bluuebunny/crossref_metadata_2025 huggingface dataset:
P027 The clinical role and outcomes of non-invasive ventilation in motor neuron disease: An Australian tertiary hospital experience
Authors: Cruickshank A , Curtin D
Published: October 2021

Introduction

In motor neuron disease (MND), non-invasive ventilation (NIV) in patients who develop respiratory muscle weakness improves both quality of life and survival. This study aimed to evaluate the current practice and outcomes of NIV use in MND patients in an Australian tertiary hospital.

Methods

The medical records of all MND patients who attended a specialist multidisciplinary clinic requiring NIV treatment between January 2015 and January 2020 were retrospectively analysed.

Progress to date: Forty-five patients have been analysed with a mean age at time of NIV commencement of 61±10(SD) years, 67% were male, 33% were current or past smokers and 7% had OSA with previous CPAP use. MND onset was limb in 58%, bulbar in 36% and respiratory muscle in 7%. Riluzole was prescribed in 47% and PEG/RIG insertion performed in 47%.

At time of NIV commencement, 82% were symptomatic and 47% hypercapnic. No patient was commenced based on functional testing alone.

NIV adherence (usage ≥4hours/night) was observed in 80%. NIV non-adherence was associated with bulbar subtype (p=0.02) and empirical NIV initiation (p<0.01) on univariate analysis.

Average survival from NIV commencement was 17±22(SD)months. Average survival on NIV in adherent patients was 19±24(SD)months and non-adherent patients was 2±2(SD)months, although this did not reach statistical significance (p=0.1).

Intended outcome & impact

Overall clinical practice and outcomes of NIV use in this study is comparable to literature. The factors influencing NIV tolerance and adherence require further study to optimise outcomes in MND patients with respiratory muscle weakness.
P028 The Nox A1 ambulatory system is reliable when self-applied
Authors: Cuesta R , Roebuck T , Ho S , Naughton M , McDermott E , VanBraak E , Beranek R , Davis S , Spiteri M , Dabscheck E , Miller B , Yu C
Published: October 2021

Background

Home Sleep Apnea Tests (HSAT) increases access to SDB diagnostic testing (Safadi, 2014). A previous study defined a reliable HSAT if: ≥4hours total recording time, an intelligible position signal and respiratory effort, airflow and oximetry for at least 80% of the night were recorded, however, admits no standardized criteria in the literature (Domingo, 2010).

Aim

To test the reliability of a self-applied HSAT using the Nox-A1 ambulatory system (NOX Medical, Iceland).

Method

Patients self-applied the HSAT guided by industry produced video and written instructions. Signals for the HSAT included; two electro-occulagrams (EOG), two sub-mental electromyograms (EMG), a single modified frontal encephalogram (EEG), a lead I ECG, single leg anterior tibialis EMG, chest and abdominal inductance respiratory effort, nasal pressure airflow, WristOx 2 3150 SpO2 (Nonin Medical, Inc., USA) and 3-D accelerometer and body position sensor. Analysed with ProFusion PSG 4 (Compumedics Limited, Australia) after importing data into Nexus. 33 consecutive studies were recorded during lock-down. Recording satisfactory if SpO2 signal and EEG present >80% of study, it was considered a failure if doctor requested test repeat.

Results

33 subjects, age 43.1 ± 13.7 years, BMI 27.4 ± 6.0 kg/m2, 66.6% male. 81.8% of studies satisfactory. 6% of studies needed a repeat in-lab PSG due to 1) loss of oximetry & EEG and 2) loss of EEG

Discussion

6% doctor request repeat in-lab PSG is comparable to a study (Lloberes, 2001) of partially self-applied HSAT. Demonstrated good reliability with this self-applied COVID-safe method of HSAT.
P031 Associations between sound pressure levels and amplitude modulation from wind farm noise and ambulatory recorded objective macro-sleep parameters
Authors: Dunbar C , Catcheside P , Vakulin A , Zajamsek B , Hansen K , Lack L , Scott H , Micic G
Published: October 2021

Introduction

This study used ambulatory sleep studies to examine potential relationships between wind farm sound pressure level ([SPL] in dBA) and amplitude modulation (AM) on conventional measures of sleep quality in individuals residing within 10 km of a wind turbine in Australia.

Methods

Twenty six individuals (42:58%, females:males) aged (mean ± standard deviation) 53.2±12.2 years and residing 2.9±1.7 km from the nearest wind turbine underwent two consecutive ambulatory sleep studies and detailed indoor time-synchronised acoustic recordings inside their home. Associations between averaged whole night SPL and AM prevalence versus sleep onset latency, wake after sleep onset (WASO), percentage of sleep in each stage, sleep efficiency and total sleep time on each recording night were explored using bivariate and multiple regression analyses, using log-normalised data where required.

Results

Forty-five technically successful sleep studies (24 night 1, 21 night 2) were available for analysis. On night 2, AM prevalence explained 18.9% of the variance in sleep efficiency (R=.434, F(1,19)=4.421, p=0.049) and SPL explained 23.5% of the variance in WASO (R=.484, F(1,19)=5.821, p=0.026) in multiple regression analyses adjusting for age. No other sleep macrostructure variables were associated with AM prevalence or SPL on either night.

