bluuebunny/crossref_metadata_2025 huggingface dataset:
O059 Exploring Environmental Light Exposure in Children: A novel pilot spectrometer study
Authors: Pattinson C , Mann D , McKenzie J , Rossa K , Edmed S , Westwood E , Smith S
Published: October 2023

Introduction

Light plays an important role in the timing of children’s circadian system. Artificial manipulation of the timing, intensity, spectra, and duration of light exposure has increased, but with little consideration of the impact on children’s development, health, and wellbeing. Children are exposed to brighter nights, darker days, and less natural light environments than prior generations. Exploring the 24-hour light environment is a critical first step in understanding how light affects children.

Methods

We conducted a pilot feasibility and acceptability study. The study is of children aged 5 – 8 years. Children wore a miniature spectrometer and an actigraph for 48-hours. During this period, their parents completed a survey and daily time-use diary. At the end of the study, children undergo a short evaluation interview, as this is a new form of wearable not previously used with children. This study examines the feasibility and potential utility of this form of measurement.

Results

5 children have been recruited into the study (3 boys, 2 girls). Initial feasibility testing with children supports high acceptability and adherence to the study protocol. This presentation will focus on both the technology development aspects, useability and feasibility in children, and preliminary results.

Discussion

This study presents preliminary data that supports the feasibility of novel light exposure metrics. Understanding the impact of increased use of digital devices by children, and increased control and manipulation of their light environments, requires new measures and protocols. These tools will help improve understanding of the effects of light on children’s sleep.
O061 Maternal Circadian Disruption from Shift Work and the Impact on the timing of Melatonin in their Breast Milk
Authors: Booker L , Wilson D , Spong J , Deacon-Crouch M , Lenz K , Skinner T
Published: October 2023

Introduction

Infants are not born with a circadian rhythm. Research shows that breast milk clearly exhibits a 24-hour pattern, with melatonin concentrations high during the evening and night but barely detectable in daytime milk. The presence and timing of melatonin in breast milk suggests that this hormone may help provide sleep timing information to infants, thereby supporting the development of their own circadian cycle. Currently, it is not known if disturbances of maternal circadian rhythm, such as shift work, impact the circadian rhythmicity of breastmilk. The aim of this study was to investigate whether maternal circadian disruption, from working night shift has an impact on melatonin timing in breastmilk.

Methods

A prospective repeated measures study design was undertaken to compare melatonin levels in breastmilk across shift types (day shift/non-workdays and night shifts). Four 10ml breastmilk samples were collected by participants the same time of the day, across five consecutive days.

Results. A total of 11 mothers completed the study. Analysis is still ongoing but preliminary results show a potential difference in breastmilk melatonin between pre-night shift, night shift and post night shift, indicating a change in the circadian timing of the breastmilk.

Discussion

The findings from this study suggest that there is a potential effect from maternal circadian disruption from shift work on breast milk melatonin. This is an important first step in exploring the impact of maternal circadian misalignment disorders on breastmilk hormones and provides preliminary evidence that future research is needed in this area.
O062 Adolescents’ Mental Health Hrajectories throughout the COVID-19 Pandemic and the Protective role of Healthy Sleep Patterns
Authors: Bauducco S , Gardner L , Newton N , Gradisar M , Smout S , Chapman C , Gamble A , Teesson M , Champion K
Published: October 2023

Introduction

The COVID-19 pandemic has seen a rise in emotional problems among adolescents. Improving young people's mental health is a public health priority, and examining protective factors throughout the pandemic can offer insights on targets for prevention. This study aimed to investigate longitudinal trajectories of depressive and anxiety symptoms among a large sample of Australian adolescents and to examine sleep patterns in high- and low-risk trajectories.

Methods

This study utilises data from the control group of the “Health4Life” cluster RCT. We used three waves of questionnaire data collected annually (from 2019) from Year 7 students at 71 secondary schools across New South Wales, Queensland and Western Australia (N = 2,781, Mage = 12.6, SD = .51; 47% boys and 1.4% ‘prefer not to say’). Adolescents reported on their mental health (i.e., depressive and anxiety symptoms) and sleep (i.e., sleepiness, weekday sleep duration, SOL, WASO, and chronotype).

Results

We found four trajectories of depressive symptoms: low-stable (64.3%), average-increasing (19.2%), high-decreasing (7.1%), moderate-increasing (9.4%), and three anxiety symptom trajectories: low-stable (74.8%), average-increasing (11.6%), high-decreasing (13.6%). Adolescents in low-risk trajectories were more likely to be boys and to report shorter SOL and WASO, longer sleep duration, less sleepiness, and earlier chronotype. Where mental health waxed and waned, sleep patterns changed in the same direction.

Discussion

This is the first study to thoroughly examine adolescents’ sleep patterns as a protective factor for the development of emotional problems during the pandemic. Healthy sleep was clearly linked to low-risk trajectories, although this association is likely bi-directional.
O063 Objective Sleep Quality Metrics underlying next-day Sleep Quality Ratings in Adolescents
Authors: Tang C , Meredith-Jones K , Signal L , Galland B
Published: October 2023

Introduction

Good sleep quality is critical for good sleep health, but how sleep quality is defined remains uncertain; most defining it based solely on subjective or objective measures, and more recently, a combination of the two. PSG-derived sleep efficiency and WASO are linked to subjective sleep quality in healthy adults, but whether this is the same in adolescents (an age group notorious for not getting enough sleep), remains unknown.

