bluuebunny/crossref_metadata_2025 huggingface dataset:
P006 Initiation of Continuous Positive Airway Pressure as an inpatient in Patients with Obesity Hypoventilation Syndrome admitted to General Medical Unit
Authors: Banjade S , Entesari-Tatafi D
Published: October 2021

Background

With higher rates of obesity in regional and rural Australian population, there will be higher rates of Obesity Hypoventilation Syndrome (OHS). The cornerstone of the treatment of OHS is Positive Airways Pressure. We studied the initiation of Continuous Positive Airways Pressure (CPAP) in an inpatient setting in patients with OHS in the regional population of Ballarat and subsequent impact on their hospital stay/readmission.

Methods

We performed a retrospective study of 22 patients with OHS during the 6-month study period (01/07/2021–31/12/2021) admitted into General Medical Unit at Ballarat Base Hospital.

Progress

Complete

Outcome/Impact

The mean age in the cohort was 60 with average weight of 139.5 kg. The mean pCO2 and pH were 68.1 and 7.33 respectively. CPAP was initiated in 9 of 22 patients (40.1%) with mean of 7.3 days. Mean days of oxygen use was 4.7 days with mean length of hospital stay 10 days. We did not find any statistical difference in length of hospital stay, ICU stay, supplemental oxygen use or readmission rates between CPAP and non-CPAP group. Subgroup analysis showed that CPAP group had higher rates of COPD (44.4% vs 30.8%) and diabetes (44.4% vs 30.8%) with trend to lower FEV1 (mean FEV1 47.6% vs 57.2%). There were 4 deaths (16.7%), 3 of them did not have CPAP initiated.

The longer duration to CPAP initiation is likely to explain the non-significant difference between the groups. Proactive measures to increase initiation of CPAP is likely to improve patient outcome in terms of their morbidity and mortality.
P008 A systematic review and meta-analysis of inflammatory bowel disease activity and sleep quality
Authors: Barnes A , Spizzo P , Mountifield R , Bampton P , Andrews J , Fraser R , Mukherjee S
Published: October 2021

Background

Poor sleep quality has been associated with active inflammatory bowel disease (IBD) in several studies. This review examines sleep quality in people with active IBD and in those in remission, with meta-analyses performed, considering subjective and objective sleep quality and IBD activity.

Methods

Electronic databases were searched from inception to December 1st 2020. A random effects model was used with separate meta-analyses performed for objective and subjective sleep and IBD activity, considering sleep quality in active and inactive IBD.

Results

19 studies were included in the qualitative review representing 4972 IBD patients. Subjective IBD activity (11 studies) was associated with subjective sleep quality with pooled odds ratio (OR) for subjective poor sleep in active IBD compared to remission of 3.04 (95% CI 2.41–3.83). Including only studies with objective sleep measures (5 studies), sleep efficiency was lower in those self-reporting active IBD and time awake post sleep onset was higher in those with active IBD. Objective IBD activity was associated with subjective poor sleep (4 studies), with pooled OR of 6.64 95% CI (3.02 – 14.59). Insufficient data was available to consider objective IBD activity and objective sleep quality.

Conclusion

IBD activity is associated with poor sleep using subjective and objective measures of sleep quality. This poor sleep manifests as decreased sleep efficiency and increased number of waking episodes post sleep onset. The relationship between objective IBD activity and sleep requires further investigation.
P013 A pilot study for ultrasound examination of the pterygomandibular raphe to predict efficacy of mandibular advancement splint therapy in obstructive sleep apnoea
Authors: Brereton C , Ferreira A , Juge L , Bilston L , Brown E
Published: October 2021

Background

A lack of predictive indicators for mandibular advancement splint (MAS) efficacy limits their use in the treatment of obstructive sleep apnoea (OSA). The absence of a tendinous pterygomandibular raphe (PMR) in the lateral nasopharynx on MRI may predict MAS efficacy, however MRI is time and resource intensive. We aimed to assess the feasibility of ultrasound in determining PMR absence compared to MRI.

