bluuebunny/crossref_metadata_2025 huggingface dataset:
P001 Role of Stress Management on Perceived COVID-19 Health Risk Associated with Sleep (Quantity and Quality) of Undergraduate Business Students
Authors: Abbas A , Martín-Núñez J , Ar A , Dalat Ward Y , Rincón G
Published: November 2022

Introduction

Since the COVID-19 pandemic began in 2020, it has significantly caused disruptions in various aspects of daily life. In particular, students have been negatively affected by these changes due to unexpected alterations in educational modalities. Stress management can help students to adapt new normality easier and monitor their daily activities, which can reduce their COVID-19 risk while improving sleep quality for better health and academic performance.

Methods

For this pilot study, a Google form–based survey was distributed among 87 volunteer undergraduate business students from Tecnologico de Monterrey, Mexico. The survey was distributed during May 2021. The designed survey contains questionnaires related to perceived COVID-19 health risk, stress management, and sleep (quality and quantity). To test the mediating effects of stress management, we applied a mediation test using the “medmod” plugin of the Jamovi software.

Results

Analyzed results of the path estimate show that perceived health risk has a significant association with stress management (Estimate=.418, Z=5.58, p<.001), and stress management has a significant association with sleep (Estimate=.618, Z=5.18, p<.001). The value of mediation estimates calculated as =.618, Z=5.63, p<.001, 95% confidence intervals (LLCI=0.403 – ULCI=0.833). The analysis confirms that stress management mediates perceived COVID-19 health risk and sleep (quantity and quality) of undergraduate students.

Conclusion

Based on the analyzed results of this pilot study, we conclude that stress management helps undergraduate students to accept and adopt new norms, cope with daily COVID-19 challenges, take greater preventive measures to decrease COVID-19 health risks, and improve the quantity and quality of sleep.
P004 Addition of an oral expiratory positive pressure valve (EPAP) to an oral appliance therapy device can resolve obstructive sleep aponea (OSA)
Authors: Aishah A , Osman A , Tong B , Pitcher G , Eckert D , Mukherjee S
Published: November 2022

Background

Mandibular advancement splints (MAS) provide effective therapy for many people with OSA. However, in ~50% of cases, MAS alone does not fully resolve OSA. A single-night study showed that ~45% of people with incompletely treated OSA with MAS alone had resolution (apnoea-hypopnea index [AHI]<10 events/h) with the addition of an oral expiratory positive airway pressure (EPAP) valve. This study aimed to determine the safety, tolerability, and longer-term efficacy of oral EPAP valve plus MAS in incomplete responders to MAS alone.

Methods

Seven people with OSA (AHI=26±13events/h) not fully resolved with MAS alone (AHI>10events/h) were recruited. In-laboratory polysomnography with MAS plus oral EPAP was performed on night 1. Participants then used MAS+EPAP at home for 30-days and completed weekly questionnaires to assess safety, tolerability, and next-morning sleepiness (Karolinska sleepiness scale, KSS). Impact on daytime sleepiness (Epworth sleepiness scale, ESS) was assessed at night 1 and 30. A final at-home WatchPAT study was performed at night 30.

Results

OSA was successfully treated (AHI<10events/h) in 4/7 participants during the night 1 in-laboratory study (MAS alone vs. MAS+

EPAP

13±2 vs. 7±2events/h). Five had treatment success by night 30 (6±3events/h). Daytime sleepiness (ESS) did not change after 30 days of MAS+EPAP although next-morning sleepiness tended to reduce (

KSS

4.4±1.9 vs. 3.3±1.5, p=0.047 n=7). Oral EPAP was generally well-tolerated with no major side effects reported.

Discussion

Oral EPAP may be an effective treatment addition for some people with OSA who have an incomplete therapeutic response to MAS alone.
P007 CPAP implementation and its outcomes among Indigenous adult patients with OSA in the Top End Northern Territory of Australia
Authors: Al-Dossary B , Howarth T , Heraganahally S
Published: November 2022

Introduction/Aim

Obstructive sleep apnoea (OSA) is reported to be highly prevalent among Indigenous Australians. However, the studies assessing the outcome of CPAP therapy among this population is sparsely reported. In this study we compared the polysomnographic (PSG) characteristic among Indigenous patients who underwent both diagnostic and continuous positive airway pressure (CPAP) implementation study in the Top End Northern Territory of Australia.

Methods

All adult Indigenous patients identified to have undergone both a diagnostic polysomnography followed by an in-lab CPAP implementation study were included.

Results

145 patients (44% female) were included with a median age 49 years, and median BMI of 35 kg/m2. The OSA severity was - 5% mild, 26% moderate & 68% severe on the diagnostic sleep study. On application of CPAP the Total Arousal Index (diagnostic 28 to 16/hour on CPAP), Total Apnea Hypopnea Index (AHI) (diagnostic 48 to 8/hour on CPAP), Non-rapid eye movement (NREM) AHI (diagnostic 46 to 8/hour on CPAP), Rapid eye movement (REM) AHI (diagnostic 56 to 8/hour on CPAP) and SpO2 (diagnostic 93% to 95 % on CPAP) significantly improved.