Aims

To investigate which objective measures of sleep correlate with next-day ratings of sleep quality (primary outcome), sleep sufficiency, morning and daytime sleepiness, mood and concentration.

Methods

Seventy-one 16-17 y-olds (50% female) without anxiety/depression symptoms, completed a week of actigraphy and daily ratings of the subjective elements described above (469 days analysed). Statistical analyses used generalised estimating equation models.

Results

In unadjusted models, sleep quality showed significant within- and between-subject relationships with variables of sleep timing, amount, efficiency and variability. However after adjustment, total sleep time (TST) was the only metric that remained significant; for every 1 h less TST/night, teens were 1.56 (95%CI: 1.29, 1.88) times more likely to rate their sleep quality as poor rather than good. TST also correlated with daily mood ratings, and awakenings with morning sleepiness. No other significant relationships were found.

Discussion

The key sleep metric contributing to perceptions of sleep quality in adolescents was in fact one related to sleep quantity. Surprisingly, none of the sleep quality metrics used in sleep quality guidelines, linked to subjective ratings of sleep quality in this age group.
O071 MOEMOEĀ: The Development of an Indigenous Sleep and Well-being Intervention in Aotearoa WHĀNAU (New Zealand families)
Authors: Russell-Camp T
Published: October 2023

Introduction

The creation of culturally relevant interventions is essential to improving access and outcomes for Māori. Moemoeā is a Māori-led, tikaka ritual-based, Multiphase Optimisation Strategy (MOST) sleep intervention. This presentation will outline the creation of three pou (components) which aimed to increase connection to Māori language, culture, and well-being as well as sleep.

Methods

Māori members of our team co-designed with whānau (families) and experts in mātauraka Māori (knowledge) using kaupapa Māori methods. The team undertook semi-structured interviews with experts and structured interviews with whānau using kaupapa Māori principles of: taonga tuku (passed down knowledge), ako (learning), utu (reciprocity) and aroha ki te takata (respect).

Results

Three pou (Rongo time, Uru time, whanau support) were created and are currently being tested in a MOST factorial trial in 500 whānau across Aotearoa. Qualitative feedback to date shows that use of ritual rather than routine works in varied whānau contexts, and that our pou create a better sense of connection to living as Māori. This connection is a significant driver of good outcomes and removes the shame that whānau often experience as research participants in Western projects.

Discussion

Whānau who have a strong sense of (honoka) connection felt validated in their use of ritual and mātauraka, while those who were less connected appreciated being able to grow their connection to the Māori world. Use of the western MOST trial design posed challenges as everything is interconnected in Māori culture, but our decolonizing tools and measures were able to overcome much of this.
O073 The Relationship between Circadian type and Physical Activity on Cognitive Performance during Simulated Nightshifts: A Randomised Controlled Trial.
Authors: Easton D , Gupta C , Vincent G , Ferguson S
Published: October 2023

Introduction

Physical activity might be a nonphotic strategy which could improve cognitive performance for nightshift workers. Innate characteristics like circadian type may also influence individual performance. Thus, this study explores the relationship between circadian type and physical activity on cognition over consecutive nightshifts.

Methods

Thirty-two healthy adults (age M±SD: 24.3±4.6 years; 19 females) participated in a 7-day laboratory study, with 5 nightshifts (2200-0600). Participants were randomised into the Breaking up sitting (BUS; n=19) or Sedentary (SED; n=13) condition. Overnight, BUS participants completed 3-min bouts of light-intensity walking every 30-min, while SED participants remained seated. At 2200, 0000, 0200, 0400 and 0600, participants completed the 10-min Psychomotor Vigilance Task (mean RRT). Participants completed the 11-item revised Circadian Type Inventory (factor 1: rigid/flexible; factor 2: languid/vigorous), resulting in four-subgroups (rigid; n= 12, flexible; n= 11, and languid; n= 11, vigorous; n= 13). Participants may only be one type from either factor (i.e. rigid and vigorous).

Results

Linear mixed models showed a significant 3-way interaction between nightshift (1-5), condition (BUS, SED), and circadian type (rigid/flexible) for mean RRT (p=0.03), such that flexible types in the Breaking up sitting condition outperformed Sedentary flexible types and Breaking up sitting rigid types, with performance worse on the first nightshift. There were no significant interactions between nightshift, condition and circadian type (languid/vigorous).

Discussion

Breaking up sitting improved performance for flexible types over rigid types. These findings have significant implications for nightshift rostering, suggesting that incorporating breaking up sitting may optimise cognitive performance, and therefore work efficiency.
O074 Does Sleep Duration, Shift work or Sleep Disorder Status Predict Perceived work Performance and Quality of Life in Young Adults?
Authors: Sansom K , Eastwood P , Brown B , Crowther M , Wanstall S , McArdle N , Adams R , Reynolds A
Published: October 2023