Conclusion

Weak relationships between SPL and AM prevalence and sleep outcomes in a real-world wind farm noise exposure setting support the need for more detailed investigations of potential wind farm noise effects on sleep quality.
P047 Sleep and diet in older adults: what do we know and what do we need to find out?
Authors: Gupta C , Irwin C , Vincent G , Khaleesi S
Published: October 2021

Older adults experience reduced sleep quality and quantity more frequently than younger adults. Inadequate sleep in older adults has been linked to several adverse outcomes such as poor psychological and physical health, cognitive impairments, increased risk of falls, lower quality of life, and greater risk of all-cause and cardiovascular mortality. Diet is one modifiable lifestyle factor that may influence sleep outcomes. The purpose of this review was to synthesise the current literature investigating the impact of diet, including foods and nutrients, on sleep quality and quantity in older adults (defined as >50 years based on age-related changes in sleep quality and quantity that begin age 50). A systematic search of four databases identified 17 articles for inclusion (observational (n=8) and interventional (n=9) studies). Overall, findings suggest that following a Mediterranean diet, consuming milk, fish, bean and egg products, cherries, vitamin D and vitamin E have demonstrated some efficacy in improving sleep outcomes in this population demographic. Given the heterogeneity of the included studies (i.e. aims, methodologies, outcomes assessed), it is difficult to consolidate the available evidence to make specific recommendations. However, this review describes dietary factors that show promise for improving sleep outcomes in older adults. More targeted research exploring the relationship between dietary factors and sleep outcomes in older adults is needed to strengthen the current evidence base. This presentation will provide a much-needed research agenda that includes a need for more randomised control trials that employ rigorous dietary assessments and objective measures of sleep.
P056 Using Polysomnography in Young People with Borderline Personality Disorder: A Pilot and Feasibility Study
Authors: Jenkins C , Thompson K , Chanen A , Nicholas C
Published: October 2021

Introduction

Few studies have assessed sleep in young people (aged 15–25 years) with BPD using polysomnography. The feasibility of using polysomnography in this population might be questioned due to polysomnography’s invasiveness, anxiety and sensory sensitivities in BPD, and misconceptions that individuals with BPD are uncooperative and non-compliant. This study aimed to provide pilot sleep quality and architecture data and assess polysomnography feasibility.

Method

Participants were 13 females aged 15–25, 7 (Mage = 19.97, SD = 3.15) with BPD and 6 age-matched healthy controls (Mage = 20.13, SD = 3.31). Participants completed two non-consecutive nights of polysomnography monitoring (second night’s data were used in analyses). Participants were given the option of completing polysomnography monitoring at home or in a sleep laboratory.

Results

Young people with BPD displayed less arousals across the night and specifically during NREM sleep compared with healthy young people. All other sleep parameters were comparable across groups. There was considerable heterogeneity among participant preferences for in-home vs. sleep laboratory-based monitoring, due to comfort, safety, convenience, interest in seeing a sleep laboratory, or their living situation (eg. presence of bed partner at home). Anxiety was identified as a potential barrier to polysomnography research in this population.

Discussion

There were some indications of more consolidated sleep in BPD, which might reflect a greater sleep need in this population. The feasibility and tolerability of in-home and sleep laboratory-based polysomnography were demonstrated. Future protocols should incorporate ways to minimise anxiety, for example through providing a choice of monitoring location.
P073 Co-morbid insomnia and obstructive sleep apnoea is associated with all-cause mortality and cardiovascular event risk
Authors: Lechat B , Appleton S , Melaku Y , Hansen K , McEvoy R , Adams R , Catcheside P , Lack L , Eckert D , Sweetman A
Published: October 2021

Introduction

Co-morbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating condition. Previous studies have investigated associations between insomnia and mortality, and OSA and mortality, but not COMISA. Thus, this study investigated associations between OSA, insomnia and COMISA on mortality and cardiovascular event risks.

Methods

Sleep Heart Health Study data (n = 5803) were used to identify people with insomnia defined as difficulties falling asleep, maintaining sleep, and/or early morning awakenings from sleep at least 5 times a month and daytime impairment. OSA was defined as an apnoea-hypopnoea index ≥15 events/h. COMISA was defined if both conditions were present. Cox proportional hazard models were used to determine the association between COMISA and all-cause mortality (n = 1210) and cardiovascular events (N = 1243) over 15 years of follow-up.

Results

This analysis included 5236 participants. 2504 (47.8%) did not have insomnia/OSA, 374 (7.1%) had insomnia-alone, 2027 (38.7%) had OSA-alone, and 331 (6.3%) had COMISA. Compared to participants with no insomnia/OSA, COMISA was associated with a 32% (HR, 95%CI; 1.32 (1.06, 1.64)) and 38% (1.38 (1.11, 1.71)) increased risk of mortality and cardiovascular events, respectively. Insomnia-alone and OSA-alone were not associated with all-cause mortality or cardiovascular event risk.

Conclusions

Participants with COMISA have decreased longevity and increased cardiovascular event risks compared to participants with no insomnia or OSA. It remains to be determined if these associations are causal and whether treatment of insomnia, OSA, or combination treatment can effectively decrease mortality and/or cardiovascular event risks in individuals with COMISA.
P078 Oral Appliance Fabrication Settings Impact Treatment Efficacy
Authors: Levendowski D , Sall E , Odom W , Beine B , Cruz Arista D , Fregoso T , Munafo D
Published: October 2021

Purpose

Assess the impact of custom oral appliance (CA) fabrication settings on treatment outcomes.

