bluuebunny/crossref_metadata_2025 huggingface dataset:
O085 “It's Satisfying but Destructive”: A Mixed Methods approach to understanding the Impact of Bedtime Procrastination and Pre-sleep Screen time on Sleep in in new Career Starters.
Authors: Hill V , Ferguson S , Vincent G , Rebar A
Published: October 2023

Introduction

Bedtime procrastination, the volitional delay of going to bed, is linked to multiple indicators of inadequate sleep. Intervening to reduce bedtime procrastination may be an avenue to improve sleep outcomes, yet the phenomenon remains poorly understood in populations at-risk for bedtime procrastination. New career starters, those who are transitioning from tertiary education to full-time employment, may be susceptible to problematic bedtime procrastination and are at an opportune time for a ‘fresh start’ to change behaviour.

Methods and results

Two studies were conducted: (1) a qualitative approach to understand how bedtime procrastination is experienced by new career starters, identify barriers to behaviour change and explore themes for future interventions; and (2) a 7-day repeated-measures design to test generalisability of findings. In Study 1, data were collected through in-depth semi-structured interviews (n = 28). Inductive thematic analyses were used to find seven themes: negative feelings before and during bedtime procrastination; wanting to vs. knowing I shouldn’t; difficulty falling asleep; influence of automatic processes; consequences of bedtime procrastination; lack of self-control and technology captures late-night attention. Participants emphasised the need for me-time, self-negotiation to continue procrastinating and knowledge of the value of sleep. Study 2 aimed to quantify the relationship amongst bedtime procrastination, habit and motivation on daily pre-sleep screen use and sleep outcomes. Data collection and analyses are ongoing, preliminary findings suggest that bedtime procrastination involves both reflective and automatic cognitive processes.

Conclusion

Future interventions would benefit from a dual-process approach, using cognitive and behavioural techniques to reduce bedtime procrastination.
P002 Positive airway pressure adherence in children with sleep apnea may be similar to adults
Authors: Park D , Ryu U , Mun S
Published: October 2023

Introduction

Most pediatric patients with obstructive sleep apnea (OSA) are known to be treated with adenotonsillectomy (AT). However, in some of them, positive airway pressure (PAP) can be used for underlying diseases or in case of AT failure. Thus, PAP adherence and compliance were compared in pediatric OSA to adult OSA.

Methods

A retrospective study was conducted on 17 children and 167 adults who had performed polysomnography (PSG) and were prescribed PAP and followed up for more than 3 months from July 2018 to January 2023. Adherence was defined as the percentage of patients continuing to use PAP after prescription and compliance was defined as an average of more than 4 hours per night usage of 70% of the monitoring days.

Results

There were 11 males (64.7%) in pediatric and 141 males (84.4%) in adult patients. The mean age was 8.0 years (6.50-12.50) in pediatric and 50.0 years (41.00-58.00) in adult patients. The mean apnea hypopnea index (AHI) (37.0 vs 50.7) and Lowest O2 saturation (79.4% vs 75.5%) did not show any differences in the 2 groups. Longest apnea showed considerable differences (25.9 sec vs 50.8 sec) (p=0.000). After 18 months of PAP usage, AHI dropped from 37.0 to 5.1 vs 50.7 to 2.6, adherence decreased from 94.1% to 41.2% vs 90.4% to 38.9% (p=0.944), compliance reduced from 64.7% to 28.9% vs 67.0% vs 29.3% (p=0.268) in pediatric and adults groups.

Conclusions

There were no significant differences in adherence and compliance with PAP in children compared to adults.
P014 Go to bed! A Systematic Review and Meta-analysis of Bedtime Procrastination Correlates and Sleep Outcomes
Authors: Hill V , Rebar A , Ferguson S , Vincent G
Published: October 2023

Introduction

Bedtime procrastination is defined as the volitional delay of going to bed, without any external circumstances causing the delay, and is associated with inadequate sleep. Alleviating bedtime procrastination may be an important target for interventions promoting adequate sleep, yet the correlates of bedtime procrastination are poorly understood. This study examined (1) correlates of bedtime procrastination, and (2) strength and direction of the association between bedtime procrastination and sleep outcomes.

Methods

Six databases (CINAHL, EMBASE, PsychINFO, PubMed, Scopus, Web of Science) were searched from inception to September 2021 against pre-determined eligibility criteria.

Results

Forty-three studies were included (GRADE = low). Meta-analysis revealed that bedtime procrastination had a moderate negative association with self-control (z = -0.39; CI: -0.45, -0.29) and a moderate positive association with evening chronotype (z = 0.43; CI: 0.32, 0.48). Furthermore, bedtime procrastination was moderately negatively associated with sleep duration (z = -0.31; CI: -0.37, -0.24), sleep quality (z = -0.35; CI: -0.42, -0.27) and moderately positively associated with daytime fatigue (z = 0.32; CI: 0.25, 0.38).

