bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary Nicotine Metabolites and Self-Reported Tobacco Use Among Adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013–2014
Authors: Feng June , Sosnoff Connie S , Bernert John T , Blount Benjamin C , Li Yao , Del Valle-Pinero Arseima Y , Kimmel Heather L , van Bemmel Dana M , Rutt Sharyn M , Crespo-Barreto Juan , Borek Nicolette , Edwards Kathryn C , Alexander Ricky , Arnstein Stephen , Lawrence Charles , Hyland Andrew , Goniewicz Maciej L , Rehmani Imran , Pine Brittany , Pagnotti Vincent , Wade Erin , Sandlin James , Luo Zuzheng , Piyankarage Sujeewa , Hatsukami Dorothy K , Hecht Stephen S , Conway Kevin P , Wang Lanqing
Published: October 2021

Introduction

The Population Assessment of Tobacco and Health (PATH) Study is a longitudinal cohort study on tobacco use behavior, attitudes and beliefs, and tobacco-related health outcomes, including biomarkers of tobacco exposure in the U.S. population. In this report we provide a summary of urinary nicotine metabolite measurements among adult users and non-users of tobacco from Wave 1 (2013–2014) of the PATH Study.

Methods

Total nicotine and its metabolites including cotinine, trans-3′-hydroxycotinine (HCTT), and other minor metabolites were measured in more than 11 500 adult participants by liquid chromatography tandem mass spectrometry methods. Weighted geometric means (GM) and least square means from statistical modeling were calculated for non-users and users of various tobacco products.

Results

Among daily users, the highest GM concentrations of nicotine, cotinine and HCTT were found in exclusive smokeless tobacco users, and the lowest in exclusive e-cigarette users. Exclusive combustible product users had intermediate concentrations, similar to those found in users of multiple products (polyusers). Concentrations increased with age within the categories of tobacco users, and differences associated with gender, race/ethnicity and educational attainment were also noted among user categories. Recent (past 12 months) former users had GM cotinine concentrations that were more than threefold greater than never users.

Conclusions

These urinary nicotine metabolite data provide quantification of nicotine exposure representative of the entire US adult population during 2013–2014 and may serve as a reference for similar analyses in future measurements within this study.

Implications

Nicotine and its metabolites in urine provide perhaps the most fundamental biomarkers of recent nicotine exposure. This report, based on Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, provides the first nationally representative data describing urinary nicotine biomarker concentrations in both non-users, and users of a variety of tobacco products including combustible, e-cigarette and smokeless products. These data provide a urinary biomarker concentration snapshot in time for the entire US population during 2013–2014, and will provide a basis for comparison with future results from continuing, periodic evaluations in the PATH Study.
The effect of phytoplankton properties on the ingestion of marine snow by Calanus pacificus
Authors: Cawley Grace F , Décima Moira , Mast Andrea , Prairie Jennifer C
Published: October 2021

Marine snow, formed through the aggregation of phytoplankton and other organic matter, can be consumed by various types of zooplankton, affecting both planktonic trophic dynamics and the export of carbon to depth. This study focuses on how two factors—phytoplankton growth phase and species—affect copepod feeding on marine snow. To do this, we conducted a series of grazing experiments using gut pigment and stable isotope methods to quantify the ingestion of the copepod, Calanus pacificus, on both marine snow aggregates and individual phytoplankton. Results demonstrate that marine snow can represent a substantial food source for copepods, comparable to rates on individual phytoplankton. Moreover, we found that both the overall ingestion and the relative ingestion of aggregates vs. individual phytoplankton depended on phytoplankton growth phase for experiments conducted with the diatom Thalassiosira weissflogii. Although copepods consumed aggregates composed of Skeletonema marinoi at similar rates as those composed of T. weissflogii, no effect of growth phase was observed for S. marinoi. These findings suggest that marine snow can be an important source of nutrition for copepods, but that its role in planktonic food webs may differ depending on the phytoplankton community composition and the stage of phytoplankton blooms.
Inclusion body myositis: correlation of clinical outcomes with histopathology, electromyography and laboratory findings
Authors: Pinto Marcus V , Laughlin Ruple S , Klein Christopher J , Mandrekar Jay , Naddaf Elie
Published: October 2021

Objective

To determine whether histopathological, electromyographic and laboratory markers correlate with clinical measures in inclusion body myositis (IBM).

Methods

We reviewed our electronic medical records to identify patients with IBM according to European Neuromuscular Center (ENMC) 2011 criteria, seen between 2015 and 2020. We only included patients who had a muscle biopsy and needle electromyography (EMG) performed on the same muscle (opposite or same side). We used a detailed grading system [0 (normal) to 4 (severe)] to score histopathological and EMG findings. Clinical severity was assessed by the modified Rankin scale (mRS), muscle strength sum score (SSS), quadriceps strength and severity of dysphagia on swallow evaluation. Serum markers of interest were creatine kinase level and cN-1A antibodies.

Results

We included 50 IBM patients, with a median age of 69 years; 64% were males. Median disease duration at diagnosis was 51 months. On muscle biopsy, endomysial inflammation mainly correlated with dysphagia, and inversely correlated with mRS. Vacuoles and congophilic inclusions did not correlate with any of the clinical measures. On EMG, the shortness of motor un it potential (MUP) duration correlated with all clinical measures. Myotonic discharges, and not fibrillation potentials, correlated with the severity of inflammation. Serum markers did not have a statistically significant correlation with any of the clinical measures.

