bluuebunny/crossref_metadata_2025 huggingface dataset:
P087 What is keeping Australian farmers awake at night? Associations between sleep and mental health
Authors: Paech G , Fehlberg R , Tong K
Published: November 2022

Introduction

In Australia, suicide rates are higher in farmers compared to the general population. The relationship between poor sleep and mental health is well known, yet there is limited evidence examining Australian farmers’ sleep and the role sleep plays in farmers mental health. Therefore, this study investigated the sleep and mental health of Australian farmers using an online questionnaire.

Methods

Farmers aged 18 and older (n=101; 52 males) completed a questionnaire (REDCap). The questionnaire included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Depression Anxiety Stress Scales (DASS-21). PSQI and ISI scores were split into normal values (‘below threshold’; PSQI<5; ISI<8) and abnormal values (‘above threshold’). Independent t-tests (Mann-Whitney) were performed to assess differences in mental health between the two threshold groups.

Results

Most participants worked full time (89%) on a family farm (70%) and were aged 26-55 (61%). Individuals with PSQI scores above threshold had higher DASS-21 scores across all subscales (p≤0.01; Depression 4.9±3.9; Anxiety 7.6±4.4; Stress 3.8±3.7) compared to those below threshold (Depression 2.9±3.0; Anxiety 5.1±3.2; Stress 1.9±2.0). All DASS-21 subscales scores were also higher in individuals with ISI scores above threshold (p<0.001; Depression 5.0±3.9; Anxiety 7.3±4.2; Stress 3.8±4.1) compared to those below threshold (Depression 2.5±2.9; Anxiety 4.5±3.0; Stress 1.7±1.9).

Discussion

Results suggest that Australian farmers who have insomnia symptoms and poor sleep quality are at a higher risk of poor mental health. Identifying at-risk individuals by examining sleep quality, then investigating and treating sleep problems, may improve mental health amongst farmers.
P088 Sleep study report checking on night shift: Does it have an impact on the quality of the night study
Authors: Partridge G , Partridge G
Published: November 2022

Introduction

The aim of this study is to determine if the process of sleep study report-checking by the sleep scientist during an overnight shift affects the quality of sleep study acquisition performed during that shift.

Methods

In this unit one sleep scientist performs 3 sleep studies per night on a 10 or 12 hour shift. All studies are assessed at the time of scoring for quality of acquisition as ‘excellent’, ‘average’, ‘poor’ or ‘failed’. Scored studies are checked by another sleep scientist for accuracy in regard to patient demographics, study date, referring doctor, and sleep parameters. Between October 2021 and May 2022 two senior sleep scientists performed 87 sleep studies (both diagnostic and CPAP titration) and checked an average of 5 (SD 3.2) reports per night. The quality of their study acquisition was compared with 127 historical controls by the same scientists during the previous year. The proportions of ‘excellent’ and ‘average’ quality acquisitions in cases and controls were compared using the McNemar test (MedCalc 2012).

Results

There were no ‘poor’ or ‘failed’ studies. The percentages of ‘excellent’ study acquisition in cases (93.1%) and controls (89.7%), and ‘average’ cases (6%) and controls (11%) were not statistically different (p=0.58, 95% CI -5.7 to 11.2) .

Discussion

Results of this study demonstrate the process of report-checking on an overnight shift does not impact on the quality of the study acquisition, in our unit.
P089 Medical co-morbidities among Indigenous patients with OSA
Authors: Perez A , Howarth T , Heraganahally S
Published: November 2022

Introduction

Obstructive sleep apnoea is being increasingly recognised among Indigenous Australian adults. Moreover, other medical co-morbidities are also highly prevalent among Indigenous Australians. The bidirectional relationship between OSA and long-term metabolic consequences and its linkage to chronic medical conditions such as cardiovascular disease, hypertension and diabetes is well recognised. However, literature pertaining to presence of medical co-morbidities among Indigenous patients diagnosed with OSA is sparce. We therefore aimed to document the medical co-morbidities among Indigenous patients diagnosed to have OSA.

Methods

Demographic characteristics, clinical characteristics and presence of medical co-morbidities among patients diagnosed to have OSA with an AHI >5/hour were assessed.

Results

Of a total 741 Indigenous patients who underwent a diagnostic sleep study between 2011- 2020, 662/741 (89%) were diagnosed to have OSA. At least one comorbidity was reported in 79% of patients, of which Hypertension was the most common in 52%, followed by diabetes in 39% and heart disease including coronary artery disease in 37%. Among patients with a comorbidity, 58% had three or more recorded. The prevalence of comorbidity and multimorbidity did not significantly differ by severity of OSA, aside from hypertension which was noted in 57% of patients with severe OSA compared to 46% with mild OSA. Furthermore, patients who have severe OSA were more likely to be male.

Discussion

Medical co-morbidities are highly prevalent among Indigenous patients diagnosed to have OSA, especially presence of hypertension, diabetes and heart disease. The long-term consequences are not known. Hence, further studies are warranted.
P099 Feasibility of assessing environmental factors in residential treatment settings: Preliminary associations between objective sleep and mental health outcomes
Authors: Rossa K , Salom C , Mann D , Edmed S , Morris L , Lorimer N , Stokes H , Dignan J , Smith S
Published: November 2022

Introduction

Circadian dysregulation is implicated in substance use and comorbid mental health problems, but is also exacerbated by these states. In addition to conventional treatment, environmental factors (light, temperature) are potential targets for improving sleep, circadian functioning, and recovery outcomes. This study explored the feasibility of objective sleep and environmental monitoring for recovering substance users in residential treatment, and also examined the relationship between objectively measured sleep-wake rhythms and mental health outcomes.