Young adults are vulnerable to the consequences of disturbed sleep from insufficient sleep, shift work and sleep disorders. The impact of these causes of disturbed sleep on perceived work performance and quality of life (QOL) in young adults is unclear. This study sought to investigate these associations in a community sample of 22-year-old adults. Participants studied (n=565, 53% female) were a subset of the Raine Study. All were employed and provided information on sleep disorders (obstructive sleep apnoea by polysomnography and insomnia and restless legs syndrome symptoms by validated questionnaires), shift work status, habitual sleep duration, QOL (Short Form (SF) 12) and perceived work performance (categorical response: perform better, same or worse than most workers). Multinomial and linear regression models adjusted for sex, comorbidities and work hours were used to examine the associations between disturbed sleep with work performance and QOL, respectively. In total 25% of participants had a sleep disorder, 29% were shift workers, and 31% had insufficient sleep (<6 hours). Presence of a sleep disorder was associated with poorer perceived work performance (OR, 2.27; 95%CI, 1.3 – 4.1). Sleep disorders were also associated with significantly lower SF-12 mental (β, -4.19; 95%CI, -5.92 to -2.45, p<0.001) and physical (β, -1.56; 95%CI, -2.70 to -0.42, p<0.008) component scores. Shift work and insufficient sleep were not associated with either perceived work performance or QOL. Identifying and treating sleep disorders in young adults may be important given its negative association with perceived work performance and QOL.
O076 Changes in Sleep and Perceived Health risk in early Career Paramedics
Authors: Crowther M , Ferguson S , Adams R , Reynolds A
Published: October 2023

Shift work is associated with increased chronic disease risk and suboptimal health behaviours. However, our understanding of the impact of shift work on health behaviours is impacted by a lack of longitudinal studies that examine health behaviours in shift workers relative to behaviours prior to shift work commencement. To address this limitation, we examined sleep changes and perceived health risk (i.e., individual’s perception of risk to their health) in intern paramedics during the first 12 months of shift work.

The current study examined self-report sleep quality and duration in 21 interns (15 Female, 6 Male, aged 23.0 [20.0, 36.0]) from one Australian Ambulance service. Data were collected quarterly for a year (pre-shift work, and then 3, 6, 9 and 12 months post recruitment training).

Linear mixed models, controlling for chronotype and baseline perceived health risk, showed that the first 12 months of shift work were associated with a significant decline in sleep quality (p=0.021) but no change in sleep duration (p=0.76). Linear mixed models also showed that perceived health risk significantly increased (p=0.036). Substantial between-subjects differences were observed, highlighting individual differences in response to shift work onset on sleep and perceived health risk.

This study demonstrates that commencement of shift work is associated with a decline in sleep quality and increase in perceived health risk in early career paramedics. The considerable individual differences observed in this study highlight a need for larger studies with more participants, and a focus on personalised strategies for workers commencing shift work.
O082 A Survey to explore the Knowledge and Education needs of Perinatal Health Professionals to support the Provision of Inclusive Care to Transgender people in Aotearoa New Zealand
Authors: Baddock S , Miller S , Ker A , Kerikeri E , Veale J , Parker G
Published: October 2023

Background

International literature shows that transgender teens and young adults are more likely to report insomnia compared to cis-gendered individuals of the same age – often linked with discrimination or minority stress. Trans people often encounter health providers with limited knowledge of gender diversity.

Objective

to understand the education needs, knowledge, and attitudes of the perinatal health workforce in New Zealand when providing care for trans people.

Methods

Interviews with trans people who had engaged with perinatal services, informed the development of a workforce survey, alongside extensive consultation with Māori, health professionals and trans community groups. The survey was shared with perinatal care providers via their professional organisations and social media. It included questions about strategies utilised in their clinical practice towards trans inclusion, previous education opportunities and current needs, as well as attitudes towards gender diversity.

Results

Survey participants (n=476) reported using multiple strategies when providing inclusive practice for trans people. Gaps in knowledge to support inclusive practice were identified, along with support needs to ensure perinatal care providers are resourced to provide culturally safe and affirming care for trans people and whānau/families. Most respondents had not received education on gender-inclusive care but three quarters of them reported they would access this if available.

Conclusions

Survey results identified strategies for inclusive care as well as knowledge gaps, in relation to meeting trans people’s perinatal care needs. Findings led to recommendations for education, practice and policy which could readily apply to those supporting trans people to improve their sleep health.
O083 Myopic, or Short-sighted, Children show Delayed Melatonin Circadian Timing, Lower Melatonin Output and Sleep Disruptions
Authors: Chakraborty R , Scott H , Seby C , Tang V , Lovato N , Lack L , Kemps E , Anstice N , Juers E
Published: October 2023

Introduction

Recent studies have reported poor and reduced sleep in myopic, or short-sighted, individuals. Here, we investigated differences in melatonin secretion timing and output and actigraphy-derived sleep in myopic and non-myopic (or emmetropic) children, aged 8-15 years.

Methods

26 myopes [refractive error (mean ± standard error mean) -2.06 ± 0.23 dioptres] and 19 emmetropes (-0.06 ± 0.04 dioptres), aged 11.74 ± 2.31 years were recruited. Melatonin timing was assessed using salivary dim light melatonin onset (DLMO), collected half-hourly for 7 hours in a sleep laboratory, beginning 5 hours before and finishing 2 hours after habitual bedtime for the past week. Total melatonin production was assessed via aMT6s levels from urine voids collected from 05:30 pm and until 08:00 am the following morning. Actigraphy-derived sleep was acquired for one week prior to the sleep laboratory visit.