Conclusions

Dysphagia was the main clinical feature of IBM correlating with endomysial inflammation. Otherwise, inclusion body myositis clinical measures had limited correlation with histopathological features in this study. The shortness of MUP duration correlated with all clinical measures.
O031 Nocturnal melatonin secretion in post-treatment breast cancer patients: a preliminary study
Authors: Subramanian H , Fuchsova V , Man H , Trivedi R , Elder E , Cain S , Amis T , Kairaitis K
Published: October 2021

Purpose

Breast-cancer patients frequently report of poor sleep-quality. Although the pathophysiology is unclear, circadian-sleep misalignment is a plausible mechanism. We compared nocturnal melatonin-secretion, a circadian rhythm marker, in post-menopausal, post-treatment (≥12-months) female breast-cancer patients (BCG), with post-menopausal female controls with no history of cancer (CG)

Methods

We recruited 6 BCG and 10 CG from Westmead Hospital breast-cancer outpatient clinic or hospital-staff community, respectively. Participants completed the Pittsburgh Sleep Quality Index (PSQI; >5 PSQI-score=poor sleep-quality) and ~7 days of home-actigraphy (Philips Actiwatch-2, Philips Respironics, USA) to ascertain habitual bed-time (HBT). Later, participants completed an overnight, in-laboratory study, with saliva sampled (n=13) at regular intervals under strict dim-light conditions (<1 lux). Salivary-melatonin concentrations were quantified via radioimmunoassay (University of Adelaide). We measured 1) clock-time when salivary-melatonin concentrations reached 4pg/mL (melatonin onset-[DLMO-4pg/ml]) and 2) time-interval between HBT and DLMO-4pg/ml (indicates circadian-sleep misalignment-[PAR-DLMO]). Data were expressed as median [interquartile range], and compared using 2-sided Mann Whitney U-tests. p<0.05 was considered significant.

Results

BCG and CG had similar ages (62.5 [59.5–67.3] vs. 58.5 [54.0–66.3] yrs, respectively; p=0.23). Compared with CG, BCG had higher PSQI-scores (8.50 [5.25–10.75] vs. 4.00 [3.75–5.50] a.u.; p=0.07), but similar HBT (22:49 [21:46-23:38] vs. 22:17 [21:59-22:21] h:min; p=0.26). BCG had later DLMO-4pg/ml (20:46 [20:01-22:03] vs. 18:23 [17:55-20:07] h:min; p=0.03) and shorter PAR-DLMO (1.43 [0.96–2.38] vs. 3.63 [2.18–3.90] hrs; p=0.09), than CG.

Conclusion

Preliminary data indicate BCG had poorer sleep-quality, delayed melatonin onset, and altered circadian-sleep alignment; compared with CG. We speculate disrupted nocturnal melatonin-secretion potentially influences poor sleep-quality reported by breast-cancer patients.
O032 The influence of travel and recovery inequality on game outcome in the National Basketball Association
Authors: Leota J , Hoffman D , Mascaro L , Facer-Childs E
Published: October 2021

Introduction

Elite athletes are often required to travel for National and International competitions. However, the direction (westwards or eastwards), time zones crossed, and recovery days relative to their opponents may influence team success. The aim of this study was to determine whether differences in jetlag-induced circadian misalignment and number of recovery days between National Basketball Association (NBA) teams influenced the subsequent game result.

Methods

A total of 11,598 games from the 2011/2012 to the 2020/2021 seasons were analysed using mixed models with two fixed effects (travel, recovery) and three random effects (team, opponent, game time). Mediation modelling was also performed to determine if any influence of the fixed effects were mediated by another variable. The data is presented from the home team’s perspective.

Results

Teams with more recovery days between games, won by larger margins (F = 5.0, p < 0.001). Compared to one fewer recovery day (1.45 ± 13.92), one more recovery day (3.53 ± 13.51) advantaged the home team by 2.08 points (d = 0.15). The effect of travel on greater home team margins was completely mediated via recovery day differences (95% CI -0.11 to -0.03, p = 0.002).

Discussion

Using 10 seasons of data, our findings show that regardless of travel, recovery days between games significantly impact game margins. An advantage in recovery days should be considered for teams who travel more time zones westwards relative to their opponent. This suggests inequalities of the NBA schedule may be minimised for future seasons.
O033 Predicting subjective sleep quality using multi-day actigraphy data: A machine learning approach
Authors: Kao C , D’Rozario A , Lovato N , Bartlett D , Postnova S , Grunstein R , Gordon C
Published: October 2021

Objectives

Insomnia is diagnosed using clinical interview but actigraphy is often used as a consecutive multi-day measurement of activity-rest cycles to quantify sleep-wake periods. However, discrepancies between subjective complaints of insomnia and objective actigraphy measurement exist. The aims of the current study were to (i) predict subjective sleep quality using actigraphic data and, (ii) identify features of actigraphy that are associated with poor subjective sleep quality.

Methods

Actigraphy data were collected for 14-consecutive days with corresponding subjective sleep quality ratings from participants with Insomnia Disorder and healthy controls. We fitted multiple machine learning algorithms to determine the best performing method with the highest accuracy of predicting subjective quality rating using actigraphic data.

