bluuebunny/crossref_metadata_2025 huggingface dataset:
P052 Is Circadian Adaptation to Night Work Affected by the Intensity of Ambient Lighting?
Authors: Roach G , Kosmadopoulos A , Sargent C
Published: October 2023

Introduction

The aim of this study was to examine whether the intensity of ambient lighting affects the rate at which the human circadian system adapts to working at night.

Methods. The whole study will include 60 participants (50:50, F:M; aged 28–35yr; good sleep/health) randomised to one of three conditions. In each condition, participants work 14 x 12-hr simulated night shifts (19:00–07:00h) while living 24h/day in an accommodation suite. The only difference between conditions is in the light intensity during night shifts – dim (5–10lx), moderate (50–100lx), normal (300–350lx). Circadian adaptation is being assessed using the hourly rate of 6-sulphatoxymelatonin (aMT6s) production during sleep.

Results

The project is in progress, so these results are for the first 6–12 participants in each condition. For each day, circadian adaptation is assessed by expressing the rate of aMT6s excreted during the daytime sleep period as a percentage of the rate of aMT6s excreted during the night-time baseline sleep period (for an adaption score of 0–100%). On average, participants in the dim condition are adapted by 26%,37%,32% after nights 1,7,14; participants in the moderate condition are adapted by 23%,37%,60% after nights 1,7,14; and participants in the normal condition are adapted by 27%,117%,103% after nights 1,7,14.

Discussion

These data indicate that the rate, and degree, of circadian adaptation to night work is substantially affected by the intensity of ambient lighting. Therefore, lighting conditions should be incorporated into OHS guidelines related to managing the fatigue risks associated with night work.
P056 Improvements in Daytime Function Items of the Insomnia Severity Index Are Correlated with a Positive Impact of Treatment on the Patient Global Impression Insomnia Scale
Authors: Drake C , Gardiner F , Yardley J , Pinner K , Moline M
Published: October 2023

Introduction

Items 4-7 (daytime function [DF]) of the 7-item Insomnia Severity Index (ISI) can assess daytime impairment. In Study E2006-G000-303 (Study 303; NCT02952820), lemborexant (LEM), a dual-orexin receptor antagonist, was associated at 6 months (6mo) with both significant improvement in ISI-DF items and significantly more subjects reporting positive effects on sleep, as assessed by the Patient Global Impression–Insomnia version (PGI-I), versus placebo (PBO). This analysis looked at the correlation between ISI-DF improvement and patient ratings on the PGI-I.

Methods

Study 303 was a 12-month, randomized, double-blind PBO-controlled (first 6mo) phase-3 study in adults with insomnia disorder. Subjects were randomized to PBO, LEM 5mg or 10mg for 6mo (2nd 6mo not reported here). ISI items are rated from 0 (no problem) to 4 (very severe problem). ISI-DF includes sleep satisfaction, extent symptoms are noticeable to others, cause worry/distress, and interfere with daily function. On the PGI-I, subjects assess positive, neutral or negative treatment impact on falling asleep, overall benefit on sleep, and total sleep time.

Results

A total of 739 subjects completed the ISI and PGI-I and were included in these analyses. At 6mo in all treatment groups, there were significant correlations (all P<0.001) between improvement in both ISI-DF items and PGI-I ratings regarding falling asleep, overall benefit on sleep, and total sleep time.

Discussion

These data suggest that the PGI-I may be a useful, quick tool to use in clinical practice, since an improvement in its score reflects improvements in daytime function.

Sponsor

Funded by Eisai Inc.
P059 Sleep and Fibromyalgia: Identifying and Managing Sleep Disorders.
Authors: Lovato N , Reynolds A , Whittle S , Watson N , Dyer K , Gill T , Adams R , Hill C
Published: October 2023

Introduction

Little is known about the presentation and management of sleep problems in patients with fibromyalgia [FMS]. This pilot study aims to 1) characterise sleep/wake patterns and sleep disorders in participants with FMS, and 2) assess changes in sleep and FMS symptoms with individualised sleep disorder treatment.

Methods

Women with FMS were recruited from the Rheumatology Unit at The Queen Elizabeth Hospital, South Australia. Participants recorded their sleep and activity for two-weeks using an under-mattress sleep sensor (Withings), sleep diaries and a wrist accelerometer. Questionnaires included Berlin Sleep Questionnaire (OSA); Epworth Sleepiness Scale; Flinders Fatigue Scale; Restless Legs Syndrome (RLS) Screener, Sleep Condition Indicator, and Fibromyalgia Impact Questionnaire.

Results

Preliminary data from 7 women (aged 49.3±12.8years, BMI 30.9±7.8kg/m2, average pain duration 14.1±9.4 years) were investigated. Sleep efficiency was low (65.9%±11.9). Five women were ‘high-risk’ for a sleep disorder (3 RLS, 3 OSA, 3 insomnia, 3 circadian rhythm disorders). Two were ‘high-risk’ for >2 sleep disorders. Two women had delayed, and one had advanced, circadian rhythms. Average self-reported sleep time in ‘high-risk’ women was shorter than the two women not at risk (6.2±1.1 vs 7.8±0.4hours). (6.2±1.1 vs 7.8±0.4hours). Fatigue Scores exceeded those commonly observed for respondents living with a medical condition (25.2±2.4 vs. 20.4 + 6.2). Participants are currently undergoing sleep disorder treatments and preliminary results will be reported.