Methods

10 healthy participants were recruited to undergo both MRI and ultrasound of the lateral airway. Surrounding anatomical landmarks were examined to establish the presence or absence of the PMR. These results will be compared to MRI to determine parameters on ultrasound which correlate to an absent PMR.

Progress to date

8 of the 10 participants have undergone both MRI and ultrasound, of which half were women, mean age 53 years, mean BMI 28 and mean AHI 3. In all 8 participants so far parameters for assessment of the PMR were identified and described, including presence of anatomical landmarks, localisation and width of the PMR space, and presence of a hyperechoic structure within the space. Comparison of these parameters with MRI to determine predictors of PMR presence or absence is currently underway.

Intended outcome and impact

Validation of ultrasound in the assessment for presence or absence of a tendinous PMR will enable further study of this structure as a predictive marker for MAS efficacy in OSA. This could assist clinicians in identifying suitable patients for MAS therapy.
P016 Daytime light exposure predicts better mood-, sleep- and circadian-related outcomes in >8,000 UK Biobank participants
Authors: Burns A , Windred D , Lane J , Saxena R , Phillips A , Cain S
Published: October 2021

Introduction

Light has powerful effects on mood, sleep, and the circadian system. Humans evolved in an environment with a clear distinction between day and night, but our modern lighting environments have blurred this distinction. While the disruptive effects of night time light exposure are well described, the potential positive effects of daytime light exposure on these systems are less well studied.

Method

Participants were a subset of the UK Biobank cohort who were invited to complete a seven day wrist-worn actimetry and light sensor study (n = 8,372, 61% female, age range: 39–70). Hierarchical linear models assessed the association between average daytime light exposure and mood-, sleep- and circadian-related outcomes, adjusted for age, sex, and season of assessment.

Results

Greater daytime light exposure was associated with earlier chronotype (p < .001), greater ease of getting up in the morning (p < .001), lower odds of using antidepressant medication (p < .001), less frequent low-mood (p = .002), less frequent anhedonia (p < .001), greater happiness (p < .001), less frequent insomnia symptoms (p = .01) and less frequent tiredness (p < .001).

Conclusions

In the largest study to-date, we observe that greater daytime light predicts better outcomes across a range of mood-, sleep- and circadian-related measures. Our findings are consistent with the known effects of light on the circadian system, whereby greater daytime light enhances the strength of the rhythm allowing for greater distinction between sleep and wake states. These findings
P019 Obstructive sleep apnoea endotypes in people with multiple sclerosis
Authors: Carter S , Hensen H , Krishnan A , Chiang A , Carberry J , Eckert D
Published: October 2021

Purpose

Obstructive sleep apnoea (OSA) is common in people with multiple sclerosis (MS) despite a lack of typical risk factors for OSA in people with MS such as obesity and male predominance. Therefore, underlying factors other than sex and obesity may be particularly important in the pathogenesis of OSA in people with MS. Thus, the primary aim of this study was to determine the relative contributions of OSA endotypes in people with MS and compare this to matched controls with OSA only.

Methods

Eleven people with MS and OSA (MS-OSA group) (apnoea-hypopnoea index [AHI]>5events/h) and eleven controls matched for OSA severity, age and sex without MS (OSA group) were studied. Participants underwent a detailed overnight polysomnography with an epiglottic pressure catheter and genioglossus intramuscular electrodes to allow for quantification of pathophysiological contributors to OSA. This included the respiratory arousal threshold, genioglossus muscle responsiveness, respiratory loop gain and upper airway collapsibility.

Results

Measures of the four primary OSA endotypes were not different between the MS-OSA and OSA groups (e.g. NREM respiratory arousal threshold -27±15 vs. -23±8 cmH2O respectively, p=0.24). Within group analysis indicated higher loop gain in non-obese MS-OSA participants compared to obese MS-OSA participants (0.53±0.11 vs. 0.37±0.11, p=0.04).

