bluuebunny/crossref_metadata_2025 huggingface dataset:
P010 The characteristics of patients with symptomatic unilateral diaphragm dysfunction and hypoventilation
Authors: Hynes D , Lee E , Chew C , Treanor D , Bruzzese K , Brazzale D , Crump N , Dobson J , Barnett S , O’Donoghue F , Howard M
Published: December 2024

Introduction

Despite the diaphragm being the primary muscle involved in respiration, clinical manifestations in those with unilateral diaphragm dysfunction (UDD) are heterogeneous. Though often asymptomatic, UDD can be implicated in breathlessness, sleep disordered breathing and hypoventilation. The characteristics of those with UDD and sleep hypoventilation are poorly described. We aimed to provide a descriptive analysis of patients with UDD considered for plication, and the characteristics of those with hypoventilation.

Methods

A clinical audit was performed at a tertiary centre providing evaluation of UDD for consideration of plication. Anthropomorphic data, symptom scores and respiratory function measurements were collected. Patients underwent polysomnography, with hypoventilation assessed based on PaCO2 >45mmHg and/or transcutaneous CO2 rise of ≥10mmHg for over 10minutes. Characteristics of those with- and without hypoventilation were compared using unpaired t-test or Mann-Whitney U test.

Results

39 patients were included (median age 65 [50—73]). Of the 34 participants who underwent polysomnography, 14 (41.2%) demonstrated hypoventilation. Compared to those without hypoventilation, the group with hypoventilation had a lower forced vital capacity (74±17.3% vs 61.8±13.4%, p<0.05), lower maximal inspiratory muscle pressures (55.8±16.4% vs 39.3±13.4%%, p=0.02) and lower maximal expiratory muscle pressures (84.5 [74—93.8]% vs 66 [47.5—86.5]%, p=0.03). There were no differences in body mass index.

Discussion

Hypoventilation was common amongst patients with symptomatic UDD referred for plication, who may benefit from nocturnal ventilatory support. Though respiratory function was found to be worse in those with hypoventilation, it was surprising that BMI was no different.
P013 Healthy from the start: using participatory co-design as a novel approach for developing health resources for young shiftworkers
Authors: Shriane A , Ferguson S , Gupta C , Hilditch C , Kolbe-Alexander T , Marino J , Paterson J , Rigney G , Sprajcer M , Stanton R , Thomas M , Vincent G
Published: December 2024

Young adults are increasingly joining shiftwork professions, exposing them to elevated health risks. To mitigate these risks, tailored, evidence-based resources on health areas most affected by shiftwork - sleep, nutrition, and physical activity – are essential. To ensure such resources are tailored and engaging, lived experience must be embedded in their design. To date, such participatory, co-design approaches are yet to be implemented in resource development for shiftworkers.

A participatory approach engaged co-designers (young, experienced, and former shiftworkers, workplace health and safety specialists, science communicators, and academic experts) in a series of online workshops and surveys, aiming to create sleep, nutrition, and physical activity resources for young shiftworkers. Following resource development, co-designers assessed their participation and the resulting resources through an online questionnaire, which included the Public and Patient Engagement Evaluation Tool (PPEET).

Co-designers (n=48) successfully participated in the development of sleep, nutrition, and physical activity resources for young shiftworkers. Co-designers evaluated the participatory approach positively, with a mean rating across all PPEET items of >4.8 on a 5-point Likert scale, also providing positive ratings for the resources, with the majority (91.9%) either agreeing or strongly agreeing that they were user-friendly, valuable, and informative for young shiftworkers, serving as a credible source of health information.

By adopting a novel participatory approach, we successfully co-designed sleep, nutrition, and physical activity resources for young shiftworkers. Participatory approaches, including co-design, should be considered when developing health interventions for shiftworkers, given their unique lifestyle challenges and the value of embedding lived experience.
P015 Sleep hygiene and sleep health of mining shift workers in Australia
Authors: Beranek P , Dunican I , Cruickshank T , Turner M
Published: December 2024

Introduction

The Australian mining industry operates 24/7/365 days per year, with operations often located in remote areas. This requires fly-in, fly-out (FIFO) shift workers to follow a roster-based work schedule and reside in camp accommodations between consecutive shifts. Initial research reported sleep difficulties in this population. This study evaluated sleep hygiene and sleep health and their respective relationships in FIFO shift workers in the mining industry in Australia.

Methods

Employing a cross-sectional study design, an online survey was disseminated between June 2023 and February 2024. Sleep hygiene was assessed using the Sleep Hygiene Index and sleep health was assessed using the Sleep Health Index. The sample comprised 488 respondents (139 females, average age: 39±12 years, average BMI: 28±5 kg/m2).

Results

Findings revealed average scores of 30±7 for the Sleep Hygiene Index and 73±16 for the Sleep Health Index. Better sleep hygiene was associated with better sleep health (β=-0.52, se=0.10, [-0.72, -0.33], p<0.05). Differences in Sleep Health Index scores were found between engagement frequencies for sleep hygiene practices related to sleep regularity, sleep environment, mental health, and time in bed (p<0.05 for all). No differences in Sleep Health Index scores were found between engagement frequencies for sleep hygiene practices related to substance consumption and exercise close to bedtime (p≥0.05 for all).