Results

We analysed a total of 1278 days of actigraphy and corresponding subjective sleep quality ratings from 86 insomnia disorder patients and 20 healthy controls. The k-neighbors classifier provided the best performance in predicting subjective sleep quality with an overall accuracy, sensitivity and specificity of 83%, 74% and 87% respectively, and an average AUC-ROC of 0.88. We also found that activity recorded in the early morning (04:00-08:00) and overnight periods (00:00-04:00) had the greatest influence on sleep quality scores, with poor sleep quality related to these periods..

Conclusions

A machine learning model based on actigraphy time-series data successfully predicted self-reported sleep quality. This approach could facilitate clinician’s diagnostic capabilities and provide an objective marker of subjective sleep disturbance.
O035 Automated vs. expert manual analysis of the Multiple Sleep Latency Test
Authors: Miseski S , Tolson J , Ruehland W , Worsnop C , Toman P , Churchward T
Published: October 2021

Purpose

To compare Compumedics Profusion PSG™ automated sleep analysis of Multiple Sleep Latency Tests (MSLTs) with expert consensus manual analysis.

Methods

Consecutive PSG with MSLTs were analysed using automated software (Compumedics Ltd (Abbottsford, Victoria, Australia) Profusion PSG™ V4.5 Build 531) (‘Auto’) and by two of nine experienced scientists. Discrepancies between scientists were discussed to establish expert consensus (‘Final’).

Results

Fifty consecutive patients referred for investigation of Narcolepsy were included. Two were excluded due to poor signal quality (1) and early test termination (1). The remaining 48 (37 M, 10 F, 1) had a median (range) age of 37 (17–63) years, BMI 28.0 (19.9–66.1) kg/m2, and mean sleep latency (MSL) 14.0 (1.5–20.0) minutes. Of five MSLTs with MSL <=8 min, Auto-MSL was also <=8 min. Of 43 MSLTs with MSL >=8 min, Auto-MSL was <=8 min in 12. MSL sensitivity was 100% and specificity 72%. For the one MSLT with >=2 SOREMs, Auto identified 1 SOREM. Nap-wise, Auto-SOREM sensitivity was 17% and specificity 98%; one of six REM-positive naps was detected by auto-analysis and there were seven false positive and five false negative SOREM results.

Conclusions

(1) Automated analysis poorly detected short MSL and SOREM occurrence but was able to rule out all true-negative MSLT results, in this MSLT dataset. (2) This comparison methodology and dataset facilitates robust prospective testing of other current and future algorithms.
P005 The effect of alcohol on the motor control of the genioglossus muscle
Authors: Avraam J , Dawson A , Nicholas C , Kay A , O’Donoghue F , Trinder J , Jordan A
Published: October 2021

Rationale

Alcohol is recognised to worsen snoring and obstructive sleep apnea (OSA). This effect is thought to be due to alcohol’s depressant effect on upper airway dilator muscles such as the genioglossus, but how alcohol reduces genioglossus activity is unknown. The aim of this study was to investigate alcohol’s effect on genioglossus single motor units (SMUs).

Methods

Healthy individuals visited the lab on two days (Alcohol: breath alcohol concentration ~0.08% or Placebo). They were instrumented with a nasal mask, 4 intramuscular genioglossus SMU EMG wires and an ear oximeter. They were exposed to 8–12 hypoxia trials (45-60s of 10%O2 followed by one breath of 100%O2) while awake. The SMUs were sorted according to their firing patterns with respect to respiration and were quantified during baseline, hypoxia, hyperoxia and recovery.

Results

The total number of SMUs recorded at baseline (68 and 67 respectively) and their distribution (ET: 29 vs 22, IP: 5 vs 10, IT: 8 vs 20 and TT: 26 vs 15 respectively) was similar between conditions. The discharge frequency did not differ between conditions (21Hz vs 22.4Hz, p>0.08). There was no difference between placebo and alcohol in the number (101 vs 88 respectively) and distribution (ET: 35 vs 32, IP: 22 vs 16, IT: 14 vs 22 and TT: 30 vs 17 respectively, p<0.05) of SMUs during hypoxia. Afterdischarge following hypoxia was also not different between conditions.

Conclusion

Alcohol has little effect on genioglossus SMUs and afterdischarge. OSA following alcohol may be related to increased upper airway resistance/nasal congestion.
P009 Australian consultant pharmacists’ potential roles in sleep health care - Exploring a new avenue for improving the management of insomnia
Authors: Basheti M , Tran M , Wong K , Gordon C , Grunstein R , Saini B
Published: October 2021

Background

Insomnia is a highly prevalent sleep disorder and the first-line recommended treatment is cognitive behavioural therapy. However, there is persistent use of pharmacotherapy, mainly, sedative-hypnotics. Consultant pharmacists can provide medication review services for patients on polypharmacy, and are therefore well placed to educate patients and provide sleep health/insomnia care with regards to pharmacotherapy and behavioural therapy use.

Objectives

To explore consultant pharmacists’ current sleep health-related practice and what their perspectives are around developing/implementing a consultant pharmacist-led behavioural service for insomnia.

Methods

Qualitative semi-structured interviews were conducted with a convenience-based sample of consultant pharmacists. Interviews were audio-recorded, transcribed and thematically analysed.

