bluuebunny/crossref_metadata_2025 huggingface dataset:
O028 Effectiveness of digital brief behavioural therapy for insomnia with wearable technology: pilot randomized controlled trial
Authors: Gordon C , Aji M , Glozier N , Bartlett D , Calvo R , Marshall N , Grunstein R
Published: October 2021

Objective

This pilot trial aimed to test the effectiveness of integration of a wearable device with digital brief behavioural therapy for insomnia (dBBTi) on insomnia symptom severity, sleep metrics and therapy engagement.

Participants and Methods

One hundred and twenty-eight participants with insomnia symptoms were randomised to a 3-week dBBTi program with a wearable device enabling sleep data synchronization (dBBTi+wearable group; n = 62) or dBBTi alone (n = 66). We assessed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI; wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST)) at baseline and weeks 1, 2, 3, 6 and 12. Engagement was measured by the number of daily sleep diaries.

Results

There was no significant difference in ISI scores between the groups (d = 0.7, p = 0.061). The dBBTi+wearable group showed greater improvements in WASO (d = 0.8, p = 0.005) and TST (d = 0.3, p = 0.049) compared to the dBBTi group after 6 weeks. There was significantly greater engagement in the dBBTi+wearable group compared to the dBTi group (d =0.7, p = 0.010).

Conclusions

This pilot trial found that wearable device integration with a digital insomnia therapy led to improvements in WASO and TST and enhanced user engagement. We suggest that incorporation of adjunctive wearable technologies may improve digital insomnia therapy.
O037 Genioglossus motor control following the return to sleep after brief arousal
Authors: Dawson A , Avraam J , Nicholas C , Kay A , Trinder J , Jordan A
Published: October 2021

Rationale

Arousal from sleep has been shown to elicit a prolonged increase in genioglossus muscle activity that persists following the return to sleep and may protect against airway collapse. We hypothesised that this increased genioglossal activity following return to sleep after an arousal is due to persistent firing of inspiratory single motor units (SMUs) recruited during the arousal.

Methods

34 healthy participants were studied overnight while wearing a nasal mask/pneumotachograph to measure ventilation and with 4 intramuscular genioglossus SMU electrodes. During stable N2 and N3 sleep, auditory tones were played to induce brief (3-15s) AASM arousals. Ventilation and genioglossus SMUs were quantified for 5 breaths before the tone, during the arousal and for 10 breaths after the return to sleep.

Results

A total of 1089 tones were played and gave rise to 236 SMUs recorded across arousal and the return to sleep in 20 participants (age 23±4.2 years and BMI 22.5±2.2kg/m2). Ventilation was elevated above baseline during arousal and the first post-arousal breath (p<0.001). The peak firing frequency of expiratory and tonic SMUs was unchanged during arousal and return to sleep, whereas inspiratory modulated SMUs were increased during the arousal and for 4 breaths following the return to sleep (p<0.001).

Conclusions

The prolonged increase in genioglossus activity that occurs on return to sleep after arousal is a result of persistent activity of inspiratory SMUs. Strategies to elevate inspiratory genioglossus SMU activity may be beneficial in preventing/treating obstructive sleep apnea.
P017 Am I sleepy? – Subjective Sleepiness and Drowsy Driving: A systematic review and meta-analysis
Authors: Cai A , Manousakis J , Lo T , Horne J , Howard M , Anderson C
Published: October 2021

Introduction

Driving impairment due to sleep loss is a major contributor to motor vehicle crashes resulting in severe injury or fatalities. Ideally, drivers should be aware of their sleepiness and cease driving to reduce risk of a crash. However, there is little consensus on how accurately drivers can identify sleepiness, and how this relates to subsequent driving impairment. To examine whether drivers are aware of their sleepiness, we systematically reviewed the literature.

Methods

The research question for this review was “are drivers aware of sleepiness while driving, and to what extent does subjective sleepiness accurately reflect driving impairment?”. Our search strategy led to thirty-four simulated/naturalistic driving studies for review. We then extracted the relevant data. Correlational data were examined using meta-analysis, while predictive data were assessed via narrative review.

Results

Results showed that drivers were aware of sleepiness, and this was associated with both driving impairment and physiological drowsiness. Overall, subjective sleepiness was more strongly correlated (a) with ocular and EEG-based outcomes (rweighted = .70 and .73, respectively, p<.001), rather than lane position and speed outcomes (rweighted = .46 and .49, respectively, p<.001); (b) under simulated driving conditions compared to naturalistic drives; and (c) when the Karolinska Sleepiness Scale was used to measure subjective sleepiness. Lastly, high levels of sleepiness significantly predicted crash events and lane deviations.

Discussion

This review presents evidence that drivers are aware of sleepiness when driving, and suggests that interventions such as stopping driving when feeling ‘sleepy’ may significantly reduce crash risk.
P020 Reduced duration and continuity of N3 sleep is associated with excessive daytime sleepiness in suspected obstructive sleep apnea patients
Authors: Chen X , Korkalainen H , Leppänen T , Oksenberg A , Töyräs J , Terrill P
Published: October 2021

Introduction

Excessive daytime sleepiness (EDS) is a common but not universal-accompanying symptom of obstructive sleep apnea (OSA). The mechanisms explaining the presence of EDS in OSA subjects are not fully understood. We hypothesised that characteristic differences in sleep architecture can be quantified with more comprehensive descriptors of sleep continuity in those with and without severe-EDS according to the Multiple Sleep Latency Test (MSLT).