Discussion

This study suggests that shift workers in the mining industry may improve their sleep health by improving their sleep hygiene. Specifically, greater emphasis should be placed on improving sleep regularity, sleep environment, mental health, and time in bed.
P017 Relationships between daily step count and sleep in over 30 million person-days of real-world longitudinal monitoring data
Authors: Fitton J , Nguyen P , Lechat B , Scott H , Toson B , Manners J , Sansom K , Hudson A , Vakulin A , Naik G , Dunbar C , Catcheside P , Pinilla L , Eckert D
Published: December 2024

Given their importance for health and wellness, the relationship between sleep and physical activity has garnered considerable research attention. Previous studies have, however, often been limited by relatively small and geographically limited samples, reliance on self-report measures of sleep, and little longitudinal data. We aimed to expand upon previous research by exploring relationships between sleep and daily step count in a large global sample (N = 76,434).

Over 30 million person-days of sleep- and health-related monitoring data were collected through Withings’ consumer health-tracking devices from users in 250 regions worldwide. We used generalized additive models to investigate the relationship between daily step count with total sleep time (TST), sleep onset latency (SOL), and sleep efficiency (SE).

Linearly, a between-subject difference of 10,000 daily steps predicts reduced SOL (-2.72 95%CI ± 0.01 min) and TST (-11.72 ± 0.06 min), and increased SE (1.19 ± 0.01 %). Notably, our descriptive analysis showed that, on average, a very small proportion of users (5.1%) attained both the recommended 7-9 hours of sleep per night and ≥10,000 daily steps, whilst 17% of the sample lead sedentary lives (<5,000 daily steps) and sleep less than 7 hours per night.

Findings highlight the interplay between sleep and daily step count in a large global sample, whilst also calling into question the compatibility of prominent sleep duration guidelines with physical activity recommendations. More research is needed to further investigate the temporal dynamics of the relationship between sleep and daily step count.
P019 No mythical effect of moon cycles on sleep
Authors: Nguyen P , Lechat B , Scott H , Vakulin A , Eckert D , Catcheside P
Published: December 2024

Introduction

The lunar cycle effects behaviours in invertebrates. In humans, lunar cycle effects on sleep have been reported, but with mixed and inconclusive findings. This study sought to leverage a very large longitudinal consumer device dataset to more definitively investigate potential moon cycle effects on human sleep.

Methods

We used sleep data recorded between March 2017 and September 2023 from two consumer devices, using location and date data to determine moon phase and total sleep time from all available data covering at least 80% of a moon cycle. One device was a pneumatic under-mattress bed sleep sensor with 124,544 users and 81 million nights of data. The other device was a wrist-worn sleep sensor with 232,576 users and 96 million nights of data. Both a Cosinor and Genearlized Additive Model (GAM) were used to test for moon phase effects on sleep.

Results

Univariate analysis using the Cosinor model showed no discernible moon effect, a poor model fit for over 99% of users (effect size <0.33 hrs and R-squared <0.25) and a random distribution of the cosine peak across the moon cycle. GAM adjusted for multiple confounders also showed no evidence of moon phase effects on total sleep time (effect size <0.02 hrs). Multiple sensitivity analyses with different sleep related outcomes and model structures showed no evidence of moon phase effects on sleep.

Conclusions

Comprehensive analysis of two very large independent data sources of sleep time estimates do not support any moon cycle effects on total sleep time.
P020 Spinning sleep: Constructions of sleep in New Zealand’s online magazine texts
Authors: Gibson R , Breheny M , Thompson A , Signal L , Haami D , Dew K
Published: December 2024

Introduction

Approximately a third of adults report suboptimal sleep, however, medicalised approaches to sleep seldom align with the realities of ordinary life. Familial sleep arrangements and schedules of contemporary society influence sleep experiences. These experiences are also shaped by social and cultural beliefs concerning rest and production. Mainstream media presentation of sleep and the implications of sleeplessness provides a lens for interrogating the complex messages people receive regarding sleep and society.

Method

A thematic analysis was conducted on sleep-related content from The SPINOFF, New Zealand’s largest freely accessible online magazine source. A search of content containing the keyword “sleep*” (2014-2023) yielded 1,313 texts, 125 of which were deemed relevant for analysis.

Results

Sleep was constructed as vital for optimal functioning and happiness. This was explicit within texts concerning topics of “sleep and mental health” and “how to improve sleep”. Other texts supported this message implicitly using examples of the dangers of sleep disruption for health and wellbeing. These included accounts of sleep disorders; unsolicited changes to sleep through social schedules; and (overwhelmingly) experiences of sleeplessness during early parenthood. Unique juxtapositions were apparent between the jovial nature of texts that normalised sleep loss across the life course versus those that emphasised the severity of situations of chronic sleep loss.

Discussion

Moving between the comedic and tragic accounts of sleep loss, sleep disruption was constructed as both ordinary and serious. These constructions of sleep inform adjunct research concerning audience receptions to sleep-related messaging and their influence on beliefs and practices.
P022 How well are we communicating the complications of adenotonsillectomy in children for sleep disordered breathing – a longitudinal analysis of medical information on the internet in Australia.
Authors: Coussens S , Theodoulou E
Published: December 2024

Introduction

Sleep-disordered breathing is a prevalent sleep disorder among children, Adenotonsillectomy is the usual treatment. However, this procedure carries potential complications, including pain and various morbidities and even death. As the internet increasingly serves as the primary source of medical information, it is crucial to have quality information, that is consistent with current literature and at an appropriate readability available for parents and patients.

Methods

The study employed a three-point longitudinal study (2018, 2020 and 2023) mixed analysis, utilizing NVivo 12 software, to assess the quality, consistency, and readability of website text data. Various metrics were used, including the Flesch-Kincaid reading ease score, Flesch-Kincaid grade level, amongst others and the DISCERN Tool for evaluating quality. Website information was compared to known complications to determine the consistency which these potential issues are addressed.