Results

Twenty-four consultant pharmacists were interviewed. Three themes were gauged: 1) Trivializing insomnia and sleep health, 2) Patients – an integral piece of the treatment puzzle, 3) Making it work. Participants commonly dealt with older patients and frequently encountered patients with sleep complaints/consuming sleep aids. Generally, it was believed that sleep health was considered a ‘non-priority’, with other comorbidities taking precedence in health provisions. While interested in expanding their sleep health/insomnia practice, participants expressed the need for appropriate education/training, funding and collaborative treatment configurations. Further, patients’ attitudes towards treatment approaches were regarded critical to future service developments.

Conclusion

Insomnia/sleep health concerns are growing. Primary health professionals need to scale up their sleep health care provisions to accommodate for this health demand. Consultant pharmacists are interested/willing to expand their sleep-related practice and provide evidence-based insomnia therapies, however factors such as education/training, service configuration support and patient attitudes should be addressed.
P012 Maternal and infant stress during a bedtime separation: a pilot RCT
Authors: Blunden S , Osborne J
Published: October 2021

Background

Behavioural sleep interventions to improve infant sleep disturbance commonly include extinction where an unwanted behaviour (night time crying) is periodically ignored. There have been conflicting findings regarding the impact of extinction methods on infant stress levels as measured with cortisol and as perceived by mothers and only one that measured cortisol at the time of the separation. This study aimed to compare a responsive method to extinction (controlled crying) and a control group evaluating subjective and objective stress for mother/infant dyads at the time of bedtime separation.

Methods

Mother/infant dyads were randomly allocated to behavioural sleep interventions (Responsive - n= 7, Controlled Crying - n=6 or Controls - n=4). Cortisol (two oral swabs on two nights at T2), maternal self-reported stress (Subjective Units of Distress - SUDS), and perceived infant distress (PIS) were compared over eight weeks. Correlations tested relationships between PIS, SUDS and infant cortisol levels. Mixed models analysis were used for cortisol analyses.

Results

There were no significant differences in cortisol levels between groups across time points but significant inter and intra-individual variability. Maternal stress was positively correlated with infant cortisol and PIS (p<0.05) and mothers in the Responsive group were significantly less stressed (p=0.02).

Conclusion

In this small sample, infant cortisol during bedtime separation was variable, elevated in all sleep interventions and not significantly different. Mothers were less stressed in the Responsive group. Findings indicate responsive methods are comparable to extinction and less stressful for mothers offering a possible gentler choice at bedtime separation.
P014 Shift work disorder and the prevalence of help seeking behaviours for sleep concerns in Australia
Authors: Brown B , Crowther M , Appleton S , Melaku Y , Adams R , Reynolds A
Published: October 2021

Introduction

Shift work disorder is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help-seeking behaviours for sleep in shift workers is limited.

Methods

As a part of a national sleep health survey, data were collected on the help-seeking behaviours for sleep problems in an online sample of Australian individuals on non-standard work schedules (n=448). Of the sample of non-standard workers, 10.5% (n=41) met the criteria for probable shift work disorder (pSWD).

Results

Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD (p = .979). General practitioners were the most reported healthcare professional sought out for sleep problems of individuals with pSWD. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of ‘accept it and keep going’ as a sleepiness management strategy, highlighting a potential barrier to help-seeking behaviour in workers with pSWD.

Discussion

These findings provide novel insight into the help-seeking behaviours of individuals with pSWD. There is a need for further research to understand why individuals at risk for shift work disorder are not actively seeking help, and to develop health promotion and intervention strategies to improve engagement with healthcare professionals.
P015 Home (Level 2) sleep studies are feasible in children
Authors: Russo K , Greenhill J , Burgess S
Published: October 2021

Introduction

In-hospital polysomnography (PSG or Level 1 study) is the “gold-standard” for investigating sleep disorders in children. There are long waiting lists for sleep studies in Australian tertiary centres. Level 2 home-PSG has been proposed as an alternate option. However, there are limited data regarding the feasibility in a clinical population. The aim of this study is to assess the feasibility and patient experience of home-PSG in a clinical cohort.

Methods

The signal quality and outcomes of a home-PSG in young people undergoing sleep investigation in a single centre were reviewed. A successful home-PSG was defined as a study with ≥ 6hrs of sleep and all channels present for ≥90% of sleep time. Feedback from the guardian/young person was collected using a questionnaire.

Results

Fifty-five patients (4m-18yrs) were included. Successful home-PSG, on the first attempt, was achieved for 48/55 (87%) patients. There were no differences in success when accounting for neurodevelopmental conditions, OSA severity or age. A clinical diagnosis was confidently made in 53 (96%) patients. The majority (76%) rated their sleep as the same or better than normal and only 12% found having the study conducted at home difficult. Following the study, only 8% would have preferred a hospital sleep study.

Discussion

Home-PSG produced technically adequate recordings for most subjects and families found the experience of having a home sleep study to be positive. These data support, in appropriate circumstances, home-PSG as a viable alternative to an in-patient sleep study.
P018 The effects of zopiclone on sleep spindles in obstructive sleep apnea: A randomized placebo-controlled trial
Authors: Carter S , Siong J , Hoyos C , Carberry J , Grunstein R , Eckert D , D’Rozario A
Published: October 2021

Purpose

This study aimed to determine the effects of a standard dose of zopiclone (7.5mg) on sleep spindle activity and to assess if potential changes in sleep spindles correlate with improvements in next-day measures of sleepiness and simulated driving performance in people with obstructive sleep apnoea (OSA).