Conclusion

Identifying and managing sleep disorders, using cognitive behavioural therapy for insomnia and chronotherapeutic approaches may be an important therapeutic target for FMS patients to improve sleep quality, daytime functioning, and FMS symptoms.
P060 Effectiveness of current digital interventions for children and adolescents with sleep problems: a systematic review and meta-analysis
Authors: Cleary M , Richardson C , van Kins R , Heussler H , Wilson A , Downs J , Walsh J
Published: October 2023

Introduction

Sleep problems occur in up to 50% of typically developing children. Sleep problems include difficulty initiating sleep, frequent night waking, daytime sleepiness, or frequent nightmares, which lead to poor quality sleep. We conducted a systematic review and meta-analysis to examine the effectiveness of digital sleep interventions for children and adolescents.

Method

Databases (MEDLINE, PubMed, PsycINFO, Scopus, EMBASE, CENTRAL and Web of Science) were searched for studies published from January 2012 to April 2023. Within-subject studies or randomised controlled trials reporting the effects of a digital sleep-based intervention were included. Random-effects meta-analyses estimated pooled standardised mean difference to assess effectiveness. Nine studies involving 484 children/adolescents were included in this review.

Results

Digital sleep interventions were effective in reducing insomnia symptoms, decreasing subjective sleep onset latency and wake after sleep onset, and increasing subjective sleep efficiency. Objective measures of SOL, WASO and SE were all unchanged following digital sleep intervention. However, objective but not subjective increases in TST were identified.

Discussion

These results suggest that digital sleep interventions are effective in improving children and adolescent’s perceptions of their sleep but are less effective at improving some objective measures of sleep. Further, uptake of current digital sleep interventions was low, therefore future interventions should aim to address this, potentially through co-design, and integrating treatment components to enhance young people’s motivation. In order to achieve a clear understanding of how digital sleep interventions compare to other behavioural interventions, additional high-quality randomised controlled trials comparing digital interventions to traditional in person modalities are needed.
P062 Validation of Unattended Polysomnography using Somte for Diagnosis of OSA in Pregnant Women during Early Gestation.
Authors: Clements F , Chung Y , Marshall N , Melehan K , Hennessy A , Makris A , Vedam H
Published: October 2023

Introduction

The detection of obstructive sleep apnoea (OSA) in pregnant women in early gestation using polysomnography (PSG) was logistically difficult during covid-19 lockdowns. Reliable alternates to PSG haven’t been well validated in early pregnancy. We compared the agreement between self-applied, unattended Somte and attended PSG, in pregnant women by 24 weeks gestation.

Methods

Women were recruited to undergo self-applied, unattended Somte and attended Grael PSG, by 24 weeks gestation. Tests were scored by a single experienced scorer (blinded to PSG result). An apnoea-hypopnea index (AHI) 5 or above at PSG was considered diagnostic of OSA. Diagnostic test analysis was undertaken (sensitivity, specificity, positive and negative predictive value (PPV/NPV)), by creating receiver operating characteristic (ROC) curves. The calculated AHI was compared and Bland-Altman plot used to plot agreement.

Results

Twenty-Four participants were included for analysis, median age 33.5(29.0, 37.0) years, gestation at PSG 14.1(13.4, 15.7) weeks and median BMI 31.2(26.3, 36.5). Five (20.8%) women had OSA. Median AHI were similar, 1.75 (0.50, 4.53) and 1.6 (0.58, 4.25) for Somte and PSG respectively. Somte demonstrated reasonable diagnostic test accuracy (area under the ROC curve 0.94 (95%CI 0.81-1.0)), sensitivity 80% (cut off AHI 5) and specificity 89.5%. The PPV and NPV were 80.0% and 94.7% respectively. Bland-Altman plot upper and lower confidence intervals of 6.37, -8.89, demonstrated lower and higher AHI scores slightly underestimated and overestimated, respectively.

Discussion

Somte provided reasonable accuracy compared to PSG in identifying OSA in early gestation in this sample. Larger studies will be helpful to confirm this finding.
P072 Sleep, Shift work Patterns and Work-Related Accidents in Regional/Rural versus Metropolitan Healthcare Shift Workers.
Authors: Booker L , Spong J , Hodge B , Deacon-Crouch M , Bish M , Mills J , Skinner T
Published: October 2023

Introduction

Sleep impairment can decline alertness and performance and increase the risk of occupational injuries such as medical errors, workplace injuries and car accidents. Australia has a shortage of healthcare shift workers, particularly in regional/rural areas. The consequence of this is that rural healthcare shift workers potentially have to work longer hours, be more on-call and/or have to commute longer distances to/from work. These factors could impact the worker's sleep and recovery. The aim was to explore the differences in sleep and shift work patterns in regional/rural and metropolitan healthcare shift workers and the risk of workplace accidents, medical error, and car accidents.

Method

An anonymous online survey was distributed targeting nurses, midwives and paramedics.

