bluuebunny/crossref_metadata_2025 huggingface dataset:
P057 Review of longitudinal CPAP compliance in a government funded program
Authors: Carballo A , Madden G , Eriksson N , Roberts C
Published: December 2024

Intro

Compliance to CPAP therapy in patients with significant sleep apnoea improves overall health outcomes. The Government Funded Sleep Disorders Program (GFSDP) supplies CPAP devices to patients with significant sleep apnoea (apnoea-hypoxia index (AHI)>15) or significant symptom burden (Epworth sleepiness score (ESS)>10). To retain a GFSDP device, participants must meet the minimum usage requirements of 4hours/night. The aim of this study is to investigate longitudinal CPAP compliance of patients within the GFSDP. This information will assist with the goal of improving overall patient outcomes and tailoring service provisions offered by the healthcare institution.

Methods

150 GFSDP devices were issued from 2018 to May 2024. A retrospective analysis of patient compliance at commencement of therapy (Group 1), compared with current 3month compliance data (Group 2). 45 devices without remote monitoring were excluded from the study. Usage (hours/night) and AHI comparison between data groups were analysed using a paired T-test.

Results

105 subjects were analysed, age=60.9±12.80SD, 56 female, BMI=42.26±6.59SD, diagnostic AHI=59.4±32.16SD.

Group 1: usage=6.6hrs/night(SD±1.35); Group 2: usage =6.96hrs/night(±1.93SD), p=0.743.

Group 1: AHI=6.7(±1.38SD); Group 2: AHI=3.21(±4.18SD), p=0.492.

9% (n=10) patients were found to be non-compliant with an average usage of 1.26hrs/night.

Discussion

91% of patients showed continued acceptable compliance. There was no statistical difference in usage or AHI between Group 1 and Group 2. Patients identified as not compliant with the program in the past 3 months will be booked into clinic for review. More data is required to further investigate other relationships or trends that might exist within GFSDP participants
P060 Explainable machine learning reveals associations between sleep breathing disorder biomarkers and incident type 2 diabetes
Authors: Nguyen P , Catcheside P , Lechat B , Wittert G , Vakulin A , Adams R , Appleton S
Published: December 2024

Introduction

Obstructive sleep apnoea (OSA) and type 2 diabetes (T2D) show bidirectional relationships that negatively impact overall health. Although this relationship has been extensively studied with multiple reported OSA severity markers derived from polysomnography, no studies have systematically searched for novel OSA biomarkers of T2D. This project sought to investigate if state-of-the-art explainable machine learning (ML) models could identify new OSA biomarkers predictive of incident T2D.

Methods

We applied explainable ML models to longitudinal MAILES study data from 536 males who were free of T2D at baseline and identified 52 cases of T2D at follow-up (mean 8.3yrs, range 41.9-126.5mths). Beyond ranking biomarker importance, we explored how the explainable ML model approach can identify novel relationships, assist in hypothesis testing, and provide insights into risk factors.

Results

The top most predictive biomarkers included waist circumference, and novel biomarkers: number of desaturations in non-supine sleep, mean heart rate in supine sleep, and mean hypopnea duration. Explainable ML also identified a strong association between the number of desaturation events and incident T2D (Odds ratio=2.4 [95% CI 1.2-4.8], P=0.013). Finally, the explainable ML model revealed an individualized breakdown of risk factors, opening promising new avenues for more personalized precision sleep medicine.

Conclusions

Explainable ML supports the role of established biomarkers and reveals novel biomarkers of T2D likely to help guide further hypothesis testing and validation of more robust and clinically useful biomarkers. Although further validation is needed, these proof-of-concept data support the benefits of explainable ML in prospective data analysis.
P062 Development of a new Stepped Care approach to Insomnia treatment in a public health system
Authors: Crocker S , Szollozi I , Rolls T , Curtin D , Winter S
Published: December 2024

Introduction

Challenges exist in managing the clinical need for Insomnia treatment in the public health system. Traditional insomnia treatments can inflate wait times and are becoming unsustainable in the face of rising patient acuity/demand. The objective of this project is to develop a new Stepped Care (SC) treatment approach within a large tertiary hospital sleep disorders service.

Method

Online surveys on experiences and perspectives of existing and novel insomnia therapies were sent to 121 dyads (patients and their GPs) who had accessed the Sleep Psychology service between January 2021 and June 2023, as well as 41 multi-disciplinary staff from the Sleep Disorder Centre. A consensus group workshop was conducted to co-design the new SC treatment approach, which was informed by consumer and stakeholder feedback.

Results

Most GPs were familiar with online therapies, but few prescribed. Similarly, most patients who completed an online program found it helpful. The consensus group data revealed a preference for patient allocation to one of the following Steps based on clinical presentation/acuity: Level1: self-administered CBTi via validated online program; Level2: supervised small group CBTi delivered by psychology intern; Level3: 1:1 supervised CBTi treatment with psychology intern; and Level4: 1:1 intensive CBTi with an experienced psychologist.