Methods

2111 participants with suspected OSA and complaints of daytime sleepiness underwent in-lab diagnostic polysomnography (PSG) and next-day MSLT. Sleep continuity was quantified by calculating the cumulative-frequency relationship of continuous sleep-state duration against proportion of sleep time; and continuous sleep-state duration against absolute sleep time.

Results

Study contained 368 severe-EDS participants (MSLT≤5min) and 385 non-EDS participants (MSLT>15min). Severe-EDS participants had less Wake After Sleep Onset (48.1±37.7 vs. 68.1±44.2-minutes, p<0.05 [mean±SD]), and greater Total Sleep Time (366.5±50.3 vs. 336.2±58.2-minutes, p<0.05).

While total NREM sleep time was similar between groups, severe-EDS participants had less N3 sleep (67.7±38.0 vs. 78.6±32.0-minutes, p<0.05) and more N2 sleep (230.7±59.3 vs. 178.4±45.9-minutes, p<0.05). Moreover, severe-EDS participants had both less cumulative N3 sleep (36.9±2.9 vs. 60.0±3.3-minutes, p<0.05) and a lower proportion of N3 sleep (66.8±5.3% vs. 77.2±4.2%, p<0.05) occurring in periods ≥10mins duration.

Discussion

Whilst OSA participants with severe EDS have similar NREM sleep time to non-EDS participants; they have less N3 sleep, and N3 sleep periods are less consolidated. These preliminary results suggest that individuals with OSA which disturbs both the quantity and consolidation of N3 sleep are at greater risk of severe EDS.
P024 Children’s sleep and fathers’ health and wellbeing: a systematic review
Authors: Coles L , Thorpe K , Smith S , Hewitt B , Ruppanner L , Bayliss O , O’Flaherty M , Staton S
Published: October 2021

Introduction

Night-waking is typical across infancy and early childhood. Although mothers are traditionally primary carers for children overnight, child sleep may impact others in the household, such as co-dwelling fathers. Despite expectations of more ‘hands on’ fathering, the relationship between children’s sleep and fathers’ health and wellbeing has not been previously synthesised.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and registered with the Prospective Register of Systematic Reviews (PROSPERO). Focusing on fathers, this review synthesised evidence pertaining to effects of children’s sleep (from birth to 12 years) on fathers’ health and wellbeing.

Results

From 4,421 records, 29 studies met inclusion criteria. Findings showed: (1) child sleep was associated with father’s sleep when child sleep was measured through father-report or objective measurement; (2) poorer child sleep was associated with poorer general health and wellbeing among fathers, however, associations of poor child sleep with depression were fewer; and (3) poor child sleep was negatively associated with quality of within-couple and parent-child relationships.

Discussion

Results suggested two principal issues: (1) Systematic variation in measures and findings underscores importance of objective measurement. Yoked actigraphy techniques are vital for understanding inter-relationships of family sleep and attendant outcomes. (2) Different patterns of child sleep and parent outcomes suggest direct and indirect pathways of effect. Understanding patterns of overnight caregiving, and factors underpinning parent decisions, are important for understanding mechanisms linking child sleep to fathers’ outcomes and for designing effective interventions to support parents.
P037 Indigenous Australians’ conceptualisation of sleep health differs from western interpretations
Authors: Fatima Y , King S , Solomon S , Bucks R , Skinner T
Published: October 2021

Purpose

Despite a significant burden of poor sleep, Aboriginal and Torres Strait Islander peoples’ (Indigenous Australians) conceptualisation of sleep health is poorly understood. This research explored Indigenous Australians’ understanding and interpretation of sleep health and how that affects their health.

Methods

Indigenous people from remote Queensland were invited to participate in focus group discussions exploring their understanding of sleep health, the link between dreaming and sleep, and perceived implications of poor sleep. Participants were also asked to complete an adapted pictorial Epworth Sleepiness Scale (ESS). Descriptive statistics were used to summarise ESS data and participants’ demographic data. Thematic analysis was used to analyse focus group data.

Results

A total of 29 Indigenous Australians (82% females), median age 39 years (Interquartile range 26–51 years) from various geographical areas within North West Queensland participated in focus group discussions (n=6). The following themes emerged from the data: interconnection among sleep, emotional and physical health; challenges and successes in obtaining healthy sleep; the impact of dreams on waking life; and lack of support from health services in managing sleep issues. Scores from the modified pictorial scale indicate 24% of the participants had excessive daytime sleepiness (ESS score>10 points).

Conclusion

Indigenous Australians’ conceptualisation of sleep health is different from the western interpretation of sleep health. In particular, the connection between dreams and sleep is not adequately captured in current tools and resources to promote sleep health. This will limit effective prevention and management of sleep issues in Indigenous communities.
P049 Sleep Regularity is Associated with Stability of Daily Light Exposure in Adolescents During School and Vacation
Authors: Hand A , Stone J , Shen L , Vetter C , Cain S , Bei B , Phillips A
Published: October 2021

Study Objectives

Light is the main time cue for the human circadian system. Irregular sleep/wake patterns are associated with poor health outcomes, which could be mediated by irregular patterns of light exposure. The relationship between sleep and light regularity has not been directly explored. We investigated the relationship between sleep and light regularity in adolescents, across school-term and vacation, using novel metrics for measuring light regularity.

