bluuebunny/crossref_metadata_2025 huggingface dataset:
P066 Long-term outcomes from home invasive mechanical ventilation in Queensland
Authors: Morrison S , Gavey R , Moman A , Kwiatkowski S , Duce B , Hukins C , Ellender C
Published: December 2024

Home invasive mechanical ventilation (HIMV) is an uncommon but life-sustaining therapy for patients with chronic respiratory failure. However, the published literature on patient outcomes is inconsistent, reflecting varied practices. Moreover, local Australian data and detailed therapy outcomes are scarce. A retrospective review of patients treated with HIMV at a single tertiary centre between 01/01/2005 and 18/05/2024 was conducted. The primary outcome was the time from HIMV initiation to cessation or death. Secondary outcomes included diagnostic group, cause of death, number of hospitalisations and length of stay. Patient demographics were recorded.

31 patients were identified, with 26 meeting the inclusion criteria. The median age at injury was 35 years (9-77), with n=15 (57) male. Diagnostic groups included 13 (50%) spinal cord injuries, 4 (15%) brain injuries, 2 (8%) restrictive thoracic, 5 (19%) neuromuscular including 2 motor neuron disease and 2 (8%) other conditions. The mean survival on HIMV therapy was 19.6 years (95th CI 13.8-25.4). There was no significant difference in survival between patients with or without spinal cord injuries. Cause of death was predominantly respiratory failure (36%) and cardiovascular disease (27%). Median hospital encounters per patient-year on HIMV included 1.7 emergency department presentations, 1.4 hospital admissions, and 8.1 days of hospital stay.

This study reported the longest mean survival on HIMV compared with international datasets. This may be due to low sample size, younger population, lower proportions of diagnostic groups with known poorer prognoses and heterogenous prior research.
P071 Legislative and governance pathways to psychologist prescribing of melatonin in the behavioural sleep medicine setting in Queensland
Authors: Sullivan D
Published: December 2024

Introduction

Melatonin can be a beneficial adjunctive therapy alongside behavioural sleep medicine (BSM) interventions for circadian rhythm disorders or other behavioural sleep problems with an element of circadian disruption. Current psychologist scope of practice in Australia is federally regulated and does not include activities with medicines, including prescribing. Authorisation of health professions to prescribe medicines as part of an extended scope of practice, including research or scope of practice trials, is subject to individual state and territory government regulation.

Methods

Queensland legislation and health department procedures were reviewed to outline the mechanisms for psychologists to prescribe melatonin in a public sector BSM setting.

Results

Authority to prescribe medicines is provided by the Medicines and Poisons Act 2019 (Qld) (MPA) and the Medicines and Poisons (Medicines) Regulation 2021 (Qld) (MPMR). This authority may be provided under s75 (General Approval) or s52 (clinical trial) of the MPA without an MPMR amendment. Alternatively, for extended scope models in both public sector and private community settings, an amendment to the MPMR made by the executive branch of government provides authority for a health professional to prescribe medicines alongside an extended practice authority (EPA) by the state health department which specifies the circumstances under which the clinician can execute that authority.

Discussion

Queensland’s medicines legislation enables allied health extended scope of practice models. Implementation of psychologist prescribing of melatonin alongside BSM requires a MPMR amendment and EPA, or General Approval or clinical trial approval which would specify requisite training requirements, formulary, and any other limitations.
P072 Developing Generative AI Products for Sleep Health Support: A Risk-Based Approach
Authors: Deas R , Cotton A , Santizo R , Webb K , Signoroni M , Tjia J , Li M , Au-Yeung G , Lyle A , Silva C , Armitstead J
Published: December 2024

Introduction

Generative AI tools can assist individuals with sleep problems by providing information about sleep disorders, sleep health, and product support. However, it is crucial to mitigate the risks of misinformation and ensure that tools do not unintentionally provide medical advice.

Methods

A set of topics and patient/customer queries were identified to define the use case. Despite not meeting the definition of a medical device in Australia, a multidisciplinary team employed risk management principles to meet user needs while complying with regulatory, legal, and clinical requirements. Key considerations included selecting the LLM and grounding content to create a prototype. The prototype was tested by a multidisciplinary team to evaluate performance and introduce additional requirements via prompt engineering, disclaimers, and topic exclusions. Upon meeting requirements, the product launched with 100% human oversight of customer responses, planning to reduce oversight as the product consistently met all requirements.

Results

The digital assistant has successfully answered over 1000 user inquiries, meeting all requirements. Data sources are regularly updated to align with current information and the risk analysis is continuously updated based on performance, and.

Discussion

The risk-based process used for developing the digital assistant has resulted in a generative AI tool to support people with sleep problems. Collaboration with a multidisciplinary team is crucial to ensure the responsible use of generative AI tools that are fit for the purpose to support people with sleep problems as they look for reliable information about sleep health and sleep disorders.
P074 Design of general practice-delivered models of care for sleep health care: lessons learnt from chronic disease management in general practice
Authors: Grivell N , Brown B , Fuller J , Chai-Coetzer C , McEvoy R , Hoon E
Published: December 2024

Introduction

General practice-delivered models of care for obstructive sleep apnea and insomnia have been developed in response to challenges with access to care. However, despite evidence of effectiveness, these models are not yet integrated into routine practice. Understanding factors influencing implementation can facilitate translation into practice however research exploring the implementation of models of care for sleep health care is scarce. As such, a systematic review exploring the implementation of models of care for chronic disease was conducted to inform models of care for chronic sleep disorders.