Results

403 healthcare shift workers completed the survey. Those in regional/rural locations were significantly older, had more experience, worked significantly more hours per week, more night shifts and on-call shifts in the previous two weeks. However, metropolitan shift workers took significantly longer (in minutes) to travel to work, reported more feelings of sleepiness while driving to/from work, having a car accident or near accident while commuting home, and having a workplace accident in the last 12 months. There was however no differences in sleep quality between the groups but poor sleep quality was the main contributing factor related to workplace incidents, medical errors and car accidents.

Conclusion

There were differences in shift work patterns between metropolitan and regional/rural healthcare shift workers. More exploration is needed to understand the components that contribute to increased OH&S risks.
P076 Comparing Four Different Simulated Shiftwork Schedules on Higher order Cognitive Function
Authors: Guzzetti J , Marando I , Owen M , Matthews R , Yates C , Banks S
Published: October 2023

Introduction

Changes in cognitive performance during shiftwork due to fatigue and circadian misalignment are well-documented. However experimental evaluations of shiftwork schedules are often limited to basic tasks such as vigilance and attention. The current study evaluated several higher order cognitive functions such as memory and task switching during four simulated shiftwork schedules.

Methods

N=27 completed a 10-day laboratory shiftwork simulation. They were randomly assigned to one of four shiftwork conditions: Condition A, 4h-on/4h-off/8h-on/8h-off schedule; Condition B, 6h-on/6h-off schedule; Conditions C and D represented to different sections of a 4h-on/4h-on call/4h-off/4h-on/4h-on call/4h-off schedule. The Automated Neuropsychological Assessment Metrics (ANAM) was used to assess cognitive function. The tasks included in this analysis were Code Substitution (CDS/CDD), Pursuit Tracking (PUR), Matching to Sample (M2S), and Switching Task (SWT). Stability of performance during waking was compared between the conditions using Kruskal-Wallis tests.

Results

The analysis of cognitive performance tasks yielded mixed findings. Performance on all tasks was ranked from best to worst: Condition D (>Conditions A, B, C; all p < .05), Condition A (>Conditions B, C; p < .05 and p <.001, respectively), Condition B, Condition C. Regarding stability of higher order cognitive function across the waking day, Condition A exhibited the worst stability, and was the only condition whereby performance degraded across the wake period.

Discussion

These findings highlight the variability in cognitive capacities during different shiftwork schedules. It is important to examine higher order cognitive function, and other cognitive abilities during shiftwork, when evaluating different shiftwork schedules.
P077 Associations of sex, sleep, and circadian rhythms with performance in elite Australian Rules footballers
Authors: Mascaro L , Leota J , Rajaratnam S , Drummond S , Facer-Childs E
Published: October 2023

Introduction

Poor sleep and circadian misalignment are associated with poorer performance. In elite Australian Rules football (ARF), both sex and professionalism could alter or exacerbate these associations. This study provides preliminary insights on how the relationships of sleep and circadian alignment with cognitive performance differ between male full-professional and female semi-professional elite ARF athletes.

Methods

Participants were 72 elite ARF athletes (42% female; M-age = 24.1±4.4 years). During pre-season, participants completed two weeks of sleep/wake monitoring via actigraphy, and a circadian phase assessment (dim light melatonin onset; DLMO) after one week. Cognitive performance testing (psychomotor vigilance task, PVT; and the balloon analogue risk task; BART) was conducted five times throughout this period.

Results

Preliminary findings suggest average total sleep time and sleep efficiency, sleep regularity, DLMO, and phase angle (interval between average sleep onset and DLMO) did not predict reaction time on the PVT, nor did sex moderate these relationships. After controlling for sex, longer sleepers demonstrated greater risk taking on the BART. Only among male athletes did larger angles predict greater risk taking.

Discussion

Elite ARF athletes, regardless of sex, sleep, or circadian alignment, have similar reaction times. Risk taking is greater among longer sleepers and in male athletes experiencing relatively delayed circadian phases. Where risk-taking has negative implications (e.g., injury and sporting errors), these findings identify at-risk groups. Few sex-specific findings may suggest that the semi-professional status of female ARF (and associated lifestyle factors such as scheduling and income) is not altering elite performance in controlled settings.
P079 Shifting the Paradigm: Implementation Science in Enhancing Sleep Health among Shiftworkers
Authors: Vincent G , Thorne H , Sophocleous R , Shriane A , Vandelanotte C , Duncan M , Sprajcer M , Gupta C , Rigney G , Hilditch C , Kolbe-Alexander T , Thomas M , Ferguson S
Published: October 2023

Introduction

Addressing the urgent public health concern of sleep health among shiftworkers, our study examined the application and effectiveness of a tailored sleep intervention, the Sleepfit app. We assessed reach, effectiveness, adoption, and maintenance, while identifying potential implementation barriers across diverse shiftwork industries.

Methods

The two-phase study commenced with the Sleepfit app's optimisation, originally developed for day workers, by integrating sleep improvement strategies specifically for shiftworkers. The feasibility of large-scale implementation was then evaluated based on the RE-AIM framework, considering reach, effectiveness, adoption, implementation, and maintenance. The study involved existing shiftworkers (current sample, n=29; anticipated final sample n=90). Validated sleep health measures and RE-AIM metrics were used, with data analysed through a mixed-methods approach.

