bluuebunny/crossref_metadata_2025 huggingface dataset:
Jain Tantric Diagrams of the Goddess Padmāvatī
Authors: Gough Ellen
Published: October 2023

This chapter compares some popular modern tantric diagrams of the Jain goddess Padmāvatī with some yantras outlined in the eleventh-century Jain Sanskrit text, the Bhairavapadmāvatīkalpa. Scholarship has identified the Bhairavapadmāvatīkalpa, a manual on the propitiation of various yantras, including those to the goddess Padmāvatī, as one of the most important “Jain Tantras.” An examination of modern Jain yantras shows, however, that the yantras of the Bhairavapadmāvatīkalpa have had little impact on Jain ritual practice. Rather than finding the yantras of this text in modern temples and homes, instead, we find yantras filled with generic Sanskrit praises to goddesses, diagrams connected to medieval praise poems (stotra), and “magic squares,” or auspicious grids of numbers (aṅkayantra). The meditative practices, mantras, and deities of the Bhairavapadmāvatīkalpa reflect general tantric trends common to medieval Jain and non-Jain texts, but the text does not seem to be particularly influential today.
The Politics of Equality in Secondary Education Across Wealthy Postwar Democracies
Authors: Gingrich Jane R. , Giudici Anja , McArthur Daniel
Published: October 2023

In the postwar period, the focus of governments in advanced democracies generally shifted from generalizing basic education to staffing an increasing share of the population with more complex and specialized knowledge and skills through the expansion of secondary schooling. The demands of industrial development, heightened by the rise of the knowledge economy, meant policymakers across place and partisan divides have largely supported secondary expansion. However, despite these common trends lie ongoing differences across place in terms of the logic of the massification of secondary education—its ideal degree of differentiation among pupils and teachers, standardization of teaching and pedagogical practices, and the structure of control. This chapter analyzes the patterns resulting from the policy choices of political parties and organized interests across advanced democracies in these three domains as well as the political determinants underlying these choices.
Diffusion of Mass Education
Authors: Besche-Truthe Fabian , Seitzer Helen , Windzio Michael
Published: October 2023

In this chapter, we investigate the diffusion of mass education. We define the establishment of a “mass education system” in a country as an exceedance of the threshold of an overall enrolment of 40% in primary education for boys and girls combined. We focus on countries’ interrelations to explain the institutional development of mass education. What effects do networks of cultural and colonial linkages have on the emergence of national mass education systems? Our theoretical considerations follow sociological functionalism and neoinstitutionalism, but enhance these concepts with a focus on global “cultural spheres,” which we assume are of particular importance for the global diffusion of mass education. We apply social network analysis to describe global cultures in a nonessentialist way and apply network diffusion models in order to estimate the effects of contagion on the emergence of mass education in 156 countries around the world from 1880 to 2010.
Economic Globalization and Evolution of Education Spending in the Brazilian Federation, 2013–2019
Authors: Batista Cristiane , Dutt-Ross Steven
Published: October 2023

Building upon a critical evaluation of studies on the effect of commercial opening on local public policies, this investigation focuses on some of the factors that impinge upon the expenditure executed by states in education in the period spanning from 2013 to 2019. One of the independent variables observed is the degree to which these subnational units open up to the international market. The chapter identifies in particular whether the new pattern of commercial insertion of the Brazilian economy in the global market, based on the demand for agricultural and primary products, affects the educational spending of subnational units. In some Brazilian states the intensification of exports, based on commodities, has an impact on the decision-making capacity related to social spending compared to states that are more dependent upon services and domestic industry.
Globalization, Cultural Logics, and the Teaching Profession
Authors: LeTendre Gerald K.
Published: October 2023

Globalization has not had a uniform impact on the teaching profession. Understanding how teachers are affected by globalization, and what role they play in the process of institutional change, requires further theoretical elaboration of (a) the relationship between culture and institutions; (b) the “institutional work” teachers do to transmit or disrupt institutional patterns; and (c) how “institutional logics” may conflict or align with broader cultural systems of meaning, that is, “cultural logics.” Institutional logics are diffused globally across multiple levels, and resonance between national cultural logics and globally diffusing institutional logics aids their diffusion. Teachers, individually and collectively, may advocate for new institutional logics, and thus engage in institutional change, but their efficacy to mobilize on a national scale is often limited. The evolution of technologically supported, dense communication networks affords teachers opportunities to elaborate on diffusing institutional logics.
The Globalization of Expertise?
Authors: Ozga Jenny
Published: October 2023

This chapter adopts a structuralist perspective on the growth of expert policy advice, its global dissemination, and its uses in the contemporary governing of education. It engages with debates about the uses of evidence, drawing on recent research in education and on relevant social science literature that highlights the simultaneous externalization of policy advice, especially from scientific and technical sources, and the politicization of the knowledge production processes through which scientific and technical knowledge is produced. Epistemic governance, where political actors appeal to the authority of science and expert knowledge, is associated in the policy field of education with the Organisation for Economic Co-operation and Development’s Programme for International Student Assessment, and its publication of comparative performance data, enabling international organizations to establish themselves as authoritative sources of epistemic capital and capacity-building knowledge.
Does Globalization Reward Education?
Authors: Bleynat Ingrid , Monroy-Gómez-Franco Luis
Published: October 2023