Results

Quality: The 2020 average quality score of 2 of 4 indicated average quality, The 2018 quality was not measured, and the 2023 quality measure will be presented at the conference but is yet to be performed.

Consistency

Most sites mentioned common complications like bleeding and pain but mostly failed to discuss rarer complications across all 3 time points.

Readability

The readability for 2018 was 53.11 and 2023 was 53.36 for the Flesch-Kincaid reading ease score indicating content was “fairly difficult to read” across time points.

Discussion

This study demonstrates website information concerning the potential complications of adentonsillectomy could be improved with only average quality, low consistency and low readability over the preceding 6 years.
P025 If a human falls asleep in water do they sleep with half their brain like a dolphin?
Authors: Cho G , Nelson A , D’Rozario A , Marshall N
Published: December 2024

Aims

Dolphins sleep one half of their brain at a time presumably to avoid drowning – called unihemispheric slow wave sleep. The Northern Fur Seal has been reported to do this whilst in the water but sleep bihemispherically when it is terrestrial. These observations made us wonder whether unihemispheric slow wave might be an evolutionarily conserved ability in humans that might be revealed if we simply slept in water.

Methods

We built a waterproof and temperature regulated housing to protect an EEG recorder (Alice PDX, Respironics) from being near a float tank (AKA floatation REST therapy) with very low level light and sound levels and thermoneutral temperature. Float therapy uses a highly concentrated Epsom salt solution making the human body extremely buoyant. Reports of single channel automatically processed EEG being measured in float tanks convinced us we could try to find unihemispheric slow wave in a human sleeping in water. Active EEG placements were recorded at Fp1 and Fp2 both referenced to Fpz on the forehead. Left and right electrooculogram (EOG) was also recorded referenced to Fpz. EEG was scored using Alice G3 Sleepware 3.9.5 (Philips Respironics Pittsburgh, USA) following the scoring manual American academy of sleep medicine. A single male human with previous float tank experience was recorded in the float tank in the morning (1 hour).

Results

We captured scorable EEG and detected stage 2 sleep characteristic K complexes and sleep spindles. At no point did we detect slow wave sleep or uni-hemispheric sleep. Slow waves around sleep onset are artifactual slow rolling eye movements being detected in these frontal channels.

Discussion

It is possible to record EEG and score human sleeping in water. We saw no asymmetry in the stage 2 sleep but captured no SWS to compare to see whether humans sleep like dolphins in water.
P026 Obstructive sleep apnoea as a risk factor for Alzheimer’s Disease pathogenesis: a literature review and proposal of a novel model of neuropathological pathways
Authors: Rawson G , Pase M , Howard M , Jackson M
Published: December 2024

Background

Obstructive sleep apnoea (OSA) is a common sleep disorder that has been associated with an increased risk of Alzheimer’s disease (AD). Potential mechanistic pathways in this relationship include hypertension and oxidative stress (the imbalance of antioxidants and reactive oxygen species incurred by hypoxemia). Recently, the role of sleep microarchitecture has been investigated both as a consequence of OSA, and as a potential contributor to AD pathogenesis.

Aims

The aim of this literature review is to integrate findings pertaining to OSA as a potential risk factor for AD pathogenesis. The mechanisms of interest are hypertension, oxidative stress, and sleep microarchitecture. A secondary aim of this review is to develop a model that illustrates the theorised mechanistic pathways (hypertension, oxidative stress, and sleep microarchitecture) concurrently.

Methods

A search of databases between 2004 and 2024 including PubMed, Oxford Academic, and SpringerLink, with key terms amyloid burden, OSA, hypertension, slow wave sleep, and microarchitecture.

Results & Discussion

Common consequences associated with OSA, such as hypertension, oxidative stress, and abnormal sleep microarchitecture, are potential risk factors for AD pathogenesis. The exact nature of the interplay between these mechanisms is not fully understood but highlights the need for further research. The new model presented in this review illustrates how the three pathways of interest may contribute to AD neuropathology. The model identifies areas of possible interactions where the cumulative effect of the potential pathogenic pathways may, metaphorically, be more than the sum of its parts.
P027 Dream characteristics are sex-specific in REM Sleep Behaviour Disorder and healthy older adults
Authors: Bramich S , Noyce A , Pérez-Carbonell L , Bindoff A , Wang X , King A , Naismith S , Vickers J , Alty J
Published: December 2024

Introduction

REM sleep behaviour disorder (RBD) is strongly associated with neurodegenerative disease (NDD), and the isolated form is a known prodrome of several alpha-synuclein-related NDD’s. RBD is difficult to diagnose, and screening questionnaires focus on vivid and aggressive dream content, but these characteristics may be more common to males, leading to underdiagnosis of RBD in females. It is important to explore dream characteristics in males and females to improve screening methods and identify RBD early in its trajectory to NDD.

Method

Adults aged 50+ years were recruited from the community to complete the REM Sleep Behaviour Disorder Single-Question Screen (RBD1Q; to identify pRBD) and the Mannheim Dream Questionnaire (MADRE). The MADRE includes 20 questions enquiring about different characteristics of dreaming, such as dream recall, emotional intensity, and frequency of nightmares.