Methods

Fifty-two (Mage=38, SD=9.6; 56% female) individuals receiving treatment for substance use were included. Environmental light exposure, temperature, and activity data were collected via wrist-worn actigraphy, and in-room sensors for a minimum of 1-week of stay within a 6-week program. Actigraphy derived sleep-wake patterns were used to calculate Interdaily Stability (IS). Data were linked to routinely collected clinical measures of mental health.

Results

No individuals opted out of the environmental monitoring aspect of the study, indicating acceptability and feasibility. Environmental loggers mounted in individual rooms recorded average nightly temperatures >21 degrees for 5/8 months. Objectively measured IS (M=.79; 95%CI=.67-.73) was negatively associated with Anxiety (r=-.33, p=.024) and Depression (r=-.36, p=.012), while sleep duration was not. Relationships between participant-level light exposure and clinical outcomes were also examined.

Discussion

Preliminary results indicate that circadian regularity appears important for mental health outcomes in this population and setting. The structured residential environment provides opportunities for regulating sleep-wake rhythms via scheduling of activities at circadian-appropriate times. This research suggests that optimising circadian- appropriate lighting and thermal comfort may lead to improved individual outcomes.
P101 Paediatric obstructive sleep apnoea in primary care: an integrative review of practitioner knowledge, practice, attitudes, and behaviours
Authors: Russo K , Burgess S , Soenen S , Zwar N
Published: November 2022

Introduction

Obstructive sleep apnoea (OSA) is a common health problem in children (1-6%) and is associated with deficits in various health, cognitive and behavioural domains. Early diagnosis, and treatment, significantly reduces associated sequelae. Primary care practitioners (PCPs) could play a crucial early and continuing role in the identification and management of OSA due to regular and ongoing interaction with the children and their families. PCPs must however have appropriate knowledge and confidence in their skills to address this effectively. The integrative review aims to explore and describe PCPs knowledge, practice, attitudes, and behaviours regarding identification and management of childhood OSA.

Methods

Five electronic databases were searched up to May 6th, 2022, in addition to reference lists of selected/key references. Quality appraisal of included studies (Mixed Methods Appraisal Tool) and meta-synthesis of extracted data, using a five-stage synthesis process, will be undertaken.

Results

The search yielded a total of 3341 potentially eligible papers. After screening of titles, abstracts, and full text papers, 26 papers are currently included. Data extraction, quality appraisal and data synthesis is ongoing. Inductively developed themes and sub-themes will be presented at the conference.

Discussion

The findings from this review will describe current practice and provide recommendations and strategies for improving PCP identification and management of childhood OSA, with the goal of reducing the impact and burden of OSA on children and their families. In addition, barriers and facilitators to identification, practitioner knowledge and skill discrepancies will be explored and recommendations for future research will be presented.
P104 Exploring the heterogeneity of psychiatric symptom profiles in sleep clinic patients using a cross-cutting dimensional approach
Authors: Saunders W , Wellecke C , Spina M , Lu S , Ng Y , Wasgewatta S , Cahill F , Jenkins C , Rajaratnam S , Hamilton G , Mansfield D , Bei B
Published: November 2022

Introduction

Individuals attending sleep services commonly present with comorbid psychiatric symptoms. This study reports our ongoing effort to characterise presenting psychiatric symptom profiles of individuals seeking treatment at a sleep clinic and classify heterogenous subgroups within a large sample.

Method

Data were collected at a university-based multidisciplinary sleep clinic via opt-out consent. Prior to treatment, individuals completed the Cross-Cutting Symptom Measure (CCSM), which provides a transdiagnostic symptom profile by measuring 13 domains of mental health (e.g., anger, anxiety, depression, psychosis, mania, memory). Additional questions on demographics and the Morningness-Eveningness Questionnaire Reduced (rMEQ) were also administered.

Results

1263 participants (52.9% male; age M±SD= 43.53±16.06) completed the CCSM and were analysed. Latent class analysis revealed 3 distinct profiles: Low-Symptom subgroup (n=655, 51.9%) reported mild affective and somatic symptoms; Psychopathology subgroup (n=342, 27.1%) reported moderate to severe psychopathology including psychosis, dissociation, and suicidality, in conjunction with severe affective, obsessive-compulsive, and somatic symptoms, and significant interference with memory and personality functioning; Affective-Disturbance subgroup (n=266, 21.1%) reported moderate affective and somatic symptoms, and some interference with memory and personality functioning. The three subgroups did not differ significantly on key demographics or the rMEQ.