Conclusion

This study demonstrates that there is significant improvement in arousal Index, reduction in AHI both during NREM and REM sleep along with improvement in overall oxygen saturation upon application of CPAP among Indigenous patients with OSA. Hence, long term CPAP therapy should be offered/considered among Indigenous patients diagnosed to have OSA when clinically appropriate.

Grant Support

Nil to declare and no funding received for this study
P011 Preschoolers’ Engagement with Screens: Time of Day and Associations with Sleep and Cognitive Development
Authors: Axelsson E , Paech G , Metse A
Published: November 2022

Screen time is associated with poorer sleep in children, but there are calls for more evidence in the preschool years – a period of rapid cognitive and language development which are both influenced by sleep. The aim was to investigate preschool children’s length of exposure to screen media and associations with sleep duration and sleep quality, but also screen content and times of day children engaged with screens. Associations with cognitive development were also assessed. The study was conducted with an online questionnaire completed by caregivers recruited via social media. Most children engaged with content of an entertaining nature. Half of the children engaged with screens during the day only and half both during the day and at night. Longer time engaged with screens was associated with shorter sleep duration and poorer sleep quality and this was regardless of time of day of engagement. Greater screen time also predicted lower communication and problem solving scores, and more attention difficulties, but sleep duration was not a significant predictor of cognitive outcomes. The findings indicate that preschoolers’ engagement with screens has implications for their sleep even when engagement is predominantly occurring during the day. Greater screen time also has implications for cognitive development during a sensitive period. The findings raise questions about the time children spend on screens even during the day that could be spent on activities that better support sleep and development. Future studies with objective measures of sleep and direct measures of cognition with preschoolers are needed.
P013 Continuous Positive Airways Pressure (CPAP) Adherence in Remote Patients using Telemedicine Model of Care
Authors: Banks J , Parker J , Samaratunga D
Published: November 2022

Background

CPAP is an established first-line treatment for moderate-to-severe OSA. Adherence is universally low and is predicted by short-term adherence. Moderate-to-severe OSA is strongly associated with adverse cardiovascular outcomes. Evidence of CPAP benefit is limited to underpowered subgroups with arbitrarily defined "good adherence".

Covid-19 has generated widespread acceptance and uptake of telemedicine. This study aims to determine if CPAP adherence is affected when health service is provided by telemedicine rather than in-person.

Methods

Single-centre, retrospective, cohort study of moderate-to-severe OSA patients identified between 1/6/21 and 30/6/22. Medical records were reviewed for residential address, referral pathway (face-to-face or telemedicine), age, gender, BMI, ESS, AHI and AI. Short-term adherence was determined from CPAP downloads.

Progress to date

368 patients were identified, 40% had moderate-to-severe OSA. 31.5% were reviewed by telemedicine (64% remote, 36% local). Compared to in-person, remote telemedicine cohort was similar age (age ≥ 50, 64.9% vs 53.2%, p= 0.075) but more likely male (66.2% vs 50%, p= 0.014). ESS (9.7 ± 1.4 vs 9.1 ± 0.7, p= 0.38), BMI (36.1 ± 2.5 vs 33.5 ± 1.3, p= 0.08), AHI (27.5 ± 7.5 vs 21.7 ± 3.4, p= 0.12) and presence of moderate-to-severe OSA (48.6% vs 42.5%, p= 0.35) were similar. Patient subgroups including local, remote, telemedicine and face-to-face reviews were analysed. Adherence data is pending.

Intended outcome and impact

Pilot telemedicine programs (e.g. TeleSleep) are developing services designed to provide accessible and efficient care to remote patients. $800 per patient, environmental and transport savings can be anticipated.
P024 Defining sleep hygiene: A scoping review of intervention studies
Authors: El Kazzi M , De Pasquale C , Vincent G , Shriane A , Bin Y
Published: November 2022

Background

Inadequate sleep is common in the community. For those with subclinical sleep problems there are few interventions for improving their sleep. Sleep hygiene advice has received interest as a possible intervention, however, studies using sleep hygiene as an intervention have been inconclusive. A possible explanation is the inconsistency in sleep hygiene advice in these studies. This scoping review aimed to systematically review studies which used sleep hygiene as an intervention to clarify what individual components comprise “sleep hygiene”.

Methods

Search of 4 databases (EMBASE, MEDLINE, CINAHL, PsychINFO) revealed 298 intervention studies. Information pertaining to the use of sleep hygiene as an intervention was extracted.

Results

49% of papers defined sleep hygiene. 66% of papers used sleep hygiene as an active intervention while 34% used it as a control intervention. Sleep hygiene advice included caffeine (mentioned in 36% of papers), alcohol (31%), exercise (31%), food intake (29%), sleep time regularity (26%), light (25%), napping (23%), noise (22%), nicotine (18%), bed restriction (18%), stimulus control (18%), room temperature control (18%), stress (15%), and wind down routine (11%). The specific advice provided about each behaviour varied between studies. Advice also varied depending on the methodology used. Papers using cognitive behavioural therapy for insomnia were more likely to include advice about stimulus control and bed restriction and less likely to include advice about light, noise, and room temperature.