Methods

A mixed-methods JBI convergent integrated systematic review. Seventy-two records, published between 1995 and 2022, were included. Framework synthesis was conducted however data that did not fit the chosen conceptual framework was identified, necessitating the development of a new amended framework.

Results

Relationship between general practice staff and specialist services, compatibility with existing work processes, patient-centred care, and an understanding of the benefits of the model of care by clinicians and patients were facilitators to implementation. Lack of transparency and understanding about the roles and responsibilities of team members, inadequate funding, and models of care that restrict individualised patient care limited implementation.

Discussion

This review provides recommendations that can be used to inform the design and implementation of new general practice-delivered models of care for chronic sleep disorders. Establishing relationships, understanding the general practice context, and engagement of patients (co-design) when designing models of care, may facilitate the implementation of models of care that meet the needs of patients and general practice staff.
P075 Use of an innovative tool to screen for sleep disorders in primary care
Authors: Haycock J , Maloney S , Boeselt J , Loffler K , Sweetman A , Hoon E , Lovato N , Catcheside P , Adams R , Reynolds K , Vakulin A
Published: December 2024

Effective screening for sleep problems in primary care is an essential first step in the diagnosis and management of sleep disorders. However, sleep disorders are complex and often overlooked by both primary care clinicians and patients. This pilot project trialled an innovative technological approach to help screen for common sleep disorders and provide treatment decision support recommendations to general practitioners (GPs) and patients in primary care.

This mixed methods study included interviews with GPs to investigate the needs and specifications for a digital sleep health decision support tool in primary care. A pilot study trialled the usefulness and feasibility of an innovative tool to screen for sleep disorders in general practice. Data collected included uptake of the tool, feedback from GP follow-up interviews and patient surveys.

Results from 5 GPs and 23 patients indicate ease of use in primary care and clinical utility are important, and that the decision support tool helped to reinforce clinical decision making and raised the priority of sleep disorders with patients. Issues with workflow, patient motivation and engagement were identified as barriers limiting usage.

With growing interest in the management of sleep disorders in primary care, GPs need streamlined tools to easily identify patients at risk of sleep problems. An innovative decision support tool is useful in primary care to support clinical decision making and encourage patients to seek help for sleep problems. A larger scale trial is warranted to assess the impact of this tool on clinical decisions and patient outcomes in primary care.
P077 Death anxiety, disturbing dreams and nightmare severity in Australian adults
Authors: Dunican I , Turner M , Meaklim H , Cunnington D , Burge M , Menzies R
Published: December 2024

Introduction

In recent years, death anxiety has been identified as a transdiagnostic risk factor for many mental health conditions and potentially for disturbing sleep and nightmares. In this cross-sectional study, we aimed to identify the prevalence and predictors of death anxiety and examine its relationship to disturbing dreams and nightmares in Australian adults.

Methods

Participants completed a series of questionnaires as part of a larger study, including measures of death anxiety with the Death Anxiety Beliefs and Behaviour Scale (DABBS), nightmare severity with the Disturbing Dream and Nightmare Severity Index (DDNSI), and dream content with the Typical Dreams Questionnaire (TDQ).

Results

432 (47% female) Australian participants completed the study, with an average age of 45±18 years. Overall, 10% reported a sleep disorder diagnosis, and 47% reported a mental health diagnosis. Overall, DABBS scores were significantly higher in females than in males aged 18-30 (p<0.001). Similarly, DDNSI was significantly higher in females compared with males between ages 31-44 years (p<0.02). Typical themes for most people’s dreams included being chased or pursued. Those with a mental health disorder also had significantly higher DABBS scores (p<0.001). Importantly, DABBS scores were significantly and positively related to DDNSI (p<0.003, R2 0.006).

Discussion

These findings indicate that gender differences in death anxiety appear largest in young adults. Importantly, death anxiety was significantly associated with nightmare severity. In particular, the most reported dream themes revolved around threat (i.e., being chased). These results highlight the potential benefits of treating death anxiety to improve nightmare severity.
P079 Words matter: Dream content may predict psychological distress
Authors: Burge M , Meaklim H , Turner M , Dunican I , Menzies R , Cunnington D
Published: December 2024

Introduction

Dream content analysis is not a routine part of a clinical sleep assessment. However, dreams are an important part of the sleep experience and may provide insights into other health domains. This study investigated the relationship between descriptions of dream content and psychological distress.