Results

Myopic children (21:07 ± 0.2 hrs) had a DLMO time 1.1 hrs later compared to emmetropes (19:59 ± 0.2 hrs), p=0.002. aMT6s melatonin levels were significantly lower among myopes (18.70 ± 2.38) than emmetropes (32.35 ± 6.93, p=0.001). Myopes also exhibited significantly delayed sleep onset (21:42 ± 0.2 vs 23:00 ± 0.2 hrs), delayed wake-up time (06:38 ± 0.2 vs 07:29 ± 0.1 hrs), shorter sleep duration (8.1 ± 0.2 vs 7.6 ± 0.1 hrs), and more evening-type diurnal preference than emmetropes (all p<0.05).

Discussion

These findings suggest a potential association between circadian rhythm dysfunction and myopia in children, supporting towards a shared mechanism of myopia and delayed sleep-wake phased disorder development during adolescence.
P006 The Impact of Growth Hormone Treatment on Cardiovascular Control in Children with Prader-Willi syndrome
Authors: Patoglu O , Walter L , Davey M , Nixon G , Edwards B , Horne R
Published: October 2023

Background

Many children with Prader-Willi syndrome (PWS) are treated with growth hormone (GH), which may increase the risk of obstructive sleep apnoea. Children with PWS also have impaired cardiac autonomic control due to reduced parasympathetic activity, which may increase cardiovascular risk, however the impact of GH on autonomic control is yet to be elucidated.

Methods

Pre- and post-GH polysomnographic data in 38 children (aged 0-18 years) were retrospectively collected. Spectral analysis of heart rate variability (HRV) was used to determine total, low frequency (LF, sympathetic and parasympathetic activity), high frequency (HF, parasympathetic activity) power and LF/HF (sympathovagal balance). Data were compared with Wilcoxon Signed Rank Test and Spearman Rank Order Correlation analysis and are presented as median [interquartile range].

Results

HRV data were significantly correlated with age so children were grouped into those <2 years (n=22) and >2 years (n=16). There were no significant differences in the obstructive or central apnoea-hypopnoea indexes between pre- and post-GH studies in either group. In children <2 years, there were no significant differences in total power, LF, HF and LF/HF between studies. In children >2 years, total power (1912.2 ms2, [920.2, 4916.1] vs 1010.2 ms2 [416.0, 2828.7), LF (434.0 ms2 [247.0, 1340.7] vs 278.9 ms2 [83.4, 676.0]) and HF (986.0 ms2 [321.8, 2400.6] vs 414.4 ms2 [146.2, 1152.7]) were lower (p< 0.01 for all) post-GH.

Conclusions

Our results demonstrate that GH decreases both sympathetic and parasympathetic activity during sleep in children >2 years, which could further increase cardiovascular risk.
P009 Time spent with SpO2 below 90% during Sleep is Greater in Children with Down syndrome and OSA than in Typically Developing Children
Authors: Walter L , Bhatnagar D , Ong M , Davey M , Nixon G , Horne R
Published: October 2023

Background

Children with Down syndrome (DS) have a higher predisposition to obstructive sleep apnoea (OSA) compared to typically developing (TD) children. Children with DS have more frequent dips <90% compared with TD children matched for age, sex and OSA severity. Intermittent hypoxia with repeated desaturations and resaturations is associated with cognitive impairment in children. New methods which calculate the time spent with SpO2 <90% have identified an association with cardiac dysfunction in adults with OSA. We aimed to determine if children with DS and OSA spent longer with SpO2 <90% during sleep compared with TD children.

Methods

44 children with DS (3-19 y) and age, sex and OSA severity matched TD children underwent overnight polysomnography. Time spent with SpO2 <90% as a percentage of total sleep time (%TST) was calculated. SpO2 nadir when <90% was recorded.

Results

SpO2 fell <90% in 32 (73%) children with DS and 15 (34%) TD children. The %TST spent with SpO2 <90% was higher in the DS group (median [IQR] 0.029% [0.004, 0.114]) compared with the TD group (0.000% [0.000, 0.020]; p<0.001). There was no difference in SpO2 nadir between the groups (DS mean±sem 84%±1.1%; TD 85%±1.1) when the SpO2 fell <90%.

Conclusion

Twice as many children with DS experienced periods of oxygen desaturation below 90% as did TD children matched for age, sex and OSA severity. Although as a %TST, the time spent <90% was small, different physiologically-based metrics to characterise OSA severity and the consequences of recurrent hypoxia in children may be merited.
P010 Delivery of volume assured pressure support (VAPS) through tracheostomy in paediatric patients
Authors: O'Connor A , Saddi V , Thambipillay G , Teng A
Published: October 2023

INTRODUCTION

Volume assured pressure support (VAPS) allows the ventilator to deliver a constant pre-set tidal volume or alveolar ventilation by automatically adjusting the inspiratory pressures within a set range, providing targeted pressure support. Data on its use in children are limited. We describe a series of four children effectively and safely ventilated using VAPS mode through tracheostomy.

METHODS

Retrospective review of patient notes.

PROGRESS TO DATE

Four paediatric patients were identified in our cohort who were successfully and safely ventilated using the VAPS mode through tracheostomy. The patients were between 6-14 years of age inclusive, with four differing underlying disease processes – Prader-Willi syndrome, congenital central hypoventilation syndrome, Guillain-Barré syndrome and Moebius-type syndrome.