Discussion

Stepped Care (SC) treatment models are flexible, allow intervention adaption based on patient treatment response, as well as offer service efficiencies in a public health setting.
P063 App-delivered Sleep Therapy for Older Individuals with insomnia (ASTEROID Study) – mixed method user experience study
Authors: Rahimi M , Hoyos C , Chapman J , Cheung J , Lee S , Bartlett D , Lillis S , Grunstein R , Gordon C
Published: December 2024

Introduction

Insomnia affects over 40% of older adults, impacting on their health and quality of life, but is often untreated. This study investigated the acceptability of digital therapy for insomnia in older adults using a mixed-methods approach.

Method

Eligible (age≥60, ISI≥10) respondents participated in an online survey exploring their smartphone usage patterns, app design preferences, and experiences with health and sleep-related apps. Additionally, a two-session focus group explored participants’ perceptions of sleep issues, insomnia treatments and their digital health needs. Focus group participants subsequently engaged in the usability testing of a mobile app designed to treat insomnia (SleepFix) for 3 weeks.

Results

203 participants completed the online survey (mean age=68.7±6.2; 66.0% female). Most (63%) used iOS phones, with 37% also using wearable devices, primarily for fitness and sleep tracking. The most desired features reported for an ideal sleep app were sleep diary entry and sleep quality tracking (83%) followed by lifestyle tracking (73%). Participants expressed a willingness to use an app to discover their sleep needs (95%) and improve overall sleep (93%). Preliminary focus group analysis (n=5) revealed long-standing struggles with insomnia and a desire for better solutions. After using SleepFix, participants reported improvements in sleep quality, expressing a willingness to recommend and continue using the insomnia app.

Discussion

This study found older people used mobile phones in many aspects of their lives, challenging stereotypes regarding older adults’ digital health literacy. There was a willingness to embrace digital health interventions to address long-standing insomnia and improve overall health outcomes.
P067 How much sleep medicine is taught to Australian and New Zealand medical students?
Authors: Bin Y , Chawla J , Dorrian J , Pal Singh A , Falloon K , Wong K , Meaklim H , Ferguson S , Ellender C , Young A
Published: December 2024

Background

Sleep disorders are prevalent with wide-ranging consequences but often underdiagnosed. Previous research indicates low coverage of sleep topics in medical curricula and knowledge gaps in primary care physicians around the world.

Methods

The medical dean and one staff member from the 22 medical programs in Australia and New Zealand were surveyed about sleep content within the curriculum and barriers and facilitators to providing sleep education.

Results

Eleven programs responded (48% responding; 5 undergraduate-, 4 postgraduate-entry, 2 both) and reported a median of 4h of sleep education (IQR 1.0 – 5.9h). Most frequently covered topics were normal sleep (91% of respondents), sleep apnoea (91%), insomnia (55%), circadian disorders (51%), sleep and circadian rhythms as related to student wellbeing (45%), movement disorders (36%), hypersomnias (36%), and parasomnias (27%). More than half gave students the opportunity to meet a sleep specialist (55%), but fewer provided opportunities to attend a sleep clinic (36%), observe a sleep investigation (27%), or visit a sleep laboratory (18%). Most respondents (73%) believed sleep content could be increased; these institutions actually provided more sleep education than their counterparts (median 7.4h vs. 3.3h). Respondents suggested professional bodies can help by advising on educational frameworks, developing standard learning outcomes, and creating reference and teaching materials but noted the main barrier of limited space in the curriculum.

Conclusions

There is scope to improve sleep education in Australian and New Zealand medical programs, however, consensus on core topics and content integration with other disciplines are key, given limited curriculum space and time.
P068 Books, Bath, Bed and Beyond: The role of digital technology and family dynamics in the evening routines of primary school aged children
Authors: Hillier E , Edmed S , Rossa K , Pattinson C , MacKenzie J , Smith S
Published: December 2024

Introduction

Digital technology is reported to impact children’s sleep, yet there is limited knowledge about how it is used and managed in the home. The family dynamics associated with technology use, a child’s bedtime, and family sleep are uncertain. This study examined the evening routines of families by constructing detailed individual timelines of evening routines, including the digital technology use, of 5–8-year-old children in their home environment.

Method

Semi-structured interviews, with time-of-day reconstruction, data prompting, and novel graphical elicitation techniques, were used to gather rich information about family evening routines. Interviews were conducted via Zoom and facilitated with the visual collaborative software, ‘Mural’. Qualitative data were analysed using thematic analysis.

Results

Thirty interviews were conducted with parents (86.7% female) of 5–8-year-old children (66.7% boys). Families’ evening and bedtime routines were characterised variously on dimensions of rigidity or flexibility of routine based on time of day and order of activity, with variations in the tempo of these routines (paced versus rushing). Technology played a diverse range of roles within routines of families, including that of child minder, behavioural reward, distraction during mealtimes, calming device, bedtime aide, and to facilitate family connection.