Conclusion

Research incorporating sleep hygiene as an intervention provide different sets of advice hence reducing study replicability. Consensus on what constitutes sleep hygiene is required.
P026 Feasibility and acceptability of a novel approach to sleep disorder screening and management for prospective shift workers
Authors: Brown B , Adams R , Wanstall S , Crowther M , Rawson G , Vakulin A , Lechat B , Rayner T , Eastwood P , Reynolds A
Published: November 2022

Introduction

Sleep disorders negatively impact health and occupational safety. Individuals commencing shift work with an undiagnosed sleep disorder may be at an increased risk of negative health and safety outcomes due to the addition of sleep schedule interruption associated with shift work. The aim of this study was to assess the feasibility and acceptability of screening for, and treating, sleep disorders in pre-service shift workers.

Methods

Paramedic students were invited to participate in an intervention comprising of sleep disorder screening (obstructive sleep apnoea, insomnia, restless legs syndrome) and 15 weeks of non-invasive sleep monitoring (Withings Sleep Analyser) with regular follow-up (3, 6, and 12 weeks). Those at risk of a sleep disorder were contacted by the study physician and offered treatment pathways for their identified disorder (primary care or sleep specialist). Feasibility and acceptability will be assessed by a) reaching recruitment targets, b) participation rates, and c) qualitative interviews at 6 and 12 weeks.

Results

Thirty participants are currently active in the trial with 63% female and an average age of 23 years. Seventeen participants (57%) met criteria for a sleep disorder based on baseline data and treatment pathways were initiated in July 2022 with a planned completion date of October 2022.

Discussion

Participation rates, sleep parameters (collected through the sleep monitoring device), objective and subjective sleep disorder severity, and qualitative findings about feasibility and accessibility will be presented. Findings from this study will provide insight into barriers associated with accessing treatment for sleep disorders within pre-service shift workers.
P027 Predictors of CPAP failure in severe obstructive sleep apnoea and obesity hypoventilation syndrome patients
Authors: Chen K , Laks L , Cossa G , Brillante R
Published: November 2022

There are mixed findings regarding predictors of failing continuous positive airway pressure in the obstructive sleep apnoea and obesity hypoventilation population, with duration of time under 90% oxygen saturation independently associated with treatment failure. Our study examined predictors of CPAP failure in severe OSA and OHS patients using baseline characteristics, diagnostic polysomnography, arterial blood gases and TcCO2 oximetry data.

An observational review of patients in an accredited sleep laboratory from 2016 to 2021 was performed. Patients with treatment studies demonstrating CPAP failure were compared to patients controlled on CPAP therapy via pressure determination study. Independent t-test compared group characteristics and multivariate logistic regression was performed to assess predictors of CPAP failure. Data is presented as mean unless otherwise stated.

Twenty patients who required bilevel support ventilation were compared to thirty-five patients controlled by CPAP. Total sleep time (266vs328minutes, p=0.007) and sleep efficiency (62% vs 75%, p=0.028) was lower in the BSV group. Patients who failed CPAP spent a greater percentage of T<88% on their diagnostic study (T<88%, 46.4%vs9.66%, p=0.001). Percentage of T<88% oxygen saturations were significant in being able to predict CPAP failure (p<0.001) using a model including arterial blood gas PaCO2 and TcCO2 data. TcCO2, blood gases and baseline demographic data were not significant in determining CPAP failure.

Our study strengthens the duration of time spent hypoxic or T<88% as a significant predictor of CPAP failure.

Surprisingly, TcCO2 data and paired arterial blood gas data was not able to predict who would require bilevel ventilation in our cohort.
P028 Sensory Sensitivity, Anxiety and Hyperactivity are Related to Different Parent-Reported Sleep Problems in Children with Autism Spectrum Disorder
Authors: Matassoni E , Conduit R
Published: November 2022

INTRODUCTION

This study aimed to understand how ASD symptoms may relate to different sleep problems.

METHODS

128 parents of children with ASD aged 4-14 participated in an anonymous survey. Parents completed the Short Sensory Profile (SSP), Children Sleep Habits Questionnaire (CSHQ), Strengths and Weaknesses of Attention-Deficit/Hyperactivity-symptoms and Normal-behaviours (SWAN) and Revised Child Anxiety and Depression Scale (RCADS). It was hypothesised that: 1) hyper-sensitivity indicated by the SSP, would be positively correlated with night waking from the CSHQ; 2) children at risk of Delayed Sleep Phase Syndrome (DSPS), indicated by the CSHQ, would be more light sensitive as indicated by the SSP; 3) anxiety measured by the RCADS would be positively correlated with longer Sleep Onset Latency (SOL) from the CSHQ; and 4) hyperactivity and inattentiveness from the SWAN would be positively correlated with SOL and parasomnias from the CSHQ.

RESULTS

Results revealed: 1) under-responsivity and low energy from the SSP were correlated with night waking (r = -.31 and r = .36, p < .05). 2) children at risk of DSPS demonstrated greater light sensitivity than those not at risk (t (55) = 2.83, p < .01); 3) Anxiety was not correlated with SOL; 4) Hyperactivity and inattention were related to longer SOL (r = .25 and r = .61, p < .05) and hyperactivity was correlated with parasomnias (r = .29, p < .05).