Conclusion

Further high-quality studies are needed to identify causal relationships between bedtime procrastination and correlates, as well as bedtime procrastination and sleep. Future work will guide the development of interventions targeting bedtime procrastination for improved sleep outcomes.
P021 Daily association between post-traumatic stress symptoms and sleep in trauma-exposed young adults
Authors: Schenker M , Theoswin P , Qian H , Jordan A , Nicholas C , Felmingham K
Published: October 2023

Sleep disruptions and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a daily basis. However, most of the previous research has focused on subjective sleep measures only. In this study, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective sleep measures (actigraphy) in 41 non-treatment seeking, trauma-exposed young adults (age M=24.68, SD=8.15) with a range of PTSD symptom severities (PTSS, 0-53 on PCL-5). Participants reported daily PTSS and number of intrusions as well as nightly sleep, while wearing an actigraphy watch over four weeks. Linear mixed models showed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and more intrusions both within and between participants. Similar effects were found for PTSD symptoms influencing subsequent subjective sleep. However, these associations were not found in the objective sleep data. Exploratory moderator analyses including sex (male vs. female) suggested sex-specificity in these associations. While subjective sleep results were in line with previous research, objective sleep results differed. Several factors may underly the divergent findings, such as the COVID-19 pandemic and/ or sleep-wake state discrepancy. Although further research is required, these data suggest the relationship between sleep and PTSD symptoms differs between objective and subjective sleep measures and depending on sex.
P022 Sleep Biomarker Phenotyping of Neurodegenerative Disorders Using Artificial Intelligence – A Pilot Study
Authors: Levendowski D , Tsuang D , Neylan T , Walsh C , Lee-Iannotti J , Berka C , Mazeika G , Boeve B , St. Louis E
Published: October 2023

Introduction

In this pilot study, we explored sleep biomarker risk probabilities for different neurodegenerative disorder (NDD) phenotypes across a spectrum of NDD patients, compared with controls.

Methods

We analyzed a cohort of patients with different NDD phenotypes who underwent in-home recordings with Sleep Profiler, including Lewy body disease (LBD=20), Alzheimer’s disease dementia (AD=29), and isolated REM sleep behavior disorder (iRBD=19). Controls with an MMSE>28 (CG=61) and patients with Parkinson disease (PD=16) and mild-cognitive-impairment (MCI=41) also participated.

We developed a machine-learning classifier that assigned NDD probabilities for LBD, AD, iRBD, and CG. The input variables included: time-REM, non-REM hypertonia, autonomic-activation index, spindle-duration, atypical-N3, time-supine, sleep-efficiency, relative-theta, and theta/alpha. Probabilities >50% were assigned “likely”, and for CG>=50% and a NDD group probability 20-50%, the assignment was normal “plus”. Probability assignments were then made for the NDD and CG groups, then further applied to the PD and MCI patient groups.

Results

The CG group participants were assigned Normal-Likely=74%, Normal+AD=11%, Normal+iRBD=5%, iRBD-Likely=5%, and AD-Likely=5%.

LBD patient distributions were LBD-Likely=70%, iRBD-Likely=5%, AD-Likely=5%, Normal+LBD=5%, Normal+iRBD=5%, Normal+AD=5%, and Normal-Likely=5%.

AD group distributions were AD-Likely=71%, LBD-Likely=4%, Normal+AD=14%, Normal+iRBD=4%, Normal-Likely=7%.

iRBD patients were characterized with iRBD-Likely=37%, LBD-Likely=5%, AD-Likely=5%, Normal+iRBD=27%, Normal-Likely=26%.

PD patients were assigned iRBD-Likely=29%, LBD-likely=14%, AD-Likely=14%, Normal+iRBD=21%, Normal+AD=7%, Normal-Likely=14%.

MCI distributions were AD-Likely=45%, LBD-Likely=8%, iRBD-Likely=5%, Normal+AD=21%, Normal-Likely=13%.

Conclusions

For LBD, AD and CG groups, correct risk assignments were >70% while gross misclassifications were <10%. Classification patterns for PD, MCI and iRBD were disbursed in a manner consistent with the range of severities expected in each group.
P026 Should we consider new mothers an at-risk group for fatigued driving?
Authors: Sprajcer M , Thorne H , Newman L , Gupta C
Published: October 2023

Introduction

New mothers typically experience a high level of sleep disruption during the first year of their child’s life. Other populations who are likely to experience sleep disruption (e.g., shift workers) are considered at-risk for fatigued driving. As a result, significant educational resources and support are available to minimise risks for these groups. However, no similar resources are available for new mothers as it is unclear whether they should be considered an at-risk population. This study therefore aimed to identify the frequency of fatigued driving and fatigue-related near misses / vehicle crashes in new mothers.

Methods

A cross-sectional survey was undertaken with a sample of 187 Australian mothers who had a child aged under one year. Participants completed the Pittsburgh Sleep Quality Index and a series of questions addressing their driving behaviour and experiences of fatigued driving.

Results

Over 50% of participants who drove regularly did so while fatigued at least a few times per month. Of the participants who reported experiencing near misses while driving, >70% indicated that at least some were caused by fatigue. Furthermore, >55% of participants who had experienced a vehicle crash since the birth of their child reported that the crash was caused by fatigue.