Methods

Thirty-one people with OSA completed polysomnography (PSG) at baseline followed by 1-month nightly treatment with 7.5mg zopiclone or placebo according to a double-blind, parallel design (ANZCTRN12613001106729). Participants completed two further PSGs on the first (night1) and final (night30) night of treatment. A 30-min AusEd driving simulator task and a subjective sleepiness questionnaire (Karolinska sleepiness scale, KSS) on each visit were also performed in the morning. Sleep spindle events and spindle frequency activity (SFA, sigma EEG power) were quantified during N2 sleep from all-night EEG recordings.

Results

Sleep spindle events were consistently higher in both frontal and central EEG sites on night1 and night30 treatment nights in the zopiclone group compared to placebo (e.g. F4 night30 = 346[SEM±28] vs. 239[SEM±27] total # of sleep spindles respectively, p=0.009). Additionally, greater sleep spindle density in the zopiclone group correlated with better next-day simulated driving performance on night1 and night30. No correlations were observed between sleep spindle activity and the KSS.

Conclusions

Zopiclone is associated with greater sleep spindle activity in OSA compared to placebo, and sleep spindle increases are associated with better driving simulator performance. Thus, hypnotic-induced increases in sleep spindles may help alleviate certain cognitive performance decrements in people with OSA.
P021 Does Obstructive Sleep Apnea (OSA) lead to impairment within the cochlea?
Authors: Cheung I , Thorne P , Neeff M , Sommer J , Hussain S
Published: October 2021

Introduction

The cessation of breathing with OSA is linked to the continuous decrease in oxygen saturation throughout the night which could impact the inner ear as it is sensitive to hypoxic changes. Inner ear hair cells response from the cochlea is measured through Transient Otoacoustic Emission (TEOAEs). This study aimed to evaluate TEOAEs in suspected OSA patients and its correlation with oxygen saturation.

Methods

TEOAEs were measured before sleep and in the morning in suspected OSA patients and healthy participants. The following frequencies were measured: 1000Hz, 1500Hz, 2000Hz, 3000Hz and 4000Hz. Polysomnography with oxygen saturation was completed overnight. Preliminary analysis was completed on 11 no OSA, 22 mild OSA, 13 moderate OSA and 27 severe OSA patients.

Results

One-way ANOVA with Tukey post-hoc analysis revealed a difference between severe vs mild with average TEOAE only (p = 0.04). A moderate correlation was found between average TEOAE and minimum O2 saturation, rs (72) = 0.444, p< 0.0001) through Spearman’s rank-order correlation. As middle ear function can impact TEOAE results, regression analysis revealed an association between a decrease in TEOAE and lowered minimum O2 saturation (F (1,63) = 8.951, p = 0.004, partial n2 = 0.124) when middle ear pressure was controlled.

Discussion

Oxygen desaturation with OSA is associated with a decrease in inner ear hair cells response, which was independent from middle ear function. Despite this association, a difference in TEOAE was only found between severe vs mild, which could be due to the current sample size of the preliminary data.
P022 Unattended home sleep studies have a high recording failure rate in a preoperative anaesthetic clinic cohort when done as a routine screening procedure for Obstructive Sleep Apnoea (OSA)
Authors: Chuong B , Cho J , Wheatley J
Published: October 2021

Introduction

Preoperative screening for OSA is strongly advised but attended laboratory sleep studies have limited availability. Portable unattended sleep monitors, such as ApneaLink, may provide a practical solution for large scale preoperative OSA screening. However, these unattended monitors may be prone to data recording failure.

Methods

We performed a prospective, uncontrolled, before-after study from March 2017 to December 2018 where patients from a pre-operative anaesthetic clinic were screened for OSA with an ApneaLink home sleep study (AHSS). 24 initial patients were provided with version 1 (v.1) recording instructions, while the next 24 patients received version 2 (v.2) which included colour, more detail and larger pictures compared to v.1. Recording failure was defined as an absence of recorded ApneaLink data. We analysed predictors of recording failure including instruction version and patient factors using logistic regression.

Results

Thirty-three of 48 (69%) patients successfully completed an AHSS. Failure rate was 31%. Median duration of recorded data was 480 minutes. The successful recording group was more likely to have used v.2 instructions than the failure group (61% vs. 27%; p=0.029). The odds ratio for successful recording using v.2 was 4.2 (95% CI: 1.1–16.2). Age, gender, country of birth, and number of days prior to surgery were not associated with recording failure.

Discussion

There was a high failure rate of AHSS for OSA screening from a preoperative anaesthetic clinic. Clear written instructions with greater use of colours and pictures may improve the recording success rate in this cohort.
P023 Quantitative EEG analysis of polysomnography in a case of Fatal Familial Insomnia
Authors: Churchward T , Kao C , D’Rozario A , Wimaleswaran H , McMahon M , Howard M , Tolson J , Ruehland W
Published: October 2021

Purpose

To report on quantitative electroencephalograph (EEG) activity during polysomnography (PSG) in a rare case of confirmed Fatal Familial Insomnia (FFI).

