy controls. Participants underwent polysomnography, MSLT, and questionnaires. Robust linear regression models examined associations between MSLT mean sleep latency and PROMIS SRI T-scores, including race, study group, age, and relevant interactions. Results In total, 174 children, age 9.9±1.4 years, 67% Black, MSLT mean sleep latency 15.5 ±4.3 min, child-reported SRI 53.3±10.2, parent-reported SRI 52.7±10.3 completed testing. Study groups were age-balanced, but the SDB group included significantly more Black children than controls. Child-reported PROMIS SRI scores showed no association with MSLT sleep latency (β=0.001, p=0.983). However, Black children reported significantly higher sleep-related impairment scores than White children (β=20.5, p=0.038), independent of objective sleepiness and SDB diagnosis. Parent-reported models revealed a significant SDB × MSLT latency interaction (β=–0.217, p=0.014), where longer MSLT latency was linked to lower SRI among children with SDB but not controls. This protective effect of a longer sleep onset latency was attenuated in Black children with SDB in a three-way interaction with race included (β=0.221, p=0.031). Conclusion Objective sleepiness shows minimal correspondence with child-reported sleep-related impairment, though Black children reported substantially more impairment than White children, regardless of SDB diagnosis. Parent-reported SRI was associated with objective sleepiness in children with SDB, with notable variation by race. These findings underscore the importance of integrating both subjective and objective measures when assessing sleep-related daytime functioning and investigating socioecological factors that may contribute to racial disparities in pediatric sleep health. Support (if any) R01HL152454