Methods

Daily sleep and light patterns were measured via wrist actigraphy in 104 adolescents (54% male, age M±SD = 17.17±0.80 years) over two weeks of school-term and a subsequent two-week vacation. The Sleep Regularity Index (SRI) was computed for each two-week block. Stability of daily light exposure was assessed using variation of mean daily light timing (MLiT), variation in daily photoperiod, and the Light Regularity Index. Associations between SRI and each light regularity metric were examined, and within-individual changes in metrics were examined between school and vacation.

Results

More regular sleep was significantly associated with more regular scores for each light variability metric, during school and vacation. Between school and vacation sleep regularity decreased and nuanced changes in light patterns were observed. Variability measured by the MLiT variable increased, whereas variability measured by the LRI and photoperiod variable decreased.

Conclusions

Adolescents with irregular sleep also have irregular patterns of light exposure. These findings suggest sleep regularity may be a useful proxy for variability in the main circadian time cue, meaning that irregular light exposure may carry implications for the developing adolescent circadian system.
P095 Heart Rate Variability during Sleep in Paroxysmal Atrial Fibrillation patients with and without Obstructive Sleep Apnoea
Authors: Mohammadieh A , Dissanayake H , Sutherland K , Ucak S , de Chazal P , Cistulli P
Published: October 2021

Introduction

Physiological studies have demonstrated the importance of the autonomic nervous system in mediating acute apnoea-induced atrial fibrillation (AF). We aimed to compare Heart Rate Variability (HRV) markers of autonomic function in paroxysmal atrial fibrillation (PAF) patients with and without obstructive sleep apnoea (OSA). A secondary aim was the analysis of ectopic beats in these groups.

Methods

Nocturnal ECG traces from 89 PAF patients who underwent in-laboratory polysomnography were included. After identifying ectopic beats in the ECGs, periods of arrhythmia as well as sleep apnoea events were excluded. HRV time and frequency domains were reported by sleep stage (REM vs Non-REM) for patients with and without OSA.

Results

Frequency domain analysis of HRV during non-REM sleep in PAF patients with OSA showed increased cardiac parasympathetic modulation (HF-nu: 39.13 ± 15.74 vs 47.98 ± 14.60, p = 0.008*) and reduced cardiac sympathetic modulation (LF/HF ratio: 2.05 ± 2.02 vs 1.17 ± 0.98, p = 0.007*). Results remained significant after adjusting for age, sex and BMI (adjusted p values 0.024 and 0.018 respectively). PAF patients with severe OSA (AHI ≥ 30/hr) had more AF beats and Ventricular Ectopic Beats than those without severe OSA (22.7 ± 42.8% vs 3.7 ± 17.9%, p = 0.006*, 1.7 ± 3.8 vs 0.3 ± 0.9%, p = 0.004* respectively).

Conclusions

This is the first study of HRV in AF patients with and without OSA. It suggests a chronic increase in parasympathetic nervous modulation and relative reduction in sympathetic modulation in PAF patients with OSA.
P101 Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea in the adult population: a systematic review
Authors: Natsky A , Vakulin A , Chai Coetzer C , Kaambwa B
Published: October 2021

Background

Obstructive sleep apnoea (OSA) is a significant public health problem with large health and economic burden. Despite the existence of effective treatment, undiagnosed OSA remains a challenge. The gold standard diagnostic tool is polysomnography (PSG), yet this test is expensive, labour intensive, and time-consuming. Home-based, limited channel sleep study testing (Level 3 and 4) can advance and widen access to diagnostic services. This systematic review aims to summarise available evidence regarding the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA.

Method

Eligible studies were identified across the following databases: MEDLINE, Psychinfo, Proquest, Scopus, CINAHL, Cochrane, Emcare and Web of Science. Studies were screened, critically appraised and eligible data were extracted using a standardised template. Relevant findings were summarised using a qualitative approach adhering to economic reporting standards.

Results

915 non-duplicate abstracts were identified, 82 full-text articles were retrieved for review. 32 studies met the inclusion criteria and were included in the final analysis: 28 studies investigated Level 3 and four assessed Level 4 OSA diagnostic tests. Using a dominance ranking framework to compare cost and outcomes, both Level 3 and Level 4 OSA diagnostic tests were cost-effective compared to PSG.

Discussion

Although study designs and methodologies differ broadly, findings indicate that using limited channel diagnostic sleep tests for OSA is associated with lower cost and non-inferior health outcomes relative to PSG. Limited channel tests also resulted in shorter waiting times and improvements in access to diagnostic services for patients with OSA.
P102 Accessing healthcare for sleep problems during the COVID-19 pandemic
Authors: Ng Y , Nguyen E , Bei B , Hamilton G , Rajaratnam S , Ou C , Mansfield D
Published: October 2021

Introduction

As part of a study to assess the impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic, we surveyed how they accessed healthcare for sleep problems.

Methods

Patients were invited to complete an online survey in October 2020.