Discussion

The reported rates of fatigued driving suggest that new mothers experience a similar degree of fatigue-related driving risk as other at-risk populations and are likely at greater risk than the general population. It may therefore be appropriate to provide targeted educational resources and/or fatigue management strategies for new mothers.
P029 Comparing the Impact of General Strength Conditioning and Motor Control Manual Therapy on Sleep Quality in Adults with Chronic Low Back Pain: A Randomised Controlled Trial
Authors: Vincent G , Craige E , Belavy D , Ford J , Miller C , Main L , Hahne A , Ferguson S , Owen P
Published: October 2023

Introduction

There is strong evidence indicating interactions between sleep and chronic low back pain (CLBP). However, evidence on the effect of exercise training (first-line treatment for CLBP), especially of specific modes of exercise training, on sleep is limited. This study aimed to investigate the effect of two exercise-based interventions (general strength and conditioning [GSC] and motor control and manual therapy [MCMT]) on sleep quality in adults with CLBP.

Methods

We conducted a two-group parallel (1:1), randomised controlled trial. Forty adults (mean age [SD]: 34.7 [6.1] years) with CLBP were randomised to receive either GSC (n=20) or MCMT (n=20) for 6 months. Sleep quality and its sub-components (e.g., sleep disturbance, sleep duration) were measured by the Pittsburgh Sleep Quality Index (PSQI). Analysis employed an intention-to-treat approach and group-by-time effects were assessed with mixed linear effect models.

Results

Both GSC (PSQI mean change [95%CI]: -1.58 [-2.70, -0.46] points) and MCMT (-1.61 [ 2.79, -0.43]) improved sleep quality at 6 months, but no group-by-time effect was detected (β [95%CI]: 0.03 [-1.60, 1.65]). For sleep quality sub-components, GSC improved daytime dysfunction (-0.33 [-0.65, -.0.01]), but led to a small decline in sleep efficiency (0.06 [0.01, 0.10]). MCMT improved sleep disturbance ( 0.31 [-0.55, -0.07]).

Conclusion

Both GSC and MCMT improved sleep quality, although neither intervention appeared superior. Sleep disturbance was improved in the MCMT group and daytime dysfunction was improved in the GSC group. Future studies would benefit from including a true control, objective sleep measures, and investigation of potential mediators.
P030 Understanding the relationships between sleep quality, and depression and anxiety in neurotrauma: A scoping review.
Authors: Saravanan K , Downey L , Sawyer A , Jackson M , Berlowitz D , Graco M
Published: October 2023

Introduction

Sleep problems, depression, and anxiety are highly prevalent following a spinal cord injury (SCI) and traumatic brain injury (TBI) and may worsen functional outcomes and quality of life. This scoping review examined the existing literature to understand the relationships between sleep quality, depression, and anxiety in people with SCI and TBI, and to identify gaps in the literature.

Methods

A systematic search of seven databases was conducted. The findings of 30 eligible studies reporting associations between sleep quality and depression and/or anxiety following SCI or TBI were synthesised.

Results

The included studies were mostly cross-sectional and employed a range of subjective and objective measures of sleep quality. Poor subjective sleep quality and insomnia tended to be significantly associated with increased levels of depression and/or anxiety, but no such associations were reported when sleep quality was measured objectively. Two longitudinal studies observed worsening depressive symptoms over time were related to insomnia and persistent sleep complaints. Two interventional studies found that treating sleep problems improved symptoms of depression and anxiety.

Discussion

The findings of this review suggest that sleep and psychopathology are related in people with neurotraumatic injuries. This has important therapeutic implications, as individuals may benefit from therapy targeting both sleep and psychological issues. More longitudinal and interventional studies are warranted to further understand the direction and strength of the relationships, and how they impact patient outcomes.
P032 Prospective Crossover Trial of Positional and Continuous Positive Airway Pressure Therapy (PaCT) for the Treatment of Mild-to-Moderate Positional Obstructive Sleep Apnoea
Authors: Kinder S , Ryan A , Carroll R , Duce B , Ellender C , Wilson M
Published: October 2023

Introduction

Positional obstructive sleep apnoea (pOSA), defined by a supine-to-non-supine AHI ratio ≥2, is a phenotype present in a significant subset of patients with sleep-disordered breathing. CPAP has been the gold standard for OSA treatment since its first description in clinical use, although various practical and patient factors may preclude its use. Positional therapy (PT) provides an alternative for pOSA – shown to be effective in restricting supine sleep, thereby reducing the frequency of events and improving outcomes.

Methods

Prospective, single-centre crossover trial of consecutive, treatment-naïve participants with symptomatic, mild-to-moderate pOSA on diagnostic polysomnogram. Eligible participants were randomised to undergo paired treatment CPAP and PT polysomnography to assess efficacy. Participants thereafter received a two-month trial of each, according to randomisation. Adherence, symptom, quality of life (QoL) measures, and patient preference were assessed.

Results

53 participants completed treatment and follow-up. Mean age was 55.1±12.7 years. 30 participants were male (56.6%). Median BMI was 30.1kg/m2 (27–34). Median baseline AHI was 14.4 (9.9–20.2). Median baseline Epworth Sleepiness Scale (ESS) was 12 (10–14) and improved after treatment with positional [8 (6–11); p=0.001] and CPAP [8 (6-11); p<0.001] therapies. There was no difference in ESS reduction between treatment groups (p=0.691). There was no significant difference in usage between therapies (p=0.877). QoL measures were also assessed.