Discussion

Evening routines and sleep management in daily life are complex and private experiences. This study provides rich contextual narratives about how family dynamics and technology fit into children’s lives during their evening and bedtime routines. This knowledge may inform behavioural strategies to ameliorate the potential negative effects of digital media on sleep health during childhood.
P070 Cultural determinants of Sleep Health for First Nations adolescents: Perspectives of Service Providers in Remote Communities
Authors: Ashby C , Kinghorn M , Von Senden R , Wigginton B , Sullivan D , Yaqoot F , Kalmadka S , Caple R
Published: December 2024

Background

Despite established links between sleep and mental health across the general population, sleep health within a First Nations context is less understood. Moreover, there remains a dearth of culturally responsive approaches for Australian First Nations communities, including adolescents. This qualitative study explores the cultural determinants of First Nations adolescents’ sleep health, drawing on yarning sessions with service providers in remote Northern Queensland (NQ) communities as part of the Let’s Yarn About Sleep Project.

Methods

Ten yarning sessions were conducted with health and wellbeing and education service providers (N= 27; 23 female; 12 Indigenous) in remote NQ. First Nations community researchers reviewed the data and the Lowitja Cultural Determinants of Health and Wellbeing Framework was used to culturally ground the work and thematically organise First Nations adolescents’ sleep health narratives.

Results

Preliminary analysis revealed Family, Kinship and Community; and Self-determination and Leadership as key cultural determinants to First Nations adolescents’ sleep health. Participants emphasised there is no ‘one-size-fits-all’ approach, suggesting sleep health programs should be guided by place-based, culturally sensitive, First Nations-led, methods sensitive to myriad determinants of sleep health.

Discussion

Adopting a strengths-based approach, this study sought to situate First Nations adolescents’ sleep health within a rights-based, First Nations-led framework. Findings suggest future sleep health initiatives must privilege First Nations voices and be guided by a holistic health and wellbeing concept, encompassing place-based, culturally responsive and First Nations-led local service delivery. This study advocates for upstream determinants of health to guide future sleep health research, practice and policy.
O009a Ko Te honoka te whariki o whanau ora: Bridging indigenous and Western world views to create a sleep and connection intervention in the Moemoeā MOST trial
Authors: Russell-Camp T
Published: December 2024

Introduction

Bridging indigenous and Western world views to create a sleep and connection intervention in the Moemoeā MOST trial“aimed to blend Māori cultural practices with Western methods to enhance infant sleep and family wellbeing. Researchers from the University of Otago used Kaupapa Māori Research theory and a Multiphase Optimisation Trial (MOST) design to test culturally tailored sleep intervention components online over six months.

Methods

Caregivers of infants aged 2-12 months were recruited and randomly assigned to one of eight combinations of three intervention components: Rongo time (promoting peace through nature), Uru time (guiding sleep transitions), and Whānau Support (emphasizing family support). Interventions were delivered online through a website and an app. Outcome measures assessed at baseline and 6 months included our Perception of Infant and Toddler Sleep Scale (PoITSS), caregiver wellbeing (WHO-5), and connection measures (researcher developed scales).

Results

Of 503 caregivers (98.6% mothers, 35.4% Māori, 38.8% high deprivation), 377 (75%) completed the study. Most caregivers accessed the online resources, with varying levels of engagement. Qualitative feedback indicated improved connection to Māori culture and a perceived calming effect on infants from Uru Pou. However, there were no significant differences in PoITSS scores for Uru or Rongo time, and only minor improvements for Whānau Support. The intervention did not notably affect caregiver wellbeing or connection.

Discussion

While the intervention showed limited impact on infant sleep health, the positive qualitative feedback highlighted the value of culturally relevant resources and the need for further research in designing Indigenous-led interventions.

Funding was provided by the Ministry of Business, Innovation and Employment as part of the A Better Start National Science Challenge.
P078 Poor sleep quality in Australia: The role of disturbing dreams, nightmares, and psychological distress
Authors: Meaklim H , Turner M , Cunnington D , Burge M , Menzies R , Dunican I
Published: December 2024

Introduction

Disturbing dreams and nightmares can cause night-time awakenings and disrupt sleep. Despite high rates of poor sleep quality in Australia, there has been little investigation into the impact of disturbing dreams and nightmares on sleep quality. This study aimed to determine the relationship between disturbing dreams and nightmares and sleep quality in Australia while also examining the contribution of psychological distress.

Methods

Four hundred and thirty-nine Australian adults (310 females, average age: 44.9 years) completed an online survey investigating sleep, dreams, nightmares, and mental health. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), nightmares were assessed with the Disturbing Dreams and Nightmares Severity Index (DDNSI), and psychological distress was assessed using the Depression Anxiety Stress Scale (DASS-21) total score. Two linear regression models (adjusted for age and sex) examined the contribution of DDNSI and DASS-21 on PSQI scores.

Results

In the first model, disturbing dreams and nightmares were a significant predictor of PSQI scores (p < 0.001), explaining 10% of the variance. Once psychological distress was added to the model, both disturbing dreams and nightmares (p = 0.004) and psychological distress (p < 0.001) significantly predicted PSQI scores. The final model explained 22% of the variance in PSQI scores.