Results

1,809 participants completed the RBD1Q and MADRE, and 129 (7.1%) screened positive for pRBD (mean (SD) age 62 (7.7) years; 58% female). In the pRBD group, females reported more nightmares related to waking-life experiences than males. The pRBD group recalled dreams more often, experienced more lucid dreams and more nightmares during childhood compared to non-pRBD controls. In the control group, females reported more negative emotional tone to their dreams, had a stronger interest in dreams and attributed more meaning to dreams, than males

Discussion

This study found sex-specific differences in dream characteristics in pRBD and controls. This is relevant to RBD screening questionnaires as questions on nightmares related to waking life may aid identification of females with pRBD.
P028 Sleep depth and wake propensity measured with the Odds-Ratio Product (ORP) in a shift work protocol comparing two lighting interventions
Authors: Stuart N , Manners J , Guyett A , Nguyen P , Younes M , Gerardy B , Kemps E , Scott H , Catcheside P
Published: December 2024

ORP is a continuous metric of sleep depth and wake propensity, which distinguishes different levels of sleep depth within the same conventional sleep stage. Circadian-informed lighting may improve sleep depth compared to regular, dim lighting. Previous analyses found that circadian-informed lighting extended N2 sleep compared to standard lighting. The present study used ORP to further elucidate sleep effects under different lighting during shift work.

Nineteen healthy sleepers (12 males, mean±SD 29±10yrs) underwent two 8-day sessions (circadian-informed versus standard lighting). During days 3-7, participants transitioned to night work, sleeping from 10:00–19:00. ORP was calculated using C3 and C4 electrodes in 3-sec epochs. Values ranged from 0 (very deep sleep) to 2.5 (full wakefulness). Main outcomes included average ORP and ORP post-arousals (ORP-9), with lower ORP-9 suggesting rapid return to deep sleep.

Linear mixed models demonstrated a significant main effect of day on average ORP in N3 (F (4, 143.13) = 2.64, p=.037). Pairwise comparisons showed a significant increase in average ORP in N3 from day 2 to day 5 (p=.028), implying a lighter sleep in both lighting conditions as the study progressed. Two significant two-way interactions (condition*day) on average ORP-9 measured on the right hemisphere (F (4,125.35) = 3.31, p=.013) and on average ORP in wake (F (4,149.43) = 2.46, p=.048) were found; however, pairwise comparisons were not significant.

Our results indicate that the increase in sleep duration with circadian-informed lighting is not associated with changes in sleep depth. Results suggest that sleep changes with circadian informed lighting are complex.
P033 Validation of GENEActiv actimeters and Cicada Actigraphy Suite in a clinical sleep laboratory setting.
Authors: Wilson C , Rees M , Kee K , Stonehouse J , Perkins A
Published: December 2024

Introduction

The use of Actigraphy in clinical settings is an established approach, with the American Academy of Sleep Medicine (AASM) describing actigraphy as a suggested aid in the diagnosis of multiple sleep disorders such as delayed sleep phase syndrome, narcolepsy and insomnia.

Aim

The purpose of this study was to review the validity of the GENEActiv accelerometer (Activinsights, Kimbolton, UK) and Cicada Actigraphy Suite (Rick Wassing) in the setting of clinical practice and to optimise settings to align with gold-standard PSG.

Methods

Actigraphy data of 60 patients using GENEActiv were reviewed against concurrent overnight PSGs. Actiwatch data was compared to PSG metrics of Total Sleep Time (TST), Sleep Efficiency (SE), Sleep Latency (SL) and WASO. Using the open-source GGIR algorithm, the default Cicada 5-Sec epoch was measured against a 30-Sec epoch length comparable with PSG.

Results

For both epoch durations and following Boneferroni correction (α=0.016), TST and SE were shown to be significantly over-calculated while SL was under-calculated compared to PSG. When comparing epoch lengths WASO times were closer to PSG values when set to 5-second epochs (p>0.016). No other values were shown to be significantly different between the epoch lengths.

Conclusion

The results demonstrate that when compared to PSG, GENEactiv/Cicada settings markedly overestimate TST and SE and greatly underrepresent SL.

While Actigraphy remains a beneficial aid in assisting diagnosis of sleep disorders, clear discrepancies are evident when compared to gold standard PSG. Appropriate clinical correlation should be encouraged when utilising GENEactiv & Cicada actigraphy in a clinical setting.
P034 Noxturnal cRIP: An alternative to AASM recommended flow sensors in analysis of respiratory events in polysomnography
Authors: Eriksson N , Burr L
Published: December 2024

Introduction

AASM recommends the use of nasal pressure (NP), oronasal thermal flow (Th), and respiratory inductance plethysmography (RIP) for detecting and characterising respiratory events (RE) in polysomnography. A previous comparative study assessed utility of Noxturnal RIP flow (cRIPflow) as an alternative to Th for identification of RE in polysomnography. This demonstrated that cRIPflow was comparable with AASM recommendation for Th and NP (TH-NP) and indicated higher accuracy than Th in RE identification. We further investigate utility of cRIPflow between varying groups of apnoea hypopnoea index (AHI) severity.

Method

Respiratory scoring was performed by an experienced scorer on 10 diagnostic studies under AASM standards. Scoring was repeated using three different measurements for each study: cRIPflow only, Th only and Th-NP. AHI, central apnoea index (CAI), obstructive apnoea index (OAI), mixed apnoea index (MAI) and hypopnoea index (HI) were calculated. Data was catagorised into Group1 (AHI <30/hr) and Group2 (AHI >30/hr). Wilcoxon matched pairs test was utilised for comparison between flow measurements.