Discussion

In this cohort with symptomatic mild-to-moderate pOSA, treatment with both PT and CPAP resulted in comparable, clinically significant symptomatic improvement with similar usage. Our findings suggest either therapy can be considered effective in appropriately selected patients.
P038 Characterising Pulse Wave Amplitude Drops in Patients with Acute Coronary Syndrome
Authors: Tong B , McClintock S , He S , De Chazal P , Yee B , Cistulli P
Published: October 2023

Pulse wave amplitude derived from photoplethysmography signals is a surrogate measure of autonomic function and vascular response. Recent studies have demonstrated low pulse wave amplitude drop(PWAD) index to be associated with increased cardiovascular risk in obstructive sleep apnoea(OSA). The nature of PWAD in patients with cardiovascular disease remains unknown. We aimed to characterize PWAD in patients with acute coronary syndrome(ACS) diagnosed with OSA in terms of cardiovascular measures.

We studied 70 patients with ACS (age:58[52,63]years, BMI:27[24,30]kg/m2). A level 2 polysomnogram was conducted to confirm OSA diagnosis within 6 months after discharge. Cardiovascular measures of heart rate variability(HRV), baroreflex sensitivity, pulse wave velocity (PWV) and endothelial function(FMD) were measured. PWAD was analysed using a validated algorithm. PWAD with an amplitude reduction of >30% from baseline and a duration >4 heartbeats were identified. PWAD frequency, duration, amplitude, area under the curve(AUC), descending and ascending slopes were calculated.

There was no relationship between PWAD frequency and AHI (r=0.057, p=0.642). PWAD amplitude (rs= 0.308, p=0.031) and duration (rs= -0.319, p= 0.025) correlated with baroreflex effectiveness index. After controlling for age, gender and BMI, baroreflex effectiveness index was associated with PWAD duration (β±SE: -0.009±0.003, p=0.009). Aortic augmentation index correlated with PWAD duration (rs= 0.3565, p=0.0041). HRV parameters, FMD and PWV did not correlate with PWAD parameters (data not shown).

These preliminary findings suggest PWAD duration and amplitude are not associated with OSA severity in patients with ACS. However PWAD may be appropriate markers of vascular and autonomic nervous system response in patients with cardiovascular disease.
P034 An economic evaluation comparing the provision of sleep disorder services via a regional hub-and-spoke model of care to standard care in a metropolitan tertiary hospital
Authors: Szollosi I , Worley S , Curtin D
Published: October 2023

Introduction

A new hub-and-spoke model of care (New-MOC) was introduced in a very remote Queensland region for the management of Obstructive Sleep Apnoea. Standard Care required travel and admission to a major metropolitan hospital. The aims were to increase access to services and ensure the New-MOC was cost-effective for sustainability.

Method

A cost-utility evaluation was performed from the health service perspective. Administrative and clinical data was collected in the 2-years prior and 1-year post implementation of the New-MOC to compare costs and outcomes. Base-case was modelled using decision tree analysis for a hypothetical cohort of 100 patients over a time horizon that captured 12-months of treatment. One-way sensitivity analyses were performed to evaluate uncertainty of inputs in which a) all costs were adjusted to upper bound b) set up costs were added and c) QALYs were reduced in the New-MOC.

Results

Under base-case the New-MOC was dominant and projected to save $226,511 of health service costs over 1.2 years and result 0.488 QALYs gained compared Standard Care. The New-MOC remained cost effective under all scenarios modelled.

Discussion

Whilst the New-MOC was cost effective, primary source data was only available up to diagnosis and therefore modelling relied on assumption around outcomes. Follow-up of patients in relation to treatment compliance would improve the accuracy of the model as would applying a lifetime horizon to capture all outcomes for a chronic condition. However, sufficient evidence exists to support the New-MOC as cost saving and cost-effective.

Acknowledgement

supported by a Metro North LINK Grant
P041 Audit findings of Bilevel Titrations performed in 2022 at a Public Sleep Laboratory
Authors: Doyle G , Szollosi I , Segal T , Downey C
Published: October 2023

Introduction

The aim of this audit was to benchmark and grade outcomes of NIV titrations for chronic hypercapnia as per the NPPV titration task force of the AASM.

Methods

All NIV studies performed in 2022 were included in the audit. Titration gradings of success were defined as per the NPPV titration task force. Each change in setting was reviewed for consistency with laboratory protocols based on task force guidelines.

Results

50 of 72 NIV titrations have been audited to date. Patients were mean age (56.4 years +/-17.6), 59% male, with the following pathophysiology leading to chronic hypoventilation. 46% OHS, 35% neuromuscular disease, 16% lung disease, 2% brain or spinal injury. 81% of all setting changes were consistent with laboratory protocols. Protocols were most often not followed when adjusting rise (86.2%), EPAP (82%), and ti max/min (62%). Titration grading outcomes were optimal (43%), good (14%), adequate (0%) and unacceptable (43%). Suboptimal titrations were attributed to; lack of supine REM sleep (24%), lack of sleep or any REM sleep (18%), persistent asynchrony (10%), uncontrolled obstruction (10%), or tcCO2/SpO2 not responding to treatment (38%).

Patients with a primary condition of a neuromuscular disease had less suboptimal titrations (36%) compared with OHS (46%), lung disease (43%) and other conditions (50%) however were not statistically significant.