Methods

CPAP-intolerant patients completed a two-night home-sleep-apnea study (HSAT); Night1=baseline, Night2=Apnea Guard® trial appliance (AG). The AG vertical-dimension-of-occlusion (VDO) selection was based on tongue-scallop (women=5.5/6.5 mm, men= 6.5/8.0 mm), with a target protrusion of 70% from neutral-maximum while in situ.

Study1 CA VDO was dependent on sex (women=2.5 mm, men=5 mm), with protrusion set using a George-Gauge measured 70% from maximum retrusion-protrusion with dentist-directed titration. Study2 CA was fabricated to the AG VDO and target protrusion bite-registration.

Efficacy HSATs were conducted after completion of Study1 CA titration with vertical-elastics optional, and at the AG target protrusion with vertical-elastics mandatory in Study2. Statistics included Mann-Whitney, Chi-squared, and Bland-Altman analyses.

Results

The Study1 (n=84) and Study2 (n=46) distributions were equivalent for tongue-scallop (64/63%) and sex (women=45/41%), however, noted differences in age (53.8±11.9 vs. 58.4±12.2; P=0.052), body-mass-index (29.4±5.7 vs. 27.8±4.0; P=0.128) and pre-treatment AHI severities (24.6±14.4 vs. 29.2±17.4 events/h; P=0.155) were observed.

The Bland-Altman biases were significant different (Study1=4.2±7.8 vs. Study2=1.3±7.0 events/h, P=0.035). The significant Study1 differences between the CA vs. AG AHIs (12.3±9.2 vs. 8.2±5.9 events/h, P<0.0002) were not apparent in Study2 (11.7±8.0 vs. 10.4±6.7 events/h, P=0.362), however, the Study2 AG AHI values were higher (P=0.055).

Discussion

Despite the trend toward greater Study2 pre-treatment and AG AHI severities, CA treatment efficacy was equivalent to the AG once VMO was controlled and fabricated using the AG VDO and protrusion bite-registration. These findings confirmed CA fabrication settings impact treatment outcomes.
P086 The organization of sleep-wake patterns around daily schedules in college students
Authors: Lu S , Klerman E , Stone J , McHill A , Barger L , Sano A , Czeisler C , Rajaratnam S , Phillips A
Published: October 2021

A potential contributor to insufficient sleep among college students is their daily schedule, with sleep sacrificed for other waking activities. We investigated how daily schedules predict day-to-day sleep-wake timing in college students. 223 undergraduate college students (M±SD = 19.2±1.4 years, 37% females) attending a Massachusetts university in the US between 2013–2016 were monitored for approximately 30 days during semester. Sleep-wake timing was measured using daily online sleep diaries and wrist-actigraphy. Daily schedules were measured using daily online diaries that included self-reported timing and duration of academic, exercise-based, and extracurricular activities, and duration of self-study. Linear mixed models were used to examine the association between sleep-wake patterns and daily schedules at both the between-person and within-person levels. An earlier start time of the first-reported activity predicted earlier sleep onset (between and within: p<.001) and shorter total sleep time (within: p<.001) for the previous night, as well as earlier wake onset on the corresponding day (between and within: p<.001). A later end time of the last-reported activity predicted later sleep onset (within: p=.002) and shorter total sleep time (within: p=.02) on that night. A more intense daily schedule (i.e., greater total duration of reported activities) predicted an earlier wake onset time (between: p=.003, within: p<.001), a later sleep onset time (within: p<.001), a shortened total night-time sleep duration (between: p=.03, within: p<.001), and greater sleep efficiency (within: p<.001). These results indicate that college students may organize their sleep and wake times based on their daily schedule.
P125 Sleep and fear conditioning, extinction learning and extinction recall: a systematic review and meta-analysis of polysomnographic findings
Authors: Schenker M , Ney L , Miller L , Felmingham K , Nicholas C , Jordan A
Published: October 2021

Sleep may contribute to the long-lasting consolidation and processing of emotional memories. Experimental fear conditioning and extinction paradigms model the development, maintenance, and treatment of anxiety disorders. The literature provides compelling evidence for the involvement of rapid eye movement (REM) sleep in the consolidation of such memories. This meta-analysis correlated polysomnographic sleep findings with psychophysiological reactivity to the danger (CS+) and safety stimuli (CS-), to clarify the specific role of sleep stages before and after fear conditioning, extinction learning and extinction recall. Overall, there was evidence that more pre-learning sleep stage two and less slow wave sleep was associated with higher psychophysiological reactivity to the safety stimulus during extinction learning. Preliminary evidence found here support the role of REM sleep during the post-extinction consolidation sleep phase in clinical populations with disrupted sleep, but not in healthy controls. Furthermore, the meta-regressions found that sex moderated the associations between sleep and psychophysiological reactivity throughout the paradigm providing evidence for diverging correlations in male and females. Specifically, increased post-extinction REM was associated with poorer extinction and safety recall in females while the opposite was found in males. These results have implications for future research in the role of sleep in emotional memory processing.
P126 Systematic review of outcome measures used in narcolepsy clinical trials
Authors: Schokman A , Bin Y , Naehrig D , Cheung J , Kairaitis K , Glozier N
Published: October 2021

Introduction

Treatment of the sleep disorder narcolepsy is primarily symptomatic. With limited population data and insufficient systems to capture patient data, a greater emphasis has been placed on the patient perspective in determining satisfaction and treatment success in clinical settings. While Randomised Controlled Trials (RCTs) are considered the gold standard when determining treatment effectiveness, how effectiveness is measured in a narcolepsy population remains unknown. Therefore, we aimed to explore the outcome measures used in narcolepsy RCTs, and further evaluate the adequacy of any self-reported outcome measures used.