Results

Statistical difference found in Group1 (n=6) HI comparing cRIPflow vsTh (cRIPflow 6.08/hr+/-5.87SD, Th 4.57/hr+/-4.27SD, p=0.0312). No other statistical differences in RE identified when comparing cRIPflow vsTh, cRIPflow vs Th-NP and Th vs Th-NP within Group1 (n=6) and Group2 (n=4).

Discussion

This data suggests cRIPflow may be more sensitive in HI identification in lower severity AHI populations. Analysis with larger sample size would provide more insight. cRIPflow is comparative with AASM recommended flow sensors across varying AHI severity populations, suggesting an alternative method for detecting and characterising RE in polysomnography.
P038 Autonomic cardiovascular control is unaffected in children referred for assessment of excessive daytime sleepiness.
Authors: Plunkett G , Francis J , Shetty M , Davey M , Nixon G , Walter L , Horne R
Published: December 2024

Introduction

There is conflicting evidence for impaired autonomic control of heart rate (HR) in adults with narcolepsy and idiopathic hypersomnolence (IH). Despite these conditions primarily being diagnosed around the age of puberty, there are limited studies in children. The present study investigated cardiovascular control using heart rate variability (HRV) and the extent of nocturnal HR dipping during sleep in children and adolescents with narcolepsy and IH.

Methods

All children having an overnight polysomnographic study followed by a multiple sleep latency test (MSLT) for investigation of excessive daytime sleepiness (EDS) between May 2010 to December 2023 were included: 28 children diagnosed with narcolepsy, 11 with IH and 26 subjectively sleepy children who did not meet the diagnostic criteria for either narcolepsy or IH. Each clinically-referred child was matched for age and sex with a control. Time domain and frequency domain HRV were calculated from ECG recorded at 512 Hz.

Results

There were no differences in either time domain or spectral analysis of HRV between clinical groups or between clinical groups and their control group. The expected sleep state differences in HRV were observed in all groups. There was also no difference in HR nocturnal dipping between groups.

Conclusion

Despite evidence for abnormal autonomic function in adults with narcolepsy and IH, our study did not identify any abnormalities in HR, HR control or nocturnal dipping of HR in children referred for assessment of EDS. This suggests that autonomic dysfunction may be a feature of these conditions that develops in later life.
P039 Families’ experiences of having a child with neurodisability and sleep problems
Authors: Cooke E , O’Neil M , Langdon G , Vandeleur M ,   Waters, Chawla J
Published: December 2024

Introduction

This qualitative study investigates families’ experiences of having a child with neurodisability (ND) and sleep problems, and is a subset of a broader mixed-method study entitled Early Sleep Interventions to Improve Outcomes in Children with Neurodisability

Methods

We surveyed 294 parents of children with ND and sleep problems. This qualitative study focuses on the free-text responses to questions about what parents consider to be important areas for research priority, and how they and their family members are affected by their child with ND’s sleep problems. We conducted a reflexive thematic analysis of parents’ responses.

Findings

We identified five key themes in parents’ reports. Firstly, child sleep problems are compounded by physical medical conditions and have adverse effects on child functioning. Secondly, child sleep problems negatively impact the whole household, with heightened parental concern for siblings’ sleep and wellbeing. Thirdly, parents experience detrimental impacts on their emotional, mental, physical, social, and work-related wellbeing. Fourthly, parents primarily seek out medical intervention to address their child’s sleep problems but also emphasise the importance of understanding their individual child’s needs. Finally, parents desire better sleep service supports, resources, sensitivity, and awareness of sleep issues among non-specialists.

Discussion

These findings raise concerns for the health and wellbeing of children with ND and sleep problems and their parents and families. There is a need for improved awareness, education, and treatment of sleep problems in this group, which would not only benefit the children themselves, but also their parents and siblings.
P042 Comparing NOX auto-analysis of sleep staging and quality parameters in a paediatric cohort
Authors: Roberts C
Published: December 2024

The comparison of NOX auto-analysis (NOXAA) and manual score is well documented in adult populations. This is not well defined in paediatric populations due to nuances in staging criteria, as children <9years have lower posterior dominant rhythm (3.5-9.5Hz) compared to children >9years (8-13Hz). This study will compare the accuracy of the NOXAA with a highly trained manual reference score, and asses the reliability of NOXAA in a paediatric setting.

A retrospective analysis compared NOXAA (A) (V6.3.1.34324) and manually scored (J) paediatric polysomnography data. 52 studies were assessed with 16 analysed post exclusion. Exclusion criteria: ages <1, oxygen studies, moderate-severe OSA and EEG impedance >200Hz. Two data sets were separated based on age: data-set 1 = <9years and data-set 2= >9years. Parameters compared: sleep stage (N1, N2, N3 and REM)%, total sleep time (TST)(hours), sleep efficiency (SE)%, sleep latency (SL)(min), REM latency (RL)(min), arousal index (AI) and apnoea hypopnea index (AHI).