Mexico has seen a significant improvement in the educational attainment of its population in recent decades, with the proportion of people with complete secondary schooling growing from 21% to 25%, and those with college degrees increasing from 11% to 18% in the period between 2005 and 2019. At the same time, the country stands out as an open, highly globalized economy. In 2021 foreign trade stood at 84% of GDP, with manufactures representing 77% of exports and 74% of imports. This chapter uses data from the Mexican Labor Survey (ENOE) and the Input-Output Matrix to explore the interplay between these two trends and, in particular, to assess whether employment in globalized sectors has rewarded human capital accumulation in the form of higher wages. The chapter shows that the skill premia in globalized sectors have shown a secular downward trend for both male and female workers, and that the premia for college and upper secondary education have been consistently lower than in nonglobalized sectors. While these trends are consistent with a reduction in income inequality, and with shortfalls in the geographical coverage and the quality of educational opportunities, it is important to not lose sight of what is driving them: In both globalized and nonglobalized sectors, the incomes of most workers have remained stagnant, whereas those for people with college degrees have shown a substantial decline. Globalization does not, therefore, appear to have rewarded education in Mexico.
Redrawing What Counts as Education
Authors: Weinbach Christine
Published: October 2023

This chapter focuses on the constitutive dependence of the education system on the performance of the political system. It shows that the recent redrawing of what counts as institutionalized early childhood education in Germany largely originate in the impulses of global organizations in the political system of world society. These early childhood educational institutions operated for centuries at the margins of the formal education system, and they were only relatively recently incorporated into the core of the system. In the course of this development, the global program of early childhood education replaced a system that privileged the simulation of familial environments over pedagogical achievement, and it was designed from the start as a learning process that brings together pedagogical and social objectives.
The Rats Under the Rug
Authors: Vanden Broeck Pieter
Published: October 2023

This chapter focuses on the boundary work that accompanies the formation of the education system. Drawing on Michel Serres’s parasitology, it proposes that we rethink the differences of context between the household and school as interferences or perturbations of a system that undermine its normal or aspired-to operativity. The attempt to exclude such disturbance—the expulsion of the so-called parasite—should accordingly be considered the constitutive moment for the formation of the education system. On the basis of such characterization, the chapter then turns to contemporary examples of transnational and digital education that eschew the classroom in favor of new formalizations that roam far beyond the national project of mass schooling. The global scope of such education hinges on their ability to successfully reformalize education, thus dismissing the formal traits of classroom instruction.
The Global Scale in Higher Education and Research
Authors: Marginson Simon
Published: October 2023

Along with communications, higher education and research are among the most globalized sectors, and this continued in the decade after 2010 when there was a partial retreat from globalization of the political economy. In science the global system has arguably become primary in terms of knowledge formation, though the national scale remains highly determining in institutional higher education. The chapter discusses the main features of globalization in higher education and science (global systems, global connections, and global diffusion) and reviews the relationship between the global science system and the connected national science systems. It finishes with a discussion of scale and its materiality, and reflects on the potential contribution of plural scalar perspectives and Amartya Sen’s transpositional analytical framework to understandings of higher education.
The PISA Pendulum
Authors: Volante Louis
Published: October 2023

Since the initial administration of the Program in International Student Assessment (PISA), governments have increasingly turned their attention to the policy implications stemming from this global benchmark measure. Educational jurisdictions such as Finland, South Korea, Hong Kong, Canada, and more recently Singapore, at various points in time, have been internationally lauded for their high achievement and touted as global reference societies by policymakers wishing to emulate their relative success. Yet questions and concerns remain regarding the undue influence and policy recommendations promoted by the Organization for Economic Cooperation Development. This chapter explicates some of the dominant political narratives as well as sources of contestation attributed to PISA that have shaped global, transnational, and national education governance agendas. Overall, the chapter provides a critical analysis of the policy influence of PISA.
Mentalizing and Psychodynamic Approaches to Nonsuicidal Self-Injury
Authors: Motz Anna , Bateman Anthony , Fonagy Peter , Luyten Patrick
Published: October 2023

This chapter covers the mentalizing and psychodynamic approaches to nonsuicidal self-injury (NSSI). It explains that the communicative and meaningful aspects of NSSI can be found in mentalization-based treatment approaches, which are part of the family of psychodynamic treatments. The mentalization-based therapy (MBT) model conceptualizes NSSI and provides further elaboration on the more traditional psychodynamic approaches to self-harm. MBT operates using an approach that addresses the underlying difficulties in integrating thoughts and feelings while also resisting the urge to find action-based interventions for painful thoughts and emotions. The chapter also mentions the efficacy of the treatment in reducing the major public health issue of NSSI.
The Aesthetics of Transitional Justice
Authors: Clarkson Carrol
Published: October 2023

This chapter discusses the aesthetics of transnational justice. It looks into the dynamic interrelationships between art and justice, while also referencing the human effort to create meaning. Aesthetic acts, such as essays and artworks, interrupt somnolent complacencies of the received idea while also bringing shifts in the social order. Additionally, the creation of perceptible value demands a feat of the human imagination, so value is not simply coterminous with factual or historical truth. The chapter highlights how an aesthetic understanding allows people to appreciate the ways sensory fields affect thoughts and values. It also references Judith Mason's artwork as the manifestation of a human impulse to create meaning and value.
Effects of 1-year tofacitinib therapy on angiogenic biomarkers in rheumatoid arthritis
Authors: Kerekes György , Czókolyová Monika , Hamar Attila , Pusztai Anita , Tajti Gábor , Katkó Mónika , Végh Edit , Pethő Zsófia , Bodnár Nóra , Horváth Ágnes , Soós Boglárka , Szamosi Szilvia , Hascsi Zsolt , Harangi Mariann , Hodosi Katalin , Panyi György , Seres Tamás , Szűcs Gabriella , Szekanecz Zoltán
Published: October 2023

Objectives

Cardiovascular (CV) morbidity and mortality, and perpetuated synovial angiogenesis have been associated with RA. In our study we evaluated angiogenic factors in relation to vascular inflammation and function, and clinical markers in RA patients undergoing 1-year tofacitinib therapy.