Methods

Electronic databases (MEDLINE, EMBASE, CINAHL, SCOPUS, PSYCHINFO) and clinicaltrials.gov were searched in April 2020, with primary and secondary outcomes extracted from eligible studies. Self-reported outcome measures used at least once as a primary outcome measure were further explored, with validation studies of these systematically searched for (using the above databases) and analysed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias tool.

Results

We identified 82 published RCTs involving patients with narcolepsy, of which 35 objective and 46 subjective measures were used. Of these, the Maintenance of Wakefulness Test (n=29), Epworth Sleepiness Scale (ESS) (n=14) and Multiple Sleep Latency Test (n=9) were the most frequently selected primary outcome measures. While our analysis of self-reported outcome measures is ongoing, preliminary results suggest that few have been adequately validated in a narcolepsy-specific population.

Discussion

Our preliminary results identify a high level of heterogeneity between outcome measures used in RCTs, thus difficult to draw conclusions and compare interventions.
P136 Domiciliary Bilevel Ventilation at Sunshine Coast University Hospital
Authors: Smith D , Anderson J
Published: October 2021

Introduction

Positive airway pressure therapy, including bilevel (BPAP) and continuous positive airway pressure (CPAP), is the mainstay of management of a group of chronic conditions that culminate in chronic hypercapnic respiratory failure such as chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS) and respiratory muscle weakness. Heterogeneously across these conditions, BPAP can decrease hospital admission and prolong quality and duration of life. In COPD (when with comorbid obstructive sleep apnoea) and OHS, there has been some evidence to suggest that the far more economical CPAP is as effective. Here we compare local practice to guideline suggested management and previous Australasian audit data.

Methods

Adult patients currently managed with domiciliary BPAP by the SCUH Sleep Department were identified from local a database. Demographics, medical diagnoses, premorbid functional status, indications for BPAP, funding of BPAP, outcomes of therapy and attempts to de-escalate to CPAP were collected.

Results

64 patient were identified. Data collection and analysis is ongoing and will be presented at full at the conference.

Intended Outcome and Impact: We aim to review local practice managing chronic hypercapnic respiratory failure with BPAP with hope it could inform future local practice.
P138 Nocturnal oxygen desaturation and MET call criteria during in-laboratory sleep studies
Authors: Stonehouse J , Perkins A , Irving L , Goldin J , Wallbridge P , Hii S , Rees M , Manser R , Kee K
Published: October 2021

Introduction

Patients undergoing sleep studies can experience frequent and profound oxygen desaturation. Most hospitals have standard MET (Medical Emergency Team) call criteria which obligate a response to severe oxygen desaturation. At our tertiary institution this is “Pulse oximetry/oxygen saturation: < 90 despite oxygen administration”. For most sleep studies provision of oxygen overnight would not be appropriate. We sought to examine the proportion of our sleep study patients who would meet MET call criteria.

Method

We retrospectively examined the data of all sleep studies which were performed in our laboratory between 01/01/2021 and 30/04/2021. Demographic and pulse oximetry data was collected.

Results

We collected data from 448 studies (95 CPAP, 342 diagnostic, 9 Split, 2 other). Patients were 40% female, 49±15 (mean±SD) years old and had a median AHI of 10 events per hour. 290 (65%) patients had a nadir SpO2 of <90%. The percentage of patients below with nadir SpO2 of 80%, 70%, 60% and 50% was 20%, 9%, 5% and 3% respectively. These proportions did not significantly change if treatment studies were excluded. In contrast, 23 (5%) of patients had a mean overnight SpO2 < 90%. During the period studied no serious adverse event was recorded.

Discussion

Most patients presenting for a sleep study to our tertiary institution would potentially meet standard hospital MET call criteria. This demonstrates the need for hospitals to be flexible in terms of hospital wide protocols when it comes to sleep laboratories. Evidence based criteria for medical escalation in sleep laboratories are required.
P140 A study of sleep quality, smartphone use and chronic neck pain among male and female university students
Authors: Szeto G , Chow C , Chu A , Ng B , Kwok A
Published: October 2021

Purpose

Intensive smartphone use may contribute to chronic neck and shoulder pain and sleep disturbance. This study aimed to examine the relationship of sleep quality with daytime smartphone use and self-reported neck-shoulder symptoms among university students in Hong Kong.

Methods

Nineteen university students participated (11 males, 9 females, mean age=21.7±3.9). The actigraphy device Actiwatch 2 (Philips Ltd) was used to record 7 nights of sleep data. Daytime smartphone use and neck and shoulder pain scores (on a Pain scale 0–10) were recorded.

Results

Total sleep time (TST) was significantly longer in females (410.2min) than males (359.6min) (p=0.012), as was the sleep efficiency (females: 87.8%, males: 79.8%, p=0.003). Their sleep onset latency was similar at around 18min. The mean weekly Screen time and pre-bed Screen time were 430.1min and 37.9min for females, and 427.2min and 26.7min for males respectively. All the participants reported mild neck-shoulder symptoms (mean pain scores=0.9±1.8 for neck, 1.5±2.4 for shoulder). Pearson correlation showed no statistically significant association between sleep parameters, neck/shoulder pain score, screen time during day, and pre-bed screen time.