Methods

Sleep/wake characteristics of a 32-year-old male patient were quantitatively analysed using central EEG recordings during two PSGs (FFI-1 and FFI-2) first, for investigation of insomnia and PLMS but with no suspicion of FFI and second, 120 days later with suspected but unconfirmed FFI at the time; 89 days prior to death. PSG metrics; absolute EEG power in specified frequency bands; EEG slowing ratio of slow-to-fast frequencies ((delta + theta)/ (alpha + sigma + beta)); and sleep spindle density were calculated. Results were compared with gender and age-matched insomnia and healthy controls (two of each).

Results

FFI-1 and FFI-2 PSGs revealed total time in bed of 413.5 and 392 minutes, total sleep times of 208.5 and 7.5 minute, including NREM 153.0 and 2.5 minutes, and REM 55.5 and 5.0 minutes, respectively. FFI-1 had approximately 1.5 times lower slow wave activity (SWA, 0.5–4.5Hz) during N3 than insomnia and controls.​ FFI-1 had 2 times and 1.8 times higher slowing ratio during REM than insomnia and controls, respectively. Spindle density (per minute of NREM sleep) for FFI-1 was 0.9, compared to pair-averages of 1.2 for insomnia disorder and 4.7 for healthy controls.

Conclusions

PSG in FFI revealed poor sleep efficiency that severely deteriorated with disease progression. Quantitative analysis of EEG revealed lower spindle density, lower SWA in N3, and higher slowing ratio in REM, when compared to insomnia patients and healthy sleepers.
P033 Randomised controlled trial on the efficacy of Audio-visual Health Educational materials on CPAP ADherence: The AHEAD trial
Authors: Ellender C , Samaranayake C , Duce B , Boyde M , Winter S , Hukins C
Published: October 2021

OSA is a prevalent chronic disease with significant health implications, for which achieving >4 hours/night on continuous positive airway pressure (CPAP) is essential for effective treatment. Educational videos to improve CPAP adherence are of interest as a low-cost intervention, however trials have shown mixed results. This study aimed to compare CPAP usage following standard of care education (SOCE), with the usage following the addition of educational videos, customised to incorporate low health literacy communication, motivational and self-efficacy techniques.

Methods

Adults with OSA recommended treatment with CPAP, were recruited and randomised in a single blinded method, to watch short educational videos following their in laboratory CPAP study or SOCE. The primary outcome was CPAP usage at 2mths and secondary outcomes were usage at 12mth and proportion of patients with adequate usage >4hrs/night.

Results

195 patients met the eligibility criteria and were randomised to video education (n = 96) or to SOCE (n = 99). There was no significant difference in compliance at 2mths (median usage 1.7hrs IQR 0–6.2 SOCE, 4.4hrs IQR 0–6.7 video education p = 0.1), however at 12mths there was increased usage in the video education arm (median 0hrs IQR 0–5.4 standard of care, 3.8hrs IQR 0–6.87 p = 0.05). The proportion with adequate CPAP usage >4hrs/night at 12mths was higher in the video education group (33, 33% versus 48, 50% p = 0.01).

Conclusions

Long-term adherence to CPAP is enhanced by the addition of educational videos that incorporate low health literacy communication and motivational techniques, compared to SOCE.
P035 Is the Grael oximetry averaging time interchangeable with a Masimo pulse oximeter algorithm in polysomnography?
Authors: Eritaia J , Suthers B
Published: October 2021

Compumedics recording software (Grael V2) for polysomnography (PSG) calculates SpO2 values using a 3-heartbeat long averaging window. This is derived from the ECG and thus introduces variability in the averaging time that is dependent on the heart rate. Little is known about the effect this has on the common oximetry metrics used in PSG interpretation. This study explorer the interchangeability of the Grael V2 inbuilt 3-beat averaging algorithm with a short averaging window of 2 - 4 seconds using a Masimo Radical 7 pulse oximeter during a PSG.

SpO2 data were collected from 2 oximeter probes (Grael and Radical 7) both attached to a patient’s fingers. After SpO2 artifacts were removed, the following SpO2 parameters from each oximeter were generated: mean sleep SpO2, oxygen desaturation index (ODI) using 2%, 3% and 4% drop in SpO2 in sleep, total sleep time (TST) with SpO2 < 90% and < 80% as well as time spent < SpO2 88% in minutes. 88 sleep studies were included in the data collection.

For ODI2%, 3% and 4%, bias (95% limits of agreement) values were -0.75 events/hr (9.99 to -11.49 events/hr), -0.74 events/hr (10.00 - -11.49 events/hr) and -0.20 events/hr (8.45 - -8.86 events/hr) respectively. There was no significant difference between measurements except for the mean sleep SpO2 values, p < .001.

Although no bias found between measurements, there was poor agreement between the algorithms as demonstrated by the wide 95% limits of agreement suggesting that the two oximeter devices are not interchangeable.
P036 Trajectories of emotional and behavioural problems in Aboriginal and Torres Strait Islander children: Role of sleep and cultural attachment
Authors: Fatima Y , Bucks R , King S , Solomon S , Skinner T
Published: October 2021

Purpose

This study explored the link between sleep and emotional and behavioural problems and assessed whether cultural attachment reduces the risk of emotional and behavioural problems in Aboriginal and Torres Strait Islander (Indigenous) children.