Discussion

Despite local titration protocols, a high number of unacceptable titrations were identified along with a high proportion of patients not responding to treatment. Further analysis to identify reasons for titration protocol deviations and treatment non-responders is required.
P043 Comparison of sleep position classification between neck and abdominal placement in late pregnancy
Authors: Wilson D , Whenn C , Ruehland W , Barnes M , Walker S , Howard M
Published: October 2023

Background

Going to sleep in the supine position during pregnancy is associated with an increased risk of stillbirth, however objective sleep position data are needed to verify the mechanisms of this relationship. Sleep position measurement devices are typically worn at the neck or chest, but abdomen position is more important for assessing impact of the gravid uterus on inferior vena cava compression. This study aimed to compare sleep position measured at the neck versus the abdomen in late pregnancy.

Methods

Twenty women in the third-trimester of pregnancy wore the Night Shift Sleep Positioner with both the neck band and abdominal band for one night. Position classified as left, supine, right, prone and upright was recorded in 30-second epochs and compared across device locations.

Results

There was substantial agreement between the neck and abdomen for determination of all sleep positions with 88% concordance on an epoch-by-epoch basis (κ = .797 [SE .006], p<.001). However, agreement was only fair (κ = .407 [SE .007], p < .001) for supine versus non-supine positioning, with a trend for more supine sleep using the neck device compared to the abdomen (47.5 [16.3,80.5] vs 19.0 [6.8,83.8] minutes, median difference =7.3 [0.5,39.3], p=.12). The average absolute supine difference across device locations was 30.8 minutes [4.0,65.3].

Conclusion

Position measurement at the neck and abdomen has considerable concordance on an epoch-by-epoch basis, however agreement was reduced when comparing supine position only. Site of sleep position measurement in pregnancy has implications for assessing supine positioning, intervention success and stillbirth risk.
P044 Assessing Sp02 Data Reliability in a Paediatric Laboratory: A Comparative Study of Pulse Oximetry and Transcutaneous Oxygen Monitoring
Authors: Roberts C , Carballo A , Erikson N , Madden G
Published: October 2023

Introduction

Pulse oximetry is the primary method for measuring Sp02 in polysomnography studies to determine the presence of sleep apnoea. In paediatric studies where there is significant artefact in pulse oximetry, we investigate if transcutaneous oxygen monitoring (TcOM) can be used as a reliable alternative to measure blood oxygen concentration (Sp02).

Methods

A comparison of pulse oximetry (Nonin) and TcOM (Sentec) data was performed by a retrospective analysis of 16 diagnostic studies (Male=50%; Median age= 8±4.69SD). 6 studies were excluded due to: AHI >5/hr, missing data and artefact. A comparison was made between the two sampling methods for: Oxygen desaturation index (ODI) per hour, nadir and baseline. Statistical analysis run was a paired t-test.

Results

Poor test-retest reliability was observed for all parameters- mean(SD): ODI Nonin=1.13(1.24), ODI Sentec=50.74(29.13)*; Nadir Nonin=91.10(3.78), Nadir Sentec=69.10(10.62)*; Baseline Nonin=98.(0.57), baseline Sentec=99.50(0.71)*. These results strongly indicate a significant statistical difference between data groups. *indicates P=<0.05

Discussion

Our analysis demonstrated inconsistent data between the two methods, and unstable Tc0M readings, which if used could lead to misdiagnosis of sleep-disordered breathing. Further comparative analysis using different Tc0M skin sites could yield more reliable data. Two reliable sources of SpO2 data would provide an in-clinic verification tool in instances of significant artefact or troubleshooting, to improve quality of studies conducted.
P047 Slow Wave Dynamics in Mild Cognitive Impairment compared with Age Matched Controls: A High Density EEG study.
Authors: Chapman J , Kao T , Teh J , Haroutonian C , Grunstein R , Naismith S , D'Rozario A
Published: October 2023

Introduction

Slow wave activity during non-rapid eye movement (NREM) sleep has been linked with memory consolidation in healthy older adults. To date, there has been limited research in mild cognitively impaired populations, particularly looking across the whole brain using high density EEG. We aimed to determine if the dynamics of slow wave activity (delta power) during the first NREM sleep cycle differ between patients with mild cognitive impairment (MCI) and healthy older adults.

Methods

Participants were assessed for MCI by a panel of neuropsychologists and clinicians. They underwent full polysomnography including high-density EEG (256 electrodes). We computed the delta power (0.5-4.5Hz) for each NREM cycle and slope between sleep onset and the peak of delta in the first NREM sleep cycle (rise-rate) which were compared between groups using t-tests.

Results

17 older adults with MCI and 21 older healthy controls were assessed. The mean delta power in the first NREM cycle did not differ between MCI and controls across the whole brain, but the global rise-rate (1/min) of MCI and controls was 0.0015 and 0.0032 respectively (t-value -2.35, p=0.025).

Discussion

Global slow wave dynamics in the first NREM period appear to be altered in patients with MCI compared with age-matched controls. The gentler slope of rise-rate to the first delta peak in MCI patients than in healthy controls may indicate the dysfunction of sleep homeostasis in MCI patients. Regional slow wave dynamics, ultra-low frequency delta (0.25-1Hz), and associations with sleep dependent memory consolidation will further be explored.
P054 Neurotransmitters of Sleep and Wake in Flatworms
Authors: Omond S
Published: October 2023

Introduction

Sleep is something that we all do, regardless of how much or how little. But why we sleep, and how sleep evolved is still something of a mystery. This research investigated how neurotransmitters and pharmaceuticals commonly seen in mammalian sleep and wake, play a role in the sleep of free-living flatworms.