Results

Preliminary results indicate significant improvement in sleep satisfaction and reduction in insomnia severity, indicating the potential of the intervention in enhancing sleep outcomes. We also observed increased engagement with healthy sleep practices, demonstrated by a significant decrease in poor sleep behaviours. Interestingly, our preliminary findings propose specific benefits for younger shiftworkers who typically engage in problematic sleep practices. Preliminary data suggests 71% of shiftworkers engaged with the app at 2-weeks post intervention, with 23% continuing to use the app during long-term maintenance evaluation. As data collection is ongoing, a detailed analysis incorporating feasibility and all RE-AIM dimensions will be subsequently presented.

Conclusion

Preliminary findings suggest the Sleepfit app may serve as an effective sleep health intervention among shiftworkers, with further analyses needed to fully understand its feasibility and long-term adoption.
P080 Using your Mobile/Tablet Device at Bedtime for Work: Implications for Adult Sleep and Job Performance
Authors: Lushington K , Markobotsaris M , Dollard M , Parkin A , Potter R , Zadow A , Pignata S , Afsharian A , Owen M , Bakker A
Published: October 2023

Introduction

A substantial number of workers post-COVID-19 now work at home. Remote work allows for greater flexibility in work timing including the preference to work at bedtime. Thus, increasing the likelihood of digital device use at bedtime with possible negative consequences for sleep, job recovery and, in turn, job performance. This interplay remains to be tested.

Methods

202 university workers (54M, 144F; mean age (SD) = 48.38 ± 10.23y) completed a 10 day diary over two working weeks (Oct/Nov 2021) assessing digital device use, sleep, workload, worksite location, job recovery in the evening and job performance.

Results

Linear mixed model analyses revealed when comparing between individuals that greater digital device at bedtime was associated with greater wakefulness after sleep onset and shorter sleep and, in particular, if they worked from home compared to the office. By contrast, when comparing within individuals it was not the case if an individual used their digital device more on one night than another that this was associated with worse sleep nor was sleep worse on those nights when an individual had worked at home rather than the office. Analyses examining job recovery and job performance are currently under review.

Discussion

The present findings suggest that individuals who habitually use their digital device at bedtime are at a greater risk for poor sleep and supports the need for workplace implementations to discourage workers taking work to bed.
P083 Evaluation of OSA in children: Defining the scope of a paediatric sleep service
Authors: Carballo A , Madden G
Published: October 2023

Introduction

The sleep unit runs as a diagnostic paediatric service, and does not provide titrations as part of its scope. This study evaluates the requirement for titration studies for our patient cohort to better understand the scope of service. Obstructive sleep apnoea (OSA) affects 0.7%-13% of the general paediatric population, where a normal AHI is <1, mild >1-4.99, moderate >5-9.9 and severe OSA >10.

Method

A retrospective audit was undertaken of patients who attended between January and April 2022. Patients <2 years old and oxygen titration studies were excluded. Data was obtained by collating information from electronic medical records and physician reports. Parameters analysed: study indication, gender, AHI, desaturations, and BMI percentile.

Results

Preliminary data (n=101) (males 59.6%, age 8.6 ±4.3SD) shows that 12.9% (Male n=7; age 8.9 ±4.9SD) of our paediatric patients have OSA. 61.5% were mild, 7.7% were moderate and 30.8% of those had severe OSA. Patients had an average oximetry of 96% (±1.3SD) at baseline and an average Nadir of 83% (±10.1SD). It was also found that 53.8% of patients with OSA had a BMI percentile well above the healthy range. Other preliminary findings show 58% of the patients were snorers, and 8.9% of the patients were diagnosed with periodic limb movements.

Discussion

Only patients with severe OSA were referred externally for bi-level studies. Of the remaining OSA positive patients, adenotonsillectomy was recommended for three subjects, and the rest received no bi-level intervention. The data suggests a diagnostic only laboratory is sufficient to service our paediatric population.
P087 Exploring Associations between, and Temporal Changes in, the Sleep, Psychological Affect, and Exercise Performance of Elite Cyclists during a period containing the Tour de France
Authors: Fitton J , Manners J , Lechat B , Loffler K , Altree T , Catcheside P , Reynolds A , Eckert D
Published: October 2023

The effects of partial sleep restriction and minimal sleep impediment on endurance exercise performance remain incompletely understood. Moreover, the suggested role of psychological factors in the relationship, or lack thereof, between sleep and endurance performance is yet to be rigorously investigated in naturalistic settings. This study investigates the relationships between sleep, psychological affect, and exercise performance in elite cyclists during the Tour de France (TDF).

Data from eight male professional cyclists were collected over a 6-week period, including the 3-week TDF. Sleep, exercise performance, and affect (e.g., motivation) data were collected through smartwatches, bicycle-based instruments, and smartphone-administered questionnaires. Relationships between, and temporal changes in, sleep, affect, and performance metrics were explored through correlation and ANOVA analyses.

Participants were ~30±4 years old. Over the 6-weeks, average sleep duration was 08:11±00:58, with mean sleep onset and wakeup times of 23:46±00:44 and 07:57±00:52, respectively. Wakeup time (r = -0.40) and sleep quality (r = -0.32) were negatively associated with Performance Index. Compared to pre-race, sleep onset and wakeup time were delayed, sleep duration increased, and sleep quality and subjective mood declined, during the race (00:26±00:14[95%CI]; 00:48±00:16; 00:22±00:20; -6.4±5.2, -9.5%; -5.7±4.4, -9.1%, respectively). All p <.05.