Discussion

Disturbing dreams and nightmares contribute to poor sleep quality in Australia. Psychological distress also plays a key role. Sleep health researchers, therefore, need to include validated measures of disturbing dreams, nightmares, and psychological distress when investigating factors contributing to poor sleep quality in Australia.
P083 Sleep in an ageing society: Key propositions for future sociological research
Authors: Gibson R , Coveney C , Martin W , Green R , Hine C , Ryan C , Sabatini S , Jin H , della Monica C , King A , Meadows R
Published: December 2024

Introduction

Recent policy reports have identified the importance of healthy ageing as well as sleep but rarely together. When they are, it often neglects existing sociological insights. It is possible that this is because this work is becoming historical or less applicable. This project considers the past and present contributions of sociology in ageing-related sleep research to identifying future research agendas.

Method

A group of scholars based in New Zealand and England and active in sociology, sleep and/or ageing-related research came together to map past and present research and workshop future agendas. Following extensive discussion, a range of consensus points were developed and refined.

Results

Three key propositions were identified as a foundation for future work in this space. These related to (i) ontological and epistemological questions; (ii) issues related to agency, autonomy, habits and routines; and (iii) time and temporality. Specific examples include the increasing trend towards datafication of ageing sleeping bodies and the implications for older individuals’ independence as well as the complexities of risk, uncertainty and surveillance.

Conclusion

If we are to meet the aims of leading policies for healthy ageing; it is imperative that we bring a sociological lens via ageing-related sleep research. This approach should not create new silos but encourage interdisciplinary reflection on what constitutes ‘sleeping well’ in the context of ageing.
P087 Pharmacotherapy and prescribing practices for paediatric insomnia
Authors: Bartlett H , Vandeleur M , Griffiths M , Efron D , Maraffa C
Published: December 2024

Background

Paediatric insomnia is common, with prevalence estimate ranging from 2-36%, with up to 86% of patients with neurodevelopmental disability effected. It is associated with lower quality of life and increased risk of poor developmental and health outcomes. Currently there is no pharmacotherapy approved for treatment of insomnia in the paediatric population. This scoping review aims to summarise the current literature available for efficacy, safety and prescribing practices for pharmacological agents used to treat insomnia in the paediatric population.

Methods

Searches were conducted in MEDLINE, Cochrane Database of Systematic Reviews, and Pubmed using terms for antihistamines, alpha-adrenergic agonists, benzodiazepines, chloral hydrate, melatonin and nonbenzodiazepine hypnotics. Studies were limited to those undergone peer review, available online and published in English.

Progress to date

1538 abstracts reviewed for inclusion, grouped and critically appraised according to drug class category.

Antihistamines

4 papers included, 3 demonstrating antihistamines as most common medication prescribed for insomnia.

Benzodiazepines

11 papers included with no randomised controlled trials. 6 papers demonstrating common prescription by General Paediatricians and Psychiatrists, and 3 papers showing improvement in parental perceived sleep quality in patients with neurodevelopmental disability.

Chloral hydrate

No papers meeting inclusion criteria

Clonidine

14 papers, with 7 describing prescribing practices and common usage for insomnia in neurodiverse populations and5 case series showing improved sleep latency and reduced frequency of night waking.

Melatonin and Nonbenzodiazepine hypnotics

Pending review

Intended impact

To identify current prescribing practices and identify areas of further research to guide clinicians in prescribing pharmacotherapy to treat paediatric insomnia.
P088 Screening for Paediatric Sleep Disordered Breathing in Dental Settings: A scoping review
Authors: Baskar R , Silva M , Vandeleur M
Published: December 2024

Introduction

Sleep-disordered breathing (SDB) can have a significant impact on a child’s growth and neurocognitive development. The gold standard for the diagnosis of SDB is an overnight polysomnography (PSG). However, challenges such as the limited availability, accessibility and cost of diagnostic services along with limited parent/caregiver awareness of symptoms can contribute to diagnostic delays. Screening questionnaires offer a simple and cost-effective method to identify at-risk paediatric patients and can guide referrals to sleep specialists. Dental appointments represent an opportunity for screening in the community. This scoping review aims to explore the existing literature on paediatric SDB screening in dental settings and identify knowledge gaps.

Methods

Using a scoping review framework, a comprehensive search was undertaken using Medline, Embase, and PubMed. The search strategy included broad search terms relating to questionnaires, sleep-disordered breathing, dentists and children.

Progress to Date

The scoping review protocol was registered on Open Science forum on 15th April 2024. Of the total eligible 482 peer-reviewed publications included in the original search, 40 studies have been included in the final analysis. The author is currently in the process of data extraction.

Intended Outcome and Impact

The intended outcomes are to identify current screening tools for SDB in dental settings, describe their components, advantages, disadvantages, and pinpoint gaps in the literature.
P089 Mental Health and Health-Related QoL in Central Disorders of Hypersomnolence vs Unexplained Excessive Daytime Sleepiness
Authors: Bild E , Winter S
Published: December 2024

Introduction

Central Disorders of Hypersomnolence (CDH) (Narcolepsy Type 1, Narcolepsy Type 2, and Idiopathic Hypersomnolence) have an essential element of excessive daytime sleepiness (EDS) despite an adequate duration of sleep. CDH significantly impact mental health and health-related quality of life (QoL). However, less is known about the impact of unexplained EDS (i.e., not better explained by CDH, insomnia, or uncontrolled Obstructive Sleep Apnoea (OSA)) on mental health and health-related QoL. The objective of this study was to compare the mental health and QoL of patients diagnosed with CDH vs unexplained EDS.