DISCUSSION

These findings suggest that different sleep problems may relate to different ASD symptomology, and that symptom-based approaches should be considered for future research.
P031 Comparison of Level three sleep study against Level two studies in the diagnosis of OSA among Indigenous patients at the Top End Northern Territory of Australia
Authors: Crespo J , Howarth T , Heraganahally S
Published: November 2022

Introduction/Aim

Level three sleep studies are performed on portable devices which provide information on 3 channels. Some studies have reported that the accuracy of level 3 studies could be as accurate as polysomnography in a sub-set of population in the diagnosis of OSA. However, there is limited information in the literature regarding the effectivity of level 3 study in comparison to level 1 or level 2 study among Indigenous patients.

Methods

Patients included in this study were adult Indigenous patients identified to have undergone both level 2 and level 3 sleep study. We assessed the accuracy of diagnosing the presence of OSA as per AHI

Results

There were 12 indigenous patients identified to have undergone both level 2 and level 3 study. Four out of the 12 level 2 sleep studies failed due to sensor dropouts. Excluding patients with failed studies, 4 out of the 8 patients showed a higher AHI on their level 2 sleep study compared to level 3 study. Six patients had the same severity of OSA identified on both Level 2 and Level 3 studies.

Conclusion

This study shows mixed results in the efficacy of Level 3 studies compared to Level 2 studies, though failure rates may be lower on Level 3 studies. A larger sample size is required to further elaborate on the validity and efficacy of Level 3 studies in the diagnosis of OSA among indigenous Australian population.

Grant Support

Nil to declare and no funding received for this study
P035 Understanding cosleeping arrangements, motivations and satisfaction with sleep location in cosleeping mothers
Authors: D'Souza L , Morris Z , Borgkvist A , Blunden S
Published: November 2022

Introduction

Nighttime infant care practices differ across the globe. In western cultures, where independent solitary sleep is the norm, there is an expectation that parental presence at bedtime is minimized in favour of teaching children independent sleep initiation, maintenance, and resumption skills. In non-western cultures, parental presence at bedtime and overnight is the accepted norm. Despite and against current safe-sleep recommendations, rates of co-sleeping and bed-sharing are increasing in western countries. The purpose of this study was to understand motivations and satisfaction with mother’s choice to engage in co-sleeping.

Methods

Using an internet-based survey, this cross-sectional study aimed to understand mothers’ (n=3298) motivations to engage in co-sleeping (includes room-sharing and bed-sharing), and the satisfaction with their sleep arrangements.

Results

Quantitative analysis reported on the variability in co-sleeping arrangements, intentions, preference and satisfaction with the child (under 12 years) current sleep location.

Qualitative analysis reported on parent’s motivation to engage in cosleeping and reasons for dissatisfaction with the sleeping arrangement.

Discussion and Conclusion

The results of the study overwhelmingly highlights the need for education and information for parents who want to engage in overnight proximal sleeping arrangements with their children. The study lends support to adopt risk minimization approach when providing safe sleep related information to parents. Findings will help inform clinical delivery of culturally appropriate and safe practices to ensure safe sleeping, and enable parents to make informed choices in relation to their children sleep location.
P037 Differences in endotypes in people with multiple sclerosis in those with versus without OSA
Authors: Sloane J , Djonlagic I , Chiang A , Hensen H , Eckert D
Published: November 2022

Background

Obstructive sleep apnoea (OSA) is as common if not more common in people with multiple sclerosis (MS) versus the general population. However, in contrast to the typical OSA risk factors in the general population, MS is far more common in women versus men, many of whom are not obese. Thus, while some people with MS likely get OSA via the same mechanisms as the general population (i.e., anatomical compromise), others may develop OSA due to specific MS-related consequences (e.g., CNS lesions that effect respiratory or upper airway neuromuscular control- i.e. via non-anatomical mechanisms). Accordingly, we investigated if the key OSA endotypes that contribute to OSA differ in people with MS in those with versus without OSA.

Methods

Nine people with MS with moderate-severe OSA (AHI=41±22events/h) and seven people with MS without moderate-severe OSA (AHI=9±3events/h) completed in-home level 2 sleep studies (n=11 Boston, n=5 Sydney). OSA endotypes were estimated using validated algorithms from the staged sleep study airflow signals and compared between those with versus without moderate-severe OSA.

Results

Respiratory control instability (loop gain) was significantly higher in people with OSA versus without (0.62±0.2 vs. 0.45±1, p=0.04). Upper airway collapsibility was also higher in OSA participants (Vpassive at the lowest decile= 53±13 vs. 74±6 %eupnea, p<0.01). Other OSA endotypes were not systematically different between groups.

Discussion

These findings suggest that while some people with MS likely get OSA via primary anatomically driven mechanisms, in others, OSA may be largely driven via non-anatomical mechanisms, potentially related to MS-specific disease consequences.
P038 Sleep disorders, perceived control over sleep and depression in paramedic students
Authors: Evans M , Reynolds A , Brown B , Wanstall S , Crowther M , Rawson G , Vakulin A , Lechat B , Rayner T , Eastwood P , Adams R
Published: November 2022

Introduction

University students are commonly affected by sleeping difficulties and poor mental health, and ~20% of this demographic live with a clinical sleep disorder. This is particularly concerning for students who will progress into careers which will introduce further sleep disturbance via shift work schedules. The aim of the current study was to explore the relationship between sleep disorders and depression in paramedic students, and determine whether perceived control over sleep moderates the relationship.