Methods

The data from wave 5 to wave 10 of the Footprints in Time cohort were used. Multi-trajectory modelling was used to identify sleep trajectories using weekday sleep duration, weekday bedtimes, wake times, and sleep problems (waves 5, 7 & 10). Trajectories of emotional and behavioural problems were derived from the Strengths and Difficulties Questionnaire (SDQ) data (waves 6, 8 & 10). Cultural attachment assessment included the knowledge of Indigenous language, clan, people, family stories/history and other cultural practice. Multivariable logistic regression models were used to assess the link between sleep and emotional and behavioural problems.

Results

Analysis of sleep data from 1270 Indigenous children (50.6% females, mean age 6.3 years (±1.5)) identified four distinct trajectories: early sleepers/early risers (19.3%); early/long sleepers (22.1%), normative sleepers (47.8%), and late sleepers (10.8%). Three emotional and behavioural problem trajectories emerged: low stable (49.1%), high decreasing (40.5%), and high stable (10.4%). Early sleepers//early risers (OR: 0.48, 95% CI: 0.28–0.82) and children with strong cultural attachment (OR: 0.47, 95% CI: 0.27–0.82) had lower odds of being in the high emotional and behavioural problem trajectory group.

Conclusions

Early bedtime in children may reduce the risk of future emotional and behavioural problems. The protective effect of cultural attachment further highlights the need for strengths-based approaches to reduce mental health issues in Indigenous children.
P039 Interventions used to increase sleep duration in young people: A systematic review
Authors: Gadam S , Pattinson C , Soleimanloo S , Rossa K , Moore J , Begum T , Srinivasan A , Smith S
Published: October 2021

Introduction

Habitual short sleep duration affects a substantial proportion of young people, which is problematic due to its association with various adverse consequences. The aim of this systematic review was to identify the effectiveness of current interventions to increase sleep duration in healthy young people (14–25 years).

Methods

A systematic literature search, following PRISMA guidelines was conducted across multiple databases including PubMed, Ovid MEDLINE, CENTRAL, Embase, CINAHL (via EBSCOhost), PsycINFO, Scopus, Web of Science, ProQuest Dissertations and Theses, and Trove. Eligible studies were required to report sleep duration before and after exposure to the intervention, published from 2005 onwards, and participants 14–25 years of age. The Newcastle-Ottawa scale and Cochrane Risk of Bias were used to evaluate quality of studies.

Results

2695 citation were screened, and 29 studies met the eligibility criteria for this review. The included studies implemented differing methodologies, including behavioural (48.3%), educational (24.1%), and combination (24.1%) of behavioural, educational and other methods, such as mindfulness, light therapy, and naturalistic observation (3.4%). Initial findings indicate that educational interventions on their own are not effective at increasing sleep duration as behavioural or combination of both.

Discussion

These results indicate that behavioural interventions which prescribe new sleep schedules show positive treatment effects on sleep duration. Hence, provide promise for mitigating sleep difficulties and improving health in young people aged 14–25 years.
P045 A prospective review of sleep quality in hospitalised respiratory inpatients
Authors: Guo H , O’Driscoll D , Ogeil R , Tse W , Young A
Published: October 2021

Background and Aim

Sleep is an active and restorative state that is vital for maintaining optimal physical and mental health. Hospitalised patients are particularly at risk of poor sleep. We aim to review the sleep quality of respiratory inpatients at a tertiary hospital and to identify modifiable barriers to sleeping well in hospital environments.

Methods

Prospective data were collected from respiratory ward patients at time of discharge by completion of a medical records review and a Sleep Questionnaire created by Working Group Sleep Health Foundation, including patient rating of sleep quality (very poor, poor, fair, good, very good) and sleep disrupting factors. These data were stratified by pertinent environmental, patient and clinical care factors.

Results

Data from 6 patients were analysed; median age was 65 years, 3 (50%) were male and median length of hospital stay was 5 days. Four (67%) patients used sedating medications, 1 (17%) used this for treatment of insomnia. Two (33%) of patients characterised their sleep quality as poor or very poor and 3 (50%) patients described their sleep in hospital as slightly worse or much worse than sleeping at home. The main contributing factors to poor sleep quality were noise, checking of vital signs by hospital staff, medical treatments and medical condition relating to admission (eg. pain, dysnpea). Data collection is ongoing.

Conclusion

A significant proportion of patients experienced poorer sleep quality as a result of their hospital admission, attributable to both extrinsic factors (noise and clinical care) and underlying medical conditions.
P055 Mechanisms Underlying Sleep Disturbance in Young People with Borderline Personality Disorder Features
Authors: Jenkins C , Thompson K , Nicholas C , Chanen A
Published: October 2021

Introduction

Sleep problems are common in young people (aged 15–25 years) with features of borderline personality disorder (BPD). Yet the mechanisms underlying this relationship remain largely unknown. This study explored the indirect roles of emotion regulation difficulties, depression, anxiety and stress in the relationship between BPD features and sleep disturbance in young people.

Method

Sleep was measured subjectively (self-report) and objectively (10 days wrist actigraphy) in 40 young people with BPD features (36 females, Mage = 19.77, SD = 2.51) and 38 healthy young people (34 females, Mage = 20.06, SD = 2.52). Participants also completed the Difficulties in Emotion Regulation Scale and the Depression, Anxiety and Stress Scale.

Results

Mediation analyses revealed that impulse control difficulties, limited access to emotion regulation strategies, and anxiety played an indirect role in subjective sleep disturbances in young people with BPD features. Lack of emotional awareness and anxiety indirectly contributed to associations between BPD features and objectively longer time in bed and bedtime variability, respectively.