Methods

Patients referred to a sleep psychology service in a major tertiary hospital from January 2022 to May 2024 for management of CDH or unexplained EDS were included. Exclusion criteria were a referral for insomnia, OSA, or circadian rhythm disorder. Data included were the number of sessions and initial Depression Anxiety Stress Scales (DASS-21), Kessler Psychological Distress Scale (K10), EQ-5D-5L, and Insomnia Severity Index (ISI).

Results

During the assessed period, the service received 31 referrals for EDS (CDH = 19, unexplained EDS = 12). The average number of sleep psychology sessions attended was 4 (range = 0-12). Although the sample was too small to achieve adequate power for analysis, patients with unexplained EDS trended towards higher scores across all mental health and health-related QoL measures than patients with a CDH diagnosis.

Discussion

This study highlights the importance of studying patients with unexplained EDS and the benefits they may gain from accessing sleep psychology services.
P092 Māori Sleep Health across the Lifespan: A scoping review of the literature
Authors: Baddock S , Campbell A , Love R , Paine S
Published: December 2024

Introduction

In Aotearoa New Zealand, Māori experience poorer health outcomes than non-Māori and these inequities extend into sleep health. Our aim was to summarise the peer reviewed literature on Māori sleep health to understand the equity gaps to inform policy and future research.

Methods

A broad systematic search of widely used literature databases was conducted using the keywords: “sleep”, “insomnia” “sleep initiation and maintenance disorders” combined with “Māori”; “New Zealand” or “Oceanic Ancestry Group”. Studies providing information on Māori sleep health were reviewed for Māori versus non-Māori results. Sleep outcomes were tabulated against Buysee’s five sleep health dimensions along with variables such as socioeconomic deprivation. Sleep data summaries were presented for each life stage.

Results

Eighty seven articles published between 1982 and 2021 met the inclusion criteria. Data collection measures were mostly self or parental-report utilising rating scales or validated questionnaires. Inequities in sleep health between Māori and non-Māori were identified across all life stages. Adult studies demonstrated inequities over all five sleep health dimensions of sleep duration, efficiency, timing, alertness, and sleep quality. Socio-economic deprivation and unemployment were associated with poorer sleep health outcomes.

Conclusion

Evidence from Aotearoa New Zealand clearly shows that Māori children and adults experience significant inequities in sleep health over all sleep health dimensions with strong links to socioeconomic deprivation.

We conclude that a public health policy for sleep that prioritises Māori and targets long-term, sustainable achievement of sleep health equity goals is required. Future sleep health research should involve Māori at all stages.
P094 How parasomnias challenge different expertise and forensic evidence: The awareness of legal judgment, the development of neuroscience, and the practice of sleep medicine
Authors: Cheong M
Published: December 2024

When coming across parasomnia correlated with murder is whether there is a valid legal defense. There were cases acquitting defendants of murder who claimed just because of sleepwalking. As sleepwalking is an unconscious activity; actus reus and means rea are both requirements in criminal charges and contain voluntary acts. Not all experts agreed with the parasomnia defense because of a lack of convincing history of sleep disorders. Forensic evidence plays a vital role in proving and assisting the crime to support either the prosecution or the defendant and to determine whether the defense can persuade juries. A question arises involving what happens in the brain activity during parasomnia when committing a crime and convincing the crime is automatism and not murder. This research involves, firstly, how sleep works and how the human brain works with and without parasomnia. There are types of sleep-related crime and their application in criminal law. Secondly, how many objective sleep data are needed to convince parasomnia as a legal defense? Thirdly, the significance of exploring both neuroscientists and sleep forensic experts when they are involved in crime solving. The forensic evidence at the crime scene plays a crucial role. Any advanced techniques are required to support the verdicts to prevent any ununiform. How neuroscientists through new technology may identify the brain function when committing a crime. The research brings awareness that will bring to a legal evaluation in the future and better determine the intermediate line between automatism and murder in parasomnia-related violence.
P098 A case of successful adaptation to continual positive air pressure therapy (CPAP) with fixed pressure set at 4cmH2O in a patient with severe obstructive sleep apnea (OSA)
Authors: Giovas L , Rosentengel A , Dalman M
Published: December 2024

Introduction

Noncompliance to continual positive air pressure (CPAP) therapy remains a major concern in the treatment for obstructive sleep apnea (OSA). Case description: 35-year-old female with a body mass index (BMI) 38.2 and Epworth Sleepiness Score (ESS) 8. Presented with snoring, excessive daytime sleepiness (EDS), poor concentration, nocturnal headaches and occasional dizziness. Diagnosed with severe OSA AHI 45.3, REM AHI 54.6, mean awake SpO2 96%, nadir SpO2 86%. Initial trial of automatic positive air pressure (APAP) over two-nights demonstrated usage of 8:08 hours, 95th percentile 11.2cm, AHI 0.4, nadir SpO2 89%. Fixed CPAP at 11cmH2O prescribed.