Discussion

There was heterogeneity in psychiatric symptoms experienced by sleep clinic patients. Affective and somatic disturbances were common across subgroups whilst severe psychopathology appeared in a sizeable (one in four) proportion of patients. These findings solidified the need for careful assessment of a wide range of psychiatric symptoms to inform treatment planning in sleep services.
P105 Women with greater post-traumatic stress symptom severity and less disrupted sleep have improved fear extinction recall compared to men
Authors: Schenker M , Ince S , Ney L , Hsu C , Zuj D , Jordan A , Nicholas C , Felmingham K
Published: November 2022

Sleep has been found to play a key role in fear conditioning, extinction learning and extinction recall, the paradigm modelling the development, maintenance and treatment of anxiety disorders including post-traumatic stress disorder (PTSD), which are disorders commonly associated with sleep disturbances. Previous studies examining associations between sleep and fear or extinction processes predominately focused on objectively measured sleep architecture using polysomnography, and the majority of the research has been done in healthy populations. To date, little research has focused on subjective sleep measures and particularly in clinical populations including PTSD, which often experience subjectively poor sleep. Here we investigated whether subjective sleep disturbance, sleep onset latency, wake after sleep onset or sleep efficiency were related to fear conditioning, extinction learning or extinction recall in a large sample of individuals with a range of PTSD symptom severity and healthy controls. Overall, we did not find that sleep was associated with fear conditioning extinction learning or extinction recall. However, emerging evidence highlighting the critical role of sex in PTSD risk, fear conditioning processes, as well as in the sleep-fear conditioning relationship. Exploratory analyses examining sex-specific effects found that shorter sleep onset latency and greater sleep efficiency during the previous night were associated with improved extinction recall in women with higher PTSD symptom severity. This suggests that less time falling asleep and longer time asleep while in bed may be protective against the commonly observed impaired extinction recall in PTSD in highly symptomatic women, but is not relevant in men.
P115 Exploring the effectiveness of Fatigue Risk Management Systems
Authors: Sprajcer M , Thomas M , Sargent C , Crowther M , Boivin D , Wong I , Smiley A , Dawson D
Published: November 2022

Introduction

Fatigue Risk Management Systems (FRMS) are increasingly being used in a range of safety-critical industries to manage fatigue-related risk. These data-driven practices use a risk-based approach to managing fatigue, rather than solely relying on prescriptive hours of work limits. However, some organisations are reluctant to implement FRMS as evidence of effectiveness is unclear. A review was undertaken to evaluate the available evidence on FRMS effectiveness, and to provide evidence-based policy guidance for FRMS use and implementation.

Methods

Seven electronic databases (MEDLINE (Ovid), PsycINFO, IEEE Xplore Digital Library, Scopus, Web of Science, MESH Occupational Health, NIOSHTIC II) were searched for relevant peer reviewed and grey literature. Documents were included if they addressed fatigue management interventions. Screening was performed on a total of 2129 documents, with 231 included in the final review.

Results

Few (n = 5) documents evaluated FRMS as a whole. However, components of FRMS (e.g., performance monitoring, fatigue detection technology, prior sleep wake behaviour assessment) appeared to improve key safety and fatigue outcomes.

Discussion

The effectiveness of FRMS components suggests that FRMS as a whole is likely to improve organisational safety outcomes. Key implementation enablers included organisational and worker commitment, and safety culture. Where organisations have limited resources and/or immature safety cultures, FRMS may not be appropriate. As such, we propose that a hybrid or transitional model of fatigue management (including risk-based and prescriptive components) could be implemented – so organisations can increase operational flexibility while improving safety.
P117 A pilot study of a novel electrode system for brainwave acquisition during sleep: Tripolar Concentric Ring Electrodes
Authors: Stuart N , Manners J , Scott H , Lechat B , Kemps E , Catcheside P
Published: November 2022

Introduction

Tri-concentric ring electrodes (TCRE) evaluate current density underlying each electrode rather than a voltage difference between two conventionally placed electroencephalography (EEG) electrodes. TCRE signals are more focal and show improved signal-to-noise with markedly reduced electromyographic interference compared to conventional EEG. This pilot study is the first to evaluate sleep using TCRE and power spectral analysis of TCRE versus conventional EEG emulated (eEEG) recordings obtained from TCRE and the outer rings of paired electrodes.

Method

Twenty healthy sleepers (8 men, mean±SD age 27.8±9.6 y) completed a single overnight sleep study with a 9-hr sleep opportunity. Participants were set up for polysomnography recording using TCRE for brain activity (18 sites) and conventional gold-cup electrodes for eye movements, muscle activity, and heart rate. A fast Fourier transform using multitaper-based estimation was applied in 5-s epochs to calculate relative powers in delta, alpha, theta, sigma and beta frequency bands for eEEG and TCRE signals throughout sleep.

Results

At the Cz position, TCRE showed greater relative delta power and reduced beta powers across sleep stages compared to eEEG. For example, TCRE had higher delta activity during NREM stage 2 sleep than eEEG (mean [SD]; 89% [5.7] vs 64% [6]) and lower beta activity during wake (3.4% [2] vs 17.3% [7.9]). Ongoing analyses will compare outcomes across electrode locations.

Conclusions

Brain activity acquisition via TCRE may reduce artefact interference and potentially identify new markers during sleep that are associated with sleep quality, health, and functioning.
P118 The use of cumulative frequency curves to analyse sedated patients
Authors: Sturdy G , Hillman D , Wilbrow B , Singh B
Published: November 2022

Introduction

Excessive or inadequate sedation in intubated patients are both associated with increased morbidity and mortality. However, it is difficult to quantify the level of sedation accurately. Conventional sleep analysis does not quantify sedation effectively. Specific sedation analysis techniques have been developed but are labour-intensive and difficult to apply. We explored the potential of cumulative frequency curves of electroencephalograms (EEG) to quantify the level of sedation.