Methods

Thirty RA patients treated with either 5 mg or 10 mg twice daily tofacitinib were included in a 12-month follow-up study. Eventually, 26 patients completed the study and were included in data analysis. Levels of various angiogenic cytokines (TNF-α, IL-6), growth factors [VEGF, basic fibroblast (bFGF), epidermal (EGF), placental (PlGF)], cathepsin K (CathK), CXC chemokine ligand 8 (CXCL8), galectin-3 (Gal-3) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) were determined at baseline, and at 6 and 12 months after initiating tofacitinib treatment. In order to assess flow-mediated vasodilation, common carotid intima-media thickness (ccIMT) and carotid-femoral pulse-wave velocity, ultrasonography was performed. Synovial and aortic inflammation was also assessed by 18F-fluorodeoxyglucose-PET/CT.

Results

One-year tofacitinib therapy significantly decreased IL-6, VEGF, bFGF, EGF, PlGF and CathK, while it increased Gal-3 production (P < 0.05). bFGF, PlGF and NT-proBNP levels were higher, while platelet-endothelial cell adhesion molecule 1 (PECAM-1) levels were lower in RF-seropositive patients (P < 0.05). TNF-α, bFGF and PlGF correlated with post-treatment synovial inflammation, while aortic inflammation was rather dependent on IL-6 and PECAM-1 as determined by PET/CT (P < 0.05). In the correlation analyses, NT-proBNP, CXCL8 and Cath variables correlated with ccIMT (P < 0.05).

Conclusions

Decreasing production of bFGF, PlGF or IL-6 by 1-year tofacitinib therapy potentially inhibits synovial and aortic inflammation. Although NT-proBNP, CXCL8 and CathK were associated with ccIMT, their role in RA-associated atherosclerosis needs to be further evaluated.
O003 Investigating the relationship between core body temperature and changes in cognitive performance during simulated night shifts
Authors: Guyett A , Lovato N , Stuart N , Manner J , Nguyen D , Micic G , Lack L , Catcheside P , Scott H
Published: October 2023

Introduction

The timing of circadian and sleep-wake behaviours is disrupted by night shift-work. Interventions involving light may prove beneficial in adjusting the circadian rhythm to shift work, although the changes in vigilance remain uncertain. This study examined the temporal relationship between core body temperature (CBT) rhythm and vigilance during a work-shift through lighting.

Methods

19 healthy individuals (12 males, mean±SD age of 28.7±10.4 years) participated in two 8-day experimental conditions with 4 days of circadian-informed lighting vs standard lighting. On Day 2, participants transitioned from a typical day-night wake-sleep schedule to night shift-work from 00:00 to 08:00 on Days 3 to 7. Psychomotor vigilance tasks (PVTs) were administered six times on shift. CBT was monitored via ingestible capsules. Daily CBT minimum (CBTmin) time was compared to the timing of the worst PVT performance on-shift (task with most lapses).

Results

In the parent study, circadian lighting improved on-shift performance and sleep quality. These effects were accompanied by a significant day-by-condition interaction effect on the degree of temporal offset between CBTmin time and worst PVT performance time during the work shift, F(3,74.660)= 4.09, p=0.01; the disparity increased over successive days under the influence of circadian-informed lighting compared to standard lighting., p<0.01.

Conclusions

The modest adjustment in the timing of the worst on-shift performance provides support that circadian lighting improves on-shift performance. These results emphasise the importance of considering the combined impact of circadian rhythms, sleep patterns, and time-on-task effects on performance outcomes when assessing fatigue and implementing countermeasures to phase-shift biological rhythms.
O004 The effect of treating OSA with CPAP on mood and sleepiness
Authors: Tolson J , Barlett D , Barnes M , Rochford P , Jordan A , Jackson M
Published: October 2023

Introduction

Excessive sleepiness and symptoms of depression and anxiety are highly prevalent in individuals with obstructive sleep apnoea (OSA). The aim of this study was to determine the effect of treating OSA with continuous positive airway pressure (CPAP) on mood and daytime sleepiness.

Methods

Seventy-eight participants (mean age 51.3±12.2 years; 41% female) with previously diagnosed OSA were randomised to either treatment as usual (TAU CPAP, n=43) or to a waitlist control group (WL, n=35). Participants in the TAU CPAP group were implemented with CPAP via an in-laboratory sleep study at the Austin Health sleep laboratory. CPAP initiation was delayed for participants in the WL group by 4 months. Sleepiness and depression, anxiety and stress symptoms, were measured at baseline and 4 months follow-up and compared between groups. CPAP use was measured in the TAU CPAP group.