INTENDED OUTCOME AND IMPACT

Whilst there have been previous paediatric case reports and case series which have demonstrated efficacy of VAPS mode used non-invasively, the use of VAPS mode to provide effective and safe ventilation through tracheostomy in children has been described in only one recent case series. The advantages of its use over conventional bilevel positive airway pressure support include its ability to compensate for changes in tidal volume, which can occur with changes in lung compliance and during different stages of sleep. This case series highlights safe and effective use of VAPS mode in children with tracheostomy.
P016 Effects of Aerobic Exercise versus Inspiratory Muscle training on Apnea-Hypopnea Index in patients with Obstructive Sleep Apnea
Authors: Ittinirundorn S , Chirakalwasan N , Kline C , Tongtako W
Published: October 2023

Introduction

There is some evidence indicating that exercise, such as aerobic training (AT) and inspiratory muscle training (IMT), improves Obstructive Sleep Apnea (OSA) symptoms. Nonetheless, no study compares the types of exercise in OSA patients.

Objective

To compare the effects of type of exercise on Apnea-Hypopnea Index (AHI) and respiratory muscle strength in OSA patients

Methods

Twenty-nine non-obese OSA patients aged 20-50 years with mild to moderate severity (Apnea-hypopnea index 5-30 events/hour) were randomized to the AT group (n=9), the IMT group (n=10) or the control (CON) group (n=10). Participants in the AT group received 60 minutes per day, 3 times per week, for 12 weeks. For the IMT group, participants received the Powerbreathe ® device for practicing 8 cycles of 30 breaths per day, 5 times per week, for 12 weeks. Participants in the CON group did not receive any intervention. Their AHI and respiratory muscle strength were analyzed during the pre- and post-tests. Dependent variables were compared between pre- and post-tests via paired t-test, and independent variables were compared between the groups using one-way analysis of variance (ANOVA). Differences were considered significant at p<0.05.

Results

AHI, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) changed significantly in the AT group and IMT group after 12 weeks of training. Therefore, AHI, MIP, and MEP in the AT group and the IMT group improved significantly compared to the CON group.

Conclusions

Aerobic training and inspiratory muscle training improve the apnea-hypopnea index and respiratory muscle strength in OSA patients.
P027 Insights from a 10-year Australasian consumer data registry study.
Authors: Anderson J , Yee B , Sivam S , Grunstein R , Cayanan E , Matar E , Chadwick M , Saini B , Chapman J , Tai J
Published: October 2023

Introduction

Idiopathic hypersomnia (IH) is a disorder of central hypersomnolence that results in excessive daytime sleepiness in the absence of another identifying cause. Case studies from sleep clinic patients have guided current knowledge but may not be a fair representation of the wider population of IH diagnoses. This study aims to better characterize patients diagnosed with IH in Australasia using online survey data.

Methods

A retrospective analysis of 686 participants from the Hypersomnolence Australia Consumer Data Registry sleep physician diagnosed with either IH (n = 554) or narcolepsy (NC) (n = 132) between January 2013 and January 2023 was performed.

Results

IH participants (98.9% had MSLT) reported additional sleep disorders such as OSA (16.4%) and restless leg syndrome (7.9%) and notable comorbidities included depression (46.2%) and anxiety (50%). Forty-two percent of IH participants were diagnosed after turning 33 years of age (compared to NC participants, 31.8%). The IH group reported more unrefreshing sleep, sleep drunkenness and the NC group reported more excessive sleepiness, hallucinations, sleep paralysis and automatic behaviour (all p values < 0.001). The most frequently used medication in both groups was dexamphetamine (IH = 44.2%, NC = 47.7%) but participants from the IH group were prescribed more modafinil and less armodafinil and sodium oxybate (p values < 0.001) than patients with NC. Further analyses are in preparation.

Discussion

This study demonstrates the value of consumer registries to better characterize symptomatology and co-morbidities in IH and NC and further research in these conditions.
P028 Treating Sleep Disturbances in Refugees – Preliminary Results from a randomized controlled pilot trial on the group therapy program Sleep Training Adapted for Refugees (STARS)
Authors: Dumser B , Ehring T , Koch T
Published: October 2023

Sleep disturbances are both highly prevalent and often persistent even after otherwise successful treatment in traumatized refugees. The need for scalable, adaptable, and easily disseminated interventions has been highlighted. Existing evidence-based treatments do not sufficiently account for the special needs of refugees and asylum seekers. The group therapy program STARS expands and complements evidence-based treatment approaches (e.g., CBT-I, IRT) with a culturally and context-sensitive approach.

The aim of this study was to examine the feasibility, acceptability, and effectiveness of the intervention.

A randomized-controlled study using a parallel group design (STARS vs. waitlist) with 47 young male Afghan refugees was conducted in a routine clinical setting (DRKS-ID: DRKS00024419) comparing pre- to post and a 3-month follow-up assessment. Insomnia symptoms (ISI) were defined as the primary outcome. Secondary outcomes included PCL-5, HSCL-25, NDI, FOSI-SF and EUROHIS-QOL. Acceptability was measured via client satisfaction and treatment adherence. The data are analyzed using mixed models.

Preliminary results indicate that dropout (18%) was comparable to other interventions with refugees. Participants who completed the intervention attended M = 7.93 out of 10 sessions (SD = 1.88). Results on the effectiveness are still pending.