Methods

Left frontal EEG was obtained over 12-24 hours in 20 sedated and 2 non-sedated patients. Six hours of time correlated data (00:00-06:00) were analysed. Cumulative frequency curves were created for each patient. Measurements obtained were: peak (frequency in Hz occurring most often, x axis), areas under the curve at five frequencies (percentage time at the selected frequency) and average signal amplitude, at peak using a power calculation on y axis.

Results

For the 20 sedated patients 72±13,% (mean±SD) of study time was recorded at <1Hz and 91% ±5.7 at <4Hz (compared to 57.8 and 84.3% respectively for non-sedated patients). The peak amplitude of the signal took place at 0.45±0.32 Hz in sedated patients. The comparative amplitude determined by a comparative power determinant was 50.8±3.8 in sedated patients (c.f. 46 in non-sedated patients).

Conclusion

This proof of concept study shows that signal amplitude and frequency can be measured using the cumulative frequency methodology and appears to differ between sedated and non-sedated patients. This methodology has the potential to provide a useful, simple and reproducible mechanism to analyse depth of sedation in intubated patients.
P119 Co-morbid insomnia is associated with worse health, and lower CPAP recommendation rates and nightly use in people with sleep apnoea
Authors: Tan D , Appleton S , Chai-Coetzer C , Lovato N , Vakulin A , Adams R , Grivell N , Sweetman A
Published: November 2022

Introduction

Co-morbid insomnia and sleep apnoea (COMISA) is associated with poor health and reduced adherence to continuous positive airway pressure (CPAP) therapy in sleep clinic samples. However, health and treatment correlates of COMISA in community-based samples of obstructive sleep apnoea (OSA) are poorly described.

Methods

Australian adults previously diagnosed with OSA were surveyed online. COMISA was defined as co-morbid OSA and nocturnal insomnia symptoms (difficulties falling asleep, maintaining sleep, and/or early morning awakenings at least a few nights a week over the past month). Logistic regression and ANCOVAs determined associations of COMISA with medical conditions and general health, controlling for age, gender, and body mass index. Treatment recommendation rates and average nightly use were compared between those with COMISA versus OSA-alone.

Results

Among 412 participants (54.6% male, mean age 58.5 [SD=13.9] years), 74.8% had COMISA. Compared to OSA-alone, COMISA was associated with higher rates of fair/poor general health (60.4% versus 46.6%, p=0.010), lower EQ-5D overall health (mean difference 7.55 [SD=2.73], p=0.010), and greater rates of depression diagnoses (56.3% versus 28.0%, p<0.001), which persisted after adjustment for covariates. People with COMISA reported lower rates of CPAP therapy recommendation (82.8%, versus 95.2%, p=0.002), and nightly use (mean difference 0.54 [SD=0.13] hours/night, p<0.001), and greater rates of upper-airway surgery recommendations (14%, versus 2.9%, p=0.002) and completion (13%, versus 1.9%, p=0.001).

Conclusions

COMISA was associated with worse health, depression, lower CPAP recommendations and use, and greater upper-airway surgery compared to those with OSA-alone.
P122 Association between variability of respiratory sleep indices and ambulatory blood pressure
Authors: Thant A , Ou Y , Seah S , Chiu S , Chan S , Teo Y , Wong S , Khoo C , Barbé F , Lee C
Published: November 2022

Study Objectives

Respiratory sleep indices are traditionally reported on the basis of the average total sleep time. The relationship between the hour-to-hour variability of these parameters and blood pressure (BP) has not been reported.

Methods

We evaluated the associations of the hour-to-hour variability of the apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation with the 24-hour ambulatory BP in patients with hypertension and newly diagnosed obstructive sleep apnea. A total of 147 patients underwent polysomnography, based on which obstructive sleep apnea was diagnosed in 106

patients

these patients underwent 24-hour ambulatory BP monitoring within the next 30 days. Each polysomnogram was divided into hourly reports to calculate the variability of the respiratory sleep indices. Variability independent of the mean was considered the primary measure of variability.

Results

The median number of hourly polysomnogram reports was 7 (range, 4–8).The hour-to-hour variability of both AHI and ODI, but not of the lowest oxygen saturation, was correlated with the 24-hour pulse pressure, 24-hour systolic BP, and awake systolic BP (p < 0.05 for all). The fully adjusted linear regression analysis indicated that the hour-to-hour variability of AHI and ODI remained associated with the 24-hour pulse pressure (AHI: β coefficient, 0.264 [95% CI, 0.033–0.495],p =0.026; ODI: β coefficient, 0.450 [95% CI, 0.174 - -0.726],p = 0.002).

Conclusions

The hour-to-hour variability of AHI and ODI is independently associated with the 24-hour pulse pressure. Further investigations are warranted to evaluate the clinical relevance of this new-found association.
P129 Neck circumference versus body mass index to predict moderate to severe obstructive sleep apnoea
Authors: Wang D , Huang H
Published: November 2022

Introduction

Neck circumference (NC) and body mass index (BMI) are both markers of obesity and established parameters in clinical models for the prediction of obstructive sleep apnoea (OSA). It is unclear if one parameter is superior for the prediction of OSA severity or if the addition of both parameters significantly enhances the accuracy of the clinical model. In this study, we evaluated the performance of NC and BMI as predictors for moderate to severe OSA (AHI≥15) when adjusted for age and male gender.