Methods

The study cohort consisted of 217 participants (149 female, age range: 19-83) who completed the Depression Anxiety Stress Scale 21 (DASS-21) and described their last remembered dream. Dream content was analysed using 26 categories from the Linguistic Inquiry and Word Count 22, including emotion, pro-social vs. conflict, lifestyle, health, drives, and perception language. Principal components analysis (PCA) identified 18 principle components (PC) that explained 90% of the variance in these categories. These components were used to predict severe and higher scores of depression and anxiety and moderate and higher scores of stress through logistic regression models. Stepwise regression using the backward method, based on Akaike Information Criterion scores, was employed to select the best models.

Results

The analysis found no significant predictors for depression. However, a PC high in frequencies of visual and auditory perception, motion, and space language and a PC high in frequencies of substances, sexual, food, and motion language significantly increased the odds of severe and higher anxiety (Tjur R² = 0.04) and moderate and higher stress (Tjur R² = 0.09).

Discussion

These findings suggest specific words used to describe dream content are associated with higher levels of anxiety and stress. Reviewing dream content may provide additional insights for clinicians.
P081 Sleep health in community-dwelling midlife women and associations with menopausal symptoms: a cross-sectional study
Authors: Noll J , Metse A , Gardiner P , Pernoud L , Scott J , Schaumberg M
Published: December 2024

Introduction

Sleep health or, ‘healthy sleep’, is a multidimensional construct, more than the absence of a sleep disorder. Menopausal women often experience sleep disturbances, yet the impact of menopausal symptoms on the likelihood of poorer sleep health remains unclear. This study examined how domains of menopausal symptoms (vasomotor, psychosocial, physical and sexual) relate to sleep health in Australian middle-aged women.

Methods

A total of 150 healthy women, aged 40-64 years, participated in this cross-sectional study. Sleep health was measured using the Ru-SATED questionnaire (scores ranging from 0 [poor sleep health] to 12 [good sleep health]), and sleep duration and efficiency were collected with actigraphy. Recommended sleep duration and efficiency were based on National Sleep Foundation (NSF) guidelines. Domains of menopausal symptoms were assessed with the Menopause-specific Quality of Life (MENQOL) questionnaire. Data were analysed through ordinal and binomial regression.

Results

The average Ru-SATED score was 9.2±2.2. According to NSF guidelines, only 20.0% of participants slept the recommended 7 to 9 hours, and 31.3% had the recommended sleep efficiency (≥85.0%). After adjusting for covariates, greater psychosocial symptoms were significantly associated with poorer sleep health (β=-0.437, p=0.002). Menopausal symptoms were not significantly associated with actigraphy measured sleep duration or efficiency.

Discussion

Most midlife women in this study did not meet the NSF sleep health recommendations. Psychosocial symptoms were associated with poorer sleep health in midlife women, consistent with research in other populations. Further research into factors beyond menopausal symptoms contributing to the likelihood of poor sleep health in middle-aged women is warranted.
P084 General practitioner training on obstructive sleep apnoea and long-term care: a pilot study
Authors: Abbas S , Liaw S , Marks G , Buchanan P , Williamson J , Johnson A , Tam M , Garden F , Chung Y , Vedam H
Published: December 2024

General practitioner training on obstructive sleep apnoea and long-term care: a pilot study

Introduction

Obstructive sleep apnoea (OSA) can be treated using continuous positive airway pressure (CPAP) therapy; however, many patients experience difficulties acclimatising and persisting with this treatment. In view of the increasing prevalence of OSA, evidence-based models of care not limited to sleep physicians are urgently required. A pilot study was conducted on the feasibility of implementing an education session for general practitioners (GPs) on OSA and its long-term care.

Methods

Fourteen GPs from a university practice-based research network participated in a 1-hour education session on the chronic nature and management of OSA, aiming to develop a format for structured follow-up. Quizzes were administered to assess knowledge before and after the sessions, with pre and post-session data compared using McNemar’s test. Prior to these sessions, surveys were sent to GPs to identify areas they wanted to cover to maximise engagement.

Results

Twelve GPs completed both pre and post-session questionnaires. Key areas demonstrating an improvement in knowledge were awareness of established treatment measures for OSA (p=0.008), compliance data parameters to assess CPAP use (p=0.014) and assessment of leak (p=0.014). All participants found sessions to be either “helpful” or “very helpful”.

Discussion

This study demonstrated that a focused education session for GPs on OSA and CPAP therapy is feasible, implementable, and led to improved knowledge and confidence in providing structured follow-up. Further work is required to determine potential benefits for patients and access to health services.
P085 Case report of direct diaphragmatic pacing in a child
Authors: Abosh D , Jarvis S , Karpelowsky J , Waters K
Published: December 2024

Background

We present the case of an 8-year-old boy who was diagnosed with acute flaccid myelitis at the age of 5 subsequent to an enterovirus infection. His course was complicated by near complete paralysis of the diaphragm and ventilatory failure necessitating tracheostomy. He has subsequently required full time ventilation via tracheostomy despite gaining sufficient motor function for walking. We describe the concept, indications, and contraindications of diaphragm pacing in ventilator-dependent paediatric populations and compare its use to similar adult populations.