STARS seems to be a feasible intervention for sleep disturbances in traumatized refugees in a routine clinical setting. Depending on its effectiveness it might be a promising intervention to enhance scalable treatment both as a low-threshold primary care intervention as well as a potential add-on to PTSD-focused treatment. To draw final conclusions replication in large-scale studies with active control groups will be necessary.
P033 Assessment of Upper Airway Dilator Muscle Function and Collapsibility in People with Multiple Sclerosis with Versus without Sleep Apnea
Authors: Thomas E , Osman A , Calonzo L , Hall L , Agzarian M , Slee M
Published: October 2023

Introduction

Upper airway reflex responses to negative pressure are important to prevent upper airway narrowing and closure. Recent evidence indicates ~30% of people with multiple sclerosis (MS) have an impaired upper airway dilator reflex response. Thus, the aims of this study were to compare genioglossus muscle reflex responses and upper airway collapsibility in non-obese people with MS, with and without OSA.

Methods

Non-obese adults with MS and OSA vs MS without OSA were instrumented with pressure sensors at the choanae and epiglottis. Bipolar fine wires were inserted into the genioglossus. A nasal mask and pneumotachograph were attached to a breathing circuit to deliver brief (~250ms) suction pressure (~-12cmH2O) during early inspiration every 2-10 breaths while awake. Genioglossus reflex onset latency, peak latency and peak amplitude were quantified. The upper airway collapsibility index was the percent difference between choanal and epiglottic airway pressures during negative pressure.

Results

15 people with MS (6 males), aged 48±13years, BMI=25±3kg/m-2 and AHI=13±17events/h (mean±SD) were studied. 47% had OSA (AHI>10events/h). Genioglossus reflex excitation onset latency (22±2 vs. 24±19ms), peak excitation latency (37±11 vs. 38±23ms) and peak amplitude (258±125 vs. 205±95%) were not different between OSA vs. non-OSA. The upper airway was more collapsible in people with OSA (49±32 vs. 17±16%, p=0.04).

Conclusions

There is a high prevalence of OSA among non-obese people with MS. There was no systematic difference in upper airway dilator muscle function. However, the upper airway is ~65% more collapsible in people with MS and OSA despite absence of obesity.
P036 A novel approach to nurture sleep education in a crowded curriculum
Authors: Falloon K , Campos C , Nakatsuji M , Moir F , Wearn A , Bhoopatkar H
Published: October 2023

Aims

To explore Year 6 medical students’ perceptions of sleep education during medical school to inform the development of a sleep curriculum.

Methods

Year 6 medical students on their final general practice (GP) placement in 2020 (71/254 of the Year 6 cohort) were invited to complete an online survey regarding sleep education recalled during the medical programme.

Results

Sleep education survey responses were received from 51/71 of students in the final GP cohort (72%). Three areas were more frequently recalled - 83% recalled learning about sleep apnoea, 71% about sleep physiology, and 69% about snoring. Only 50% recalled learning about assessing sleep and 42% recalled receiving education about insomnia. More than 80% of students reported they received no education regarding preparing for, coping with, or recovering from night shifts. Students identified common sleep disorders, sleep assessment, and shift work as priority topics.

Conclusions

Whilst the majority of students recalled receiving education on select topics, most had no awareness of education relating to sleep assessment, insomnia, or shift work. Sleep education in the curriculum needs more emphasis and reinforcement given its relevance across many domains of health and morbidity. We propose that an identifiable sleep curriculum is necessary and useful to ensure medical students have the necessary core education regarding sleep and sleep disorders both for patients and themselves. Further, we believe this is possible to achieve within the constraints of the undergraduate curriculum and propose some creative solutions.
P057 Exploring the ‘Pharmacist Role’ in Insomnia Management and Care Provision: A Scoping Review
Authors: Basheti M , Grunstein R , Gordon C , Saini B
Published: October 2023

Background

Insomnia is a highly burdensome sleep disorder, with a global prevalence of approximately thirty percent in adults. Given its impact on daily functioning and the role it plays in the development/progression of comorbid mental/physical disease, appropriate and timely management is essential. Pharmacists are at the forefront of the primary care workforce and given their expanding roles in healthcare, could aid in alleviating the burden of insomnia in the community by delivering adequate care.

Objectives

To describe the current and potential roles of pharmacists in insomnia care.

Methods

An extensive search of five databases (MEDLINE, EMBASE, SCOPUS, IPA, CINAHL) was conducted. Titles, abstracts, and full text articles were screened to identify relevant studies for review inclusion. Articles were reviewed and data extracted, analysed, and grouped categorically based on nature of care provided.

Results

Thirty studies met inclusion criteria. Insomnia management provision across these studies was divided categorically into 1) Screening/Assessment, 2) Pharmacological and non-pharmacological management provision, and 3) Deprescribing services. Regarding treatment provision, it was evident that pharmacological approaches remain the most common treatment modality adopted despite guidelines recommending behavioural therapy as first line. Overall, the results highlighted that provided with the adequate training and education, pharmacists have the potential to engage in insomnia screening, behavioural therapy and deprescribing services, improving overall insomnia management in primary care.

Conclusion

The outcomes of this review highlight a current gap in insomnia management practices carried out by pharmacists and provide evidence for improved roles when pharmacists are upskilled with specialised insomnia management education/training.
P061 CPAP Investigation Results: Physician vs Scientist delivered. Is there a difference in CPAP compliance and uptake?
Authors: Doyle G , Szollosi I , Segal T
Published: October 2023

Introduction

As standard practice in a tertiary public hospital, CPAP titration outcomes and recommendations are provided to patients by Sleep Physicians in a follow up consultation. To free up physician time, a new model of care was introduced where senior scientific staff would provide the results and recommendations after Sleep Physician reporting. The aim of this retrospective review was to determine if there were any differences in CPAP uptake and compliance between results and recommendations provided by Scientists, or Sleep Physicians.