Methods

Data from fifty-three Flinders University Paramedic students was included, consisting of sleep disorder screening (obstructive sleep apnea, insomnia and restless legs syndrome), and mental health (Patient Health Questionnaire-9) questionnaires. PHQ-9 scores ranged from 0 to 27, with higher scores indicating more severe depression. Regression analysis adjusted for age and sex at birth were conducted using SPSS version 27.

Results

Meeting criteria for a sleep disorder (n=21, 38.2%) was associated with higher depression scores (mean+standard error) in paramedic students (for sleep disorders vs no sleep disorders, 11.4±0.9 v 4.3±0.8, F₁,₅₂=33.5, p <.001). High perceived control over sleep was associated with lower depression scores than low perceived control 5.3±0.9 vs 9.6±1.1, F₁,₅₂=9.0 p = .004) but no moderating effect was observed (p = 0.17).

Discussion

Sleep disorders and low perceived control over sleep are independently associated with higher depression scores. Investigation and management of factors contributing to low perceived control over sleep, together with early screening and management of sleep disorders are important priorities to support paramedic student sleep and mental health prior to commencing shift work.
P039 A novel mean disease alleviation outcome measure in the management of adult obstructive sleep apnoea
Authors: Every J , Sideris A , Do T , Jones A , Weaver E , Mackay S
Published: November 2022

Introduction

Current methods assessing device and surgical treatment efficacy for OSA, such as apnoea hypopnea index (AHI), do not factor in compliance. Clinical effectiveness may be better represented when long-term compliance is incorporated into a mean disease alleviation score (MDA). Here, MDA scores between surgery and device are compared in a high-volume adult OSA clinic.

Methods

Three hundred and forty-five patients seen over a 13-year period in a high-volume adult OSA clinic staffed by an experienced sleep-trained otolaryngologist and sleep physician were included. Patients were managed with device (Continuous Positive Airway Pressure (CPAP), Mandibular Advancement Splint (MAS) or underwent multilevel airway surgery. Mean disease alleviation was calculated as the product of therapeutic efficacy (change in AHI) and adjusted compliance. Surgical compliance was assumed as one hundred percent. Cardinality matching was utilised to account for differences in patient and disease factors between subgroups.

Results

Surgically treated patients demonstrated higher MDA than device users (67.3 ± 29.9% vs. 59.4 ± 31.1%, p=0.039), despite higher therapeutic efficacy seen in device users (85.0±24.4% vs. 67.0±29.9%, p<0.001). Surgical patients were younger, had lower comorbidity scores, lower BMI, and suffered worse daytime sleepiness than device users. Cardinality matching for these factors demonstrated similar mean MDA between groups (66% vs 58%, p=0.11). Device users had to utilise >8hrs per night of compliant use to reach a similar MDA to matched surgical patients.

Discussion

In Adult OSA patients with less-than-ideal CPAP compliance, multilevel airway surgery is an equivalent and effective alternative, based on novel MDA measures.
P041 Poor Sleep and Mental Health Issues Among First Nations Peoples
Authors: Fernandez D , McDaid L , Tran N , Jabran D , King S , Fatima Y
Published: November 2022

To evaluate the evidence on sleep and mental health issues in First Nations peoples.

A systematic literature search was conducted covering academic and grey literature databases for studies with quantitative data on sleep and mental health association in First Nations Peoples published until November 2021.

The National Institutes of Health Quality Assessment Tool was used for quality assessment, and the Aboriginal and Torres Strait Islander Quality Appraisal Tool helped assess cultural appropriate conduct of research.

Seven studies (6 cross-sectional and 1 longitudinal) among three First Nations groups (n=3075) were included. In Indigenous Australian children, arousal problems increased aggression, and withdrawn behaviour, while early bedtime protected against behavioural problems (OR: 0.48, 95% CI: 0.28 -0.82). In Native American youth, insomnia symptoms increased depressive symptoms (OR: 4.87, 95% CI: 2.4 to 9.89), while in adults, short sleep increased the risk of anxiety (16%) and affective disorders (16%). Clinical sleep issues, restless leg (OR: 1.82; 95% CI: 0.53 to 3.12), insomnia (OR: 4.49; 95% CI: 3.14 to 5.83), and apnoea (OR: 2.46; 95%CI: 0.47 to 4.46) were associated with depression. Similarly, in Ameridian/Mestizo adults, restless leg syndrome increased the risk of depression (OR: 4.5, 95% CI: 2.2 to 9.7) and anxiety (OR: 3.6, 95% CI: 1.7 to 7.7). Majority of the studies scored high in quality assessment but the lack of information limited adequately assessing cultural appropriateness.

There is limited but strong evidence suggesting a strong role of poor sleep in mental health issues in First Nations peoples which compels investment in sleep health.
P043 Subjective sleep quality and impact of noise in a hospital respiratory ward
Authors: Gibney M , O'Driscoll D , Ogeil R , Young A
Published: November 2022

Background/Aim

Sleep is a restorative process that is vital for maintaining health. Hospital inpatients are at risk of poor sleep, with noise frequently reported as a major disruptor of sleep. This study sought to identify specific sources of noise disrupting sleep in respiratory inpatients.

Methods

Cross-sectional data were collected from respiratory ward inpatients at time of discharge through medical record review and completion of a questionnaire exploring sleep quality and factors disrupting sleep.