Methods

Using behavioural methods, I observed the behaviour of flatworms under a 12:12 LD lighting condition. Using seven neurotransmitters and one pharmaceutical, I used a novel “yolk and soak” method – feeding the animals the neurotransmitter via hard-boiled egg yolk, as well as bathing them in the same concentration of neurotransmitter, to modulate their behaviour to either induce sleep, or wakefulness.

Results

We found that GABA, dopamine and histamine appear to be evolutionarily conserved. By dosing the flatworms with these neurotransmitters, we saw that the behaviour changed toward sleep (GABA) or wakefulness (dopamine and histamine) as it does in more recently evolved mammals. We also saw that the H1 antagonist Pyrilamine induced sleep, as it does in other animals.

Discussion

Understanding how neurotransmitters involved in sleep and wake in humans, and other mammals, may work in animals that are neurologically simple, and older in evolution can lead to many opportunities. We now know that GABA, dopamine and histamine promote sleep and wake in animals that have lost most of their complex systems through secondary simplification, suggesting that these neurotransmitters might be key to the origin of sleep, and may help to understand sleep disorders in humans.
P058 Dissecting Sleep Restriction: Defining and Empirically testing a two-stage Build-Maintain model of Sleep Restriction Therapy for Insomnia
Authors: Drummond S , Bei B
Published: October 2023

Introduction

Sleep Restriction Therapy (SRT) is one of the core components of CBT for Insomnia (CBT-I). However, there is little empirical evidence regarding how SRT implementation evolves over the course of therapy. Here, we propose a conceptual model for defining stages of SRT and assess the applicability of the model in a recently completed clinical trial.

Methods

Our proposed two-stage Build-Maintain model of SRT is: 1) The Build stage starts with SRT implementation. The primary goal is building homeostatic pressure until average weekly sleep efficiency (SE) is high enough to increase time-in-bed (e.g., 85% or 90%). 2) The Maintain stage starts with the first increase of time-in-bed after the target SE is reached. The goal is to maintain sleep pressure sufficiently high that one can maintain SE in the desired range.

We assessed the model in 83 adults (age=48.3±14.8 years; 50F) undergoing CBT-I in a RCT. SRT was introduced in week 2. We explored the extent to which age, sex, psychiatric comorbidities, use of hypnotics, and baseline insomnia severity predicted progression through the SRT stages.

Results

Participants were in the Build stage 2.1±1.3 weeks (41.8% were in Build for only one week; 84% for ≤3 weeks). Higher baseline ISI (r=.238,p=.036) and lower baseline SE (r=-.365,p=.001) predicted spending more weeks in the Build stage before transitioning to the Maintain stage.

Discussion

The two-stage Build-Maintain model of SRT may inform: a) setting empirically-based expectations for client progress; b) examining adherence to CBT-I; c) evaluating shortened versions of CBT-I.
P067 Patient perceived sleep quality at CPAP titration study as an early indication of short and long-term adherence to CPAP therapy.
Authors: Riddles T , Hollamby M , Henderson D , Curtin D , Szollosi I
Published: October 2023

Background

Untreated obstructive sleep apnoea is associated with morbidity and diminished quality of life. Despite this, adherence to continuous positive airway pressure (CPAP) remains poor. Few studies have examined which factors from CPAP titration study affect adherence, with a paucity that evaluated perceived sleep quality and adherence.

Methods

We hypothesise that patients with better perceived sleep quality, at the time of their CPAP titration study will have greater uptake and adherence to CPAP. We aim to:

1. Compare the change in patients’ perceived sleep quality between diagnostic and CPAP titration studies, and future CPAP adherence at 3 and 12 months.

2. Evaluate the association between patients’ perceived sleep quality at the time of their CPAP titration study with future CPAP adherence at 3 and 12 months.

3. Evaluate factors relating to sleep architecture, and sleep disturbance that affect patients’ perceived sleep quality.

Sleep studies were obtained prospectively between 2018 and 2019. Patients completed two questionnaires grading sleep quality post study.

Progress to Date

This study was approved as a quality activity through the Metro North Quality and Safety Unit (ID 3929). Sleep study and questionnaire data were collated and merged with adherence data. Analysis will begin shortly.

Intended Outcome and Impact

We intend to publish the results of this study in an international sleep journal. Positive findings may improve management of those at risk of poor adherence. Subsequent studies may evaluate the effect of early patient follow up or early motivational interviewing on uptake and adherence to CPAP.
P081 Experiences of men who have had bariatric surgery in New Zealand
Authors: Besley E
Published: October 2023

Introduction

Bariatric or weight loss surgery is currently the most effective method of long-term weight loss, and as obesity is a major risk factor for obstructive sleep apnoea, a potential treatment option. Approximately 80% of people who have bariatric surgery are women, however there is limited research regarding men, and none from New Zealand. This project aimed to investigate the experiences of men who have had bariatric surgery in New Zealand.