Method

Retrospective review of uncomplicated CPAP naïve patients attending CPAP titration between 1/07/20 to 30/06/21. CPAP uptake, compliance, and Epworth at 2 and 12 months were compared between the groups receiving physician or scientist recommendations, using Student’s T-Tests for continuous or Chi-Square tests for categorical variables.

Results

446 patients (55% Male) received titration outcomes and recommendations, 57% from Scientists and 43% from Physicians. Mean age was 57.6+/-14.5 years, BMI=37.6+/-8.8 kg/m2, Baseline Epworth=10.5+/-5.9 and AHI=37.6+/-26.8 events/hr with no significant differences between groups. CPAP uptake for Scientists=72% and Physician=68% (p=0.403). There was also no difference in either compliance or ESS at 2 month and 12 month follow up.

Discussion

In this retrospective audit, no differences in CPAP uptake, compliance or ESS were observed between CPAP titration results and recommendations provided by Scientist compared to Sleep Physicians. However patient selection was not randomised and may have influenced results. More robust evidence requires a randomised controlled trial design to confirm findings.
P065 A Comparison of Two Obesity Related Hypoventilation Disorders – Impact on Sleep, Quality of Life and Neurocognitive Outcomes and the Effects of PAP Therapy
Authors: Zheng Y , Yee B , Wong K , Grunstein R , Piper A
Published: October 2023

Introduction

Symptom burden and neurocognitive function have not been previous compared between patients with obesity-associated hypoventilation disorders (obesity hypoventilation syndrome, OHS), and hypoventilation in the setting of obesity and obstructive airways disease (OHAD). The aim of this study is to compare baseline sleep-related symptoms, health-related quality of life and neurocognitive function between OHS and OHAD and the impact of PAP therapy on these outcomes.

Methods

ESS, PSQI, SF36, and various neurocognitive tests, in addition to anthropometric, polysomnography, lung function and blood gas data from 45 patients with OHS and 32 patients with OHAD, were included in the analysis. Between groups (OHS vs OHAD), pre- and post-treatment (with 3 months of positive airway pressure) comparisons were made using linear mixed modelling.

Results

Both OHS and OHAD had similar baseline ESS (14(5.6) vs. 12(5.4)), Global PSQI (10(3.2) vs 11(4.8)), SF36 and neurocognitive test performances (other than OHAD had lower digit symbol substitution test performance). Treatment with PAP therapy resulted in similar improvements in ESS, Global PSQI, and SF36 in both groups. Neurocognitive performance did not significantly improve after PAP therapy in either group.

Discussion

The symptom burden between two separate hypoventilation disorders (OHS and OHAD), in terms of sleepiness, sleep quality, quality of life and cognitive function, were similar. OHS and OHAD had similar treatment responses in these parameters after 3 months of PAP therapy.
P073 Examining the Complex Relationships Among Insomnia, PTSD, Psychological Distress, and Suicidal Ideation in Firefighters.
Authors: Ferguson S , Canney A , Rebar A , Paterson J , Bowen-Salter H , Van Hooff M , McFarlane A , Marcus A , Vincent G
Published: October 2023

Introduction

Firefighters endure sleep disruption and exposure to traumatic events - inherent occupational stressors that may contribute to insomnia, psychological distress, and PTSD. These factors are interrelated, with around 70% of individuals with PTSD experiencing co-occurring sleep problems but it remains unclear if insomnia has a unique effect on the risk of suicidality. The aim of this study was to investigate if there was an association between insomnia and suicidal ideation, above and beyond PTSD symptom severity and psychological distress.

Methods

Firefighters (n=578) self-reported their sleep problems, PTSD symptom severity, psychological distress, and suicidal ideation and attempts. Logistic regression was used to estimate the association between insomnia and suicidality and whether insomnia was associated with suicidality, above and beyond PTSD symptom severity and psychological distress.

Results

Insomnia was positively associated with suicidal ideation; with every one unit increase in insomnia, the odds of suicidal ideation increased by 1.42. However, the significance of the association between insomnia and suicidal ideation did not remain when accounting for PTSD symptom severity and psychological distress.

Conclusion

These findings suggest an association between insomnia and suicidal ideation in firefighters, as part of the impact of PTSD and psychological distress, rather than unique to these risk factors. Although interventions to target sleep problems in firefighters may have benefits for reducing risk of suicidality, our findings suggest a more holistic mental health approach may be more successful.
P078 “It’s very good but it needs to be better”: Usability and Acceptance of Fatigue Detection Technology in Australia.
Authors: Sprajcer M , Ferguson S , Irwin S , Naweed A
Published: October 2023

Introduction

Fatigue detection technology (FDT) is commonly used in the Australian road transport industry to monitor and/or detect driver fatigue. These devices typically provide alerts to drivers and their organisation if fatigue is detected and aim to reduce incidences of fatigue-related vehicle crashes and/or improve driver behaviour. The rise of these technologies is generating debate about how their relative design and merit might be evaluated. However, little is known about the experiences of individuals who use FDTs, including perceptions of use, acceptance, and effects on driver behaviour. The Australian Automobile Association funded the research into FDTs from which this presentation draws.

Methods

Semi-structured interviews were conducted with a range of existing users of FDT (n = 28) between November 2022 and June 2023. Participant groups included drivers (n = 17), middle managers and data users (n = 7), and executives (n = 4) from different commercial organisations that were trialling or had adopted FDT.