Findings suggest temporal change in, and inter-relationships between, sleep, affect, and performance during real-world endurance competition. Increased psychophysiological strain and event-related factors (e.g., travel) likely explain the greater sleep duration, delayed sleep timing, and reduced sleep quality observed during the race. Further research into the temporal interplay between sleep, psychological affect, and performance during real-world competition is necessary.
P089 The Predictive Value of an Omegoid Epiglottis in Upper Airway Reconstruction Surgery for Obstructive Sleep Apnea
Authors: Gunasekera D , Lightfoot E , Ekanayake M , Foreman A , Krishnan S , Hodge J
Published: October 2023

Background

Obstructive sleep apnea is a serious medical issue with significant cardiovascular health associated complications. Surgical intervention is indicated for patients who are refractory to medical management. It’s efficacy was demonstrated in SAMS Trial in 2019. Surgery in this trial predominantly widened the airway in an anterior-posterior plane. An omegoid epiglottis has been hypothesized to be indicative of chronic lateral airway collapse, which hypothetically would be less responsive to the surgical protocol used in SAMS trial.. Our aim is to determine whether an omegoid epiglottis is therefore a poor predictor of surgical success.

Method

Following ethics approval, 53 OSA patients MRI images, Apnoea-hypopnea index’s (AHI) and Epworth sleepiness scale’s (ESS) who fell into the surgical arm of the SAMS trial were de-identified and retrospectively analyzed. Two independent researchers measured the width: depth ratio and alpha angle of patient epiglottises on MRI and used this data to separate patients into omegoid and non-omegoid epiglottis cohorts. The difference between pre-operative and post-operative AHI and ESS scores were tabulated and statistically analyzed between the 2 cohorts to determine the effectiveness of surgery. Intra-rater measurement assessments were undertaken to ensure reliability of data-collection.

Result: Epiglottis shape will be correlated with the effectiveness of multilevel OSA surgery based on qualitative, Epworth Sleepiness Scale (ESS), and quantitative, apnoea-hypoapnoea index (AHI) data collection prior and post-surgery (On going).

Conclusions

This study aims to determine whether an omegoid epiglottis acts as a predictor of poor outcome following SAM trial soft tissue reconstructive protocol.
P091 Timing Efficiencies in Tertiary Care of Patients on Non-invasive Ventilation
Authors: Hartnett C , Angliss M , Leclerc M
Published: October 2023

Introduction

A lean six-sigma (LSS) approach to clinical redesign looks at aspects of patient flow, value to consumer and any areas that may be considered wasted time. This LSS approach was used to find areas of improvement in a tertiary care hospital for patients on non-invasive ventilation. The solution developed was to implement a remote download service.

Methods

Root cause analysis, current state process and effects analysis, staff surveys and time and motion work sampling studies were conducted. There was a post implementation time and motion work sampling study for the remote download service introduced in 2023.

Results

Motion, transportation, inventory and waiting time and reporting software were found to impact workflow. Time efficiencies were found for non-invasive ventilation download reports with a mean time of 14.8 mins (std 6.7min) pre-implementation down to 2.5 mins (std 0.6min) with remote software. There was an additional time saving due to batch processing prior to clinics of 2.5 mins (std 0.4mins) per patient. Staff reported workload capacity and documentation as two key barriers to effective processes.

Discussion

LSS identified areas to improve value and flow for staff in sleep clinics and patients on non-invasive ventilation.
P099 Use of Digital Technology During Child Bedtime Routines: A qualitative investigation
Authors: McKenzie J , Pattinson C , Rossa K , Edmed S , Loeffler A , Smith S
Published: October 2023

Introduction

The Child Bedtime Routines Study (CBRT) sets out to examine patterns and attitudes towards sleep in daily life in a novel and detailed way, by constructing personal timelines of 5–8-year-old children’s sleep routines in their homes, their digital technology use, and parental attitudes and behaviours surrounding sleep and digital technology use.

Methods

This project involved individual semi-structured interviews with 30 parents of 5–8-year-old children via zoom. During the interview parents completed a novel visualisation of their home environment and the visual diagramming tasks for afternoon and evening, sleep and wake routines at home via the online interactive platform Mural.

Results

Thirty parents (Female = 86.7%) of 30 children (66.7% boys) aged between 5 and 8 years participated in the study. The most common description of their child using technology was watching shows or videos via tv or tablet. Over 76% of parents identified having rules or regulations regarding digital technology use. There was little technology use reported around bed-time routines, however, the use of apps to listen to bedtime stories was reported by some.

Discussion

The interviews allowed for greater description and nuance regarding the parenting decisions around technology use in the home. Household rules around the use of digital technology by children were not specifically oriented around bedtime or the potential impact of technology on sleep quality, duration, or timing. The use of technology-based sleep aids may increase, and a better understanding of the potential benefits and costs of those technologies needs to be understood.
P108 Obstructive Sleep Apnoea in Acute Coronary Syndrome: An Observational Study
Authors: Tong B , Dissanayake H , Patel S , Ucak S , Skilton M , McClintock S , Sutherland K , Yee B , Sarkissian N , Cistulli P
Published: October 2023

Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular disease. CPAP therapy is the primary treatment for OSA and is known to improve long term cardiovascular health outcomes. Recent neutral findings of randomised clinical trials have created uncertainty about whether effective CPAP therapy can improve cardiovascular health in patients with OSA. We conducted a cross-sectional observational study in patients with acute coronary syndrome (ACS) diagnosed with OSA. We aimed to characterise key surrogate markers of cardiovascular health in this cohort to inform a future intervention study of personalised OSA therapy.