Results

Participants in both groups reported mild symptoms of depression at baseline. Daytime sleepiness (p<.001) improved in the TAU CPAP group compared to the WL group, but not symptoms of depression, anxiety and stress. Baseline stress symptoms in females improved in the TAU CPAP group compared to the WL group (p<.007). Mean CPAP use was 3.5(2.9) h/night in the TAU CPAP group.

Discussion

Daytime sleepiness was improved with 4 months of CPAP use compared to no treatment. Mood did not improve with 4 months of CPAP therapy. Developing an OSA-specific tool to measure mood symptoms may be beneficial, and future studies should carefully consider recruitment criteria to include participants with mood symptoms at baseline.
O005 Deficits in learning and overnight memory consolidation in children with mild sleep disordered breathing
Authors: Menzies B , Teng A , D'Rozario A , Lah S
Published: October 2023

Objectives

Sleep disordered breathing (SDB) is associated with sleep fragmentation that can compromise daytime learning and impact overnight memory consolidation. Yet, research into learning and overnight memory consolidation of children with SDB is very limited. The objective of the current study is to determine if school aged children with SDB show deficits in learning and overnight consolidation of declarative and non-declarative memories compared to healthy control (HC) children.

Methods

This study included 50 school aged (7-16 years) children (25 SDB, 25 HC) of comparable sex, parental SES, and BMI. Parents completed the paediatric sleep questionnaire (PSQ) for all children. Children with SDB underwent an overnight sleep study. All children completed a cognitive battery, including assessment of IQ and memory. We employed two declarative memory tasks, one verbal and one visual, and one non-declarative memory task. We measured learning and recall at two delays (30 minutes and overnight) on memory tasks.

Results

On the visual declarative memory task children with SDB performed more poorly in learning, and recalled significantly fewer pictures following a night of sleep, compared to HC. On the non-declarative task learning of children with SDB and HC children was comparable but following a night of sleep accuracy improved less in the SDB group compared to the HC group.

Discussion

This study provides, to our knowledge for the first time, evidence of impairment of overnight declarative and non-declarative memory consolidation concurrently in school aged children with mild SDB, whose declarative (but not non-declarative) learning was also impaired.
O006 Major adverse cardiovascular events in severe Obstructive Sleep Apnoea: Associations with symptom subtypes and symptom burden
Authors: Shenoy B , McArdle N , Walsh J , Cadby G , Reynor A , Dhaliwal S , McQuillan B , Hillman D , Hung J , Eastwood P , Mukherjee S , Palmer L , Singh B
Published: October 2023

Background

Obstructive sleep apnoea (OSA) is a heterogeneous disorder with certain phenotypes at increased risk of major adverse cardiovascular events (MACE). We investigated whether symptom subtypes and/or symptom burden are useful predictors of MACE risk in severe OSA.

Method

In a longitudinal sleep clinic cohort with apnoea-hypopnoea index ≥30 events/hour (n=1767), we investigated 19 OSA-related symptoms across four symptom domains (upper airway [UA], insomnia and disturbed sleep, morning, and daytime sleepiness) and the Epworth Sleepiness Scale score. Latent class analysis identified five symptom subtypes. A symptom burden score (0–8) was developed by selecting the two symptoms from each domain most strongly associated with MACE. Multivariable-adjusted associations of subtypes and symptom burden with future MACE were investigated using Cox regressions.

Results

Over a median follow-up of 7 years, 18.7% developed MACE. Relative to the moderately sleepy subtype, the disturbed sleep (adjusted hazard ratio [HR], 1.65; 95%CI, 1.15–2.37) and UA symptoms predominant (HR, 1.57; 95%CI, 1.05–2.34) subtypes showed increased MACE risk. There was a graded increase in MACE risk with increasing symptom burden score (adjusted p for linear trend = 0.003). Compared to patients that reported ≤2 of 8 symptoms, those with ≥7 symptoms showed an independent risk for MACE (HR, 1.77; 95%CI, 1.12–2.77).

Discussion

Both symptom subtypes and symptom burden may help identify severe OSA patients at increased risk of MACE. However, our novel symptom burden score may have more clinical utility as it is an easily calculated summative measure of OSA-related symptoms that allows objective comparisons across diverse patient populations.
O012 The Impact of Sleep Restriction on Reward learning in Healthy Adults
Authors: Kavaliotis E , Boardman J , Ogeil R , Bennett D , Verdejo-Garcia A , Drummond S
Published: October 2023