Results

74 patients completed the survey (mean age 50.2 years, range 21–83 years, 56.8% female). 26/74 (35%) reported at least one delay in accessing healthcare for sleep problems. In particular, 7/49 (14.3%) had delays seeing a general practitioner whilst 16/43 (37.2%) experienced delays accessing a sleep physician. 7/26 (26.9%) reported delays booking a sleep study and 4/15 (26.7%) had delays hiring continuous positive airway pressure equipment. 11/31 (35.5%) experienced delays seeing a psychologist for sleep problems. 11/74 (14.9%) preferred to wait until they were able to attend the clinic in person. 21/74 (28.4%) had telehealth consultations with a sleep physician and/or psychologist. 19/21 (90.5%) described it easy to participate and 20/21 (95.2%) reported receiving satisfactory care through telehealth consultation. Only 5/21 (23.8%) preferred to attend in-person instead of participating in a telehealth consultation again. 11/74 (14.9%) had telephone consultations with a sleep physician and/or psychologist. 8/11 (72.7%) found it easy to participate and 8/11 (72.7%) reported receiving satisfactory care through telephone consultation. Only 3/11 (27.3%) preferred to attend in-person instead of participating in a telephone consultation again.

Discussion

During the COVID-19 pandemic, 35% of patients reported delays accessing healthcare for sleep problems. Most patients who participated in telehealth and telephone consultations described positive experiences.
P103 Impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic
Authors: Ng Y , Nguyen E , Bei B , Hamilton G , Rajaratnam S , Ou C , Mansfield D
Published: October 2021

Introduction

This study aimed to assess the impact of the COVID-19 pandemic on the sleep of adult patients of a multidisciplinary sleep clinic.

Methods

Patients were invited to complete online surveys: Survey 1 in October 2020 (increased COVID-19 restrictions) followed by Survey 2 in February 2021 (after easing of restrictions for a COVIDSafe summer).

Results

Of the 746 patients invited to participate, 73 completed and 8 partially returned Survey 1 (mean age 50.1 years, range 21–83 years, 58% female). Subsequently, 46 completed and 5 partially answered Survey 2. In Survey 1, 22/74 (29.7%) reported reduced sleep quantity and 31/75 (41.3%) indicated worse sleep quality compared with prior to the pandemic. In Survey 2, 33/46 (71.7%) described unchanged sleep quantity whilst 5/46 (10.9%) reported increased sleep quantity since easing COVID-19 restrictions. 36/46 (78.3%) indicated unchanged sleep quality whereas 5/46 (10.9%) described improved sleep quality since easing restrictions. However, 9/46 (19.6%) reported that their sleep remained worse compared with pre-pandemic. For patients who completed both surveys, there was no significant change in Insomnia Severity Index scores (Survey 1 mean 13.6, Survey 2 mean 12.9, mean difference -0.67 [95%CI -2.02, 0.68], p=0.32) or PROMIS Sleep-Related Impairment 8a T-scores (Survey 1 mean 59.0, Survey 2 mean 59.5, mean difference 0.44 [95%CI -1.55, 2.42], p=0.66).

Discussion

The COVID-19 pandemic has negatively affected the sleep of 44% of patients. Following easing of restrictions, symptoms of insomnia and sleep-related impairment did not change significantly, and 19.6% reported that their sleep was not back to their pre-pandemic baseline.
P130 An audit of urinary drug screening use in multiple sleep latency and maintenance of wakefulness testing in an Australian tertiary centre
Authors: Semasinghe Bandaralage S , Sriram B , Rafla M , Sharma N , McWhae S
Published: October 2021

Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) are objective measures of excessive daytime sleepiness, used in diagnosing and monitoring patients with sleep disorders. MSLT and MWT can be affected by substances such as psychotropics, stimulants, opioids and sedatives. Recent studies demonstrate high prevalence of positive urine drug screening (UDS) results in patients undergoing MSLT and MWT.

We retrospectively audited patients who underwent UDS with MSLT/MWT at a tertiary centre from 1st January 2019 to 1st January 2020. The following data was collected: MSLT/MWT/UDS results, sleep disorder diagnosis/es, return to driving/work after testing and pre-existing and subsequent prescription of stimulants/wakefulness-promoting agents/psychotropics/sodium oxybate.

Our cohort featured 32 patients (23 female). 29 MSLTs and 3 MWTs were performed. Median age was 31 years old. 13 patients were on wakefulness-promoting agents/psychotropics when tested, where 8 were on serotonin–norepinephrine reuptake inhibitors/selective serotonin reuptake inhibitors.

13 patients (~45%) had a reduced mean sleep latency (MSL), where 10 minutes was used as the cut-off. All 3 MWTs were within normal limits. 5 patients (~16%) had a positive UDS. 1 patient had a low MSL and tested positive for cannabinoids and opioids. The other 4 patients with normal MSL tested positive for benzodiazepines (2), cannabinoids (1) and opioids (1). All patients were cleared for work and 85% of patients who had a low MSL returned to work during follow-up.