Methods

Direct diaphragmatic pacing is an alternative to phrenic nerve pacing, and it has gained popularity in recent years. The majority of reported cases are in adults with paralysis secondary to spinal cord injury. This is a prospective interventional case report of the use of diaphragm pacing in a ventilator-dependent paediatric patient with a tracheostomy, because he represents a unique clinical scenario for this surgery, including potential sensation of the pacing.

Progress to date

The patient is planned for pacing surgery in August 2024. Consent has been obtained from the family to report the case, thus permitting preparation of the manuscript while plans for surgery are underway.

Intended outcome and impact

The expectation is that with direct diaphragmatic pacing the patient will become less dependent on mechanical ventilation, enabling him to have more freedom in his activities. If successful this intervention will provide an opportunity for future utilisation in other carefully selected cohorts, to replace mechanical ventilation and improve quality of life.
P086 Taking a Comprehensive Approach to Investigating Screen Time and Sleep in Preschoolers With and Without Autism
Authors: Axelsson E
Published: December 2024

Children’s screen time has increased, and the majority of children exceed recommended screen time limits. Relationships between screen time and development are reportedly mixed, but children who meet recommended guidelines for screen time, physical activity, and sleep, perform better on cognitive measures (Walsh et al., 2018). It is therefore important to incorporate sleep into investigations of screen time and child development. Sleep is important for children’s learning, memory, and behaviour, and screen time evidently disrupts sleep. Children with developmental disorders have greater sleep difficulties (Halstead et al., 2021) and longer screen times than typically developing children (Aishworiya et al., 2018) and both could compound existing developmental difficulties. We take a comprehensive approach to investigating preschoolers’ screen time and relationships with sleep, cognition, language, and behaviour. There are limited findings with preschoolers and in particular preschoolers with autism. Caregivers of typically developing children and children with or at risk for autism complete a screen time diary that incorporates content type (entertainment, educational, relaxing), engagement type (passive/interactive; with someone/solo), and time of day; and questionnaires on their child’s sleep quality, development, and behaviour. We also administer direct measures of executive function, language, and memory. Sleep is measured objectively using actigraphy and a sleep diary. If screen time disrupts sleep, does it also interact with children’s memory for new words, their cognitive and behavioural development? We present an overview of the study and the challenges faced recruiting preschoolers and some preliminary descriptive data.
P090 Assessment of the seal, comfort, usability and performance of an ultra-compact full-face PAP mask in comparison to a competitor mask
Authors: Bindra J , Ghamedi S , Camacho L , Banodkar N , Deas R , Zhu X , Sert Kuniyoshi F , Dauphin B , Uhles M
Published: December 2024

Introduction

Positive Airway Pressure (PAP) is the standard treatment for Obstructive Sleep Apnoea (OSA), with a well-fitting mask crucial for adherence. The Oran Park (OP) mask combines full-face performance with an ultra-compact design, featuring a soft, adaptable silicone cushion for all-night comfort. This study assessed the efficacy and subjective ratings of the OP mask in the home environment, compared to a competitor mask and participants’ own masks.

Methods

PAP users with cloud-connected devices tested the OP and competitor masks for up to 7 nights each in randomised order, completing questionnaires on an 11-point Likert Scale. Objective PAP therapy data (Apnoea-Hypopnoea Index (AHI), leak, pressure, usage) was obtained from their PAP devices. Data were analysed using appropriate statistical methods.

Results

57 participants completed the study. The OP mask received significantly better median scores than the competitor for ease of adjustment (8 vs. 7), ease of use (9 vs. 8), softness and comfort (9 vs. 8), noise (9 vs. 8), venting (10 vs. 8), sleep position freedom (8 vs. 7), and confidence about continuing therapy (8 vs. 7). The OP mask was rated significantly better than own mask for facial markings. PAP therapy data showed no significant differences across all masks, with acceptable objective leak values.

Discussion

This clinical study demonstrates the efficacy of the OP mask with PAP therapy, evidenced by low residual AHI and superior subjective results for cushion softness/comfort and sleep position freedom. Further research could explore the long-term effects of the OP mask on PAP adherence and outcomes.
P091 Evaluating the effect of waterless humidification on long term adherence to PAP therapy in the home environment
Authors: Bindra J , Tellez D , Camacho L , Mastellone J , Banodkar N , Deas R , Zhu X , Sert Kuniyoshi F
Published: December 2024

Introduction

Adherence to Positive Airway Pressure (PAP) treatment in Obstructive Sleep Apnoea (OSA) patients can be challenging. Whilst humidification enhances comfort and may improve adherence, maintenance can be burdensome. Waterless humidification through heat and moisture exchangers (HMX) offers a low-maintenance alternative. This pilot study aimed to determine the effect of waterless humidification via HMX on long term PAP adherence and user feedback, after 12 months of use.

Methods

This decentralised, prospective cohort study enrolled US-based established PAP users, using cloud-connected devices and a patient engagement app. All procedures were conducted remotely. Participants used a HMX device with their home PAP device for 12 months. Average nightly usage was measured at baseline (3 months prior) and monthly post-enrolment. Usability, comfort, and ease of use were assessed monthly via 11-point Likert scale questionnaires. After 90 days of HMX use, average PAP usage and apnoea-hypopnoea index (AHI), and weighted-average patient-reported scores were calculated.