Methods

A retrospective chart review of all diagnostic sleep studies (SS) conducted from November 2017 to October 2018 was performed. All SS which were reported as normal and all SS with a diagnosis of OSA were included. Three multiple regression models were constructed with AHI≥15 as the dependent variable and the following independent variables: NC + Age + Gender (NAG), BMI + Age + Gender (BAG), and BMI + NC + Age + Gender (BNAG). The Akaike information criterion (AIC) was used for model comparison. A model that was more than 2 AIC units lower was considered to be the superior model.

Results

112 SS had AHI<15 and 193 SS had AHI≥15. The AIC for NAG, BAG and BNAG models were 333.9, 343.8 and 334.7 respectively.

Discussion

The NAG model had the lowest AIC. NC was superior to BMI for the prediction of AHI≥15. The performance of the clinical model incorporating both NC and BMI was not significantly different from the model incorporating only NC.
P130 The lived experience of shift work, sleep loss and fatigue in Australian paramedics
Authors: Wanstall S , Naweed A , Brown B , Rayner T , Adams R , Reynolds A
Published: November 2022

Introduction

Paramedics are essential health workers, and are regularly exposed to shift work, which negatively impacts sleep and fatigue. Paramedics also experience adverse mental health outcomes and sleep disorders at higher rates than the general population. Consequently, retention and occupational burnout issues are common. However, the relationship between shift work, sleep disorders, fatigue, and mental wellbeing in paramedics is poorly understood, limiting our ability to design and implement effective interventions.

Method

This study uses a qualitative action research design involving one-to-one interviews, with an intended sample of 30 paramedics (completion Aug 2022). The Scenario Invention Task Technique is used, requiring workers to explore how they engage and interact with their work. Participants generate challenging scenarios specific to their work when feeling rested, and then consider the same scenario when feeling extremely fatigued. Data are analysed using an inductive thematic structure.

Results

Analysis of preliminary data (n=10) indicates sleep loss and fatigue negatively impact workers’ ability to manage challenging scenarios and the self-regulation of emotions. While participants know sleep problems impact their wellbeing, limited knowledge on identification and management of sleep disorders is apparent. Early findings suggest an optimal window for better sleep education would be during internship, and paramedics suggest the information needs to be provided by an expert, and trusted, voice.

Discussion

Study findings will help inform sleep education, screening and support toolkits about sleep, fatigue and shift work tailored to paramedics in order to support wellbeing and sustainable careers.
P133 Modelling REM-NREM activity cycling in infants
Authors: Webb L , Phillips A , Roberts J
Published: November 2022

Sleep states in infancy differ from adult sleep states. Due to different cortical and physical manifestations, the REM and NREM equivalent sleep states in infants are often denoted as Active and Quiet sleep. Key differences in infant REM-NREM cycling include rapid cycling, and commencement of sleep in the REM state, instead of NREM. The physiological mechanisms underlying developmental changes in REM-NREM cycling in infancy are not well understood.

We extended an existing, physiologically based model of sleep-wake behaviour to include a REM-on group and REM-off group, with mutual inhibition between these providing the basis for REM-NREM cycling. We model a REM pressure driving the REM-NREM cycling, similar to other proposed models and motivated by the known phenomenon of increased REM sleep following REM deprivation.

We found parameter combinations that produce the REM-NREM cycling observed in infancy and early childhood. Through varying the parameters governing the dynamics of the REM pressure drive, the model is able to reproduce both newborn infant Wake-REM-NREM behaviours and the older Wake-NREM-REM pattern. Our results suggest that REM pressure clearance plays a dominant role in determining the initial sleep state, and increases in REM pressure from wake/NREM controls REM latency and duration.

We have identified a plausible mechanism for the immature sleep state cycling observed in infants. In line with theories of REM sleep’s purpose in cortical synaptic remodelling, a process which evolves rapidly in infancy, we found that REM pressure clearance times likely vary along early development, triggering a switch from REM-first to NREM-first sleep.
P138 Inter-observer agreement and sensitivity of definitions for hypoventilation in children with neuromuscular disorders
Authors: Withers A , Wilson A , Downs J , Jacoby P , Hall G , Gauld L , O'Donnell A , Chacko A , Schultz A
Published: November 2022

Background

hypoventilation occurs in neuromuscular disorders with respiratory muscle weakness. There are numerous definitions of hypoventilation. This study aimed to determine which definitions of hypoventilation had the highest inter-observer agreement and sensitivity in children with neuromuscular disorders.

Methods

twenty polysomnograms from children with neuromuscular disorders were examined by six paediatric sleep physicians to determine whether hypoventilation was present and which definitions of hypoventilation were used. Inter-observer agreement for the diagnosis of hypoventilation was calculated, with sensitivity determined in an exploratory analysis.

Results

mean inter-observer agreement was excellent at 82% (κ=0.533), higher for the absence (84%) than the presence (70%) of hypoventilation. Some physicians used more than one definition to diagnose hypoventilation for the same polysomnogram. Even when agreement was substantial, the definitions chosen varied between physicians.The objective defiitions used most frequently when inter-observer agreement was substantial that hypoventilation was present were; average increase in pCO2 ≥3mmHg from NREM to REM (n=15), increase of ≥10mmHg from awake to asleep (n=10) and pCO2 >50mmHg >25% total sleep time (n=8). The sensitivity for these definitions was 83%, 67% and 50%.