The rate of positive UDS in patients undergoing MSLT/MWT was comparable to existing publications and re-emphasizes the relevance of mandating UDS prior to MSLT/MWT.
P141 High prevalence of obstructive sleep apnoea in patients with mild cognitive impairment or mild dementia
Authors: Szollosi I , Georgeson T , Curtin D , Natarajan K , Eeles E , Coulson E
Published: October 2021

Aims

Obstructive sleep apnoea (OSA) occurs with greater frequency in advancing age. The resulting sleep fragmentation and oxygen desaturations may induce or contribute to neurodegeneration. As such, OSA may be an important modifiable risk factor for the development of dementia. However, the prevalence of OSA within the population with cognitive impairment remains uncharacterised. This study aims to assess the prevalence of OSA in patients attending a specialist memory clinic with either mild cognitive impairment (MCI) or mild stages of dementia (Mini-Mental State Examination (MMSE) > 20).

Methods

Eligible and consenting participants were asked to wear an ApneaLink™ (ResMed) device overnight that measured nasal airflow and oximetry to generate a Respiratory Disturbance Index (RDI). The Epworth Sleepiness Scale (ESS) was used to evaluate subjective symptoms.

Results

64 participants completed the study. Mean(±SD) age=76.1±9.2 years, MMSE=25.6±2.8, RDI=15.5±12.0. The distribution of normal, mild, moderate and severe OSA was 16%, 44%, 26% and 14% respectively. 84% of participants had an abnormal RDI (>5), with 40% being moderate to severe (RDI >15) where CPAP may be the recommended treatment. Mean ESS was 7.08±4.45 and not correlated with OSA severity.

Conclusion

The prevalence of OSA in MCI or early stages of dementia is high and represents a potential target for therapeutic intervention. Further research studies are required to determine whether treatment of OSA alters dementia progression.
P154 Upper Airway Sensation in Obstructive Sleep Apnea - A Systematic Review and Meta-Analysis to Inform Pathogenesis, Treatment and Future Research
Authors: Wallace E , Toson B , Carberry J , Eckert D
Published: October 2021

Introduction

Upper airway sensory impairment may contribute to obstructive sleep apnea (OSA) for certain patients. However, the type of sensory impairment and its role in OSA pathogenesis remain unclear. This study aimed to: (1) evaluate methods of upper airway sensory testing in the OSA literature, (2) compare upper airway sensation in people with and without OSA and (3) investigate the relationship between OSA severity and upper airway sensory impairment.

Methods

Electronic databases were searched up to February 2020 for studies reporting methods of upper airway sensory testing in people with OSA (n=3,819). From the selected studies (n=38), information on the type of sensation, testing methods, validity and reliability were extracted. Meta-analyses were performed on case-controlled studies and studies reporting correlations between upper airway sensation and OSA severity.

Results

Seven types of upper airway sensation were reported: olfactory, gustatory, chemical, tactile, vibratory, thermal and neuro-sensation. Methods of upper airway sensory testing varied. No tests were validated or assessed for reliability in OSA populations. People with OSA had impaired sensation on airflow (p<0.001), chemical (p<0.001), gustatory (p=0.01), olfactory (p=0.04) and tactile (p<0.001) tests. Upper airway sensory impairment correlated with OSA severity (p<0.001).

Conclusions

People with OSA demonstrated impaired upper airway sensation, which related to increasing OSA severity. The extent to which upper airway sensation was impaired varied across testing methods. The findings suggest that development of valid and reliable upper airway sensory tests, that relate to upper airway function in people with OSA, are necessary for future clinical and research practices.
P161 Regularity of sleep-wake patterns in the UK Biobank (N = 86 624) and an open-source tool to calculate the Sleep Regularity Index
Authors: Windred D , Russell A , Burns A , Cain S , Phillips A
Published: October 2021

Introduction

Regular sleep-wake patterns aid in the maintenance of optimal physical and mental health, by helping to align environmental, behavioural, and physiological rhythms. The distribution of sleep regularity across the population has not been well documented. Furthermore, researchers currently lack tools to easily quantify sleep regularity.

Method

We have described sleep regularity in 86 624 UK Biobank participants (age (M±SD) = 62.45±7.84; 56.2% female) using data from wrist-worn accelerometers. Regularity was measured using the Sleep Regularity Index (SRI), which quantifies day-to-day similarity in sleep-wake patterns, and which is linked to cardio-metabolic and mental health outcomes. We developed an R package to calculate SRI from accelerometer data, which works in conjunction with GGIR (a validated accelerometer processing tool) to identify sleep-wake state, including naps and broken sleep.

Results

The SRI distribution had M±SD = 78.02±11.53, and median = 80.49. The least regular quintile (SRI<70.2) had standard deviation of sleep onset = 2.23h, offset = 2.14h, and duration = 1.95h, compared with onset = 0.78h, offset = 0.85h, and duration = 0.95h in the most regular quintile (SRI>87.3). Approximately 14% of participants exhibited large day-to-day shifts in sleep timing (>3h) at least once per week.