Conclusion

The present results showed that university students in Hong Kong were sleep deprived with on average, ~6h of sleep per night and spending ~30min each night on screen devices. Female students slept ½h more than male students. Given the low pain scores and small sample size, no significant relationship was found with musculoskeletal symptoms and smartphone use. Future study should recruit those with more severe symptoms and increase the sample size.
P152 Poor sleep quality, individual experiences and increased risk of self-harm – A multi-method study
Authors: Varma P , Burge M , Meaklim H , Junge M , Jackson M
Published: October 2021

Introduction

The COVID-19 pandemic has caused significant psychological distress to many people across the globe. Poor sleep quality may be linked to poor mental health and increased suicide ideation. To contextualise the risk factors associated with self-harm or suicidal ideation during the COVID-19 pandemic, this cross-sectional study examined links between poor sleep quality, individual experiences and self-harm risk.

Methods

N=1544 (Mage=44.3y) from 63 countries completed an online survey in March-April 2020. Participants reported their pandemic experiences as free text responses, which were examined quantitatively for frequent word usage using Linguist Inquiry and Word Count software. Pittsburgh Sleep Quality Index assessed poor sleep quality (cut-off score >8). Item-9 of Patient Health Questionnaire-9 measured the risk of self-harm.

Results

Individuals with poor sleep quality (45%) used more negative emotional tone and had greater use of anxiety or money-related words in their comments than good sleepers (all ps<.05). Additionally, 19% of respondents (n=295) reported thoughts of self-harm at least several days a week (3.4% nearly every day). Logistic regression indicated that younger individuals, males, and those feeling isolated or less resilient had 1.2 to 1.5 times greater risk of self-harm (all ps<.001). Poor sleep quality was associated with a two-fold increased risk of self-harm (95%CI=1.5–2.7, p<.0001) after controlling for demographic variables.

Discussion

Poor sleep quality is linked to negative emotionality and increased risk of self-harm during the COVID-19 pandemic. Sleep is a modifiable factor; therefore interventions aimed at addressing sleep disturbances may improve resilience and reduce the risk of self-harm in vulnerable individuals.
P155 Effects of upper airway muscle training on upper airway physiology in people with obstructive sleep apnea
Authors: Wallace E , Eckert D , Osman A , Naik G , Carberry J
Published: October 2021

Introduction

Previous studies demonstrate that oropharyngeal exercises can reduce obstructive sleep apnoea (OSA) severity. However, the physiological mechanisms underlying this improvement are unknown. Thus, this study aimed to evaluate the effects of a speech-pathology led, targeted upper airway muscle training protocol on upper airway physiology.

Methods

People with mild-moderate OSA (n=12 studied to date, 5 females, 7 males) completed 12 weeks of daily upper airway muscle training targeting the muscles of the tongue and soft palate. Pre- and post-training outcome measures included anterior and posterior tongue muscle strength and endurance and upper airway collapsibility via the upper airway collapsibility index.

Results

Preliminary findings indicate that 12 weeks of targeted exercise training improved anterior and posterior tongue muscle strength, respectively (54.3±12.7 vs. 61.5±7.7kPa, p<0.01, 50.1±8.5 vs. 58.0±8.5kPa, p<0.01), and anterior and posterior tongue muscle endurance, respectively (15.7±10.9 vs. 24.1±8s, p<0.01, 9.5±4.2 vs. 23.3±17.7s, p<0.01). The upper airway collapsibility index improved post-training (25.5±18.9 vs. 12.26±12.11 %, p=0.03).

Conclusions

Twelve weeks of upper airway muscle training improved tongue muscle strength, endurance and upper airway collapsibility in people with mild-moderate OSA. These physiological changes provide insight into the potential mechanisms mediating reductions in OSA severity with oropharyngeal exercises.

This research was supported by the 2019 Phillips/ASA Sleep Research grant.
P156 Global sleep health surveillance of adults: A scoping review
Authors: Way J , Cistulli P , Bin Y
Published: October 2021

Introduction

The monitoring of sleep health is an emerging but globally under-recognised public health opportunity to help address poor health and social outcomes in the general population. This scoping review aims to identify the existing national surveillance systems monitoring sleep health and to describe the sleep indicators used in the questionnaires.

Methods

We systematically searched the grey and peer-reviewed literature for cross-sectional national health surveys that included measurement of the sleep of adults aged 18+. Countries screened were the 194 Member States of the World Health Organization (WHO). Searches included 1) targeted searches of the websites of national and international health agencies and statistics departments, 2) customised internet search, and 3) search of electronic databases (PubMed and EMBASE).

Progress to date

Searches of targeted websites and the internet have been completed. Preliminary analysis shows that 49 (25%) countries have national surveys that include at least one sleep health-related question. Breakdown by the WHO defined regions reveal the European Region (45%) with the highest sleep health surveillance and the African Region (6%) with the lowest. An electronic database search is currently being conducted.