Results

162 participants were analysed after 90 days of HMX use. Average cumulative PAP usage decreased slightly from 6.81 to 6.80 hours, while AHI changed from 2.04 to 1.87 events/hour. The HMX device received favourable ratings, with mean scores of 8.43 (overall performance), 9.43 (overall ease of use) and 8.66 (overall breathing comfort).

Discussion

This analysis demonstrates no deterioration in PAP usage or AHI following 90 days of HMX use, with favourable subjective feedback. Further analysis upon 12-month completion will provide valuable insights into real-world evaluation of waterless humidification with home PAP therapy.
P093 Associated risk factor of metabolic syndrome and relationship between metabolic syndrome and obstructive sleep apnea in Korean adults
Authors: Sim J , Chang S
Published: December 2024

Introduction

Many studies have shown an association between metabolic syndrome (MetS), and obstructive sleep apnea (OSA). However, there are insufficient studies on whether STOP-BANG is associate with MetS in Korean adults. Therefore, we attempted to clarify this relationship in Koreans adults.

Methods

A total of 2,900 participants (1,233 men and 1,667 women) were enrolled in the Korean National Health and Nutrition Examination Survey from 2019 to 2020. We used the National Cholesterol Education Program Adult Treatment Panel III criteria for MetS and STOP-BANG questionnaire for OSA risk. Logistic regression analysis was used to measure the association between MetS and various confounding factors, including high OSA risk (STOP-BANG score≥3).

Results

The percentage of subjects with high OSA risk was significantly higher in subjects with MetS than without MetS (54.9% vs 27.7%; p<.001). In multivariate logistic regression analysis, high OSA risk (OR 1.490, 95% CI 1.139 to 1.948, p=0.004), men (OR 3.966, 95% CI 2.938 to 5.353, p<.001), waist circumference (OR 1.095, 95% CI 1.076 to 1.113, p<.001), fasting glucose (OR 1.038, 95% CI 1.028 to 1.047, p<.001), and systolic blood pressure (OR 1.038, 95% CI 1.030 to 1.047, p<.001) were significantly associated with MetS in Korean adults.

Discussion

These results suggest that there is a strong association between high OSA risk and MetS in Korean adults. Therefore, MetS evaluation is required in high OSA patients, and OSA diagnosis through PSG test and treatment is necessary.
P099 An audit of the diagnostic workup of patients with Idiopathic Hypersomnia at Gold Coast University Hospital
Authors: Gordon L , Saxena K , Sriram B
Published: December 2024

Background

Idiopathic hypersomnia (IH) is a central cause of hypersomnia. The diagnosis involves excluding all other causes of hypersomnia whilst also proving reduced sleep latency without features of narcolepsy. There are many causes of increased fatigue, and therefore proving the diagnosis of IH is an involved process requiring a thorough medical and medication history, a review of basic pathology results and examination. This is then followed by a minimum of a 10-day sleep diary, a diagnostic polysomnography followed by a multiple sleep latency test. Treatment for IH can involve stimulant medication, and therefore the prescribing doctor needs to be confident in the diagnosis. This is an audit of the patients diagnosed or treated for IH at Gold Coast University Hospital (GCUH), looking to identify how often all these work up requirements have been met.

Methods

A list of all the patients treated or diagnosed with IH at the GCUH sleep department will be obtained from the Sleep Disorders Centre Database. The diagnostic workup of the patients identified will then be reviewed to ensure that they have met the diagnostic criteria.

Progress to date

data collection currently in progress.

Intended outcome

Confirmation that the patients diagnosed with or treated for IH at GCUH have been through the required diagnostic workup.
P103 Developing Visual Tools for Participant Information and Consent in Sleep Health Research
Authors: Ashby C , Cooper R , Ison H , Kinghorn M , Sullivan D , Nasir B , Edmed S , Von Senden R , Bucks R , Fatima Y , Jahan I
Published: December 2024

Introduction

Informed consent in research is crucial for meeting ethical standards, transparency, and voluntary participation. However, current institutional research consent processes often rely on text-heavy documents filled with complex academic jargon. This approach can lead to misunderstandings and disengagement, posing a significant challenge to obtaining genuinely informed consent. This study outlines the process of developing visual tools to improve the informed consent process in sleep health research with First Nations peoples.

Methods

Through a collaborative process engaging First Nations visual communication experts and First Nations community researchers, visual consent tools were redesigned to prioritise participant engagement. Iterative feedback was provided regarding accessibility, cultural responsiveness, and suitability for First Nations communities, whilst balancing consumer-centric information and the rigour of the informed consent process. Subsequently, the Lets Yarn About Sleep First Nations Data Governance team assessed the work for cultural responsiveness and suitability for First Nations sleep health research. The final stage involved obtaining institutional ethics committee approval for consumers to test and evaluate the visual tools.