70 patients with ACS (age (IQR):58[52,63]years, BMI:27[24,30]kg/m2) were recruited. A level 2 sleep study was conducted to confirm OSA diagnosis within 6 months after discharge. Carotid femoral pulse wave velocity(cfPWV), pulse wave analysis, endothelial function, heart rate variability, and baroreflex sensitivity were measured. Patients were categorised as no-mild OSA(AHI<15events/h) and moderate-severe OSA(AHI≥15events/h) for analysis.

67% of patients were found to have moderate-severe OSA(AHI≥15events/h) and 40% of patients had severe (AHI≥30events/h). cfPWV was elevated in moderate-severe OSA compared to no-mild OSA (7.4[6.6,8.5] vs. 6.1[4.7,7.1]m/s, p=0.003). This was no longer significant after adjusting for age (p=0.296) and BMI (p=0.053). cfPWV correlated with AHI (rs = 0.35, P=0.0069). Measures of pulse wave analysis, flow mediated dilatation, heart rate variability, and baroreflex sensitivity did not differ between patient groups (data not shown).

OSA is highly prevalent in patients with ACS. Arterial stiffness measured by cfPWV appears to show best promise as an outcome measure for a future intervention trial of personalised OSA therapy.
P109 Paediatric Limited Channel Sleep Monitoring Alternate Sleep Scoring Compared with Type 1 PSG
Authors: Verginis N , Davey M , Mihai R , Nixon G
Published: October 2023

Introduction

Obstructive sleep apnoea (OSA) has deleterious effects on children’s cognition, behaviour and cardiovascular system. Early diagnosis and treatment may improve long-term outcomes. Attended polysomnography (PSG) is the gold standard for OSA diagnosis, however access is limited with prolonged wait times. Home based limited channel sleep monitoring (LCSM) offers a more accessible alternative but may result in inaccurate sleep staging. We aimed to evaluate sleep scoring using a single channel combined EEG/EOG compared with full PSG.

Methods

Sample size calculations indicated 1000 epochs would be sufficient to demonstrate a kappa statistic of at least 0.7 for sleep stage comparison. Four patients undergoing in-laboratory PSG for suspected OSA gave consent for placement of an additional combined EEG/EOG simulating our LCSM montage. A single senior scientist scored sleep using full PSG montage, and after a minimum of 2 weeks, using the abbreviated montage.

Results

Epoch-by-epoch comparisons were made for 3,930 epochs. When comparing awake, N1, N2, N3 and REM, kappa=0.77 (p<0.001). Using the abbreviated montage, N1 was mostly misclassified as awake (28% of epochs) or REM (32% of epochs). When comparing awake, NREM and REM, kappa = 0.79 (p<0.001). When comparing awake and sleep, kappa = 0.82 (p<0.001).

Discussion

Accurate total sleep time is important for accurate respiratory index calculation. The abbreviated montage was reliable compared with PSG for scoring sleep versus awake (kappa >0.8). The addition of an EMG signal may correct misclassification of N1 as wake or REM and improve intra-rater agreement. EMG will be included in future studies.
P110 How do Night-time Awakenings, Assistive Technologies, and Help-seeking Behaviours Impact Australian Carers Sleep? A Cross-sectional Study
Authors: Vincent G , Commins H , Owen P , Paterson J , Thomas M , Sprajcer M , Gupta C , Gibson R , Ferguson S , Reynolds A
Published: October 2023

Introduction

Carers who provide support for those living with a disability or long-term health conditions have been recognised as being at increased risk of negative health outcomes due to the demands of caregiving. In particular, carers are much more likely than their non-carer counterparts to experience poor sleep outcomes such as lower sleep quality and inadequate sleep duration. The aim of this study is to examine how nighttime awakenings, assistive technology use and help-seeking behaviours impact sleep quality among Australian adult carers.

Methods

A cross-sectional online survey was conducted with a sample of Australian carers aged 18 to 64 years. Participants were required to answer questions regarding their sleep, caregiving duties, night-time-awakenings and completed the 9-item self-report Pittsburgh Sleep Quality Index (PSQI). They also answered questions regarding their use of assistive technologies and help-seeking behaviours. Participants were eligible if they reported sleep time <7 h or dissatisfaction with their sleep.

Results

Participants (n=352) completed the online survey. Analyses of these data have just begun and will be presented in full at the conference.