Methods

This study took a constructivist qualitative approach, collecting data using semi-structured interviews with six men who had bariatric surgery in New Zealand. Interviews were conducted in person and over Zoom. Interviews were transcribed, then thematic analysis used to develop themes.

Results

Participants were aged between 31 and 63 when they had surgery, with half having surgery in the public, and half in the private sector. Five identified as New Zealand European/Pākehā, and one as Māori. The main themes developed from the data were: attaining control of their weight, and surgery as life changing. A significant sub-theme was support, with that of health care professionals vital.

Discussion

Participants had regular interactions with health care professionals due to multiple comorbidities, including sleep apnoea, however, the topic of surgery was rarely broached. All the men were satisfied with their decision to have surgery, with an improved quality of life and most comorbidities resolved. With a high number of sleep apnoea patients also morbidly obese, sleep professionals are well placed to encourage or to refer their morbidly obese patients for bariatric surgery.
P086 Measurement of Environmental Factors affecting Sleep within Rehabilitation Wards, Sub-acute Care Wards, and Aged Care Facilities: A Scoping Review
Authors: Dunstan O , Shafiee Hanjani L , Young A , Ellender C , Hoang T , Hubbard R
Published: October 2023

Introduction

Unfamiliar environments are often poorly conducive to adequate sleep, especially for patients within different care settings, where proper sleep is vital for recovery and overall health. This scoping review thus aims to synthesise the evidence around which aspects of the sleep environment are measured within rehabilitation, sub-acute and aged care settings, how they are being measured, and to identify if there are any ‘gold standards’ against which the environmental factor measurements are compared.

Method

A search was conducted from inception to May 2023 within PubMed, EMBASE, Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Web of Science. Eligibility criteria included full length original studies of any design reporting on the measurement properties of environmental factors affecting sleep of adult patients admitted to rehabilitation/sub-acute wards and aged care facilities.

Results

This scoping review identified 2185 studies after duplicate removal, of which 82 studies have been admitted for data extraction following review from two authors. Data will be sought for the following variables: publication year, country, study aim, study design, care setting, population characteristics, environmental factors studied, unit of measurement, specific measure, measurement method, gold standard comparators (if any).

Discussion

It is anticipated that this review will be completed by August 2023 and will identify the most common methods used to measure environmental factors affecting sleep outcomes within the literature. This study will thereby inform and aid researchers and clinicians with developing future environmental interventions and measuring their impact within rehabilitation, subacute and aged care settings.
P088 The Relationship between Screen time, Sleep, and Language Development in Pre-school Aged Children
Authors: Gale M , Axelsson E , Eidels A , Robson A , Mace J
Published: October 2023

An increasingly prevalent factor in the preschool years is screen time, with possible implications for sleep and development. Few studies have simultaneously assessed screen time, sleep, and development. I aim to investigate preschoolers’ screen time, sleep, and language development, alongside predictors of screen time, social behaviours, and how sleep supports long-term memory for new words.

Screen time durations for educational, entertaining, and relaxing content types, will be recorded over three days. This is to assess whether content types have differing relationships with sleep. If sleep quality and duration are impeded, this may create a cyclical pattern between sedentary behaviour, sleep, and screen time. I will also measure screen times at differing times of the day, and the percentage of time spent interacting with another person or the screen content. Children will be exposed to new words at the beginning of the study and their memory will be tested after three nights. Importantly, assessing the interaction between screen time and sleep, in relation to children’s memory for the new words. Sleep will be measured using actigraphy watches and a sleep diary. Standardised measures of vocabulary and communication will be used to assess children’s language development.

As language development is a multifaceted process, assessing predictors, social behaviours, and memory for new words, allows assessment of factors that may benefit or hinder sleep and language development. This comprehensive study will contribute to the understanding of the relationships between screen time, sleep, and language development, and the nuanced factors that relate to its success.
P098 Risk stratification tool for gastrostomy insertion in Motor Neurone Disease
Authors: Parker J , Banks J , Lau H
Published: October 2023

Introduction

An FVC<50% has traditionally been used to quantify the risk of respiratory compromise in patients with motor neurone disease(MND) undergoing gastrostomy insertion. More recently, a Risk Stratifying Tool(RST) has been developed to better identify those patients who might be at higher risk for the procedure. We set out to evaluate whether there were any differences in the outcomes of high-risk MND patients undergoing gastrostomy insertion as determined by the FVC or RST.

Methods

A retrospective review of MND patients undergoing gastrostomy insertion was performed between June 2018 and June 2023. Data was collected on demographics, RST variables (orthopnoea, elevated serum bicarbonate or pCO2, or use of NIV), complications, and mortality.

Results

42 patients were referred for gastrostomy insertion, only 1 procedure was unsuccessful due to anatomical difficulties. 17 patients (n=8 PEG,n=9 RIG) were classified as high-risk based on FVC<50%, while 30 patients (n=17 PEG,n=13 RIG) were classified as high-risk using the RST. No direct procedure-related complications were recorded in either group. Length of stay(3 vs 3.04 days), 30-day morbidity(23.5% vs 30%), 30-day mortality(0% vs 0%), 6-month mortality(23.5% vs 20%), and median survival(271 days vs 309 day) were comparable between the FVC and RST groups respectively. The RST was more sensitive at identifying patient mortality at 6 months (4/6 vs 6/6 patients).