Sleep disruption can lead to enhanced reactivity towards pleasurable stimuli and impaired discrimination between rewarding and punishing cues. Thus, sleep may play a mechanistic role in the development and exacerbation of pathological reward-related behaviours (e.g., gambling, substance use, etc.). The study aimed to explore the impact of sleep restriction on reward processing. Involving a 7-night at-home sleep monitoring protocol, participants were randomly assigned an experimental condition: sleep restriction (5-hr time in bed/night; SR) or well-rested (9-hr/night; WR). Adherence to the prescribed sleep schedules was assessed daily. On the eighth day participants completed a battery of reward- learning tasks, 2-hrs post-habitual wake. Participants were healthy adults (n = 45, mean age = 25.4 yrs, 64% female). Total sleep time for the SR group (n = 18) was 297.4 mins, whilst the WR was 485.8 mins (n = 27). For the probabilistic reward task, response bias (RB) did not significantly differ between the SR and WR groups during the overall task (p = 0.28), or during blocks one (p = 0.26) or two (p = 0.90). However, at block three, the SR group showed higher RB as compared to the WR group (p = 0.03), indicating SR participants exhibited a systematic preference for the frequently rewarded cues, relative to the WR group. These preliminary results suggest initial reward responsiveness is not impacted by SR, but over time SR may produce heightened sensitivity to rewarding cues. This may indicate a role for sleep disruption in the maintenance of maladaptive appetitive behaviours.
O022 Characteristics of patients with obstructive sleep apnoea with a focus on the First Nations population
Authors: Bolger M , Tay G , Sharma N , Kanno E , Sivathasan A , Demidowicz A , Tran D , Welagedara S
Published: October 2023

Background

Obstructive sleep apnoea (OSA) is common with an estimated prevalence of 9-38%. First Nations Australians experience a burden of disease 2.3 times that of the general population. Notably, many of the conditions prevalent in this population are associated with OSA. However, there is a paucity of data relating to the characteristics of First Nations Australians with OSA.

Methods

This audit aims to analyse the characteristics, co-morbidities, and sleep study data of the cohort of patients referred to our facility for a sleep study between 2010-2023, with a subgroup analysis of the First Nations population.

Results

To date we have analysed data for 587 patients who attended our facility from 2022-2023 of which 28 (4.7%) identify as First Nations. We analysed 325 diagnostic sleep studies. 315/325 patients were non-First Nations. Of these 61 had a normal study, 88 had mild OSA, 73 had moderate OSA and 93 had severe OSA (as defined by apnoea-hypopnea index of 5-15, 15-30 and >30 respectively). The average BMI was 34.12kg/m2. 10/325 patients identified as First Nations. Of these 3 had a normal sleep study, 3 had mild OSA, 4 had moderate OSA and 2 had severe OSA. The average BMI was 33.98kg/m2.

Discussion

Data collection and analysis are ongoing. Our small sample size to date likely underestimates the proportion of clients who identify as First Nations. Through this study we hope to gain a deeper understanding of, and contribute to, existing knowledge of specific risk factors present in this group.
O024 Sodium oxybate for refractory narcolepsy and idiopathic hypersomnia: clinical and employment outcomes
Authors: Hernest A , Armstrong J , Vekaria S , Kosky C
Published: October 2023

Background

Sodium oxybate (SOX) is an evidenced based treatment for narcolepsy. SOX is not available in Australia through the pharmaceutical benefits scheme. In 2018, Western Australia (WA) listed sodium oxybate on the state formulary for the treatment of refractory narcolepsy. We examine the demographics, clinical and employment outcomes of patients treated with SOX.

Methods

We undertook a retrospective study of patients treated with sodium oxybate in WA for refractory narcolepsy or idiopathic hypersomnia (IH). A database of SOX patients was cross checked with pharmacy prescribing data from across WA public hospitals. Electronic medical records were used to collect demographic, polysomnographic, prescribing and outcome data. Clinical outcomes were based on the Epworth sleepiness scale, clinical assessment and employment status. Patients that responded to SOX are to be compared to non-responders using appropriate statistical methodology.

Progress to date

The study has been registered as a hospital clinical audit (number 49852). A total of 50 patients prescribed SOX for the treatment of a central hypersomnia have been identified. A request for sodium oxybate dispensing data across WA has been made. Review of 10 patient’s records has been completed. Correspondence, sleep studies, MSLT, HLA testing and prescriptions are being reviewed for the remaining 40 patients.

Intended outcome and impact

Describe the characteristics of patients treated with SOX in WA.

Explore whether clinical or sleep study characteristics predict response to SOX.

Assess patient reported outcomes from treatment with SOX based on symptoms and changes in employment status.
O028 Worsened sleep and mood after initiating elexacaftor/tezacaftor/ivacaftor treatment in children with cystic fibrosis
Authors: Pham H , Ranganathan S , Vandeleur M
Published: October 2023

Background

CFTR modulator Elexacaftor/tezacaftor/ivacaftor (ETI) significantly improves lung function and but its effect on mental health and sleep remains poorly understood. We report sleep, mood and respiratory health outcomes of adolescents with CF with ETI therapy.

Methods

We conducted a prospective longitudinal study of 31 adolescents (aged 10 to 18 years) from July 2021 to October 2022. Data collected include demographics, pediatric daytime sleepiness scale (PDSS), sleep disturbance scale for children (SDSC), patient health questionnaire-9 (PHQ-9), generalised anxiety disorder-7 (GAD-7) scores and FEV1 percent predicted.

Results

Paired-T testing demonstrated a significant improvement in FEV1, whereas PDSS, PHQ-9, and GAD-7 scores worsened following ETI therapy, but did not reach statistical significance. SDSC scores marginally reduced. Ten percent of participants developed new onset sleep concerns and new mood concerns developed in 10% following ETI initiation.