Data set 1 (J)/(A): N1=1.525%/0.25%*, N2=26.275%/25.425%*, N3=34.9%/64.475%*, REM=27.3%/9.925%*, SL=49.2625/7.1375*, RL=143.45/98.8875, TST=8.16/8.48, SE=80.625%/82.225%, AI=7.8375/5.775*AHI=2.7375/5.325*

Data set 2(J)/(A): N1=5.4375%/21.3%*, N2=45.1125%/44.7375%, N3=26.7125%/34.1875%*, REM=22.725%/18.4%*, SL=15.5125/9.5875, RL=143.325/82.025, TST=8.05/8.16, SE=90.4%/89.05%, AI=7.6625/7.7, AHI=4.775/7.675*

*indicates statistical difference between J and A

There was a significant difference between J and A in N1, N3 and REM for both data sets. TST and SE showed no difference. The data suggests NOXAA is not reliable for paediatric sleep staging, however there may be clinical utility for quality parameters such as TST and SE. Further statistical analysis with larger populations is needed to further validate NOXAA’s accuracy in a paediatric setting.
P043 Sleep disruption in children with hepatic glycogen storage diseases: a prospective correlational study using CGMS
Authors: Agnoletto L , Adams A , Halligan R , Peters H , White M , Vandeleur M
Published: December 2024

Background

Hepatic glycogen storage diseases (GSDs) are characterized by enzyme defects affecting liver glycogen metabolism, where carbohydrate supplementation to prevent overnight hypoglycaemia is common. Concerns around sleep quality in hepatic GSDs relate to emerging evidence that overnight dysglycaemia impacts sleep quality.

Methods

This prospective descriptive study reported sleep quality and duration in children with hepatic GSDs over seven days utilising: actigraphy (Actiwatch 2 by Phillips Respironics), sleep diaries, proxy reported age-appropriate sleep and quality-of-life questionnaires, in the context of nocturnal glycaemic profiles continuous glucose monitor (CGM, Dexcom G6) and nocturnal dietary management strategies. Significant hypo- and hyperglycaemia were defined as ≥1% of sleep diary documented nocturnal period, recording <3.5mmol/L and >10.0mmol/L, respectively.

Results

Seven children with hepatic GSD (aged 1-17 years) participated. Objective sleep quality was poor, with actigraphy demonstrating that no child achieved the minimum sleep duration recommended for age. Subjective sleep quality was also poor, with 4/5 documenting significant daytime sleepiness and 6/6 reporting poor sleep hygiene. Children prescribed overnight bolus feeds (OBF)(n=2) had shorter sleep duration compared to other nocturnal management strategies. Parent-reported quality-of-life (QoL) suggested poor disease-related QoL outcomes for this cohort.

Conclusion

Objective and subjective sleep disturbances and reduced QoL are common within our sample of children with hepatic GSD. These outcomes were related to nutritional overnight interventions, especially OBFs, rather than overnight glucose levels. Consideration of the impacts of overnight feeding strategies on sleep quality and QoL in children with hepatic GSD should inform future management strategies.
P044 Impact of hospital environment on sleep during recovery from acquired brain injury: A systematic review
Authors: Greenslade R , Hayes N , Barlow K
Published: December 2024

Introduction

People with acquired brain injury (ABI) commonly report trouble sleeping. Sleep problems during acute admission are associated with delayed recovery and hospital discharge. The hospital environment influences sleep and may lead to chronic sleep problems and impact long-term outcome. We evaluated the current literature investigating the effect of environmental factors on sleep after ABI.

Methods

Six database searches were performed with MeSH headings and keywords (PROSPERO CRD42023479979). Children and adults with ABI, all settings, exposures and interventions were included. Case reports, animal studies and populations with prenatal ABI, vascular dementia, genetic and neurodegenerative conditions were excluded.

Results

The review identified 1302 articles with 610 duplicates, 692 abstracts were screened, and 114 full texts were assessed. Nine adult studies were included (n=581). Noise was ≥ 50dB and mean light levels 1.74-9 lux. There were 5.43 - 18.24 episodes of nursing care overnight. Sleep quality was poor; sleep efficiency range 72-73%, wake bouts range 21-41, and wake after sleep onset range 72-83 minutes. Four hospital sleep hygiene initiatives (n=340) improved sleep quality, quantity and decreased sedative use. Nursing practices of clustering cares and safeguarding sleep times promoted sleep.

Discussion

Relatively few studies have explored the effect of the environment on sleep after ABI and none included children. Sleep in can be improved, however sleep still receives little attention. Standardized ieMR tools, policy to support practice and increased clinical education may help.
P051 A customised 3D-printed nasal mask for enhancing CPAP compliance in the treatment of obstructive sleep apnoea
Authors: Tong B , Cistulli P , Ledger S , Chan A
Published: December 2024

Current practices of continuous positive airway pressure (CPAP) mask fitting involve a trial and error approach based on two-dimensional fitting guides which fail to account for variations in facial features resulting in suboptimal mask fit. This study aimed to assess the performance of a novel three-dimensionally (3D)-printed customised nasal mask on patient compliance to CPAP therapy for the treatment of obstructive sleep apnoea (OSA).

Patients prescribed CPAP therapy for OSA with suboptimal CPAP compliance using a conventional CPAP mask (<70% of nights with ≥ 4 hours per night over 4 weeks) were recruited. A 3D-facial mapping scan was conducted to fabricate a customised nasal mask which was trialed for four weeks. Data download of CPAP compliance over four weeks was collected with patients using their pre-existing conventional CPAP mask and a customised nasal mask.

Thirty patients (22 males; age 63±13 years) were studied. Patients used CPAP on a greater proportion of nights with a customised mask compared to a conventional mask (85.7 [66.1, 98.2]% versus 63.2 [13.1, 96.8]%, P=0.009). Hourly CPAP usage was higher with a customised mask compared to a conventional mask (3.8 [2.7, 5.8] versus 2.4 [0.3, 5.0] hours; P=0.016). Mask leak was not different between mask types (P>0.05). Patients preferred the customised mask (P=0.008) for which they reported less mask-related side effects.