Results

Initial feedback from community researchers and the Data Governance team highlights the potential of the visual consent tools to enhance the informed consent process. Further testing and evaluation will confirm the impact of these tools on participant comprehension and engagement.

Discussion

This study documented initial steps in First Nations-led development of culturally responsive visual tools for seeking informed consent in sleep health research. Future work must evaluate broader acceptability of culturally grounded visual consent approaches, with a view to reforming institutional research ethics processes.
P104 Positional OSA in children: single-centre prevalence and associated CPAP adherence
Authors: Kevat A , Suresh S , Kilner D , Chawla J , Collaro A
Published: December 2024

Background

Positional obstructive sleep apnoea (POSA) is an obstructive sleep apnoea (OSA) phenotype in which most obstructive events occur in supine sleep. For adults, recent guidelines and trials suggest positional OSA devices are suitable treatment alternatives to continuous positive airway pressure (CPAP). We sought to determine prevalence of POSA and associated rates of suboptimal CPAP adherence in children.

Methods

This single centre retrospective cohort study included all children >2 years of age prescribed CPAP from 01/01/2020–01/01/2023 through Queensland Children’s Hospital (QCH) for moderate-severe OSA. Children were classified as having POSA or not through examination of obstructive events and sleep position determined by their diagnostic polysomnography. POSA was defined according to three different established diagnostic criteria (Cartwright’s, Bignold’s and Amsterdam POSA criteria), modified for paediatric use. CPAP adherence was defined as on average >4 hours usage for ≥5 nights/week.

Results

Of 120 eligible participants (median age = 13 years), 34% were female, 62% were obese, 33% had a syndromic or neurodevelopmental diagnosis and 48% had undergone adenoidectomy +/- tonsillectomy. Depending on POSA definition, 34%-68% (41-73) of the 120 participants had POSA. One-third (32-36%, depending on POSA definition used) of those with POSA had suboptimal CPAP adherence based on their first CPAP download.

Conclusion

A significant proportion of children with OSA prescribed CPAP at QCH have POSA, some of whom struggle to maintain CPAP adherence. Positional device therapy may represent an appropriate alternative management strategy. However, well-designed prospective trials in children are needed.
P106 The contribution of workload to fatigue risk in helicopter Search and Rescue operations
Authors: Ladyman C , Signal L , van den Berg M
Published: December 2024

Introduction

Routine offshore aviation transport services often co-provide Search and Rescue (SAR) operations. SAR crewmembers are required to be on immediate or standby readiness 24-hours a day and perform complex high-risk tasks when called. This study investigated work and sleep-based factors associated with workload and the contribution of those same factors to fatigue in this operation.

Methods

Across two 21-day rosters, SAR crewmembers recorded sleepiness (Karolinska Sleepiness Scale, KSS), fatigue (Samn-Perelli Fatigue Checklist, SP) and workload ratings (Overall Workload, OW and NASA Taskload Index, NASATLX), wore an actigraph to measure sleep, and completed a 3-minute Psychomotor Vigilance Task (PVT). Mixed model ANCOVAs investigated sleep and work-related factors associated with OW and NASATLX ratings and separately work-related factors associated with KSS and SP ratings and PVT performance at the end of a shift.

Results

A callout or training during a shift resulted in higher OW and NASATLX ratings (all p=<0.001). If a shift involved administration, OW and NASATLX were lower (all p≤.05). Prior sleep/wake history and shift worked were not significantly associated with workload measures. End of shift fatigue ratings were higher when a callout or training occurred, and end of shift sleepiness ratings were higher when training occurred (all p≤.05). Administrative work was not associated with changes in fatigue or sleepiness. No work-based factors were associated with PVT.

Discussion

Key contributors to both increased workload and greater fatigue and sleepiness were callouts and training. These aspects of work may directly impact fatigue and sleepiness and also indirectly, via greater workload.
P107 Overnight Oximetry for the Diagnosis of Sleep-Disordered Breathing in Cervical Spinal Cord Injury Patients
Authors: Lim S , Kovacs R , Tung C , Cistulli P , Mohammadieh A
Published: December 2024

Background

Cervical Spinal Cord Injury (cSCI) patients have altered upper airway physiology and breathing mechanics, putting them at risk of clinically significant sleep-disordered breathing, including Obstructive Sleep Apnoea (OSA), Central Sleep Apnoea (CSA) and hypoventilation syndromes. However, polysomnography (PSG) for cSCI patients may be financially and environmentally costly and may not be accessible to all cSCI patients. Overnight oximetry is a portable and cost-effective alternative screening and diagnostic test, but its diagnostic accuracy has not been assessed in a cSCI population.

Methods

Patients will be eligible if they have sustained an acute cervical SCI between Jan 2021 and Dec 2023 and have undergone full PSG as an inpatient or outpatient within one year of their acute injury. Overnight oximetry from the night of the PSG will be compared to the overall PSG result for diagnostic accuracy with respect to OSA, CSA and hypoventilation. ROC analysis will be undertaken using metrics including ODI, time with SaO2 < 90%, as well as a clinician-based “pattern recognition” of the oximetry trace morphology.

