Objective: This study compared sleep duration, screen exposure and sleep quality in school-aged children before COVID-19 to that during school closures and again when schools re-opened in fall 2020. Study design: Cross-sectional anonymous, online survey of parents of children 5-13 years old. Methods: Questions elicited information about sleep timing and quality, screen time, and schooling at three distinct periods: before the pandemic, when schools first closed in March 2020 and then re-opened in the fall. Results: Respondents described 101 children who were an average of 8.5 years old and 51% male. In lockdown, children slept an average of 25 minutes more (95%CI 00:13-00:38) due to delays in bedtime by 29 minutes (95%CI 0:00-0:58) and wake time by 75 minutes (95% CI 0:57-1:34). When schools re-opened, sleep duration returned to pre-pandemic levels, but sleep onset and offset times remained later. Despite more sleep, sleep quality and habits (e.g. bedtime refusal) worsened during lockdown and did not normalize in fall 2020. During lockdown, screen time increased in 65% of all children, and 96% of those in private schools. When school reopened in the fall, 78% of children in hybrid/virtual learning had screen time over 4 hours daily. Less daily screen time was associated with 2-fold higher odds of better sleep (OR 2.66, 95%CI 1.15-6.14). Conclusions: Although, school-aged children had an increase in sleep time when schools were closed, sleep quality and habits worsened. Upon return to school, sleep times and sleep quality did not normalize and were related to increased screen time.

Objectives: Airway clearance therapy (ACT) is an important component of therapy for cystic fibrosis (CF) but is associated with significant treatment burden. Highly effective CFTR modulator therapy (HEMT) has improved pulmonary function for many people with CF(pwCF). We sought to understand changes in attitudes and practices about ACT in the post-HEMT era. Study design: Surveys of CF community members and CF care team members Methodology: Separate surveys were created for the CF community and CF care providers to evaluate attitudes towards ACT and exercise in the post-HEMT era. We solicited answers from pwCF via the CF Foundation’s Community Voice and from CF care providers via CF Foundation listservs. Surveys were available between July 20 and August 3, 2021. Results: Surveys were completed by 153 community members (parents of children and pwCF) and 192 CF care providers. Belief that exercise can substitute partially for ACT was endorsed similarly by community members (59%) and providers (68%) . After starting HEMT, 36% of parents of children and 51% of adults did fewer ACT treatments including 13% who stopped ACT. Adults reported altering their ACT regimen more than parents of children. Half of providers had changed their ACT recommendations for those on HEMT. Fifty-three percent of respondents had discussed changing ACT with their care team (36% of parents, 58% of pwCF). Conclusions: Providers should be aware that ACT management changes may have been undertaken by pwCF who have pulmonary benefits of HEMT. Treatment burden should be considered in co-management decisions regarding ACT and exercise.