Conclusions

Overall, OSA endotypes are similar between MS-OSA participants and matched OSA controls. However, within the MS-OSA group, non-obese participants have higher loop gain (unstable respiratory control) compared to obese participants. Thus, unstable respiratory control may play an important role in OSA pathogenesis in many people with MS.
P025 Expert Opinions to Develop a Sleep Intervention for Patients with Low Back Pain: A Nominal Group Study
Authors: Comis J , Hodges P , Gordon C , Ho K , Ferreira P
Published: October 2021

Introduction

Insomnia is a common comorbidity of low back pain. Research has investigated the use of cognitive behavioural therapy interventions for insomnia (CBT-I) to treat these conditions but show little effect on improving pain outcomes. This study sought the opinion of experts to explore how existing online CBT-I interventions could be optimised to improve sleep and pain outcomes in patients with comorbid insomnia and LBP.

Methods

This study was conducted using the nominal group technique, a structured meeting to generate ideas and rank priorities amongst a panel of experts. Musculoskeletal researchers (n=7) and clinicians (n=1), sleep researchers (n=2), and a consumer advocate (n=1) were purposively sampled to participate in a 2-hour online nominal group workshop. A quantitative analysis was conducted to rank ideas by their relative importance. A qualitative analysis was used to provide context on the highest ranked ideas.

Results

A total of 58 ideas were generated and subdivided into 11 primary categories, each of which contained a varying number of sub-ideas. The primary categories, personalisation of care, assessment guided management, understanding the user experience, personalised advice on physical and environmental factors, and continual re-assessment to guide management, were ranked one to five respectively and accounted for 73% of all votes from the panel.

Discussion

An intervention framework consisting of three interacting domains, personalisation of the intervention, assessment guided management, and user experience was proposed. This framework outlines recommendations that should be considered to improve online CBT-I interventions to treat patients with comorbid insomnia and low back pain.
P065 Heart Rate and Heart Rate Variability in paediatric sleep disordered breathing: Is LF a proxy for vascular motor tone
Authors: Kontos A , Kennedy D , Baumert M , Martin J , Kohler M , Cicua-Navarro D , Pamula Y , Vokolos P , Wabnitz D , Lushington K
Published: October 2021

In children, sleep disordered breathing (SDB) is associated with changes in cardiac and vascular remodeling and hence may alter cardiac rhythm. Heart rate variability (HRV) measured during different sleep stages and at discreet times across the night, where vascular tone is known to change, provides an opportunity to better understand the effect of SDB on the cardiac function.

50 children diagnosed with SDB and 51 healthy children underwent overnight polysomnography to determine sleep staging. HRV (mean NN, SDNN, RMSSD, LF, HF, and LF:HF) was determined for the following segments pre-sleep; 3 slow wave sleep and 3 segments during rapid eye movement sleep (SWS1, SWS2, REM3, REM2, REM1). Children with SDB demonstrated higher heart rate (decreased mean NN) in all sleep segments. All HRV variables were similar between groups pre-sleep and REM3 and SWS3. LF and LF:HF were significantly lower in SWS1&2 and REM1 while as were SDNN and rMSSD were lower in the SDB group in REM1&2. LF remained low in the SDB group but rose to pre sleep levels in the control group.

Children with SDB have increased heart rate across the night even when HRV is similar between the groups. This suggests intrinsic changes to the cardiac components that determine heart rate. The HRV difference between groups was greatest post acrophase (body temperature dropping) and post nadir (body temperature rising) of the circadian cycle. We propose that impaired peripheral vascular control and sustained cardiac remodelling may underlie the heart rate and HRV changes observed in children with SDB.
P075 Travel or cheers? Examining the drivers and mechanisms of home court advantage in the 2020/2021 NBA regular season
Authors: Leota J , Hoffman D , Mascaro L , Czeisler M , Nash K , Drummond S , Anderson C , Rajaratnam S , Facer-Childs E
Published: October 2021

Introduction

Home court advantage (HCA) in the National Basketball Association (NBA) is well-documented, yet the co-occurring drivers responsible for this advantage have proven difficult to examine in isolation. The Coronavirus disease (COVID-19) pandemic resulted in the elimination of crowds in ~50% of games during the 2020/2021 NBA season, whereas travel remained unchanged. Using this ‘natural experiment’, we investigated the impact of crowds and travel-related sleep and circadian disruption on NBA HCA.