Progress to date

668 acute spinal cord admissions have been identified at a single tertiary spinal injury centre between Jan 2021 and Dec 2023. Work is ongoing to identify those patients with cervical SCI only and to analyse the oximetry and PSG data.

Intended outcome and impact

This study will help to standardise and streamline the diagnostic pathway for SDB in cSCI patients in a tertiary referral centre, and allow more time efficient access to therapy in this vulnerable patient group.
P110 Does better adherence to Sleep Restriction Therapy produce a faster clinical response in CBT-I?
Authors: Ogden J , Lim J , Bei B , Drummond S
Published: December 2024

Introduction

Sleep Restriction Therapy (SRT) is a key component of CBT-I. The goal of SRT is to build sleep debt to consolidate sleep and increase sleep efficiency. Given that, one would expect greater adherence to SRT to predict a faster clinical response, defined as fewer weeks of restriction prior to the first increase in time-in-bed (once 85% sleep efficiency is reached). Here, we examined this hypothesis for the first time.

Methods

83 participants were randomized to 7 weeks of therapist-led CBT-I. 78 initiated SRT (age: 48.0±14.3, 57.7% F). A Poisson regression was conducted to investigate the relationship between adherence to SRT (deviation from bed and wake times, naps) and the number of weeks in SRT prior to the first increase in time-in-bed. Age and diary-based sleep efficiency in week 1 (prior to beginning SRT) were added to the model as covariates.

Results

There was a significant positive association between waking later than prescribed wake time and number of weeks in SRT prior to increasing time-in-bed (p <.05). However, deviation from prescribed bedtime and napping were not significantly associated with time in SRT.

Conclusion

Overall, better adherence to morning wake time is associated with faster response to SRT. Adhering to morning wake time may further promote sleep deprivation and stabilise circadian rhythms, thereby improving the sleep efficiency required to increase time-in-bed. Given the challenging nature of SRT, a relationship between adhering to wake time and faster titration upward of time-in-bed may improve both therapist treatment fidelity and client motivation.
P111 Chronic Pain and Sleep: The feasibility of tailored group cognitive behavioural treatment for insomnia for individuals with chronic pain
Authors: Bensen-Boakes D , Dunbar C , Paterson J
Published: December 2024

Sleep disruption is a common comorbidity for individuals living with chronic pain but avenues for referrals and treatment are often difficult in these populations with competing medical demands. The ongoing struggle with sleep difficulties can result in the development of insomnia. Recent research supports that addressing difficulties with sleep may significantly improve the patient’s ability to manage their chronic pain and lighten overall illness burden. Cognitive Behavioural Therapy for Insomnia is the currently accepted gold standard for the treatment of Insomnia, however adaptations for its use in chronic pain populations is necessary. This program first aimed to investigate common presentations and the practical adaptations necessary for safe and effective implementation of CBTi in this population. This research targets the need for greater understanding of the benefits and safe use of CBTi in diverse populations. Secondly, this program explored the implementation of group-delivered CBTi within the chronic pain population to provide insight into new implementation methods and the overall feasibility. This research addresses the understudied area of individuals with chronic pain patients and sleep difficulties, and also directly relates to and promotes the need for greater multi-disciplinary approach to chronic illness management. It highlights the need for greater awareness of an understudied group and promotes opportunities for individuals to access supports beyond their chronic illness which enables them to achieve greater autonomy over their treatment journey.
P118 Sleep in adults exposed to a major flooding event in Australia
Authors: Edmed S , Rossa K , Pattinson C , Alam M , Lorimer N , Smith S
Published: December 2024

Introduction

Residents in communities impacted by major flooding events, such as those experienced in Brisbane in 2022, face a range of challenges that may impact their recovery. Poor sleep health may be a direct and potentially ongoing outcome of these events.

Method

An online survey was completed by 134 adults affected by flooding in 2022/3 in Australia (Mdn Age=27; 79% female). Data were collected12-18 months post-flood. The survey consisted of standardized assessments of socioemotional functioning and sleep, predominantly drawn from the Patient Reported Outcomes Measurement Information System® (PROMIS®), with a tailored measure of flood exposure.

Results

Residents living in a flood affected suburb whose home was affected by flood waters, or with residual problems due to flood waters, had higher PROMIS Sleep Disturbance T-Scores (PROMIS-SD; p=0.05, p=<0.01, respectively) and higher PROMIS Sleep Related Impairment T-Score (PROMIS-SRI) (p=0.02, p=.03) compared to those who did not; but there was no significant association for sleep duration (p=0.83, p=0.41) and sleep regularity (p=0.33, p=0.69). Greater worry about future extreme weather, but not worrying about climate change, was associated with greater PROMIS-SD (p<0.01, p=0.33) and PROMIS-SRI (p<0.01, p=0.34).