Discussion

This is the largest description of sleep regularity to-date. The norms established here provide a reference for researchers and clinicians intending to quantify sleep regularity with the SRI. We have combined methods described here into an open-source R package to calculate SRI from accelerometer or sleep diary data, available for download via GitHub.
Progress towards control and elimination of neglected tropical diseases targeted by preventive chemotherapy in São Tomé e Príncipe
Authors: Byrne Aisling , Rosário Alzira , da Conceição Ferreira Maria , de Jesus Trovoada dos Santos Maria , Rollinson David , Vaz Nery Susana
Published: October 2021

The São Tomé e Príncipe government is committed to achieving neglected tropical disease (NTD) control and elimination as a public health problem by 2025. In 2014, the Ministry of Health led a national survey to determine the prevalence of soil-transmitted helminths (STHs) and schistosomiasis across the country. Following this survey, a preventive chemotherapy (PC) campaign with mebendazole and praziquantel reached 31 501 school-age children in 2015. A follow-up 2017 survey to determine the impact of the intervention showed success in controlling schistosomiasis, as no infections were found, but limited impact on STHs, with prevalence similar to pretreatment levels. The survey also investigated the prevalence of a third NTD, lymphatic filariasis (LF), which was found to be endemic in the country. Since then the Ministry of Health has developed the Strategic Plan for the Fight Against Neglected Tropical Diseases 2019–2025 and identified gaps to be addressed. This narrative review systematises the existing literature reporting on the epidemiology of NTDs for which there are PC programs in São Tomé e Príncipe. PubMed was searched for relevant papers that measured the prevalence of LF, schistosomiasis and STHs. Additionally, data provided by the Ministry of Health surveys were analysed. Finally, we discuss current NTD control, including the impact of the coronavirus disease 2019 pandemic and identify priorities for program strengthening and operational research.
Telemedicine for preanesthesia evaluation: review of current literature and recommendations for future implementation
Authors: Azizad Omaira , Joshi Girish P.
Published: October 2021

Purpose of review

The in-person preanesthesia visit serves multiple purposes including identification and optimization of comorbid conditions as well as patient education. However, it imposes a significant burden on patients and healthcare providers. In this review, we define the scope of telemedicine and present the most up-to-date literature supporting its role for the preanesthesia evaluation. The opportunities and challenges are discussed and approaches to implementation of telemedicine in preanesthesia care are offered. Finally, the future of telemedicine as it pertains to preanesthesia care is examined.

Recent findings

Although telemedicine for preanesthesia practice was proposed almost two decades ago, the COVID-19 pandemic has accelerated its implementation. The potential benefits of telemedicine include improved patient satisfaction as well as the ability to provide cost-effective specialty services while reducing the burden on healthcare providers. Limitations to telemedicine include lack of technology, training, regulatory barriers, and an inability to perform a physical exam.

Telemedicine will continue to expand and its application to the preanesthesia evaluation is a clear example of how technology will revolutionize anesthesia practice. In order for telemedicine to continue to expand in the postpandemic period, steps must be taken to ensure that healthcare facilities and providers keep up with the times.
Use of a Multifunctional Cocktail for Postoperative Bleeding and Pain Control in Spinal Fusion: A Randomized, Double-blind, Controlled Trial
Authors: Jiang Wei , Fu Mengyu , Dong Wei , Zhou Nian , Shen Jieliang , Zhang Xiaojun , Hao Jie
Published: October 2021

Study Design.

A prospective, randomized, double-blind controlled trial.

Objective.

To explore the effect of multifunctional cocktail for bleeding and pain control after spinal fusion.

Summary of Background Data.

Managing postoperative bleeding and pain after spinal fusion remains a challenge. Topical application of tranexamic acid or anesthetic agents for bleeding or pain management just started recently, and the multifunctional cocktail for bleeding and pain control simultaneously after spinal fusion have never been published.

Methods.

Ninety patients who underwent posterior spinal fusion were enrolled in this study. The multifunctional cocktail was injected into the incision before wound closure in the cocktail group. In the control group, an equal volume of normal saline was injected and a patient-controlled analgesic pump was used. Visual analogue scale score; opioid consumption; intraoperative, postoperative, hidden and total blood loss; volume of drainage, hematocrit levels of drainage; hemoglobin levels; and complications were compared between the two groups.

Results.

There were no differences in the visual analogue scale within 48 hours after surgery between the two groups. However, the opioid dosages in the control group were higher than those in the cocktail group. The postoperative blood loss, total blood loss, and hidden blood loss were lower in the cocktail group than in the control group. The drainage volume showed no differences between the two groups; however, the hematocrit level of drainage at 24 hours after surgery was lower in the cocktail group than in the control group. The hemoglobin level was higher in the cocktail group than in the control group at postoperative day 3. Thirteen patients with unbearable nausea and vomiting in the control group, whereas no complications in the cocktail group.

Conclusion.

Topical application of a multifunctional cocktail that we designed provides an effective and safe method for reducing pain and bleeding after spinal fusion.
Molecular mechanism and therapeutic targeting of necrosis, apoptosis, pyroptosis, and autophagy in cardiovascular disease
Authors: Li Pan , Dong Xiao-Rong , Zhang Bei , Zhang Xin-Tong , Liu Jing-Zhuo , Ma De-Sheng , Ma Li
Published: October 2021

Cell death occurs in various tissues and organs in the body. It is a physiological or pathological process that has different effects. It is of great significance in maintaining the morphological function of cells and clearing abnormal cells. Pyroptosis, apoptosis, and necrosis are all modes of cell death that have been studied extensively by many experts and scholars, including studies on their effects on the liver, kidney, the heart, other organs, and even the whole body. The heart, as the most important organ of the body, should be a particular focus. This review summarizes the mechanisms underlying the various cell death modes and the relationship between the various mechanisms and heart diseases. The current research status for heart therapy is discussed from the perspective of pathogenesis.
Late and Long-term Symptom Management in Colorectal Cancer Survivorship
Authors: Shaw Robert D. , Ivatury Srinivas J.
Published: October 2021