A customised 3D-printed nasal mask improved CPAP use in patients with suboptimal CPAP compliance. Customised CPAP masks may have an important role in personalising CPAP therapy with the aim of optimising treatment effectiveness for OSA.
P053 Implementing rehabilitation-led management of obstructive sleep apnoea in a spinal cord injury rehabilitation centre: results of a mixed-methods evaluation
Authors: Graco M , Saravanan K , Weber G , Phyland T , Joffe D , Berlowitz D , Pryor J
Published: December 2024

Introduction

Obstructive sleep apnoea (OSA) is the most common sleep disorder in spinal cord injury (SCI), yet it is under-diagnosed and under-treated. A SCI rehabilitation centre in Sydney adapted and implemented an alternative rehabilitation-led model of managing OSA. The aim of this project was to evaluate the feasibility of this care model.

Methods

The model was implemented in July 2022 and piloted for 12 months. The mixed-methods evaluation included analysis of clinical data to assess reach and effectiveness, and qualitative interviews with staff and patients to explore acceptability and barriers and enablers to implementation.

Results

48 inpatients were screened; 24 were assessed for OSA, 12 were diagnosed and recommended treatment, six were treated with continuous positive airway pressure (CPAP), and four were discharged with CPAP. Staff reported improvements to their knowledge, skills, and confidence in managing sleep and respiratory issues, and significant benefits to patient care. Coordinating assessments was initially challenging and additional nursing time was allocated to support this. Staff experienced significant barriers to initiating CPAP, including limited opportunities for skill development, high staff turnover, and high workload pressures. Local respiratory physician support with diagnosis and treatment plans was essential.

Conclusions

This is the first time an Australian SCI rehabilitation centre has implemented a rehabilitation-led OSA management model. Assessing and diagnosing OSA was feasible. For CPAP initiation to be feasible, additional staff time and training would be required. This care model could substantially improve access to OSA treatments for people living with SCI.
P055 Identifying Sleepiness Profiles in Obstructive Sleep Apnoea
Authors: Duce B , Hukins C
Published: December 2024

Aim

Sleep clinics frequently measure the patient’s subjective sleepiness, but these measurements often conflict with more objective measures of sleepiness. This suggests that subjective and objective sleepiness have distinct properties and may have different causes in OSA. Using cluster analysis, we aimed to classify OSA patients into subgroups based on measures of objective and subjective sleepiness and assess each subgroup’s characteristics.

Methods

The study divided all patients diagnosed with OSA between 2015 and 2018 into four clinical presentation phenotypes: no sleepiness (ESS-/PVT-), subjectively sleepy only (ESS+/PVT-), objectively sleepy only (ESS-/PVT+), and subjectively and objectively sleepy (ESS+/PVT+).

Results

K means clustering of 1038 patients produced 4 groups of 463, 371, 126, and 78 patients for ESS-/PVT-, ESS+/PVT-, ESS-/PVT+, and ESS+/PVT+, respectively. Each group had no differences in AHI or BMI. The ESS-/PVT- cluster was associated with shorter sleep duration and poor sleep efficiency. The ESS+/PVT-cluster had a longer sleep duration and were younger than the rest of the groups. The ESS-/PVT+ cluster also had shorter sleep duration and poorer sleep efficiency, similar to ESS-/PVT-, but had a greater comorbidity than all the other clusters. The ESS+/PVT+ cluster exhibited a higher female prevalence and was linked to more severe desaturations compared to the other clusters.

Discussion/Conclusion

Sleep duration, comorbidity, sex, and hypoxic burden seem to be the biggest predictors of sleepiness in patients. Further work is required to explore the influence of OSA phenotypic characteristics on patient sleepiness.
P056 Comparison of Breas Vivo 45 LS and ResMed Lumis ventilators in three simulated disease conditions
Authors: Hone R , Churchward T , Sheers N , Rautela L , Tolson J , Howard M , Berlowtiz D
Published: December 2024

Background

Ventilator performance has been shown to vary across conditions, ventilator type, and in common scenarios such as mask leak. Aim: This study sought to compare the performance of a Breas Medical AB (Mölnlycke, Sweden) Vivo 45 LS™ and ResMed (San Diego, CA, USA) Lumis™ ventilator.

Methods

Pressure, flow and volume waveforms were sampled for each ventilator at analogous settings, under three simulated clinical conditions using an ASL5000™ (Ingmar Medical, Pittsburgh, PA, USA) respiratory simulator: (A) Kyphoscoliosis (very low compliance), (B) Obesity Hypoventilation (low compliance), (C) Motor Neuron Disease (normal compliance, low muscle strength).

Results

Qualitative visual comparisons of representative breaths revealed similar delivered inspiratory and expiratory pressures. Flow profiles and volumes differed, with the Lumis showing shorter breath durations (range 0.1 - 0.5s) and correspondingly lower volumes compared to Vivo 45LS. Peak flows varied among the conditions, with the Vivo 45LS higher in condition A (27 vs 31 L/min) similar in condition B (45 L/min), but lower in condition C (27 vs 24 L/min). Mean inspiratory pressures were similar except in condition A, where the Vivo 45LS was lower by around 4 cmH2O. Expiratory volumes and peak pressures were comparable across both devices.