Methods

1080 games from the 2020/2021 NBA regular season were analyzed using mixed models (fixed effects: crowds, travel; random effects: team, opponent).

Results

In games with crowds, home teams won 58.65% of the time and outrebounded (M=2.28) and outscored (M=2.18) their opponents. In games without crowds, home teams won significantly less (50.60%, p = .01) and were outrebounded (M=-0.41, p < .001) and outscored (M=-0.13, p < .05) by their opponents. Further, the increase in home rebound margin fully mediated the relationship between crowds and home points margin (p < .001). No significant sleep or circadian effects were observed.

Discussion

Taken together, these results suggest that HCA in the 2020/2021 NBA season was predominately driven by the presence of crowds and their influence on the effort exerted by the home team to rebound the ball. Moreover, we speculate that the strict NBA COVID-19 policies may have mitigated the travel-related sleep and circadian effects on the road team. These findings are of considerable significance to a domain wherein marginal gains can have immense competitive, financial, and even historical consequences.
P076 Sleep Staging Agreement Between Polysomnography and Sleep Profiler in Isolated REM Sleep Behavior Disorder
Authors: Levendowski D , Lee-Iannotti J , Shprecher D , Guevarra C , Timm P , Angel E , Mazeika G , St. Louis E
Published: October 2021

Purpose

Evaluate the sleep staging agreement between polysomnography (PSG) and Sleep Profiler (SP) in patients with suspected isolated REM-sleep-behavior-disorder.

Methods

Twenty-six patients with reported dream-enactment-behavior (Site1=16, Site2=10; 27% women; age 64±13 years) underwent a diagnostic PSG with simultaneously recorded SP. A registered sleep-technologist at each site performed PSG-staging, while SP was auto-staged and technically reviewed/edited.

Across technicians, the initial staging was blinded. Site1 then performed unblinded restaging of PSG=N3(N2) vs. SP=N2(N3) epochs, while Site2 conducted a blinded, carefully-targeted restaging of N3. Statistics included Cohen’s kappa and Chi-square analyses.

Results

Agreement between SP and Site1 vs. Site2 were significantly different for Wake (kappa:Site1=0.816;Site2=0.650;combined=0.736), stage N1 (kappa:Site1=0.149;Site2=0.228;combined=0.188), stage N2 (kappa:Site1=0.632;Site2=0.718;combined=0.659), stage N3 (kappa:Site1=0.715;Site2=0.368;combined=0.525) and REM (kappa:Site1=0.827;Site2=0.719;combined=0.766)(all P<0.001).

After restaging of N3, the kappa values improved at Site1 (unblinded:N2=0.659/N3=0.883) and Site2 (blinded:N2=0.775/N3=0.736)(combined:N2=0.735/N3=0.851). The proportion of PSG-epochs restaged from N3 to N2 was 17% at Sites1 and 38% at Site2 (P<0.001), while Site1 had fewer remaining PSG=N3 vs. SP=N2 conflicts (5.6% vs. 20.8%, P<0.001).

Compared to Site2, Site1 had a superior: REM kappa due to fewer SP=N2 disagreements (8.5% vs. 16.8%, P<0.001), and Wake kappa resulting from fewer SP=N1 (6.6 vs. 15.6%, P<0.001) and SP=N2 conflicts (5.9 vs. 12.0%, P<0.001). Conversely, the Site1 N1 kappa was inferior due to greater SP=wake disagreement (41.6% vs. 19.8%, P<0.001).

Discussion

N3 was excessively stage by both PSG technicians before restaging. At Site1, Wake, N3, and REM had almost-perfect-agreement with SP, while N2 had substantial-agreement. At Site2 and across-site, substantial-agreement was observed for Wake, N2, N3, and REM.
P079 Effect of sleepwear fibre type on menopausal sleep quality – Study protocol and preliminary data
Authors: Li X , Halaki M , Mahar T , Ropert S , Ireland A , Chow C
Published: October 2021

Introduction

Vasomotor symptoms and sleep disturbances are common in menopausal women. Different fabric types affect thermal comfort through moisture absorption and thermal insulation. This study examined the impact of cotton and wool sleepwear on menopausal women’s sleep quality.