Case Summary:

A 59-year-old previously healthy, asymptomatic man initially presented for his first screening colonoscopy. At this time, a friable, partially obstructing tumor was encountered in his proximal rectum. Final workup demonstrated a mrT2N1M0 upper rectal cancer. The patient went on to successfully complete total neoadjuvant chemoradiation therapy and was taken to the operating room for an uncomplicated robotic-assisted low anterior resection with primary anastomosis. His final pathology revealed an ypT2N1M0 rectal cancer, and he was subsequently followed in surveillance per National Comprehensive Cancer Network guidelines. At long-term follow-up visits he continued to report significant depressive symptoms and functional impairment. Despite aggressive medical management with fiber supplementation and antidiarrheal medications, the patient continued to struggle with bowel movement frequency and urgency. He reported having 4 to 6 clustered bowel movements during the day and 1 to 2 stools at night that significantly limited his ability to perform normal day-to-day activities.
The Impact of Indocyanine Green Angiography on Fat Necrosis in Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Authors: Yoo Aran , Palines Patrick A. , Mayo James L. , Bartow Matthew J. , Danos Denise M. , St Hilaire Hugo , Wise Matthew W. , Stalder Mark W.
Published: October 2021

Background

The deep inferior epigastric perforator flap (DIEP) is a widely known reliable option for autologous breast reconstruction. One common complication of DIEP procedures is fat necrosis. Consequences of fat necrosis include wound healing complications, pain, infection, and the psychological distress of possible cancerous recurrence. Clinical judgment alone is an imperfect method to detect at-risk segments of adipose tissue. Objective methods to assess perfusion may improve fat necrosis complication rates, reducing additional surgeries to exclude cancer and improve cosmesis for patients.

Methods

The authors performed a retrospective review of patients who underwent analysis of DIEP flap vascularity with or without intraoperative indocyanine green angiography (ICGA). Flap perfusion was assessed using intravenous ICGA and was quantified with both relative and absolute value units of fluorescence. Tissue with observed values less than 25% to 30% relative value units was resected. Postoperative outcomes and fat necrosis incidence were collected.

Results

Three hundred fifty-five DIEP flaps were included in the study, 187 (52.7%) of which were assessed intraoperatively with ICGA. Thirty-nine patients (10.9%) experienced operable fat necrosis. No statistically significant difference in incidence of postoperative fat necrosis was found between the 2 groups (P = 0.732). However, a statistically significant relationship was found between fat necrosis incidence and body mass index as both a continuum (P = 0.001) and when categorized as greater than 35 (P = 0.038).

Conclusions

Although ICGA is useful for a variety of plastic surgery procedures, our retrospective review did not show a reduction in operable fat necrosis when using this technology.
Is Open Reduction Internal Fixation Using Titanium Plates in the Mandible as Successful as We Think?
Authors: Capucha Tal , Shilo Dekel , Abdalla-Aslan Ragda , Blanc Ori , Ginini Jiriys George , Semel Gabriel , Emodi Omri , Rachmiel Adi
Published: October 2021

Titanium plats are the gold-standard for fracture fixation. Titanium is considered biocompatible, corrosion resistant with an elasticity-modulus closest to bone. Nonetheless, titanium plates are not always as inherent as hoped. The authors investigated morbidity associated with titanium plates in mandibular fractures. A retrospective study of mandibular fractures treated between 2000 and 2018 using internal-fixation was conducted. Data included age, gender, complications, and location. Predictor-variable was location. Outcome-variable was plate removal. A total of 571 patients were included, 107 resulted in plate removal (18.7%). Body was the most prevalent location of fracture (29.3%). Symphysis/para-sym-physis showed the highest removal rate (24.1%), followed by body and angle (21.3/19.8%). A total of 23.4% of double-plating cases resulted in plate removal, upper-border in 15% and lower-border in 8.8%, all reconstruction-plates. Exposure was the most frequent complication leading to removal. Although titanium plates are the gold standard, almost every fifth patient returns for plate removal. Age-distribution emphasizing 41 to 50 with decrease towards extremities may imply better healing in the young and soft-tissue elasticity and less complaints in the elderly. Significantly more complications in double-plating compared to lower border suggests proximity to the oral-cavity as a risk-factor for removal. Complication rates and patterns are not negligible and perhaps should encourage clinicians to consider using biodegradable-systems for upper-border plates.
The language of cooperation: reputation and honest signalling
Authors: Számadó S. , Balliet D. , Giardini F. , Power E. A. , Takács K.
Published: October 2021

Large-scale non-kin cooperation is a unique ingredient of human success. This type of cooperation is challenging to explain in a world of self-interested individuals. There is overwhelming empirical evidence from different disciplines that reputation and gossip promote cooperation in humans in different contexts. Despite decades of research, important details of reputation systems are still unclear. Our goal with this theme issue is to promote an interdisciplinary approach that allows us to explore and understand the evolution and maintenance of reputation systems with a special emphasis on gossip and honest signalling. The theme issue is organized around four main questions: What are the necessary conditions for reputation-based systems? What is the content and context of reputation systems? How can reputations promote cooperation? And, what is the role of gossip in maintaining reputation systems and thus cooperation?