Discussion

Targeting impulse control difficulties, emotion regulation strategies and anxiety through improving impulse control, improving emotion regulation skills and reducing pre-sleep arousal might be beneficial for improving subjective sleep in this population. Similarly, improving emotional awareness and reducing anxiety might help to normalise objective sleep patterns. Overall, these findings help to guide the development of targeted sleep-improvement strategies that might serve as useful adjuncts to current interventions for young people with BPD features.
P062 Sleep parameter validation of a home-based ballistocardiograph sleep tracker
Authors: Kholghi M , Szollosi I , Hollamby M , Bradford D , Zhang Q
Published: October 2021

Introduction

Consumer home sleep trackers are gaining popularity for objective sleep monitoring. Amongst them, non-wearable devices have little disruption in daily routine and need little maintenance. However, the validity of their sleep outcomes needs further investigation. In this study, the accuracy of the sleep outcomes of EMFIT Quantified Sleep (QS), an unobtrusive and non-wearable ballistocardiograph sleep tracker, was evaluated by comparing it with polysomnography (PSG).

Methods

62 sleep lab patients underwent a single clinical PSG and their sleep measures were simultaneously collected through PSG and EMFIT QS. Total Sleep Time (TST), Wake After Sleep Onset (WASO), Sleep Onset Latency (SOL) and average Heart Rate (HR) were compared using paired t-tests and agreement analysed using Bland-Altman plots.

Results

EMFIT QS data loss occurred in 47% of participants. In the remaining 33 participants (15 females, with mean age of 53.7±16.5), EMFIT QS overestimated TST by 177.5±119.4 minutes (p<0.001) and underestimated WASO by 44.74±68.81 minutes (p<0.001). It accurately measured average resting HR and was able to distinguish SOL with some accuracy. However, the agreement between EMFIT QS and PSG on sleep-wake detection was very low (kappa=0.13, p<0.001).

Discussion

A consensus between PSG and EMFIT QS was found in SOL and average HR. There was a significant discrepancy and lack of consensus between the two devices in other sleep outcomes. These findings indicate that while EMFIT QS is not a credible alternative to PSG for sleep monitoring in clinical and research settings, consumers may find some benefit from longitudinal monitoring of SOL and HR.
P069 Health professionals’ perceptions of sleep in palliative care: A qualitative study
Authors: Lalor A , Laurie R , Parikh D
Published: October 2021

Introduction

Sleep is vital for all individuals however sleep difficulties are highly prevalent for those receiving palliative care. Impaired sleep impacts their everyday participation and overall health and wellbeing. Although sleep is recognised as an important factor for care, limited evidence exists regarding health professionals’ perceptions of sleep for patients receiving palliative.

Methods

A qualitative research design was used to investigate the perceptions and roles of health professionals in identifying and addressing sleep difficulties in patients receiving palliative care. In-depth semi-structured interviews were conducted with ten health professionals across six disciplines with minimum six months experience working in palliative care. Interviews were audio recorded, transcribed verbatim and thematically analysed. Pseudonyms were used to de-identify participants.

Results

Five themes were identified: (1) patient’s sleep is highly valued; (2) sleep in palliative care is complex; (3) perspectives and approaches to sleep management vary; (4) challenges in addressing sleep; and (5) health professionals desire for sleep knowledge.

Discussion

Findings highlight health professionals’ perceptions of sleep difficulties and consequential implications, and the importance of sleep for both patients and caregivers. Participants perceive priorities of care and limited resources and training in sleep management hindered their clinical practice in addressing sleep. Health professionals working in palliative care could benefit from reorienting practice, development of and access to up-to-date resources regarding sleep, and support to provide sleep education for patients and caregivers.
P082 Gender moderates the effects of total sleep deprivation and sleep restriction on risk preference
Authors: Lim J , Boardman J , Drummond S , Dickinson D
Published: October 2021

Introduction

Total sleep deprivation (TSD) affects risk preference in decision-making. However, little work has examined the effects of sleep restriction (SR), or the potentially moderating role of gender, on risk preference. Here, we investigate the effects of TSD, SR, and gender on risky decision-making.

Methods

47 healthy adults (age=24.57±5.26 years, 24F) were randomly assigned to either of 2 counterbalanced protocols: 1) well-rested (WR: 9-hours time-in-bed for 6 nights) and 30hours TSD; or 2) WR and SR (4-hours time-in-bed for 4 nights). Participants performed the Lottery Choice Task (LCT) on the last day of each week. LCT requires a series of choices between two risky gambles with different risk levels. In one block, participants sought to maximise monetary gain (GAINS), and in another block, they sought to minimise losses (LOSSES). A trial-level analysis evaluated participants’ likelihood of choosing the “safer” gamble under influence of each sleep condition.

Results

The version*condition*gender interaction was significant. GAINS: everyone became more risk averse during TSD. Females also became more risk averse during SR, but males did not. LOSSES: everyone became more risk seeking during SR. During TSD, females became relatively more risk averse, while males became relatively more risk seeking.

Conclusion

TSD and SR had similar impacts on risk preference. However, gender moderated some effects. Women generally became more risk averse during sleep loss for both GAINS and LOSSES. Men were more risk averse for GAINS and risk seeking for LOSSES. This has implications for real-world situations where individuals are required to make risky decisions.