Method

Due to significant CPAP intolerance (side-effects including: light-headedness, and increased pressure behind the eyes), the treating Sleep Physician individulaised the CPAP therapy prescription prioritizing patient acclimatization in the short-term with a fixed pressure of 4cmH2O. Once acclimatized (usage exceeding >4hours) pressure would be gradually increased to control events. Close clinical follow up with early data download reviewed by Sleep Scientist weekly, with monthly Sleep Physician review.

Results

4 week review: 100% compliance with CPAP 4cmH2O (avg. usage 8.5hours, 1.8/min leak, AHI 0.6). Significant subjective improvement to daytime symptoms reported. 10 month review: 99% compliance with CPAP 4cmH2O (avg.usage 8.5 hours, 0.6L/min leak, AHI 0.7).

Successful adaptation to therapy with efficacious treatment.

Discussion

This case study highlights the importance of acknowledging the individuality of the patient, in this example CPAP pressure, for optimal care. Further analysis with a larger sample size would provide more insight into the future of pressure titration for patients who are reluctant to adhere to CPAP treatment.
P100 Can extending the time between last meal of the day and bedtime improve sleep regularity? A pilot study in Australian adults
Authors: Gupta C , Nordien N , Khalesi S , Vincent G , Coates A , Shah M , Ferguson S
Published: December 2024

Sleep regularity is important for health and wellbeing. Food intake close to bedtime negatively impacts sleep regularity by lengthening sleep onset and reducing sleep duration. Extending the time between the last meal of the day and bedtime could improve sleep regularity. This pilot study investigated whether extending the time between last meal and sleep onset through time-restricting eating (TRE) impacts sleep regularity. Adults (n=6, 18-38 y, 5 female) completed 2-weeks baseline with usual eating timing followed by 6-weeks of TRE (10-hours between first and last meal, with last meal by 8pm), and a daily sleep diary. The standard deviations of sleep onset and sleep duration were calculated to indicate sleep regularity. Interviews were conducted to understand lived experience of TRE and sleep regularity. A one-way ANOVA revealed differences in time between last meal of the day (p=0.04), with 2.04hours between last meal and sleep onset during baseline and 4.00hours during TRE. There were no significant differences in sleep variables between baseline, 3-weeks TRE, and 6-weeks TRE (onset p=0.54; duration p=0.85). Participants reported positive experiences of TRE on sleep, commenting that TRE is “more consistent…because if I finish eating at a certain time, then I tend to go to bed at a set time.” While there were no significant improvements to sleep regularity after TRE, participants found it easier to have a consistent sleep routine when there was a longer time between eating and sleep. The next step is to build on these findings with objective sleep measures.
P101 An audit of the clinical impact of mandatory urinary drug screening performed as part of Maintenance of Wakefulness and Multiple Sleep Latency Testing’
Authors: Henderson J , Teanau T , Cuesta R , Miller B , Naughton M , Dabscheck E
Published: December 2024

Study Objectives

Multiple sleep latency testing (MSLT) and maintenance of wakefulness testing (MWT) are validated objective assessments of excessive daytime sleepiness. However, both are open to the confounding effects of drugs. This study aims to determine the rates of detection of drugs with known effects of sleep architecture using both immunoassay (IA) and mass spectrometry (MS) urinary drug screens (UDS) during MSLT/MWT testing.

Methods

A retrospective audit was performed on all patients who underwent an MSLT/MWT test at a tertiary hospital sleep laboratory between 2013-2023. Data was collected on the rates of positive IA and MS UDS, disclosure of the drug to their treating physician, demographics, comorbidities, and polysomnographic variables.

Results

162 patients were included in the analysis, 137 MSLT patients and 25 MWT patients. 29/162 (17.9%) and 67/162 (51.3%) of patients had a positive IA-UDS and MS-UDS respectively. These drugs were disclosed in 44% of positive IA-UDS and 68% of MS-UDS positive patients. Patients with a positive IA and MS UDS during MSLT were more likely to have an elevated HADS-A questionnaire result and clinically diagnosed anxiety and depression, history of malignancy (IA-UDS) and chronic pain (MS-UDS). There was no correlation between positive UDS results and any variables in patients undergoing MWT.

Conclusions

There is limited data on the rates of positive UDS routinely performed as part of MSLT/MWT. This has made it difficult to determine the optimal screening method. This study demonstrates that in patients undergoing MSTL/MWT testing, positive IA and MS-UDS are common and frequently not disclosed.
P102 Can EEG spectral analysis distinguish children with narcolepsy from those with idiopathic hypersomnolence and subjective sleepiness?
Authors: Plunkett G , Shetty M , Davey M , Nixon G , Walter L , Horne R
Published: December 2024

Background

EEG spectral analysis provides a measurement of sleep micro-architecture and is a more sensitive measure of sleep disruption than conventional sleep macro-architecture. We aimed to examine the use of this technique in distinguishing children with narcolepsy and idiopathic hypersomnolence (IH) from subjectively sleepy children with a negative multiple sleep latency test.