Conclusions

even when inter-observer agreement was high that hypoventilation was present, there was a lack of consistency between physicians when defining hypoventilation. An average increase in pCO2 ≥3mmHg from NREM to REM sleep had the highest inter-observer agreement and sensitivity. Alternative definitions in cases without a rise of pCO2 in REM are pCO2 >50mmHg for 25% total sleep time and/or an increase of ≥10mmHg from awake to asleep.
P139 What threshold of total sleep time of hypercapnia should define hypoventilation in children with neuromuscular disorders?
Authors: Withers A , Wilson A , Downs J , Jacoby P , Hall G , Gauld L , O'Donnell A , Chacko A , Schultz A
Published: November 2022

Background

there are numerous definitions of hypoventilation, the most commonly used for children being pCO₂ >50mmHg >25% total sleep time. There are concerns that a total sleep time threshold of >25% is not sensitive enough in children and individuals with neuromuscular disorders. Alternative thresholds of 2%, 5% and 10% total sleep time have been suggested.

Methods

the relationship between percentage of total sleep time with pCO₂ >50mmHg and the presence of hypoventilation (determined by physician diagnosis) was examined in a small exploratory analysis of children with neuromuscular disorders. ROC curves were constructed to determine the impact of changing cut-off thresholds for total sleep time with pCO₁ >50mmHg to define hypoventilation.

Results

the mean percentage of total sleep time that pCO₂ >50mmHg was higher for the studies with hypoventilation (50% vs.10%). The mean difference (40%) was not statistically significant, likely due to the small number of studies (n=6) with hypoventilation. The AUC for percentage of total sleep time with pCO₂ >50mmHg was 0.808 (p=0.035, CI 0.6 to 1.0). For thresholds of total sleep time with pCO₂ >50mHg to define hypoventilation of 20% and 27%, sensitivity was 50%. For thresholds of 11%, 5% and 3%, sensitivity was 67%, 100% and 100% respectively.

Conclusions

in this study the upper limit of total sleep time with pCO₂ >50mmHg in children with neuromuscular disorders without hypoventilation was 10%. Thresholds lower than 25% of total sleep time with pCO₂ >50mmHg to define hypoventilation had higher sensitivity for diagnosing hypoventilation in this population.
P141 Periodic breathing in preterm infants before and after hospital discharge
Authors: Yee A , Siriwardhana L , Nixon G , Walter L , Wong F , Horne R
Published: November 2022

Introduction

Preterm infants have immature respiratory control that can manifest as periodic breathing (PB). We aimed to investigate the relationship between time spent in PB before and after hospital discharge.

Methods

Preterm infants born between 28-32 weeks gestational age were studied during daytime sleep in the supine position for 2-4 hours at 32-36 weeks post menstrual age (PMA) (N=40), 36-40 weeks PMA (N=27), 3 months (N=20) and 6 months (N=26) corrected age (CA). The amount of PB was determined as percentage of total sleep time (TST) spent in PB (%TSTPB). Infants were grouped into below and above the median (8.5%TSTPB) at 32-36 weeks and compared to 36-40 weeks, 3 and 6 months with Mann-Whitney U tests.

Results

%TSTPB was not different between 32-36 weeks PMA (median 8.5%; IQR 1.5, 15.0) and at 36-40 weeks PMA (6.6% (0.9, 15.1), and then decreased at 3 (0.4%; 0.0, 2.0) and 6 months CA (0%; 0.0, 1.1). Infants who were above the median %TSTPB at 32-36 weeks PMA spent more time in PB at 36-40 weeks PMA [18.05% (7.7, 23.9) vs 2.1% (0.6, 6.4)] and 6 months CA [0.9% (0.0, 3.3) vs 0.0% (0.0, 0.0)].

Conclusions

Percentage sleep time spent in PB did not decrease as preterm infants approached term CA, when they were ready to be discharged home. Preterm infants who had higher amounts of PB at 32-36 weeks PMA continued to have higher amounts of PB at term CA and their PB persisted up to 6 months CA.
P142 The interplay of digital work, working from home, and work-family conflict on insomnia among university employees: A moderated mediation approach
Authors: Yusman N
Published: November 2022

The COVID-19 pandemic has led to an increment in working from home (WFH) arrangements, causing a greater reliance on digital devices. However, excessive work-related digital use while at home may lead to greater work-family conflict (WFC), with negative consequences for sleep. Little is known about the impact of digital workload on sleep disturbances, specifically insomnia. This study aimed to investigate the interplay between digital work, WFH, and WFC on insomnia symptoms. This study used a moderated mediation model to explore the relationship between digital work demands and insomnia symptoms, mediated by WFC, and moderated by work resources and WFH. The relationships were explored using a sample of Australian university employees (N = 1932; 538 men, 1394 women; 18 to 81 years old) who completed a survey assessing their digital workload, availability of work resources, home-work life, and sleep. The model was split to compare men and women, and academic and professional staff members. A regression analysis showed that digital work demands predicted insomnia symptoms. Moderated mediation analyses revealed that WFC mediated the association between digital demands and insomnia for both men and women. In contrast, WFC did not mediate the relationship for academic and professional staff members. Both WFH and work resources did not significantly moderate the link between digital demands and insomnia. Overall findings showed that university employees reported greater insomnia symptoms when experiencing greater WFC. Findings suggest that creating boundaries around work-related digital use while at home may alleviate risk of developing sleep disturbances and improve sleep.
A cross-sectional survey of German PA employment and workforce entry
Authors: Heistermann Peter , Günther Hans-Joachim , Heilmann Claudia , Meyer-Treschan Tanja , Sesselmann Stefan , Schneke Andre , Mihatsch Lorenz , Lang Tamika , Mihatsch Walter
Published: November 2022