Results

Data includes 24 participants to date – recruitment continues. The median age was 63 years, thirteen participants (54%) were male and 12 (50%) slept in a shared room. The median number of comorbidities was seven and the most frequent admission diagnosis was COPD (29%). Sixteen patients (67%) rated sleep quality as fair to very poor, and 16 patients (67%) reported poorer sleep compared to home. Noise (10 patients – 42%) and acute medical issues (10 patients – 42%) were most frequently reported as more than a little disruptive to sleep. Seven patients in shared rooms (58%) reported noise as more than a little disruptive to sleep, compared with four patients in single rooms (25%). Environmental noise (e.g. doors banging, overhead speakers) was the most frequently reported source of noise disrupting sleep (7 patients – 29%), followed by other patients (4 patients – 17%).

Conclusion

Most patients described their sleep in hospital as worse than at home. Noise and acute medical issues disrupted sleep most frequently, with environmental noise and other patients the most frequent noise sources.
P047 Rehabilitation-led management of sleep disordered breathing: adapting a model of care for a rehabilitation centre in Australia
Authors: Graco M , Weber G , Joffe D , Saravanan K , Heriseanu R , Whitehead N , Alava-Bravo K , DelaCruz C , Sood S , Curran J , Kaumaitotoya E , Pryor J , Ross J , Chai-Coetzer C , Berlowitz D
Published: November 2022

Introduction

Sleep disordered breathing (SDB) is highly prevalent in tetraplegia, yet most remain undiagnosed and untreated for the disorder. We have described the care models of three international SCI rehabilitation centres that are independently diagnosing and treating SDB, and distilled their common pathways into the SCISTAR (SCI Sleep disordered breathing Treatment & Assessment in Rehabilitation) model.

The aim of this project was to adapt the SCISTAR model to suit the Royal Rehab Spinal Injuries Unit, and to prepare for the implementation of this new model of care.

Methods

A clinical advisory group, consisting of researchers, rehabilitation and respiratory health professionals, met six times over eight months to: • identify the multidisciplinary SDB clinical team,

• adapt the SCISTAR model,

• develop parameters for safe clinical practice,

• identify education needs,

• identify and acquire the necessary equipment.

Results

The SDB clinical team consists of two rehabilitation consultants, two physiotherapists and four nurses. All patients with SCI will be assessed for SDB following admission. Assessments will include symptoms, spirometry and sniff nasal inspiratory pressure, and a Level 3 overnight sleep study (ResMed ApneaLink). Patients diagnosed with un-complicated SDB will be prescribed CPAP, which will be initiated and progressed on the ward. Screening for hypoventilation and predominant central sleep apnoea will occur throughout the pathway and if identified, patients will be referred to a specialist respiratory service. Comprehensive education and equipment has been provided.

Conclusions

The new care model is currently being piloted for 12 months. A comprehensive evaluation has been developed.
P049 Barriers and facilitators to the delivery of insomnia management by general practice nurses: a qualitative analysis of patient perspectives
Authors: Grivell N , Hoon E , Chai-Coetzer C , Fuller J , McEvoy R
Published: November 2022

Introduction

With insufficient providers of insomnia care, alternative approaches to the delivery of insomnia treatments are being explored. Research has demonstrated that insomnia can be successfully managed by primary care nurses but patient attitudes towards this care are largely unknown. This study explored patient perspectives towards barriers and facilitators to practice nurse-delivered care to inform the development of patient-centred models of care for insomnia.

Methods

A qualitative sub-study within a process evaluation of sleep health care delivered in a pilot study in one general practice in metropolitan Adelaide. Semi-structured telephone interviews were conducted with patients with insomnia offered nurse-delivered or nurse-supported insomnia management. Thematic Analysis was used to identify themes within the data.

Results

Eleven patients participated (6 males; age mean [range] 59 years [29-72]; time at practice 14.3 years [4-21]; Sleep Condition Indicator 9.5 [3-14]). Two major themes were identified: 1. Patients are supportive of nurses providing care for uncomplicated insomnia; 2. Trust in practice nurse-delivered insomnia care is influenced by relationships with the GP, the practice, and the nurse. Participants reported confidence in practice nurses providing insomnia management provided that they had sufficient knowledge. Established relationships with the GP and the practice, along with previous appointments with the nurse, increased patient confidence in nurse-delivered insomnia care.

Discussion

Patient acceptance of practice nurse-delivered insomnia care supports further research into developing a role for practice nurses within insomnia management. The findings of this work will be tested and explored further within a large implementation study conducted in multiple general practices.
P051 Evaluating sleep stage concordance of CardioRespiratary Sleep Staging (CReSS) on level III portable sleep study via simultaneous deployment of polysomnograph and level III portable sleep study
Authors: Hassinger D
Published: November 2022

Background

Polysomnograph (PSG) has traditionally been the gold-standard for evaluation of sleep disorders; however, it is complex and costly. Alternatives to PSG have been available for some time with aim to simplify the process. One challenge of home sleep testing has been the ability to stage sleep. The conventional type 2 device does provide limited electroencephalogram (EEG) but is restricted by quality and efficiency. Use of photoplethysmography (PPG) to stage sleep has been validated in 2017. There is limited research for evaluating sleep stage concordance using simultaneous deployment of laboratory EEG and PPG.