Conclusion

Gastrostomy insertion was safe in this cohort of high-risk MND patients, independent of the tool used. Similar morbidity, mortality and length of stay were observed between the two groups. RST was more sensitive for identifying 6-month mortality.
P111 Validity and Reliability of Sleep Questionnaires in Adults: A Systematic Review
Authors: Way J , Cistulli P , Bin Y
Published: October 2023

Introduction

Sleep plays an important role in maintaining overall health and well-being. It has been well-established that poor sleep is linked to several negative health consequences. Therefore, the use of appropriate sleep measures in national surveillance systems is essential to understand the impact that poor sleep has on population health. The aim of this systematic review is to evaluate the validity and reliability of self-reported sleep questionnaires.

Method

Electronic database searches were performed on PubMed, EMBASE, and PsycINFO, focusing on studies of adults aged 18 and above that validated sleep questionnaires against objective sleep measurements or compared them with other subjective sleep instruments. Search terms were grouped into three categories: sleep health, assessment instrument type, and psychometric properties.

Progress to Date

A total of 5,071 abstracts across the three electronic databases were retrieved from the general search and screening is currently being undertaken. Relevant studies meeting the inclusion criteria will be analysed, and data will be extracted using a predefined form, which includes study characteristics, sleep measures, validated objective and/or subjective instruments, and psychometric properties.

Intended Outcome and Impact

The systematic review is expected to provide a summary of the psychometric properties of sleep questionnaires that have potential use in population health surveys as part of routine health monitoring. The findings will contribute to the identification of any gaps in the current sleep questionnaires to help enable more comprehensive monitoring and understanding of population sleep habits and associated health outcomes.
Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials
Authors: Boyce Louis , Jordan Chloe , Egan Timothy , Sivaprakasam Rajesh
Published: October 2023

Procedural anxiety and pain negatively affect surgical outcomes and the patient experience during awake, invasive procedures (AIPs). This systematic review aims to evaluate the effect of using virtual reality (VR) to enhance the intraprocedural patient experience during AIPs. PRISMA, Cochrane, and SWiM Reporting Items guidelines were followed. PubMed, EMBASE, CENTRAL, and medRxiv databases were systematically searched for randomised controlled trials (RCTs) investigating the use of immersive VR headsets to enhance the patient experience in adults undergoing AIPs. Sixteen studies were included. The VR and control groups comprised 685 and 677 patients, respectively. Patients underwent endoscopic procedures in 9 studies (“endoscopic”) and interventions that involved a skin incision in 7 studies (“incision”). Eleven (of 13) studies demonstrated a favourable effect on procedural anxiety with VR use compared with standard intraprocedural care (85% [95% CI: 46%-100%], P = 0.011). Ten (of 13) studies demonstrated a favourable effect on pain with VR use (77% [95% CI: 38%-100%], P = 0.046). Seven (of 9) studies demonstrated a favourable VR effect on patient satisfaction (78% (95% CI: 44%-100%), P = 0.070). The effect of VR on physiological markers of anxiety and pain and requirements for additional pro re nata (PRN) analgesia and sedation were not clear. No significant differences in patient experience were identified between the “incision” and “endoscopic” subgroups. This review demonstrates that VR can feasibly be used to enhance the patient experience during AIPs by attenuating subjective perceptions of procedural anxiety and pain. However, further RCTs are required to elucidate the effect of VR on more objective measures of the patient experience.
Intramural Duodenal Hematoma in a Case of Hyper IgM Syndrome
Authors: Chandola Stuti , Prabhakar Prashant , Seth Rachna , Jana Manisha
Published: October 2023

Three-year-old boy who presented with colicky abdominal pain, diarrhoea and vomiting was investigated with computed tomography which revealed a mass in the peripancreatic region. An imaging possibility of duodenal intramural hematoma was considered after reassessment with ultrasound which was subsequently confirmed by magnetic resonance imaging. The development of a spontaneous duodenal hematoma lead to further evaluation of the patient and revealed X linked hyper IgM syndrome.
The effectiveness of graded motor imagery and its components on phantom limb pain in amputated patients: A systematic review
Authors: Rierola-Fochs Sandra , Ochandorena-Acha Mirari , Merchán-Baeza Jose Antonio , Minobes-Molina Eduard
Published: October 2023

Background:

Phantom limb pain (PLP) can be defined as pain in a missing part of the limb. It is reported in 50%–80% of people with amputation.

Objectives:

To provide an overview of the effectiveness of graded motor imagery (GMI) and the techniques which form it on PLP in amputees.

Study Design:

Systematic review.

Methods:

Two authors independently selected relevant studies, screened the articles for methodological validity and risk of bias, and extracted the data. Inclusion criteria used were clinical studies, written in English or Spanish, using GMI, laterality recognition, motor imagery, mirror therapy, or a combination of some of them as an intervention in amputated patients, and one of the outcomes was PLP, and it was assessed using a validated scale. The databases used were PubMed, Scopus, Web of Science, CINAHL, and PEDro.

Results:

Fifteen studies were included in the review. After the intervention, all the groups in which the GMI or one of the techniques that comprise it was used showed decrease in PLP.

Conclusion:

The 3 GMI techniques showed effectiveness in decreasing PLP in amputees, although it should be noted that the application of the GMI showed better results.