Objective:

The contribution of physician assistants (PAs) to the German healthcare workforce has increased significantly since their introduction in 2005. From five training programs, the number has increased to the current 18, with 560 PAs awarded the PA bachelor of science degree as of 2020. Despite the growth, researchers lack systemic and reliable empirical data that provide insight into the German PA educational and professional profile. The German University Association Physician Assistant (DHPA) undertook the first nationwide cross-sectional survey on PAs in Germany to understand the German PA movement. This survey aimed to describe German PAs' entry into the profession and PA educational and job satisfaction.

Methods:

PA alumni of all universities affiliated with the DHPA and all subscribers of the Facebook online social media platform PA Blog were invited to complete an online questionnaire.

Results:

Of the 282 PAs who completed the survey, 77% were female and under age 25 years. Almost all (94%) were employed, predominantly as PAs (91%, 241 of 265), although some held other positions. Most worked full time (87%), with some citing child-care needs as reasons for part-time employment (n = 21). Few reported unemployment (1.4%, 4 of 282). Eighty-two percent said they would probably or very likely choose the same course of study again. Most employed participants found the inclusion of frequent rotations between didactic and clinical training in PA programs beneficial. However, a small number of participants (26.8%) agreed that German PA programs' didactic and clinical teaching objectives were well aligned.

Conclusions:

German PAs have a high level of satisfaction with their profession and report low unemployment. Improvement in the alignment of didactic and clinical educational objectives to improve academic qualifications and satisfaction emerged as an area of research.
The impact of omics research on our understanding of osteoarthritis and future treatments
Authors: Beier Frank
Published: November 2022

Purpose of review

To review recent studies using ‘Omics’ approaches (genomics, proteomics, metabolomics, single cell analyses) in patient populations and animal models of osteoarthritis (OA), with the goal of identifying disease-modifying mechanisms that could serve as therapeutic and diagnostic targets.

Recent findings

The number of genes, pathways and molecules with potential roles in OA pathogenesis has grown substantially over the last 18 months. Studies have expanded from their traditional focus on cartilage and gene expression to other joint tissues, proteins and metabolites. Single cell approaches provide unprecedented resolution and exciting insights into the heterogeneity of cellular activities in OA. Functional validation and investigation of underlying mechanisms in animal models of OA, in particular genetically engineered mice, link Omics findings to pathophysiology and potential therapeutic applications.

Although great progress has been made in the use of Omics approaches to OA, in both animal models and patient samples, much work remains to be done. In addition to filling gaps in data sets not yet existing, integration of data from the various approaches, mechanistic investigations, and linkage of Omics data to patient stratification remain significant challenges.
Hospital Occupational Health Service Network and Reporting Systems in Taiwan From 2008 to 2021
Authors: Shih Ping , Chu Po-Ching , Huang Ching-Chun , Guo Yue Leon , Chen Pau-Chung , Su Ta-Chen
Published: November 2022

Objective

To evaluate the provision of occupational health services at hospitals following the establishment of the Network of Occupational Disease and Injury Service in 2007.

Methods

A review of occupational health services during 2008 to 2021 was conducted. The medical practice–based reporting system was compared with the database of compensated occupational diseases (ODs) from Taiwan's Labor Insurance.

Results

First-time outpatient visits for occupational evaluation and total visits to Network of Occupational Disease and Injury Service health care institutions increased from 1777 and 9435 to 12,092 and 23,210, respectively. Reported ODs increased from 1626 to 2043 with a peak of 2791. Up to 1380 workers evaluated for work resumption in 2021. Similar to the increasing trend in reported ODs, the number of compensated ODs increased over years.

Conclusion

The health service needs of Taiwanese workers from OD evaluation to vocational rehabilitation are increasing.
Predictors of missed school days among military connected families: A feasibility study
Authors: Gehring Janet , Robert Rebecca C.
Published: November 2022

Background:

There is a paucity of research specific to military children's health, especially those with special needs. This may be partly attributed to the difficulty in accessing military connected families as a population. Yet, given the recognized importance of military connected families to the national security agenda, a need exists for studies to explore factors underlying child and family health.

Purpose:

We sought to identify factors among a sample of military children with special health care needs (CSHCN) predictive of missed school days, a commonly used measure of health and one used by NPs to monitor chronic conditions management success.

Methodology:

We used a secondary data analysis design and multivariable logistic regression with a subsample of military connected families from the National Survey of CSHCN identified by their reported insurance type.

Results:

We identified 1,656 military CSHCN. According to the adjusted model, hours of care per week, family work hours change, and activity limitations for the child were positive predictors of ≥4 missed school days per year.