Aims

To evaluate a commercially available, proprietary algorithm (CReSS) which utilises PPG based sleep staging in comparison with laboratory PSG EEG for sleep stage concordance when data is acquired simultaneously and processed in parallel post acquisition

Results

Confusion matrix analysis demonstrates an accuracy of 80% across all staging. Upon further analysis, precision and recall for wake, light sleep, deep sleep and REM sleep was 82% and 78%, 77% and 90%, 96% and 48%, and 83% and 77% respectively. When classifying sleep/wake and REM/non-REM the accuracy was 90% and 95% respectively. Comparison of sleep distribution and AHI v REI established data was statistically significant in the percentage of light sleep (p=0.004) and deep sleep (p=0.005) along with the AHI vs. REI (p=0.013).

Conclusion

It was observed that sleep stage concordance aligned with literature values and that REI was usually underestimated compared to the AHI.
P053 Acceptability, Adaptability and Adherence to Continuous Positive Airway Pressure Therapy among Aboriginal Australians - The “A5” Top End Northern Territory Australian Study
Authors: Howarth T , Heraganahally S , Crespo J , Perez A , B Atos C
Published: November 2022

Obstructive sleep apnoea (OSA) is highly prevalent among the Australian Indigenous population. In this setting, alongside a high prevalence of chronic medical comorbidities, OSA may further perpetuate adverse health outcomes. Though CPAP is a well-established, proven therapeutic modality, acceptability, and adherence have not been examined among the Australian Indigenous population.

730 Indigenous Australian patients with a diagnostic sleep study recorded between 2011 and 2020 were included. CPAP therapy was assessed as Accepting (any recorded use), Adapting (≥30 days use) and Adhering (≥30 days with ≥4 hours use on ≥70% of nights).

649 (89%) Indigenous patients had OSA (25% mild, 25% moderate & 50% severe). The majority of patients were male (53%), aged a median 47 years and were obese (72%), with 44% residing in remote locations. 309 (48%) Accepted CPAP, 197 (30%) Adapted to CPAP and 67 (10%) Adhered to CPAP. Acceptance, Adaptation and Adherence were higher in patients with Severe vs. Mild OSA (63, 44 & 16% vs. 23, 10 & 3%). OSA severity was associated with Acceptance and Adaptation to CPAP therapy but was not associated with Adherence. Remote residence was significantly and negatively associated with Adaptation and Adherence to therapy.

Remote location was found to be the major factor defining whether patients continued therapy for ≥30 days and adhered to therapeutic guidelines. Given that 80% of Indigenous Australians in the NT reside in remote communities significant work needs to be done to promote adaptation and adherence to therapy in order to reduce morbidity associated with sleep disorders.
P058 The mediating effect of sleep on the relationship between precarious employment and mental health
Authors: Jaydarifard S , Smith S , Mann D , Rossa K , Huda M , Nikooharf Salehi E , Shekari Soleimanloo S
Published: November 2022

Introduction

Precarious work is characterised with high job insecurity, low income, and reduced rights and social protections. Current evidence suggests that precarious work is a risk factor for poor mental health. The relationship between these factors, and especially the contributing role of sleep may play in poor outcomes from precarious work, is unknown. This study investigated the mediating effects of sleep quality and duration on the relationship between precarious employment and poor mental health.

Methods

Data were obtained from the Household, Income and Labour Dynamics in Australia (HILDA) survey (2017). A novel precarious employment score (PES) was developed capturing precarity across the following dimensions: Employment insecurity, level of income, and rights and social protections. Self-reported sleep quality and 24-hour sleep duration were included as mediators. Mediation analyses were conducted to evaluate the mediating effect of sleep duration and sleep quality on the relationship between precarious employment and mental health (SF-36 mental health subscale), after controlling for several covariates.

Results

The PES identified 1446 (female, n=839) workers in precarious and 7922 (female, n=3949) non-precarious employees out of 9368. There was no significant direct association between precarious employment and mental health (P=.53). We observed no significant changes due to sleep quality in the association between precarious employment and mental health (Coefficient=-0.003, 95%

CI

-0.01-0.00, P=0.32). However, this association was significant when considering sleep duration (Coefficient=0.34, 95%

CI

0.25-0.43, P<0.001).

Discussion

Encouraging precarious employees to prioritise and promote sleep appropriately may promote well-being. Further objective measurement of sleep is warranted in this group.
P065 Sleep Perceptions of Carers in Palliative Care: A Qualitative Study
Authors: Lalor A , Ip K , Parikh D
Published: November 2022

Introduction

Carers of individuals receiving palliative care have heightened responsibilities as part of their role which significantly affects their sleep. Despite the recognised importance of sleep, and the evidence regarding the impact of disturbed sleep on one’s physical and psychological wellbeing, sleep of carers is often overlooked. Furthermore, research regarding the lived experience of carers regarding their sleep is limited. This study aimed to explore carers’ sleep experiences, perceived factors related to sleep, and sleep management strategies that they adopt, in order to inform tailored assessment and sleep interventions for carers of individuals receiving palliative care.