Intended outcome and impact

This scoping review will provide an overview of the current status of global sleep health surveillance including how sleep is measured in population health surveys. The results will raise awareness about the need to monitor sleep at a national level to improve health and social outcomes.
P165 Use of Initiation checklist to improve compliance with BPAP & CPAP
Authors: Wood C , Morris L , Raths K , Waters K , Gray K
Published: October 2021

Introduction

Studies have shown that processes used during initiation of non-invasive respiratory (NIV) therapies (including CPAP and BPAP) for children, can influence subsequent compliance with therapy.

Methods

We implemented a structured checklist as a way of standardising a number of the steps during initiation of NIV in our paediatric sleep medicine service. This study retrospectively reviewed the medical records of children initiated on NIV between Nov 2018 and Dec 2020. We hypothesised that our use of a structured approach to the initiation process, with electronic documentation, would indicate areas in the initiation process that are associated with improved compliance with the therapy, in the long term.

Results

Initial results revealed that 220 children were commenced on therapy during the 2-year study period (51 BPAP & 169 CPAP). Total numbers with forms present 136 (62%) and complete forms 56 (41%). Forty-six (90%) children commenced on BPAP had forms present and 34 (74%) were completed. Ninety (53%) children commenced on CPAP had forms present and 22 (25%) were completed. Further analyses will evaluate whether sections of the initiation process and checklist (day (of week) of discharge, in-patient vs HITH, attendance at 1st follow-up appointment, financial assistance, severity of disease, eligibility for government-funded equipment) influence compliance when monitored by download at the first, subsequent sleep study.

Discussion

Use of standardised processes during initiation of NIV therapies can aid in evaluation of the factors that positively influence subsequent compliance with therapy.
Excluding Criminals or Mothers? How Vicarious Experiences Shape Legal Attitudes on Immigration Enforcement
Authors: Ramirez Blanca A
Published: October 2021

Literature provides insights as to how interior immigration enforcement can foment legal cynicism among those it targets. Yet scholars know little about individuals’ evaluative judgments after a secondhand experience, such as when a relative is apprehended, detained, or deported by immigration enforcement. Drawing on data from 26 interviews with individuals who had a family member apprehended by immigration enforcement, I examine how people evaluate a relative’s immigration case and immigration law more broadly. I argue that a gendered legal attitude formation process occurs as family members make and express their evaluative judgments. Respondents often had limited information about the case, and they turned to available gendered discourses to express their legal attitudes. As a result, with a male relative, individuals invoked criminalization discourses, whereas with a female relative, they invoked motherhood discourses. Thus, family members of males who delegitimized immigration enforcement did so via a limited challenging of criminalization discourses, whereas the family members of females tended to delegitimize immigration enforcement via motherhood discourses. Other family members of males also drew from criminalization discourses to legitimize some aspects of immigration enforcement. I argue that this process of gendered legal attitude formation demonstrates the far-reaching consequences of a men’s criminalization.
Daughters of War: Girl Guides and Service after the First World War
Authors: Proctor Tammy M
Published: October 2021

Using the lens of the largest female youth organization in interwar Britain, the Girl Guides, I argue girls became important to the rebuilding of the post-war world as future wives, mothers, and keepers of the hearth. Yet this message of return to home was complicated by a wartime message of patriotic service, citizenship, and adventure. Thus, uniformed clubs such as the Guides tried to balance these ideals, with female war veterans leading the way. Guiding taught homemaking skills in the 1920s while also offering alternative ways for girls and young women to continue to maintain a meaningful service to the nation. Such groups became a haven both for those who had performed war work and for a new generation of girls who longed to be patriots and active public-minded women. Finally, the Guides performed an exemplary role in enacting gender roles for a postwar generation, especially given the group’s connection as a complementary ‘sister’ group to Boy Scouting, which created a symmetrical training program for boys and girls.
Association between maternal serum 25-hydroxyvitamin D concentrations and the risk of pre-eclampsia in central Sudan: a case-control study
Authors: Abdelrahiem Somia K , Ahmed Abdel B A , Sharif Manal E , Adam Ishag
Published: October 2021

Background

There are few published data on the role of vitamin D concentrations during pregnancy in sub-Saharan Africa. Thus, the aim of the current study was to investigate the association between 25-hydroxyvitamin D (25[OH)]D) levels and pre-eclampsia.

Method

A case-control study, with 60 women in each arm, was conducted in Medani Hospital in Sudan. The cases were women with pre-eclampsia and healthy pregnant women as controls. The medical and obstetric history was obtained using a questionnaire. The serum 25(OH)D concentrations were measured using ELISA.

Results

The median (IQR) of 25(OH)D concentration was significantly lower in women with pre-eclampsia than in the controls (10.0 [6.5] vs 18.3 [22.1] ng/mL). Fifty-three cases with pre-eclampsia (88%) and 36 cases in the control group (60%) had vitamin D deficiency (25(OH)D level≤20 ng/mL). Multivariate logistic regression showed that the 25(OH)D levels were negatively associated with pre-eclampsia (adjusted OR [AOR]=0.87, 95% CI 0.81 to 0.92). Vitamin D-deficient women were at a higher risk of pre-eclampsia (AOR=4.51, 95% CI 1.70 to 11.94).