Conclusion/Implications:

Our models identified important predictors of missed school days among military children that may inform assessments, interventions, and referrals by nurse practitioners caring for them. We identified a robust sample of military CSHCN from the National Survey of CSHCN by using self-reported insurance, a novel and simple approach to conducting a focused study of this population. Although feasible, this sampling approach was not without limitations. We advocate for including military connected families within sampling frameworks of national surveys to ensure that studies with this critical and unique population continue.
Screening History and Survival Among Women With Cervical Cancer in Puerto Rico
Authors: Gómez-Vargas Vanessa , Ortiz-Ortiz Karen J. , Almodóvar-Rivera Israel , Torres-Cintrón Carlos R. , Deshmukh Ashish A. , Ortiz Ana P.
Published: November 2022

Objectives

Cervical cancer incidence is rising in Puerto Rico (PR). Screening for cervical cancer could prevent the occurrence of the disease or lead to its early detection, translating to survival benefits. In this study, we evaluated the association of cervical cancer screening status with tumor diagnosis and survival among Hispanic women living in PR.

Methods

We analyzed data for 506 incident cases of primary cervical cancer diagnosed from the period 2011–2014, identified through the PR Central Cancer Registry. We ascertained screening status 3 years before cervical cancer diagnosis using data from the period 2008–2014 from the PR Central Cancer Registry-Health Insurance Linkage Database. Patients were followed until 2019. Our outcomes of interest were stage at diagnosis and survival.

Results

Most women (78.86%) were covered by public insurance (Medicare and/or Medicaid), and 69.57% underwent screening 3 years before their diagnosis. The proportion of cases diagnosed with localized stage was significantly greater among the screened group compared with those unscreened (43.5% vs 33.1%, p < .0001). Multivariate analysis showed that women insured through Medicaid were less likely to have been screened when compared with women with private insurance (odds ratio = 0.29; 95% CI = 0.16–0.52). Five-year survival was significantly greater among screened (72%) than unscreened (54%) women (plog-rank < 0.05). The multivariate Cox proportional hazards model showed that women who received screening had a 39% (hazard ratio [HR] = 0.61; 95% CI = 0.43–0.87) lower risk of death compared with unscreened women.

Conclusion

Our findings exemplify survival benefits among women who underwent cervical cancer screening in PR. Interventions to improve screening uptake and adherence are a public health priority.
Diagnostic and Prognostic Value of Isolated and Combined MCM3 and Glypican-3 Expression in Hepatocellular Carcinoma: A Novel Immunosubtyping Prognostic Model
Authors: Mohamed Abdelaty Shawky , Abd El hafez Amal , Eltantawy Ahmed , Mahfouz Mena
Published: November 2022

Despite diagnostic and therapeutic advances, hepatocellular carcinoma (HCC) remains a leading cause of morbidity/mortality worldwide. This retrospective study investigates the isolated and combined mini-chromosome maintenance complex component 3 (MCM3) and glypican-3 (GPC3) immunohistochemical (IHC) expression in HCC. A novel HCC immunosubtyping model based on combined MCM3/GPC3 expression is introduced and tested in comparison with prognostic variables and survival outcomes. Seventy-six HCC patients who underwent hepatectomy were enrolled. After the collection of clinicopathological, laboratory, and 3-year-survival data, IHC was applied to HCC tissue microarray-prepared sections using anti-MCM3 and GPC3. IHC scoring divided HCCs as: MCM3-high and MCM3-low expression, GPC3-positive and GPC3-negative expression, and combined scoring model immunosubtypes: MCM3-high/GPC3-positive; MCM3-low/GPC3-positive; MCM3-high/GPC3-negative, and MCM3-low/GPC3-negative. Statistical and Kaplan-Meier survival analyses were performed using SPSS version 23. MCM3 was expressed in 84.2% of HCCs. MCM3-high HCCs (60.5%) were significantly associated with lack of tumor capsulation, portal vein thrombosis, high grades, advanced stages, and Child-Pugh Scores B and C (all P≤0.05), and had a tendency for multiplicity, metastasis, solid growth pattern, shorter overall survival (OS) and disease-free survival (DFS). GPC3-positve HCCs (56.6%) were significantly associated with multiplicity and higher alfa-fetoprotein (all P≤0.05) with a tendency for shorter OS and DFS. Among all isolated and combined-expression immunosubtypes, MCM3-high/GPC3-positive HCCs had the worst prognosis and the shortest OS and DFS whereas MCM3-low/GPC3-negative immunosubtype showed the best prognosis and had the longest OS and DFS. MCM3 is defined as diagnostic, prognostic marker, and potential therapeutic target in HCC. The novel MCM3/GPC3 immunosubtyping model provides prognostic indications and stratification criteria for patients with HCC.
Martin Fleischmann. 29 March 1927—3 August 2012
Authors: Williams David E.
Published: November 2022

Martin Fleischmann was an electrochemist whose work revolutionized the subject. He was a consummate mathematician and inspired inventor of new experimental methods. His work led to the development of several important techniques in the field: ground-breaking studies of electrocrystallization stemming from the development of high-speed potentiostats; the discovery of the surface-enhanced Raman effect; the development of microelectrodes; the study of stochastic effects as a means to derive basic information about electrochemical reactions; and the systematic development of concepts of electrochemical engineering. But for many, his name is indelibly associated with the ‘cold fusion’ episode that took place at the end of his career in the late 1980s. Regarded by some as a blemish on Fleischmann's highly distinguished life in science, cold fusion continues even today to excite debate and controversy. Nevertheless, he is remembered with esteem and affection by his many colleagues and leaves a powerful legacy in his discipline.