Methods

Relative power, the absolute power in each frequency band divided by the total absolute power, was calculated for delta power (0.5 Hz–3.9 Hz), theta power (4 Hz–7.9 Hz), alpha power (8 Hz–11.9 Hz), sigma power (12 Hz–13.9 Hz) and beta power (14 Hz–30 Hz). A mean value for each frequency was calculated for each 30 s epoch then averaged for each sleep stage within each child.

Results

28 children with Narcolepsy, 11 with IH and 26 with subjective sleepiness were included and individually matched for age and sex with a control child. In N2, Theta power was higher in the Narcolepsy group (median 13.5%, IQR 11.2-15.5) compared to the subjectively sleepy group (11.1%, 9.0-12.8, p<0.05). During N3, Delta power was higher in the subjectively sleepy group (93.3%, 91.9-93.9 vs 83.3%, 65.8-93.9, p<0.001), and Theta power (4.8%, 4.2-6.3 vs 12.6% 4.8-22.5, p<0.001), Alpha power (0.9%, 0.7-1.3 vs 2.8% 0.9-5.8, p<0.001), and Beta power were lower (0.3% 0.3 -0.4 vs 1.1% 0.3-4.2, p<0.05) compared to their controls.

Conclusions

Differences in sleep micro-architecture could not distinguish between children with narcolepsy and IH but may be able to distinguish children with narcolepsy from subjectively sleepy children.
P105 Positional OSA in children: single-centre prevalence and associated CPAP adherence
Authors: Kevat A , Suresh S , Chawla J , Collaro A
Published: December 2024

Background

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

Methods

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

Results

Of 120 eligible participants (median age = 13 years), 34% were female, 62% were obese, 33% had a syndromic or neurodevelopmental diagnosis and 48% had undergone adenoidectomy +/- tonsillectomy. Depending on POSA definition, 34%-68% (41-73) of the 120 participants had POSA. Two-thirds (64-68%, depending on POSA definition used) of those with POSA had optimal CPAP adherence based on their first CPAP download.

Conclusion

A significant proportion of children with OSA prescribed CPAP at QCH have POSA, some of whom struggle to maintain CPAP adherence. Positional device therapy may represent an appropriate alternative management strategy. However, well-designed prospective trials in children are needed.
P108 Improving continuous positive airway pressure trial compliance in obstructive sleep apnea patients
Authors: Lim W
Published: December 2024

Background

Obstructive sleep apnea (OSA) is highly prevalent in Singapore (20-30%). Patients are enrolled into a CPAP trial after the diagnosis of OSA where they are provided with a CPAP machine for one month. However, CPAP compliance and uptake rates during and after the CPAP trial are often low as it is not well tolerated. As untreated OSA results in persistent daytime sleepiness and major adverse cardiac events in the long term, our aim is to improve CPAP trial compliance in OSA patients, which in turn improves long-term CPAP compliance and uptake rates.

Method

Our team identified factors that led to low CPAP compliance and developed a new practice of contacting patients via phone during their 1st week of CPAP trial to troubleshoot CPAP issues.

Results

Data analysis of CPAP trials was conducted pre- (Year 2020) and post-implementation (Year 2021) of this new practice of follow up calls during the 1st week of CPAP trial. We sampled 30 patients from Year 2020 and 2021 respectively to analyse their CPAP compliance and long-term uptake rates after completion of CPAP trial.

Outcomes achieved are

1. Increased CPAP compliance (overall % of days with >4hours CPAP use) during CPAP trial.

2. Increased long-term CPAP uptake after completion of CPAP trial (46.7% in 2020 vs 86.7% in 2021).

3. Improved patient satisfaction

Discussion

Addressing CPAP issues early on during the CPAP trial significantly improved long-term CPAP compliance and uptake rates, which will improve quality of life and long-term cardiovascular health.
P112 Auto-titrating positive airway pressure in paediatric patients with obstructive sleep apnoea
Authors: Pham A , Adams A , Vandeleur M , Griffiths M
Published: December 2024

Background

Continuous positive airway pressure (CPAP) is the gold standard for treating obstructive sleep apnoea (OSA) in children. Standard practice involves in-laboratory titration polysomnography to determine the optimal treatment pressure for CPAP. Auto-titrating positive-airway-pressure (APAP) devices can automate this process. However, its use in children is not well studied.

Methods

Children receiving CPAP therapy for OSA were invited to participate in this study. They made two visits to the sleep laboratory within 4 weeks; the first was for CPAP titration, and the second was for unattended APAP titration. Parents/caretakers of participants completed the OSA-18 questionnaire during the second visit. Participant demographic and medical information was recorded. Optimal treatment pressures and polysomnography data from both visits were compared.

Progress to date

2 children completed the pilot study; female (9 years) and male (15 years). Comparison by the sleep physician determined optimum CPAP pressure on the manual titration and APAP unattended titration being identical in the first case and 2cmH20 higher on the manual titration in the 2nd case. Recruitment and data analysis is ongoing.