This article is part of the theme issue ‘The language of cooperation: reputation and honest signalling’.
The psychological foundations of reputation-based cooperation
Authors: Manrique Héctor M. , Zeidler Henriette , Roberts Gilbert , Barclay Pat , Walker Michael , Samu Flóra , Fariña Andrea , Bshary Redouan , Raihani Nichola
Published: October 2021

Humans care about having a positive reputation, which may prompt them to help in scenarios where the return benefits are not obvious. Various game-theoretical models support the hypothesis that concern for reputation may stabilize cooperation beyond kin, pairs or small groups. However, such models are not explicit about the underlying psychological mechanisms that support reputation-based cooperation. These models therefore cannot account for the apparent rarity of reputation-based cooperation in other species. Here, we identify the cognitive mechanisms that may support reputation-based cooperation in the absence of language. We argue that a large working memory enhances the ability to delay gratification, to understand others' mental states (which allows for perspective-taking and attribution of intentions) and to create and follow norms, which are key building blocks for increasingly complex reputation-based cooperation. We review the existing evidence for the appearance of these processes during human ontogeny as well as their presence in non-human apes and other vertebrates. Based on this review, we predict that most non-human species are cognitively constrained to show only simple forms of reputation-based cooperation.

This article is part of the theme issue ‘The language of cooperation: reputation and honest signalling’.
Are some cultures more mind-minded in their moral judgements than others?
Authors: Barrett H. Clark , Saxe Rebecca R.
Published: October 2021

Cross-cultural research on moral reasoning has brought to the fore the question of whether moral judgements always turn on inferences about the mental states of others. Formal legal systems for assigning blame and punishment typically make fine-grained distinctions about mental states, as illustrated by the concept of
mens rea
, and experimental studies in the USA and elsewhere suggest everyday moral judgements also make use of such distinctions. On the other hand, anthropologists have suggested that some societies have a morality that is disregarding of mental states, and have marshalled ethnographic and experimental evidence in support of this claim. Here, we argue against the claim that some societies are simply less ‘mind-minded’ than others about morality. In place of this cultural main effects hypothesis about the role of mindreading in morality, we propose a contextual variability view in which the role of mental states in moral judgement depends on the context and the reasons for judgement. On this view, which mental states are or are not relevant for a judgement is context-specific, and what appear to be cultural main effects are better explained by culture-by-context interactions.

This article is part of the theme issue ‘The language of cooperation: reputation and honest signalling’.
Direct punishment and indirect reputation-based tactics to intervene against offences
Authors: Molho Catherine , Wu Junhui
Published: October 2021

Punishment and reputation-based mechanisms play a major role in supporting the evolution of human cooperation. Theoretical accounts and field observations suggest that humans use multiple tactics to intervene against offences—including confrontation, gossip and ostracism—which have unique benefits and costs. Here, we draw a distinction between
direct
punishment tactics (i.e. physical and verbal confrontation) and
indirect
reputation-based tactics (i.e. gossip and ostracism). Based on this distinction, we sketch the common and unique social functions that different tactics are tailored to serve and describe information-processing mechanisms that potentially underlie decisions concerning how to intervene against offences. We propose that decision rules guiding direct and indirect tactics should weigh information about the benefits of changing others' behaviour versus the costs of potential retaliation. Based on a synthesis of existing evidence, we highlight the role of situational, relational and emotional factors in motivating distinct punishment tactics. We suggest that delineating between direct and indirect tactics can inform debates about the prevalence and functions of punishment and the reputational consequences of third-party intervention against offences. We emphasize the need to study how people use reputation-based tactics for partner recalibration and partner choice, within interdependent relationships and social networks, and in daily life situations.

This article is part of the theme issue ‘The language of cooperation: reputation and honest signalling’.
The benefits of being seen to help others: indirect reciprocity and reputation-based partner choice
Authors: Roberts Gilbert , Raihani Nichola , Bshary Redouan , Manrique Héctor M. , Farina Andrea , Samu Flóra , Barclay Pat
Published: October 2021

When one individual helps another, it benefits the recipient and may also gain a reputation for being cooperative. This may induce others to favour the helper in subsequent interactions, so investing in being seen to help others may be adaptive. The best-known mechanism for this is indirect reciprocity (IR), in which the profit comes from an observer who pays a cost to benefit the original helper. IR has attracted considerable theoretical and empirical interest, but it is not the only way in which cooperative reputations can bring benefits. Signalling theory proposes that paying a cost to benefit others is a strategic investment which benefits the signaller through changing receiver behaviour, in particular by being more likely to choose the signaller as a partner. This reputation-based partner choice can result in competitive helping whereby those who help are favoured as partners. These theories have been confused in the literature. We therefore set out the assumptions, the mechanisms and the predictions of each theory for how developing a cooperative reputation can be adaptive. The benefits of being seen to be cooperative may have been a major driver of sociality, especially in humans.

This article is part of the theme issue ‘The language of cooperation: reputation and honest signalling’.