Methods

Nine carers providing home palliative care were interviewed regarding their sleep experiences. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Results

Five key themes were identified: (1) Sleep experiences are complex; (2) Sleep is not the priority; (3) Contributing factors of sleep vary; (4) Multiple sleep management strategies exist; and, (5) Need for carer preparedness and ongoing support; under one overarching theme being “sleep is individual for every carer”.

Discussion

Sleep is an individualised and complex experience that is perceived differently by carers. To improve carers’ self-appraisal in sleep quality, consideration of personal beliefs and attitudes should be accounted for to aid addressing factors that contribute to carers’ sleep disturbances. Further, carer-specific resources are crucial to improving quality and accessibility of support services (i.e. respite care).
P073 The sleep, performance, and physiological health consequences of watchkeeping schedules: A scoping review
Authors: Marando I , Lushington K , Matthews R , Banks S
Published: November 2022

Watchkeeping schedules are commonly used on submarines and expose personnel to circadian misalignment and sleep loss. This scoping review aimed to identify the most frequently investigated schedules and examine the effect they have on sleep, cognitive performance, and physiological health outcomes. Systematic searches took place on five online databases (MEDLINE, PsychINFO, PubMed, Scopus, Embase) and Google Scholar in May 2022. The inclusion criteria consisted of peer-reviewed journal articles, industry reports and both laboratory and field studies which directly measured or compared a watchkeeping schedule used on submarines. The initial search produced 4375 results and through screening, resulted in 20 mostly field-based studies for data extraction. Sleep was the most often outcome investigated with only a few studies looking at cognitive performance and/or physiological health. The 6h on/6h off was the most studied schedule which generally demonstrated poorer sleep, cognitive performance, and physiological health than other schedules (e.g., 4h on/8h off, 6h on/12h off). This is important as this schedule is the most frequently used by navies around the world. In other schedules, sleep and cognitive performance were poorest during the biological night, whilst physiological measures were indicative of circadian misalignment. The synthesis of studies in this review provides an understanding how the currently used watchkeeping schedules around the world negatively affect submariners and increase their risk for deleterious health outcomes. The review also highlights the need for future controlled research to understand how schedules might be improved.
P077 Neurocognitive outcomes of children with sleep disordered breathing: a systematic review with meta-analysis
Authors: Menzies B , Teng A , Burns M , Lah S
Published: November 2022

Children with sleep disordered breathing (SDB) are at an increased risk of neurocognitive impairments. This systematic review with meta-analysis aims to (i) establish whether SDB differentially impacts various neurocognitive domains (intelligence, attention/executive functions, memory, visual spatial skills, and language) and (ii) examine the effects of several moderating factors. Database searches, conducted according to the PRISMA guidelines, identified 77 studies that met pre-determined criteria, 63 of which were included in the meta-analysis. Most studies were of moderate to high quality. Children with SDB had significant impairments in all cognitive domains, albeit of different magnitude. The largest impairments were found in intelligence (verbal and overall). With respect to severity of SDB, neurocognitive deficits were evident in children with primary snoring (PS) as well as in children with obstructive sleep apnea (OSA). Other moderators: higher body mass index, younger age at testing, using questionnaires rather than polysomnography, and employing a control group instead of normative data, related to poorer neurocognitive outcomes in select domains. Overall, our study provides robust evidence of multiple neurocognitive impairments in children with SDB, with no evidence of sparing in children with PS. The findings of our study provide impetus for research and interventions for children with SDB across all severities.
P084 Is there a clinical role for repeating the Multiple Sleep Latency Test across childhood?
Authors: Nisbet L , Nixon G , Anantharajah A , Davey M
Published: November 2022

Introduction

The gold standard investigation for central disorders of hypersomnolence in children is the Multiple Sleep Latency Test (MSLT). MSLT diagnostic cut-offs are extrapolated from adult data. Currently there are no guidelines available regards the utility and timing of repeating paediatric MSLTs.

Methods

Retrospective review of children with ≥2MSLTs at our tertiary centre between 2005–2022. Narcolepsy defined as mean sleep latency (MSL) <8min with ≥2 sleep onset REM (SOREM); idiopathic hypersomnolence (IH) defined as MSL <8min with <2 SOREM. MSLTs not meeting these criteria were labelled non-diagnostic.

Progress

19 children (9F) with initial non-diagnostic MSLT underwent repeat MSLT with 5 proceeding to a 3rd MSLT following 2 non-diagnostic MSLTs. Repeat MSLT resulted in diagnosis in 6/19 (32%) (3 narcolepsy, 3 IH); whereas only 1/5 3rd repeat MSLT was diagnostic (IH). Median age at initial MSLT was 7.5y (range 3.4-17.8y), with repeat after 2.9y (range 0.9-8.2y), and 3rd after 2.1 years (range 1.2-4.2y). Mean change in MSL on repeat testing was -2min (range -15.5min to +4.9min, p=0.18). MSL reduced to <10 minutes in one child, allowing access to PBS subsidised treatment. Of the 7 diagnostic repeat MSLTs, 2 had ≥2 SOREM and reduced MSL, 1 had reduced MSL (with 3 SOREM on initial and subsequent test), 4 had reduced MSL without SOREM.

Outcome

A third of repeat MSLTs became diagnostic, suggesting repeat MSLT in childhood should be considered if clinical suspicion persists. Further work needs to address the repeat interval between MSLTs and current diagnostic cut-points in the paediatric population.