Conclusion/Outcome

This is the first prospective longitudinal study of sleep and mood changes with ETI in adolescents with CF. ETI does not improve sleep and mood in the same way as respiratory health outcomes.
O036 Measuring Sleep-wake State Discrepancy in the Home across Multiple Nights
Authors: Bensen-Boakes D , Loffler K , Lack L , Perlis M , Drummond S , Kaambwa B , Paterson J , Scott H , Lovato N
Published: October 2023

Introduction

Sleep-wake state discrepancy, the mismatch between subjective and objective measurements of sleep/wake status, is estimated to affect 9-50% of individuals with insomnia, often undetected due to lack of objective measures. Consumer sleep devices allow efficient measurement of sleep-wake state across multiple nights in the habitual sleep environment. This study assessed sleep-wake state discrepancies obtained by two devices across multiple nights in individuals with insomnia.

Methods

Individuals with insomnia completed daily sleep diaries, wore a Fitbit Charge 4 device, and used a Withings Sleep Analyser under-mattress sensor for 14-days. Sleep metrics were obtained from all three data sources to calculate sleep-wake state discrepancy (device metric − diary metric).

Results

15 people participated in the study. Fitbit data were available for 12 and mattress data for 11 participants. There were no significant differences between the sleep-wake state discrepancy values derived from Fitbit and Withings devices for total sleep time (−78.7±111.8 and −95.7±124.4 minutes respectively; p .123) or wake after sleep onset (−15.4±52.9 and −17.6±110.6 minutes respectively; p .826). Significant differences were found in the sleep-wake state discrepancy values derived from Fitbit (−17.5±23.3, p <.001) and Withings devices for number of awakenings (3.2±23.1, p .175).

Discussion

Both devices comparably detected sleep-wake state discrepancy in people with insomnia, noting a device-difference for number of awakenings. These preliminary findings suggest that consumer devices may be useful to detect sleep-wake state discrepancy. Larger studies may reveal devices do so with different levels of sensitivity. Future studies should include polysomnography to assess relative magnitudes across devices.
O038 Obstructive Sleep Apnoea Prevalence and Severity in a Specialist Heart Failure with Preserved Ejection Fraction (HFpEF) Clinic
Authors: Stewart G , O’Sullivan J , Lal S , McClintok S , Tong B , Yee B , Cistulli P
Published: October 2023

Heart Failure with Preserved Ejection Fraction (HFpEF) is a debilitating, incurable form of HF associated with a normal left ventricular ejection fraction and elevated ventricular filling pressures. While Obstructive Sleep Apnoea (OSA) is common in HFpEF and OSA treatment may be associated with improved outcomes, the causal role of OSA in the pathophysiology of HFpEF remains unclear. Accordingly, accurate diagnosis and tracking of OSA in HFpEF patients is emerging as a potentially important approach for impacting prognosis. This study sought to identify the prevalence and severity of OSA in consecutive patients referred to a recently established tertiary hospital HFpEF clinic. All patients were confirmed to have HFpEF using standard clinical approaches and completed the Epworth Sleepiness Scale (ESS) to screen for sleep-disordered breathing and a level 2 polysomnogram to confirm OSA presence and severity. To date 28 patients have been assessed for OSA (9M/27F; Age 67±2y; BMI 35.0±1.6kg/m2; BNP 214±64ng/L). All 28 patients (100%) were diagnosed with OSA (AHI≥5 events/h), while 16 (57%) had moderate-severe OSA (AHI≥15 events/h). Average ESS was 7±1, with only 6 patients (21%) identified at risk for sleep-disordered breathing (ESS>9). These preliminary data confirm a very high prevalence of OSA in HFpEF patients when assessed via polysomnography. Furthermore, these patients appear asymptomatic in terms of sleepiness, as measured by the ESS. The nature of the association between OSA and HFpEF and the potential benefit of OSA treatment warrant study. Given that the ESS did not effectively identify OSA risk in HFpEF, alternative screening tools warrant consideration.
O039 A Novel Approach to Quantify Breathing effort in Obstructive Sleep Apnoea
Authors: Nguyen P , Lechat B , Reynolds K , Eckert D , Catcheside P
Published: October 2023

Introduction

Breathing effort is an important component of obstructed breathing and determinant of arousal in obstructive sleep apnoea (OSA). However, relative effects of hypopnoea versus apnoea on effort and work of breathing (WOB) are largely unknown. This study applied a novel modelling approach to quantify breathing effort, WOB and obstruction severity to evaluate differences between hypopnoea and apnoea events in OSA.

Methods

1659 apnoea and hypopnea events from six obese males (BMI: 30-41 kg/m2; age: 34-56 years; AHI: 31-114 events/hr) with severe OSA were evaluated using conventional sleep measures and a 3-compartment (nasal, collapsible upper airway and lungs) respiratory mechanics model using mask airflow and pressure, and oesophageal and epiglottic pressures. Attempted airflow and WOB, and WOB loss to obstruction (attempted minus measured WOB), were estimated breath-by-breath via the model for comparisons between hypopnoea and apnoea events and sleep stages.

Results

The model explained most of the variance in attempted flow (Pearson r= 0.91 [95% CI 0.71 to 0.98]). Compared to hypopnoea events, WOB loss during obstructive apnoeas was 3.5 [95%CI 1.7 to 5.4] times higher. WOB losses were also higher during deep versus N2 sleep. Visualising breath-by-breath WOB loss revealed a significant number of flow- limited breaths not detected using traditional human scoring. Over 30% of breaths not classified as hypopnoeas or apnoeas exhibited WOB loss higher than for hypopnoea events.