Conclusions

Comparative analysis of the Breas Vivo 45LS and ResMed Lumis ventilators under simulated clinical conditions highlights differences in breath duration, delivered volumes, and peak flow for analogous settings. Future research should better quantify and explore the impact of these performance variations between ventilators on clinical outcomes including ventilation efficacy, patient-ventilator synchrony, user comfort, and usage.
P059 Sport dentists’ role in dental sleep medicine: examination, screening and evaluation for sleep-related breathing disorders
Authors: Suzuki H , Sawa A , Nakayama T , Komiyama O , Chow C
Published: December 2024

Obstructive sleep apnea (OSA) in athletes cannot be overlooked because they contribute to daytime sleepiness and could increase the risk of cardiovascular morbidity. This study reports on the role of sports dentists in clinical examination, screening and evaluation for OSA.

Forty-four male rugby league athletes (27.1±3.3y; 176.2±5.8cm; 89.7±11.6 kg; BMI 28.8±3.1; neck circumference, 42.6±3.3 cm) were administered the Epworth Sleepiness Scale [ESS], Pittsburgh Sleep Quality Index [PSQI], and the Level III sleep test (SAS-2200). Intraoral cavity was examined using the modified Mallampati grade (MM).

A total of 90.9% (40/44) of the athletes had respiratory event index (REI) ≥5. Thirty athletes had mild OSA (68.2%), eight had moderate OSA (18.2%), and two had severe OSA (4.5%). Nineteen athletes (43.2%) reported ESS ≥ 10, and 25 athletes (56.8%) reported poor sleep quality (PSQI > 5.5). The minimum SpO2 was reduced to 90.3±3.5%. The MM and REI were strongly correlated with body weight (p<0.001), BMI (p<0.001), and neck circumference (p=0.004). MM was moderately correlated with REI (p=0.014). The REI was strongly but negatively correlated with SpO2 (p<0.001) and strongly with PSQI (p=0.002). The ESS was strongly correlated with age (p=0.004) and PSQI (p=0.001). The examination revealed that 86.3% of the athletes were eligible for oral appliance treatment.

This study suggests dentists managing athletes should assess OSA risks through anthropometric measurements, examination of the intraoral cavity for a narrow airway or enlarged tonsils/tissue blocking the airway, evaluation of daytime sleepiness and sleep quality, and an in-home sleep testing.
P064 Sleep EEG characteristics of sleep misperception in insomnia: A large community-based cohort analysis
Authors: Kao C , D’Rozario A , Gordon C
Published: December 2024

Introduction

Sleep misperception, where individuals report discrepancy between subjective and objective sleep, is common in insomnia. This study aimed to identify sleep electroencephalographic (EEG) features in insomnia and controls using a large dataset to elucidate the neural mechanisms underlying sleep misperception in insomnia.

Method

The Sleep Heart Health Study (SHHS) dataset with one-night of polysomnography was used. Under-estimated and over-estimated sleep perception was identified using the 5th percentile of the mean total sleep time (TST) for control and insomnia groups. EEG spectral power for sleep stages and sleep cycles were calculated. Analysis included slow oscillation (SO; 0.5-1.25 Hz) and sleep spindle (12–15 Hz) activity, and slow wave dynamics defined as the decline rate in delta power (1-4.5 Hz) from the first to last NREM sleep period.

Result

Data from 2024 controls (60 years old) and 284 insomnia (62 years old) were analysed. Insomnia had shorter TST (352.8 vs. 389.3 mins, p<0.001) and longer WASO (62 vs. 51.1 mins, p<0.001) and longer sleep latency (27 vs 20.8 mins, p<0.001) than controls. Insomnia showed lower NREM delta activity but higher theta, alpha, sigma, and beta activity. Insomnia Under-estimators (n=22) had lower SO activity (p=0.03) and attenuated slow wave dynamics (p=0.01) compared to Control Under-estimators (n=87). There was no significant difference in NREM EEG activity or SWA dynamics between Over-estimator groups.

Conclusion

Deficits in NREM slow oscillation activity and altered slow wave dynamics across the night suggests that an abnormal sleep homeostatic process may underlie sleep misperception in insomnia.
P065 Breath of Fresh Data: Enhancing NIV Patient Care in State-wide Service
Authors: Berlowitz D , Churchward T , Michael C , Ruehland W , Longo C , Rautela L , Sheers N , Chao C , Howard M , Conti S
Published: December 2024

Background

The Victorian Respiratory Support Service (VRSS) provides long-term management for patients with chronic respiratory failure. An expanding patient base (497 in 2000, 2,031 in 2024) necessitates service development. Integration of non-invasive ventilator (NIV) data from ResMed Airview™ (San Diego, CA, USA) presented an opportunity to review these data at a “whole of service” level.

Aim

To pilot a summarised, data visualisation system for the VRSS.

Methods

Airview™ data were ingested daily into the hospital data warehouse and queried. Categories of adherence were; average usage/month, days used/month and average leak/month. Hours of NIV use was categorised as sufficient, moderate, or insufficient (>6, 4-6, or <4 hrs/day), days used/month as sufficient or insufficient (<80%>), and mask leak (<24> L/min) as acceptable or excessive.

Results

This analysis included 748 patients. 557 patients had sufficient usage, but only 290 patients had both sufficient NIV usage and acceptable leak. Conversely, 107 patients had insufficient NIV use with 59 having both insufficient NIV usage and excessive mask leak.

Discussion

These data are consistent with previous literature suggesting that while poor NIV adherence may be observed in people who experience “excessive” leak, “excessive” leak as determined by manufacturer limits does not always align with inadequate NIV adherence.(1) Data such as these enable novel models for participant care, especially triaging of ongoing clinical needs, to be proposed.

Conclusion

The interactive report provides opportunities for comparison of real-life data with the literature and enables planning for trials of novel service models.

1. Jeganathan. BMJ Open Respir Res. 2021