Discussion

Climate change has implications for sleep health on a global scale. The frequency of extreme weather events is predicted to increase. Poor sleep may amplify and reinforce health and social risks for people after flooding. Further analysis of these data will explore the mediating impact of sleep on psychosocial trajectories of recovery.
P119 Exploring sleep in people experiencing homelessness: A scoping review
Authors: Edmed S , de Waal L , Rossa K , Pattinson C , Salom C , Lorimer N , Gadam S , Smith S
Published: December 2024

Introduction

People experiencing homelessness are among the most socially and economically disadvantaged. Homelessness is associated with a higher risk of adverse health, social and economic outcomes. This review aimed to describe published evidence available regarding sleep in adults experiencing homelessness.

Method

Guided by the Scoping Review framework in the Joanna Briggs Institute Manual for Evidence Synthesis, a systematic search of 7 databases was conducted. English language studies were included if they examined any dimension of the sleep experience reported by adults (≥18 years) experiencing homelessness in high income countries. No publication date limits were set.

Results

101 studies met inclusion criteria (45 quantitative, 43 qualitative, 6 mixed-methods studies, and 7 narrative reviews). Most studies (66%) did not explicitly investigate sleep as a core research objective. Half (52%) were conducted in the United States, with 9 Australian studies (9%). Most (94%) quantitative studies used predominantly purpose-developed, subjective sleep measures. Despite measurement heterogeneity, insufficient sleep and poor sleep quality were frequently endorsed. Qualitative studies identified safety and security, weather exposure, and comfort as important factors impacting sleep. No sleep specific intervention studies were found.

Discussion

Findings suggest that more high-quality research is needed, with greater consistency and standardization of measurement to allow evidence to be synthesised. An integrated view of sleep health should be adopted, incorporating expertise across broad sleep health areas with consideration of individuals’ neurophysiology, their beliefs, habits, and experiences, physical environment, and the broader social context. These factors are particularly important in developing public health-focussed interventions for vulnerable populations.
P120 The relationship between digital technology and sleep-wake behaviour in children aged 5-8 years
Authors: Pattinson C , Edmed S , Rossa K , Mann D , MacKenzie J , de Waal L , Smith S
Published: December 2024

Introduction

Children are growing up in 24-hour digital-enriched environments. Digital life may have significant impacts on a child’s 24-hour sleep-wake behaviours and wellbeing. This study aimed to explore the relationships between sleep, digital technology use, and daytime functioning in children.

Method

Data for this study were drawn from a pilot study investigating wearable devices in children aged 5-8 years, in their naturalistic environment. Children (N=20, Mage=7.03, SD=1, f=40%) wore an actigraph continuously for 48-hours to monitor sleep. Parents completed a daily digital technology time-use survey, as well as questionnaires to assess the purpose of digital technology use (Child Regulatory Media Use Scale) and daytime sleep related impairment (PROMIS®).

Results

Mean(SD) sleep onset and offset were 19:55 (00:39) and 05:58 (00:42), respectively. Using digital technology in the 2-hours before sleep was associated with increased parental use of media to regulate children’s emotions and behaviours (r=.59, p=.006), and poorer sleep related daytime impairment (r=.52, p=.02), but not with sleep onset, offset, or duration.

Discussion

Use of devices 2-hours prior to bedtime was associated with poorer parent-perceived daytime function, but not with objective measures of sleep duration. Use of digital media by children, including personal devices, is increasingly common. Parental choices around the role of screens in the family may be an important determinant of wellbeing. Based on findings from this study, a larger scale study is warranted to quantify and map digital exposures of children in the early years of primary school (5 – 8 years old).
P121 Chronotype Differences in Sleep Quality: A Systematic Review of Early Birds and Night Owls
Authors: Sajadi Hezaveh Z , Halaki M , Fitzmaurice M , Marin Galindo A , Chow C
Published: December 2024

Introduction

A growing body of literature explores the health risks associated with chronotype, independent of various other factors. Amongst them, sleep quality stands out as significant yet relatively underexplored. This study aims to examine the association between chronotype and sleep quality.

Method

MEDLINE, Web of Science, Scopus, Embase and Cinahl were searched for studies published before May 2024. Search terms were grouped into sleep quality and its assessment tools, plus chronotype and its assessment tools. Studies reporting the distribution of sleep quality parameters in different chronotype categories among the adult disease-free population were considered eligible. This study is registered in PROSPERO (CRD42023448002).

Progress to Date

After removing duplicates, we retrieved 1,125 abstracts. Following title/abstract screening, 724 studies remained, and upon full-text screening, 197 studies met the inclusion criteria. We are currently in the data extraction stage, having extracted data from 56 studies. Preliminary findings indicate that as chronotype progresses from morning to intermediate and late, there is a notable decrease in sleep quality and quantity, an increase in excessive daytime sleepiness, and a higher rate of insomnia. However, results regarding sleep efficiency and sleep latency are inconsistent. Additionally, different patterns may emerge when results are grouped by weekdays versus weekends or chronotype assessment tools (e.g., Munich Chronotype Questionnaire, Morningness-Eveningness Questionnaire).

Intended Outcome and Impact

After extracting the data, we will evaluate the quality of the included studies and consider conducting a meta-analysis. Our ultimate goal is to use the research findings to inform practitioners and sleep clinicians about the significance of chronotype in managing sleep issues.