Conclusions

Respiratory mechanics modelling is useful to assess breathing effort and upper airway obstruction severity and could provide novel mechanistic insights into sleep-related breathing problems and treatment outcomes.
O041 Exploring the Landscape of Sleep Data Resources: A Literature Survey
Authors: Chen L , Malagutti N , Miller S
Published: October 2023

Introduction

The complex physiologic interdependencies of sleep make sleep medicine a data-rich discipline. Emerging big data approaches hold promise for novel discoveries, however, scholars have suggested these advances may be hindered by dataset limitations. We conducted a review of the field to assess the drawbacks of available sleep data resources.

Methods

A systematic literature survey on PubMed. A keyword search identified studies based on sleep datasets which combined polysomnography records and contextual patient health information. For eligible studies, we extracted information on data provenance (existing repositories versus self-collected), data accessibility for onward research, dataset size, cohort characteristics, data/metadata inclusions, and use of systematic nomenclatures.

Results

Only approximately 40% of identified studies used public datasets, suggesting that these repositories only partially met current research needs. Alternative, self-collected cohorts were typically small, with just 20% having populations greater than 1000 subjects. Most were closed-source or lacking data access indications, which may impact the strength and reproducibility of study results. Large-size resources focussed predominantly on sleep apnoea, limiting the reach of research efforts targeting less prevalent conditions.

Datasets featuring comprehensive medical histories and long-term follow-up information were rare. Where available, this information generally lacked systematisation of nomenclatures and metadata, impairing the ability of users to extract meaning from data entities and their interrelationships.

Discussion

Limitations in current sleep data practices were substantiated by our review. There is a clear need to develop larger, diverse, multimodal and clinically representative sleep data collections that can be more easily shared, and analysed using emergent data-driven discovery tools.
O044 Are we Sleeping Enough? Short and Irregular Sleep is Common in a Large Global Community Sample with Objective, Multi-night, In-home Sleep Data
Authors: Scott H , Naik G , Lechat B , Manners J , Fitton J , Nguyen D , Hudson A , Reynolds A , Sweetman A , Escourrou P , Catcheside P , Eckert D
Published: October 2023

Introduction

Evidence-based guidelines recommend that adults should sleep 7-9hrs per/night. This study used multi-night, in-home, objective sleep duration monitoring to determine how often a large global community sample meets the recommended sleep duration range.

Methods

Data were analysed from registered users of the Withings Sleep Analyzer under-mattress device who had ≥28 nights of sleep recordings, averaging ≥4 per week. Sleep durations were assessed as the average and standard deviation of sleep duration across a ~9-month period. Proportions of participants within (7-9hrs) or outside (<7hrs or >9hrs) the recommended sleep duration range were calculated. Associations between age groups, sex, and sleep duration were assessed using linear and logistic regressions.

Results

In total, data were analysed from 67,254 adults (52,523 males, 14,731 females; aged Mean±SD 50±12y). About 30% of the sample showed an average sleep duration outside the recommended 7-9hrs per/night. Even in participants with an average sleep duration within 7-9hrs, about 40% of recorded nights were outside this range, and only 15% of participants slept between 7-9h for at least 5 nights per/week. Females had significantly longer sleep durations than males, and middle-aged participants had lower sleep durations than younger and older participants.

Discussion

A considerable proportion of adults in this sample were not regularly sleeping the recommended 7-9hrs per/night. Even amongst those who do, irregular sleep is prevalent. These novel data raise several important questions regarding sleep requirements, lifestyle factors, and the need for improved sleep health policy and advocacy.
O050 The Dose and Timing Relationship between Caffeine and Subsequent Sleep
Authors: Gardiner C , Weakley J , Johnston R , Fernandez F , Townshend A , Halson S
Published: October 2023

Introduction

There is currently a lack of evidence to guide recommendations for the consumption of caffeine to mitigate its effects on sleep. Therefore, the aim of this study was to investigate the effect of caffeine dose and timing combinations on subsequent sleep.

Methods

Twenty-three healthy adult males with a moderate habitual caffeine intake (<300mg/d) participated in a randomised, repeated-measures study. Participants completed seven conditions, including a placebo and two caffeine doses (100mg and 400mg) consumed at three different time points (12, eight, and four hours prior to habitual bedtime) with a 48-hour washout period. Sleep was measured using in-home partial polysomnography and subjective sleep diaries. Linear mixed effects models were used to estimate the effect of each caffeine condition on sleep characteristics.

Results

Caffeine negatively impacted sleep when compared to the placebo. The largest impact was observed when the highest dose of caffeine (400mg) was consumed closest to bedtime, with a 54.0 minute reduction in total sleep time (p=<0.001), a 10.2% reduction in sleep efficiency (p= <0.001), a 14.4 minute increase in sleep onset latency (p=0.047), a 25.3 minute increase in wake after sleep onset (p=<0.001), a 5.5% increase in the proportion of light sleep (N1&N2)(p=0.029), and a 4.55% reduction in deep sleep (N3)(p=0.026).

Discussion

The largest decrements in sleep occurred when caffeine was consumed at a high dose in close proximity to bedtime. These findings highlight the importance of considering the amount and timing of caffeine intake when aiming to minimise the effect of caffeine on subsequent sleep.
O053 Cardio-metabolic Health Effects of CPAP Treatment for Sleep Apnoea during Weight Loss: A Randomised Controlled Pilot Trial.
Authors: Hoyos C , Cayanan E , Yee B , Postnova S , Marshall N , Markovic T , Twigg S , Grunstein R , Phillips C
Published: October 2023

Introduction

This study assessed whether the addition of CPAP during weight loss would enhance cardiometabolic health improvements in patients with obesity and OSA.