Methods

This is a randomized, crossover, repeated-measures and triple-blinded trial comparing the sleep quality and vasomotor symptoms of healthy menopausal women between cotton and wool sleepwear at 30°C, 50% relative humidity. Participants undergo 6 laboratory visits. After a screening visit and a familiarization night, participants are randomized to 4 nights (2 nights in cotton and 2 nights in wool sleepwear) during which polysomnography and actigraphy recordings are taken including objective hot flush events, room temperature and relative humidity measurements, as well as subjective questionnaires on clothing comfort, mood and vasomotor symptoms.

Results

Eleven participants (age 51.2±4.7 years, BMI 26.8±2.9 kg.m-2, Insomnia Severity Index 11.1±5.5) completed all six visits so far. Reasons for exclusion: 3 didn’t have vasomotor symptoms; 1 on HRT, 5 had severe sleep disturbances, 3 on medications, 4 had diabetes, 1 asthma, and 1 had BMI>30. All sleep-related outcomes are pending analysis (blinding).

Discussion

Recruitment is a major study challenge. Many participants found it hard to arrange a time to attend overnight studies due to family/work commitments. The COVID-19 pandemic changed people’s attitude as some were hesitant to attend the laboratory. Menopause transition status is an important time during women’s lifespan. Effective management, e.g., through appropriate sleepwear, would be helpful to improve menopausal women’s symptom and quality of life.
P081 Assessment of Change in Palatoglossus Length with Mandibular Advancement and Relationship to Response to Mandibular Advancement Splint Therapy in Obstructive Sleep Apnoea
Authors: Lim K , Brown E
Published: October 2021

Background

The palatoglossus is a muscle of the soft palate extending from the palatine aponeurosis inferolaterally along the pharyngeal wall inserting at the posterolateral surface of the tongue. Palatoglossal stimulation dilates the retropalatal space in subjects with obstructive sleep apnoea (OSA). Whether there is alteration in palatoglossus length during mandibular advancement and how this relates to Mandibular Advancement Splint (MAS) outcomes is unknown.

Methods

Participants with OSA referred for MAS underwent upper airway MRI with and without mandibular advancement. The linear distance between the origin of the palatoglossus muscle at the palatine aponeurosis and its insertion at the tongue was measured to approximate palatoglossus length. The difference in measured lengths with and without mandibular advancement was calculated. Change in palatoglossus with advancement was compared to treatment outcomes.

Progress to date

71 participants with mean±SD AHI 26.0±16.1 events/hr were included in our study. Mean±SD palatoglossus length was 49.58±5.74mm. With mandibular advancement, mean±SD palatoglossus length was 51.21±5.46mm this was a significant change in length of mean±SD 1.63±4.3mm. This was a mean±SD 4.79±9.08% alteration in length with mandibular advancement. Treatment response was not significantly related to change in palatoglossus length (p> 0.05).

Intended outcome and Impact

Our intention was to demonstrate significant length alteration in palatoglossus with mandibular advancement and correlate this to treatment outcome. This may highlight palatoglossus as a target for MAS or other OSA therapies for future clinicians.
P084 Is Cognitive Behaviour Therapy for insomnia (CBTi) responsiveness a function of objective sleep efficiency rather than objective sleep duration?
Authors: Lovato N , Micic G , Lack L
Published: October 2021

Introduction

Past research and our own has not shown a differential response to Cognitive Behaviour Therapy for insomnia (CBTi) based on objective sleep duration. It is valuable to investigate CBTi responsiveness is a function of objective sleep efficiency (SE) instead of objective sleep duration. This study is a secondary exploratory analysis of our earlier clinical trial to assess the differential therapeutic response to CBTi for older insomniacs based on SE prior to treatment.