Conclusion

Low 25(OH)D levels were reported in women with pre-eclampsia and were an independent risk factor for pre-eclampsia.
Streptomyces rhizophilusCauses Potato Common Scab Disease
Authors: Wei Qi , Li Jie , Yang Shuai , Wang Wenzhong , Min Fanxiang , Guo Mei , Zhang Shu , Dong Xuezhi , Hu Linshuang , Li Zhugang , Wang Xiaodan
Published: October 2021

Common scab (CS) caused by Streptomyces spp. is a significant soilborne potato disease that results in tremendous economic losses globally. Identification of CS-associated species of the genus Streptomyces can enhance understanding of the genetic variation of these bacterial species and is necessary for the control of this epidemic disease. The present study isolated Streptomyces strain 6-2-1(1) from scabby potatoes in Keshan County, Heilongjiang Province, China. PCR analysis confirmed that the strain harbored the characteristic Streptomyces pathogenicity island (PAI) genes (txtA, txtAB, nec1, and tomA). Pathogenicity assays proved that the strain caused typical scab lesions on potato tuber surfaces and necrosis on radish seedlings and potato slices. Subsequently, the strain was systemically characterized at morphological, physiological, biochemical, and phylogenetic levels. Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain 6-2-1(1) shared 99.86% sequence similarity with Streptomyces rhizophilus JR-41T, isolated initially from bamboo in rhizospheric soil in Korea. PCR amplification followed by Sanger sequencing of the 16S rRNA gene of 164 scabby potato samples collected in Heilongjiang Province from 2019 to 2020 demonstrated that approximately 2% of the tested samples were infected with S. rhizophilus. Taken together, these results demonstrate that S. rhizophilus is capable of causing potato CS disease and may pose a potential challenge to potato production in Heilongjiang Province of China.
The Scope of Social Mission Content in Health Professions Education Accreditation Standards
Authors: Orban Julie , Xue Crystal , Raichur Shalini , Misak Monika , Nobles Autumn , Casimir Jaileessa , Batra Sonal
Published: October 2021

Purpose

Health professions education accreditation standards influence institutional practices and policies and ensure high-quality education that meets the needs of patients and society. Social mission is the contribution of a school in its mission, programs, and the performance of its graduates, faculty, and leadership to advancing health equity and addressing the health disparities of the society in which it exists. This study examined the scope of social mission content in major U.S. and Canadian health professions education accreditation standards.

Method

The authors analyzed publicly available accreditation standards documents from 9 accreditors across 5 disciplines—dental, medical, nursing, pharmacy, and physician assistant schools—with effective years from 2016 to 2020. They created a codebook from the previously published social mission metrics survey, which includes 18 social mission activity areas and 79 indicators within those areas. The authors then conducted detailed document reviews to identify the presence of the social mission areas and indicators within the accreditation standards.

Results

Across all 18 activity areas and 9 accreditors, the authors identified 93 instances of social mission. Curriculum was the most well-represented area with 34 instances. Interprofessional education in curriculum was the most prevalent indicator with 17 instances. The Committee on Accreditation of Canadian Medical Schools included more social mission areas and indicators than the other accreditors.

Conclusions

There is substantial variability in the social mission content in accreditation standards across accreditors and disciplines. The authors found little representation of key aspects of social mission, including community collaborations, faculty training, and pipeline programs. These findings highlight areas of potential interdisciplinary collaboration to enhance the social mission content of health professions education.
A Systematic Review on the Association Between Vestibular Dysfunction and Balance Performance in Children With Hearing Loss
Authors: Singh Anisha , Heet Hannah , Guggenheim Dana S. , Lim Margaret , Garg Bhavika , Bao Matthew , Smith Sherri L. , Garrison Doug , Raynor Eileen M. , Lee Janet W. , Wrigley Jordan , Riska Kristal M.
Published: October 2021

Objectives:

The objective of this study was to understand the functional impact of vestibular dysfunction on balance control in children with hearing loss. The vestibular system is an important contributor to maintaining balance. In adults, vestibular dysfunction is known to lead to unsteadiness and falls. Considerably less is known about the effects of vestibular dysfunction in children with hearing loss.

Design:

We conducted a systematic review in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included articles on children with hearing loss who underwent vestibular and balance testing. The Downs and Black checklist was used to assess the risk of bias.

Results:

A total of 20 articles were included in this systematic review, of which, 17 reported an association between vestibular dysfunction and balance abnormalities in children with hearing loss. Bias (as measured by the Downs and Black Checklist) was a concern, as most studies were nonblinded cohort studies or case series selected through convenience sampling.

Conclusions:

Research to date has predominantly found that children with concomitant hearing loss and vestibular impairment tend to perform more poorly on balance measures than either children with hearing loss and normal vestibular function or children with both normal-hearing and normal vestibular function. A standardized approach to assessing both vestibular function and balance would better characterize the impact of vestibular dysfunction in children with hearing loss at the population level.
Magnetically Controlled Growing Rods (MCGR) Versus Single Posterior Spinal Fusion (PSF) Versus Vertebral Body Tether (VBT) in Older Early Onset Scoliosis (EOS) Patients
Authors: Mackey Catherine , Hanstein Regina , Lo Yungtai , Vaughan Majella , St. Hilaire Tricia , Luhmann Scott J. , Vitale Michael G. , Glotzbecker Michael P. , Samdani Amer , Parent Stefan , Gomez Jaime A.
Published: October 2021

Study Design.

Retrospective review of prospective data from multicenter registry.

Objective.

Compare outcomes of posterior spinal fusion (PSF) versus magnetically controlled growing rods (MCGR) versus vertebral body tethers (VBT) in 8- to 11-year-old idiopathic early onset scoliosis (EOS) patients.