Conclusion

The results of this study aim to extend current literature and provide valuable information in the formulation of sleep recommendations and interventions for Australian carers.
Unveiling the Diversity: Plant Parasitic Nematode Effectors and Their Plant Interaction Partners
Authors: Bali Sapinder , Gleason Cynthia
Published: October 2023

Root-knot and cyst nematodes are two groups of plant parasitic nematodes that cause the majority of crop losses in agriculture. As a result, these nematodes are the focus of most nematode effector research. Root-knot and cyst nematode effectors are defined as secreted molecules, typically proteins, with crucial roles in nematode parasitism. There are likely hundreds of secreted effector molecules exuded through the nematode stylet into the plant. The current research has shown that nematode effectors can target a variety of host proteins and have impacts that include the suppression of plant immune responses and the manipulation of host hormone signaling. The discovery of effectors that localize to the nucleus indicates that the nematodes can directly modulate host gene expression for cellular reprogramming during feeding site formation. In addition, plant peptide mimicry by some nematode effectors highlights the sophisticated strategies the nematodes employ to manipulate host processes. Here we describe research on the interactions between nematode effectors and host proteins that will provide insights into the molecular mechanisms underpinning plant–nematode interactions. By identifying the host proteins and pathways that are targeted by root-knot and cyst nematode effectors, scientists can gain a better understanding of how nematodes establish feeding sites and subvert plant immune responses. Such information will be invaluable for future engineering of nematode-resistant crops, ultimately fostering advancements in agricultural practices and crop protection.

[Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2024.
Characterization of Rice–Magnaporthe oryzae Interactions by Hyperspectral Imaging
Authors: Maina Angeline W. , Oerke Erich-Christian
Published: October 2023

Hyperspectral imaging has the potential to detect, characterize, and quantify plant diseases objectively and nondestructively to improve phenotyping in breeding for disease resistance. In this study, leaf spectral reflectance characteristics of five rice genotypes diseased with blast caused by three Magnaporthe oryzae isolates differing in virulence were compared with visual disease ratings under greenhouse conditions. Spectral information (140 wavebands, range 450 to 850 nm) of infected leaves was recorded with a hyperspectral imaging microscope at 3, 5, and 7 days postinoculation to examine differences in symptom phenotypes and to characterize the compatibility of host-pathogen interactions. Depending on the rice genotype × M. oryzae genotype interaction, blast symptoms varied from tiny necrosis to enlarged lesions with symptom subareas differing in tissue coloration and indicated gene-for-gene-specific interactions. The blast symptom types were differentiated based on their spectral characteristics in the visible/near-infrared range. Symptom-specific spectral signatures and differences in the composition of leaf blast symptom type(s) resulted in unique spectral and spatial patterns of the rice × M. oryzae interactions based on the size, shape, and color of the symptom subareas. Spectral angle mapper classification of spectra enabled (i) discrimination between healthy (green) and diseased tissue of rice genotypes, (ii) classification and quantification of different blast symptom subareas, and (iii) grading of the host-pathogen compatibility (low – intermediate – high). Hyperspectral imaging was more sensitive to small changes in disease resistance than visual disease assessments and enabled the characterization of various types of resistance/susceptibility reactions of tissue subjected to M. oryzae infection.
Ipsilateral Healthy-segment Response to Leg Length Discrepancy
Authors: Birch John G. , Makarov Marina R. , Jo Chan-Hee
Published: October 2023

Background:

Few studies address frequency or magnitude of healthy lower-extremity segment response to ipsilateral companion segment shortening. We sought to document and quantify this occurrence in a variety of pediatric etiologies.

Methods:

We reviewed the medical record and radiographs of patients undergoing epiphysiodesis to manage leg length discrepancy. Inclusion criteria for this study were leg length discrepancy of a single lower-extremity segment by identifiable cause and adequate scanograms to allow accurate measurement of all 4 lower-extremity segments before any surgical treatment for the discrepancy. We recorded the etiology of shortening, age of onset of disorder, the length of the lower-extremity segments on scanograms, and age at the time of radiographs. We considered ipsilateral healthy-segment difference from the contralateral ≥ 0.5 cm. as clinically significant.

Results:

Two hundred nine patients met inclusion criteria (126 boys, 83 girls). The average age was 12.5 years. 16/60 patients with avascular necrosis of the hip demonstrated ipsilateral tibial shortening averaging 1.2 cm whereas 6/60 demonstrated ipsilateral tibial overgrowth averaging 0.6 cm. 11/30 Legg-Perthés patients demonstrated ipsilateral tibial shortening averaging 0.7 cm; none had ipsilateral tibial overgrowth. 10/42 posteromedial bow patients had ipsilateral femoral shortening averaging 0.8 cm, whereas 6/42 had ipsilateral overgrowth averaging 0.8 cm. 13/48 with distal femoral physeal injury demonstrated ipsilateral tibial shortening averaging 1.2 cm, whereas 6/48 demonstrated ipsilateral tibial overgrowth averaging 0.8 cm. 8/29 tibial physeal injuries (proximal or distal) demonstrated ipsilateral femoral shortening averaging 1.1 cm. whereas 7/29 demonstrated ipsilateral femoral overgrowth averaging 0.7 cm.

Conclusions:

Although there are individual exceptions, the ipsilateral healthy segment does not grow appreciably more than the contralateral in patients with avascular necrosis of the hip, Legg-Perthés disease, or physeal trauma. The femur is not a significant component of shortening in patients with posteromedial bow.