Method

Seventy-nine adults (male=34, mean age=63.38, SD=6.25) with sleep maintenance insomnia were selected. Participants were grouped into 3 ordinal groups; the top 50% of participants (above the median percent sleep time-normal SE), the 25% of participants in the third quartile (moderately low SE), and the bottom 25% of participants (severely low SE) based on 1-night of home-based polysomnography. Participants were randomly allocated to CBTi or wait-list control. One-week sleep diaries, actigraphy and a battery of questionnaires evaluated the efficacy of CBTi for each SE group. Outcome measures were taken at pre-treatment, post-treatment, and 3-month follow-up.

Results

CBTi produced robust improvements in sleep quality including reduced wake after sleep onset, and improved sleep efficiency. Participants reported a reduction of scores on the Insomnia Severity Index, Flinders Fatigue Scale, Epworth Sleepiness Scale, Daytime Feeling and Functioning Scale, Sleep Anticipatory Anxiety Questionnaire, Dysfunctional Beliefs and Attitudes Scale, and increased Sleep Self-Efficacy Scale. All improvements were significant relative to waitlist and comparable regardless of objective SE at pre-treatment.

Discussion

CBTi responsiveness did not differ as a function of objective SE.
P087 A validation study of the limited channel single and multi-use NightOwl sleep testing systems compared to laboratory polysomnography in the diagnosis of obstructive sleep apnoea
Authors: Lyne C , Mansfield D , Stupar D , Turton A
Published: October 2021

Background

Obstructive sleep apnoea (OSA) is common, and its prevalence is increasing. Opportunities to screen for OSA using simplified diagnostic devices may be important to addressing this clinical burden. The NightOwl (Ectosense NV, Leuven, Belgium) is a small dual channel device that acquires data from a single fingertip and is available in a disposable version, in addition to the previously validated reusable option. The devices will provide a measure of sleep duration and derived apnoea-hypopnoea index (AHI) using a proprietary algorithm.

Methods

A prospective cohort study of patients undergoing laboratory polysomnography (PSG) for suspected OSA is underway at Monash Medical Centre, Clayton (ACTRN12621000444886). Participants are fitted with a NightOwl Sensor Mini (disposable) and a NightOwl Sensor Reusable on their index and middle fingers, in addition to the standard PSG setup (Compumedics Grael, Profusion 3). The primary outcome is the level of agreement between the NightOwl Sensor Mini, NightOwl Sensor Reusable and PSG derived AHI. We also intend to compare the proprietary algorithm against Compumedics Profusion 3 for determination of oxygen desaturation index. Level of agreement will be determined utilising Bland-Altman plots.

Progress to date

Recruitment is currently underway with 29 of an intended 100 participants having completed their sleep studies.

Intended outcome and impact

The intended outcome of this study is to externally validate the two NightOwl devices against PSG for detecting OSA and accurately assessing severity. We anticipate this will enable screening for OSA in an efficient and cost-effective manner.
P091 The impact of cognitive fitness and gender on sleep quantity and timing and mental health of competitive athletes
Authors: Mascaro L , Drummond S , Leota J , Boardman J , Hoffman D , Rajaratnam S , Aidman E , Facer-Childs E
Published: October 2021

Introduction

Mental fitness is increasingly considered key to an athlete’s competitive arsenal. Its active ingredients include cognitive fitness factors, such as impulse control, and recovery factors, such as sleep, which may differ between male and female athletes. Our study investigated: 1) gender differences in cognitive fitness; and 2) the associations of gender and cognitive fitness with sleep and mental health in competitive athletes during the COVID-19 lockdown.

Methods

84 athletes competing at levels from regional/state to international (42F, mean age=23.2) completed a questionnaire battery containing validated measures of: a) depression, anxiety, and stress; b) sleep (Total Sleep Time, Sleep Latency, mid-sleep time on training- and competition-free days); and c) self-control, intolerance of uncertainty, and impulsivity (representing cognitive fitness constructs).