Intended Outcome and Impact

Optimisation of treatment for paediatric OSA may become more accessible if it is found that APAP titration (unattended) is just as effective as CPAP titration (in-laboratory). Patient parameters identifying appropriate patients for APAP titration may also be determined from OSA-18 responses and medical history.
P113 Prevalence of Periodic Limb Movements During Sleep in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Analysis
Authors: Pillay L , Altree T , Fon A , Mercer J
Published: December 2024

Introduction

This study aims to determine the prevalence of periodic limb movements during sleep (PLMS) in individuals with chronic obstructive pulmonary disease (COPD) by analysing polysomnography (PSG) data from The Queen Elizabeth Hospital (TQEH) over the past five years. Secondary endpoints include the rate of PLMS stratified by the severity of obstructive sleep apnoea (OSA) and COPD.

Background

Periodic limb movements of sleep (PLMS) are repetitive limb movements during sleep, often linked with fragmented sleep and excessive daytime sleepiness. PLMS are common in various medical conditions and increase with age. COPD patients often suffer from disturbed sleep, exacerbated by comorbid sleep disorders like OSA and restless legs syndrome (RLS). Despite the known poor-quality sleep in COPD, the prevalence of PLMS in this population remains unexplored.

Methods

This retrospective observational study includes PSG data from COPD patients who underwent diagnostic PSG at TQEH between March 2019 and March 2024. We will analyse data from approximately 200 PSG reports. Inclusion criteria are adults (≥18 years) with COPD, defined as a post-bronchodilator FEV1/FVC ratio < 0.70. Participants with significant post-bronchodilator response or inadequate medical records will be excluded. Data will be collected retrospectively and de-identified to ensure confidentiality.

Progress to Date

We are currently awaiting ethics approval to commence data collection.

Intended outcome and impact

This study will provide insights into the prevalence of PLMS in COPD patients and its correlation with the severity of OSA and COPD. The findings could inform clinical management and improve the quality of life for COPD patients experiencing sleep disturbances.
P114 Influence of sleeping position on frequency of awakenings and arousals
Authors: Rayward L , Ho S , Green D , Little P
Published: December 2024

Introduction

Little is known about the physiological and biomechanical factors that determine individual preferences in lying posture during sleep. This study investigated relationships between position preference and position specific arousals and awakenings to explore mechanisms by which biomechanical factors influence position preference.

Methods

41 healthy mature aged adults (Age: 61.6 ± 5.9 years) including 25 females and 16 males, underwent two nights of home polysomnography ~2 weeks apart, on a standardised firm foam mattress, measuring sleep architecture and position. Lateral-supine ratio (LSR) was calculated for each night of sleep as:

LSR=(Duration Lateral)/(Duration Supine+Duration Lateral)*100

Restlessness measures specific to lateral and supine positions including arousal frequency, and wake frequency were calculated and analysed for relationship with LSR via linear mixed effects regression.

Results

Wake frequency was greater in supine with greater inter-subject standard deviation (mean ± standard deviation: 4.80 ± 3.87 wakes/hr), in comparison to lateral (2.31 ± 1.05 wakes/hr). There was strong statistically significant correlation between LSR and wake frequency in supine (β = 1.9, p = 0.0013), while effect of LSR on wake frequency in lateral was weaker and not statistically significant (β = -1.1, p = 0.60). Strong significant correlation between LSR on night 1 and LSR on night 2 (β = 0.95, p < 0.001) was found indicating strong consistency in sleep preference.

Discussion

The findings suggest that some individuals have low tolerance to supine posture, represented by a comparatively high wake frequency in supine. These individuals compensate for high wake frequency in supine by sleeping a greater proportion in lateral.
P115 Towards the Perfect Mattress: influence of age on soft tissue pressure
Authors: Rayward L , Kerr G , Pearcy M , Little P
Published: December 2024

Introduction

Little is known about the relationship between mattress mechanics and sleep comfort in healthy people. Excessively firm mattresses increase arousal frequency, suggesting that control of soft tissue pressures and spinal distortion plays a role in improving sleep quality.

Methods

This study presents findings from a parametric finite element (FE) analysis to investigate influence of age, anthropometry, mattress stiffness and mattress technology on soft tissue pressure in the pelvis area during supine lying. A subject-specific multi-geometry 3D FE model was developed from a healthy 19-year-old male providing the basis for the parameterization of body size and age (20, 50 and 80 years old) by estimating increase in intramuscular adipose tissue (IMAT) to reflect stiffening of muscle tissue. Mattress stiffness (soft and firm) and technology (foam and spring) were also tested. Non-linear mechanical behaviour of foam was derived from compression testing, and comparable spring mattress properties were derived as linear elastic. FEM predicted soft tissue pressures and mattress deformation were analysed for relationship with age, anthropometry, mattress firmness and mattress technology via linear regression modelling.

Results

Soft tissue pressure increased with age (β = 0.1 kPa/year, p = 0.0047). In comparison to springs, foams were effective at reducing soft tissue pressure, with the magnitude of this effect increasing with age (age 20: -22.4%, age 50: -33.4%, age 80: -35.7%).

Conclusions

Increased soft tissue pressure may contribute to elevated awakening and arousal frequencies in older populations. Further research should investigate influence of customised non-linear mattress characteristics on overall sleep quality.