Methods

Patients with overweight or obesity, pre-diabetes and moderate-severe OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). Primary outcome: 2-hour glucose assessed by OGTT. Trial registration: ANZCTRN 12617000823370.

Results

17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Mean CPAP compliance was 5.29 hrs/night. Participants lost ~12 kg which reduced OSA severity by ~45%. The primary analysis showed no between group differences for any of the assessed outcomes. Despite this, most outcomes improved with weight loss including insulin sensitivity (.000965 units, p=.008), wake diastolic BP (-4.3mmHg, p=.03), sleep systolic BP (-16.2 mmHg, p=.0003), sleep diastolic BP (-9.8 mmHg, p=0.02), and sleepiness (Epworth Sleepiness Score -3.2, p=.0003). Two-hour glucose levels did not improve (p=0.33), but the glucose area under the curve (AUC) was reduced (-230 units, p=.009). In addition, total (-0.86mmol/L, p=0.006) and LDL cholesterol (-0.58mmol/L, p=0.007), triglycerides (-0.75mmol/L, p=0.004), fat mass (-7.6kg, p<.0001) and abdominal fat (-310cm3, p<.0001) were all reduced.

Conclusions

We did not establish any cardio-metabolic benefit from CPAP therapy during weight loss. In contrast, weight loss had a robust positive effect on cardio-metabolic health. The magnitude of weight loss improvements far exceeded those from trials assessing the impact of CPAP alone, suggesting that weight loss should be the primary focus of treatment for patients with OSA and obesity.
O056 Is Obstruction Obstructing Survival? Long-term Mortality in Patients with Chronic Obstructive Pulmonary Disease (COPD) requiring Acute Non-invasive Ventilation (NIV) with and without Obstructive sleep apnoea (OSA).
Authors: Nguyen B , Menadue C , Yee B , McGuiness O , Wong K , Marshall N , Lau E , Piper A
Published: October 2023

Introduction

COPD/OSA overlap syndrome (OVS) is associated with poor outcomes in studies conducted in ambulatory settings. However, little is known about the prognosis of patients hospitalised with acute hypercapnic respiratory failure (ARF) requiring NIV. The aim of this study was to compare the long-term prognosis of OVS patients compared to patients with COPD.

Methods

In this retrospective cohort study, 129 patients with COPD and 52 OVS patients were treated with NIV for ARF and followed up for a median of 1.8 years (IQR 3.8). We compared patient characteristics and overall survival.

Results

Compared to patients with COPD alone, OVS patients had higher prevalence of hypertension and type-2 diabetes mellitus. There was no difference in arterial pH, PaCO2 or serum bicarbonate at hospital presentation. Mortality was lower in OVS (HR 0.57, 95% CI 0.38-0.85) and remained lower after adjustment for age, gender, BMI, FEV1%predicted and comorbid cardiovascular disease. Median survival in OVS patients discharged home on NIV was significantly higher compared to OVS not discharged on therapy, as well as COPD patients, irrespective of home therapy prescription (p<0.01).

Discussion

OVS patients discharged on NIV had lower mortality compared to OVS patients not discharged on NIV. Patients with COPD and ARF requiring NIV have overall higher mortality rates compared to OVS patients. These findings suggest that following hospital admission with ARF, OVS patients may benefit from ongoing home NIV.
O058 Are short central apnoeas in preterm infants really benign? Effects on cardiovascular control.
Authors: Yee A , Shetty M , Siriwardhana L , Walter L , Wong F , Horne R
Published: October 2023

Introduction

Preterm infants frequently experience respiratory instability in the form of short apnoeas and periodic breathing. Animal studies have shown that repetitive hypoxia associated with periodic breathing can alter autonomic control. We aimed to elucidate if apnoea and periodic breathing were associated with autonomic cardiovascular control, thus exacerbating the consequences of respiratory disturbance longitudinally over the first 6 months after hospital discharge.

Methods

Preterm infants born between 28-32 weeks gestational age (GA) were studied during supine daytime sleep at 32-36 weeks post menstrual age (PMA) (n=29), 36-40 weeks PMA (n=27), 3-months corrected age (CA) (n=20) and 6-months CA (n=26). The percentage total sleep time (%TST) spent having central apnoeas at each study was calculated. Autonomic control was assessed using heart rate variability in ranges of total power, low frequency (LF, reflecting sympathetic + parasympathetic activity) and high frequency (HF, parasympathetic activity), and LF/HF ratio (sympathovagal balance).

Results

The amount of time spent with short central apnoeas decreased with increasing postnatal age in both active sleep (AS) and quiet sleep (QS). In both sleep states, total, LF and HF power increased with postnatal age, while LF/HF decreased in AS. In both AS and QS %TST spent with short central apnoeas was negatively correlated with Total, LF and HF power (p<0.001 for all) and positively correlated with LF/HF (p<0.05).

Conclusion

This study provides new evidence that short apnoeas, particularly periodic breathing, which is currently not detected or treated in the neonatal unit can affect autonomic cardiovascular control.