Results

Female athletes reported significantly higher depression, anxiety, and stress, a later mid-sleep time on free days, lower self-control, higher intolerance of uncertainty, and higher positive urgency impulsivity compared with male athletes. Self-control was negatively associated, and intolerance of uncertainty was positively associated, with depression, anxiety, and mid-sleep time on free days.

Discussion

Female athletes in our sample reported poorer mental health and cognitive fitness, and later sleeping times on free days. Greater cognitive fitness was associated with better mental health, independent of gender. Overall, these findings are consistent with prior work in community samples. Future work should examine the source(s) of these gender differences. If replicated, our findings would suggest a need to develop interventions aimed at improving athlete well-being, potentially with a particular focus on female athletes.
P092 Improving Postgraduate Psychology Students’ Sleep and Insomnia Knowledge with a Sleep Education Workshop
Authors: Meaklim H , Meltzer L , Junge M , Rehm I , Monfries M , Kennedy G , Bucks R , Jackson M
Published: October 2021

Introduction

Trainee psychologists receive limited sleep and insomnia education during postgraduate study. This study examined the delivery of a sleep psychology training workshop for postgraduate psychology students and examined changes in sleep knowledge from pre- to post-workshop.

Methods

A 6-hour Sleep Psychology Workshop was delivered to postgraduate psychology students around Victoria. Online pre- and post-workshop questionnaires were used to evaluate changes in sleep psychology knowledge and collect feedback on the workshop.

Results

The participants were 187 students (82% female, M age = 32), most of whom were in their 5th year of psychology training (69%) and had not received any sleep education during their postgraduate studies at the date of the intervention (77%). Students’ sleep knowledge significantly improved after workshop completion (pre: 56% vs. post: 80% correct), t(107)= -21.41, p < .001. Students provided positive feedback about the workshop, with 96% rating the workshop as excellent/very good and 86% reporting that they would recommend the workshop to other postgraduate students. Overall, 94% of students agreed/strongly agreed that the sleep psychology workshop improved their confidence to manage sleep disturbances in their future psychology practice.

Discussion

Postgraduate psychology students require sleep and insomnia education. This study demonstrates that students’ sleep psychology knowledge can improve after a 6-hour sleep education and training workshop and provides initial positive feedback about the benefits of sleep and insomnia education for postgraduate students.
P105 Endocrine, autonomic and vascular function in children with Sleep Disordered Breathing
Authors: Noone A , Lushington K , Kennedy D , Martin J , Vokolos P , Wabnitz D , Kontos A
Published: October 2021

SDB is a risk factor for cardiovascular disease and co-exists with chronic endocrine disorders such as type II diabetes and metabolic syndrome. Children with SDB have increased blood flow velocity, an indicator of reduced vascular compliance and early vascular aging. Increased blood flow velocity is positively associated with sympathetic activity, increased arterial sympathetic nerve fibre density and endothelial damage. Whether changes in endocrine function occur concomitantly with altered autonomic and vascular function in children with SDB was assessed.

Thirty six children scheduled for tonsillectomy underwent overnight polysomnography (SDB severity), pupil light reflex (autonomic function), fasting brachial artery blood flow assessment (vascular function - Doppler Ultrasound). Leptin and Ghrelin - both hormonal markers associated with sympathetic activity were measured in urine using ELISA and serum using MagPlex. The following dimensions of the dorsal lingual artery (tonsil) were measured – medial thickness, medial area, smooth muscle cell number/layers.

We observed a positive correlation between serum and urine leptin and ghrelin concentrations. Increased blood flow velocity and arterial medial thickness were both associated with increased serum and urine leptin and ghrelin concentrations. Pupil light reflex was negatively associated with serum leptin and ghrelin levels. OAHI was positively correlated with leptin and ghrelin concentration (urine and serum) but not blood flow velocity. Blood flow velocity was inversely correlated with SpO2 nadir (REM).