Level of Evidence:

Level III, retrospective review.
Development of Fibro-PeN, a clinical prediction model for moderate-to-severe fibrosis in children with nonalcoholic fatty liver disease
Authors: Wang Andrew , Blackford Amanda L. , Behling Cynthia , Wilson Laura A. , Newton Kimberly P. , Xanthakos Stavra A. , Fishbein Mark H. , Vos Miriam B. , Mouzaki Marialena , Molleston Jean P. , Jain Ajay K. , Hertel Paula , Harlow Adams Kathryn , Schwimmer Jeffrey B. ,   for the NASH CRN
Published: October 2023

Background and Aims:

Liver fibrosis is common in children with NAFLD and is an important determinant of outcomes. High-performing noninvasive models to assess fibrosis in children are needed. The objectives of this study were to evaluate the performance of existing pediatric and adult fibrosis prediction models and to develop a clinical prediction rule for identifying moderate-to-severe fibrosis in children with NAFLD.

Approach and Results:

We enrolled children with biopsy-proven NAFLD in the Nonalcoholic Steatohepatitis Clinical Research Network within 90 days of liver biopsy. We staged liver fibrosis in consensus using the Nonalcoholic Steatohepatitis Clinical Research Network scoring system. We evaluated existing pediatric and adult models for fibrosis and developed a new pediatric model using the least absolute shrinkage and selection operator with linear and spline terms for discriminating moderate-to-severe fibrosis from none or mild fibrosis. The model was internally validated with 10-fold cross-validation. We evaluated 1055 children with NAFLD, of whom 26% had moderate-to-severe fibrosis. Existing models performed poorly in classifying fibrosis in children, with area under the receiver operator curves (AUC) ranging from 0.57 to 0.64. In contrast, our new model, fibrosis in pediatric NAFLD was derived from fourteen common clinical variables and had an AUC of 0.79 (95% CI: 0.77–0.81) with 72% sensitivity and 76% specificity for identifying moderate-to-severe fibrosis.

Conclusion:

Existing fibrosis prediction models have limited clinical utility in children with NAFLD. Fibrosis in pediatric NAFLD offers improved performance characteristics for risk stratification by identifying moderate-to-severe fibrosis in children with NAFLD.
Heartbreak From Puppy Love: A Case of Pasteurella multocida Endocarditis and Review of the Literature
Authors: Vo Phuong-Uyen , Chaffee Roger B. , Myers Joseph P.
Published: October 2023

Background

Pasteurella multocida, a gram-negative coccobacillus associated with dog, cat, and other animal contact, often causes human bite infection, cellulitis, and osteomyelitis, but infective endocarditis is rare. We present a patient with P. multocida aortic valve endocarditis whose animal exposure was contact with his dog's saliva from frequent licking of patient's skin in the perioral area.

Case Presentation

A 62-year-old man with successfully treated hepatitis C presented to hospital after a syncopal episode while chasing his dog. He had previously noted night sweats, fever, generalized weakness, and dyspnea on exertion. He denied bites or scratches but admitted allowing his dog to lick around his mouth. On presentation, he was in septic shock with lactic acidosis. White blood cell count was 20,000/μL. Pasteurella multocida was isolated from both admission blood cultures. The patient was treated with antimicrobial therapy and resuscitated. Transthoracic echocardiogram revealed critical bicuspid aortic valve stenosis with root abscess and ascending aortic aneurysm. Transesophageal echocardiogram showed reduced ejection fraction and severe aortic stenosis but no definitive vegetations. At surgery, there were nodular lesions on the aortic valve, left ventricular outflow tract perforation, and annular abscess of aortic valve. He had mechanical aortic valve replacement, annular reconstruction, and aortic aneurysm repair. The patient received 6 weeks of postoperative intravenous ceftriaxone and remained infection-free at 1-year follow-up visit.
Effects of high-profile crossover feet on gait biomechanics in 2 individuals with Syme amputation
Authors: Slater Conrad , Hafner Brian J. , Morgan Sara J.
Published: October 2023

Background:

Prosthetic treatment options for people with ankle disarticulation (i.e., Syme amputation) are limited. Prosthetic feet designed for people with Syme amputation are often low profile to accommodate build-height restrictions, resulting in decreased energy return during gait. High-profile crossover feet that attach to the posterior proximal aspect of the prosthetic socket can bypass these restrictions and may promote a more physiologic gait pattern.

Objectives:

To compare level-ground gait biomechanics and patient-reported outcomes between crossover and traditional energy-storing feet in people with Syme amputation.

Study Design:

Within-participant pilot study.

Methods:

Both participants were fit with energy-storing and crossover feet and were randomized to the order they used the feet. Participants used each foot for 2 weeks before assessment. Step length symmetry, prosthetic ankle range of motion, prosthetic-side energy return, and peak sound-side loading were determined from motion capture data obtained in a laboratory. Mobility and balance confidence were measured using standardized patient-reported outcome measures. Foot preference was assessed with an ad hoc survey.

Results:

Two participants with Syme amputations completed the study. Prosthetic ankle peak dorsiflexion and push-off power increased with the crossover foot compared with the energy-storing foot for both participants. Both participants reported an overall preference of the crossover foot. Changes in patient-reported outcomes did not exceed published minimum detectable change values.

Conclusion:

Crossover feet increased prosthetic ankle range of motion and energy return compared with traditional energy-storing feet in this pilot investigation of 2 participants. Crossover feet seem to promote physiologic gait and may be a promising alternative to traditional low-profile feet for people with Syme amputation.