Results

Preliminary thematic analysis has identified a range of factors underlying driver and organisational acceptance of FDTs. These include: data privacy, vendor support, technical merit, training load, intrusiveness, and cost. Drivers perceived their behaviour to be moderately impacted by FDT in positive and negative ways. This included impacts on sleep/wake behaviour, in-cab activities, and driving performance. Certain types of FDT were considered highly contentious by all existing user groups.

Discussion

FDT adds further complexity to the contentious topic of fatigue management for professional drivers. Findings highlight a range of implications for FDT adoption and effective evaluation.
P084 Characteristics of sleep hypoventilation during polysomnography in a large Australian clinical sleep laboratory cohort.
Authors: Chew C , Ruehland W , Berlowitz D , Howard M
Published: October 2023

BACKGROUND

Sleep hypoventilation complicates a range of neurological and respiratory conditions. However, robust definitions are based mainly on expert consensus, and clinically significant thresholds remain unclear. This study thus aims to provide a descriptive analysis of capnography results in a large clinical cohort of patients referred for overnight polysomnography (PSG).

METHODS

Retrospective clinical audit of overnight in-lab PSGs, between Jan 2015 and June 2023, at a tertiary hospital housing the State-wide referral centre for chronic domiciliary ventilation. Diagnostic PSGs with transcutaneous CO2 (PTcCO2) monitoring and without supplemental oxygen were included.

The following data will be extracted from each PSG:

Patient demographics:

-Primary and secondary clinical diagnoses

-PTcCO2 values (e.g. Mean, Minimum and Maximum PTcCO2 in Wake, Sleep, NREM and REM)

-Sleep fragmentation measures

-Sleep macro-architecture measures

-AHI

-SpO2 values

Data analysis will be performed with IBM SPSS Statistics software, version 26 (Armonk, NY: IBM Corp)

PROGRESS TO DATE

525 PSGs meeting initial criteria have been identified. Currently processing PSG data files to extract parameters and complete exploratory data cleaning and analysis.

INTENDED OUTCOME AND IMPACT

We aim to explore and clarify:

-Differences in patterns of hypoventilation between different diagnostic groups.

-Relationships between awake hypoventilation, sleep hypoventilation and REM-isolated hypoventilation.

-Effects of applying differing criteria for hypoventilation available in the literature.

-Relationships between measures of sleep fragmentation, AHI, SpO2 and hypoventilation parameters.

The results of this study will also support and inform future research into associations between severity, duration and patterns of hypoventilation and clinically significant outcomes including morbidity and mortality.
P092 Automation in Equipment Asset Management for Laboratory Efficiencies
Authors: Hartnett C , Kevat A , Williams G
Published: October 2023

Introduction

Asset management of laboratory equipment is essential to patient safety. Traceability enables any patient affected by equipment that has been recalled, or subsequently been found faulty, to be retested. Sleep equipment in home, ward or laboratory needs to be clearly documented but this paperwork is tedious and manual.

Methods

A portable barcode scanner with software was added to the laboratory asset management and the time efficiencies were evaluated.

Results

The time reduction of using a barcode scanner to manual data entry was found to decrease time approximately fourfold, from 8 mins (std 1.5mins) to 2.2 mins (std 0.5mins). This is for each sleep laboratory testing bed and can equate to 35 minutes in a six-bed sleep laboratory. Accuracy of data is assured with a barcode scanner, compared to manual input.

Discussion

Using automation to replace manual tasks in a sleep laboratory saves time and ensures data accuracy. Further advances in automation for tagging medical devices would improve this in areas with high use of home or ward devices.
P096 The Effect of Moderate-Intensity Exercise on Sleep Quality and Quantity in Healthy Adult Males
Authors: Morrison M , Weakley J , Roach G , Sargent C , Miller D , Gardiner C , Halson S
Published: October 2023

Introduction

Acute exercise may have the ability to disrupt sleep in healthy adults. Given the popularity of afternoon exercise, it is important to determine how this affects sleep. Therefore, the aim of this study was to investigate the effect of afternoon moderate-intensity cycling exercise on objective and subjective sleep in healthy adult males.

Methods

To assess the effect of moderate-intensity afternoon exercise on sleep quality and quantity, 12 healthy adult males who were identified as good sleepers completed a repeated-measures, counter-balanced, crossover study design with two conditions (moderate-intensity aerobic exercise or no exercise). The exercise task involved cycling for 40 minutes at 70%HRmax and was completed ~15:30h. Polysomnography was used to measure sleep during a 9-h sleep opportunity (23:00h to 08:00h).

Results

There were no statistically significant differences in objective or subjective sleep between conditions. Exercise had a medium-sized effect on reducing total sleep time (mean ± SD; control 493.71 ± 12.59 mins vs exercise: 471.46 ± 55.19 mins; Cohen’s d: 0.56), sleep efficiency (mean ± SD; control 91.43 ± 2.33 % vs exercise: 87.31 ± 10.22 %; Cohen’s d: 0.56), and increasing REM onset latency (mean ± SD; control: 76.13 ± 45.10 mins vs exercise: 102.75 ± 46.85 mins; r: -0.33) (all p > 0.05).

Discussion

Healthy adult males can complete afternoon moderate-intensity exercise without compromising subsequent sleep. Individual responses in objective sleep outcomes may vary after exercise.