Summary of Background Data.

In EOS, it is unclear at what age the benefit of growth-sparing strategies outweighs increased risks of surgical complications, compared with PSF.

Methods.

One hundred thirty idiopathic EOS patients, 81% female, aged 8–11 at index surgery (mean 10.5 yrs), underwent PSF, MCGR, or VBT. Scoliosis curve, kyphosis, thoracic and spinal height, complications, and Quality of Life (QoL) were assessed preoperatively and at most recent follow-up (prior to final fusion for VBT/MCGR).

Results.

Of 130 patients, 28.5% received VBT, 39.2% MCGR, and 32.3% PSF. The VBT cohort included more females (P < 0.0005), was older (P < 0.0005), more skeletally mature (P < 0.0005), and had smaller major curves (P < 0.0005). At follow-up, scoliosis curve corrected 41.1 ± 22.4% in VBT, 52.2 ± 19.9% in PSF, and 27.4 ± 23.9% in MCGR (P < 0.0005), however, not all VBT/MCGR patients finished treatment. Fifteen complications occurred in 10 VBTs, 6 requiring unplanned surgeries; 45 complications occurred in 31 MCGRs, 11 requiring unplanned surgeries, and 9 complications occurred in 6 PSFs, 3 requiring unplanned revisions. Cox proportional hazards regression adjusted for age, gender, and preoperative scoliosis curve revealed that MCGR (hazard ratio [HR] = 21.0, 95% C.I. 4.8–92.5; P < 0.001) and VBT (HR = 7.1, 95% C.I. 1.4–36.4; P = 0.019) patients were at increased hazard of requiring revision, but only MCGR patients (HR = 5.6, 95% C.I. 1.1–28.4; P = 0.038) were at an increased hazard for unplanned revisions compared with PSF. Thoracic and spinal height increased in all groups. QoL improved in VBT and PSF patients, but not in MCGR patients.

Conclusion.

In older idiopathic EOS patients, MCGR, PSF, and VBT controlled curves effectively and increased spinal height. However, VBT and PSF have a lower hazard for an unplanned revision and improved QoL.

Level of Evidence: 3
Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
Authors: Routsi Christina , Kokkoris Stelios , Siempos Ilias , Magira Eleni , Kotanidou Anastasia , Zakynthinos Spyros
Published: October 2021

OBJECTIVES:

Since changes in pharmacological treatments for severely ill patients with coronavirus disease 2019 have been incorporated into clinical practice, both by their use (corticosteroids and remdesivir) and by stopping them (e.g., hydroxychloroquine), we sought to compare the rate of intubation and mortality of intubated patients in our ICUs between the first and second waves of the pandemic.

DESIGN:

Single-center, observational.

SETTING:

Four coronavirus disease 2019 designated ICUs at an urban Greek teaching hospital.

PATIENTS:

All adult patients with coronavirus disease 2019 consecutively admitted to ICU during the first (n = 50) and second (n = 212) waves of the pandemic.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The percentage of intubated ICU patients dropped from 82% during the first wave to 66% during the second wave (p = 0.042). However, the absolute number of intubated ICU patients was lower during the first than the second wave (41 vs 140 patients). ICU or hospital mortality of intubated patients increased from 39% during the first wave to 60% during the second wave (p = 0.028). The binary logistic regression for hospital mortality as the dependent variable in intubated patients and covariates the age, Acute Physiology and Chronic Health Evaluation II score, cardiovascular comorbidity, lactate, positive end-expiratory pressure, Sequential Organ Failure Assessment score, and wave, distinguished only Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.40 with 95% CI, 1.14—1.72; p = 0.001) as the sole independent predictor of hospital mortality.

CONCLUSIONS:

Pharmacological adaptations and other measures may have led to fewer intubations over time. However, these changes do not seem to be translated into improved outcomes of intubated patients. Perhaps the same change in the use of drugs and protocols that could cause fewer intubations of ICU patients might be a reason of increased mortality in those patients who are eventually intubated. Furthermore, the relative staff inexperience and overall increase in patients’ comorbidities during the second wave could have contributed to increased Acute Physiology and Chronic Health Evaluation II score and mortality of intubated patients.
Patients With Coronavirus Disease 2019 Requiring Invasive Mechanical Ventilation in Mexico in the First, Second, and Exponential Growth Phase of the Third Wave of the Coronavirus Disease 2019 Pandemic
Authors: Ñamendys-Silva Silvio A.
Published: October 2021

A total of 3,197,108 coronavirus disease 2019 cases (2,537 cases per 100,000 people) and 252,080 deaths (200 deaths per 100,000 people) were recorded in Mexico as of August 20, 2021. There were 36,934 of 203,582 coronavirus disease 2019 patients (18.1%) that required invasive mechanical ventilation during the first wave of coronavirus disease 2019, 24,698 of 253,899 (9.7%) patients during the second wave, and 5,610 of 65,952 (8.5%) during the exponential growth phase of the third wave (p < 0.001). The proportion of patients who received invasive mechanical ventilation in the ICU was lower in the first wave (27.9%) and then remained between 33.3% and 36.2% for the remainder of that period. Although the inhospital mortality of hospitalized coronavirus disease 2019 patients requiring intubation during the exponential growth phase of the third wave was lower than that in the first and second waves, the inhospital mortality in coronavirus disease 2019 patients requiring invasive mechanical ventilation remained greater than 82%.