Our findings suggest that SDB has a global effect on the autonomic, vascular and endocrine systems.The impact of untreated paediatric SDB on the development of comorbidities in later life needs urgent attention.
P111 Sleep disturbances are associated with poor neurobehavioural outcomes following traumatic brain injury: A study of military service members and veterans
Authors: Pattinson C , Brickell T , Bailie J , Hungerford L , Lippa S , French L , Lange R
Published: October 2021

Introduction

Sleep disturbances are pervasively reported in military service members and veterans, especially following traumatic brain injury (TBI). The purpose of this study was to examine the association between sleep disturbances and neurobehavioural outcomes in a large group of U.S. military service members and veterans, with and without a history of TBI.

Methods

Participants were enrolled into the Defense and Veterans Brain Injury Center/Traumatic Brain Injury Center of Excellence, 15-Year Longitudinal TBI study (N = 606). Participants self-reported sleep disturbances (PROMIS 8A) and neurobehavioral symptoms. Data were analyzed using analysis of variance with post-hoc comparisons. Four groups were analyzed separately: uncomplicated mild TBI (MTBI; n=218); complicated mild, moderate, severe, or penetrating - combined TBI (CTBI; n=118); injured controls (IC, i.e., orthopedic or soft-tissue injury without TBI; n=162); and non-injured controls (NIC; n=108).

Results

Participants in the MTBI group reported the highest proportion of moderate-severe sleep disturbances (66.5%) compared to the IC (54.9%), CTBI (47.5%), and NIC groups (34.3%). Participants classified as having Poor Sleep reported significantly worse scores on almost all TBI-QOL scales compared to those classified as having Good Sleep, regardless of TBI severity or even the presence of TBI (ps<.05, Cohen’s ds>.3).

Discussion

This study demonstrates that sleep disturbances remain a prevalent and debilitating concern in service member and veteran populations. Regardless of group (injured or NIC), sleep disturbances were common and were associated with significantly worse neurobehavioral functioning. When assessing and treating neurobehavioural symptoms, it is important to assess sleep, especially in service member and veteran populations.
P112 Under-mattress sleep monitoring to predict readmission risk after COPD exacerbation
Authors: Proctor S , Molloy W , Chai-Coetzer C , Catcheside P , Adams R , Mukherjee S
Published: October 2021

Background

Recurrent hospitalisation for COPD exacerbations is a major contributor to disease burden and healthcare costs. This study aims to establish if post-discharge sleep or vital sign parameters are predictive of hospital readmissions after COPD exacerbations.

Methods

Patients admitted with a COPD exacerbation were recruited from November 2019 until May 2021. Sleep parameters were assessed for at least one night in hospital and 10 nights post-discharge using an under-mattress device (EarlySense). Analysis on data from the first 26 participants were conducted using independent sample Mann-Whitney U tests comparing device-estimated sleep parameters between participants admitted versus not readmitted at one- and three-months post-discharge.

Progress to date

Thirty-four participants have consented. In the 26 participants completing the study to date, all-cause hospital readmission rates at one- and three-months were 26% and 65% respectively. Participants readmitted versus not readmitted at one-month had lower percentage of time in light sleep (43 ± 12% vs 58 ± 12%, p=0.029) and lower estimated AHI (5.6 ± 1.9 vs 17 ± 11 /hr, p=0.042). There were no differences at three-months.

Intended outcome and impact

Data from the full cohort will be used to assess heart rate and respiratory rate across each night and stage of sleep which could reveal clinically useful methods in the emerging field of ambulatory sleep monitoring. The feasibility and challenges of using ambulatory monitoring devices in patients with chronic respiratory disease will be reported. This study will guide future work that could potentially improve ambulatory monitoring through user-friendly and clinically feasible devices.
P117 Changes in prescription of home non-invasive ventilation (NIV) in Southern Adelaide Local Health Network (SALHN) from 2016 – 2020
Authors: Raja Mohamed F , Krishnan S , Bassett K , Aiyappan V , Chai-Coetzer C
Published: October 2021

Background

Long term NIV is established therapy for patients with chronic type 2 respiratory failure (T2RF) due to neuromuscular disorders and obesity hypoventilation syndrome (OHS) without significant OSA. There is emerging evidence that COPD patients with T2RF also benefit from NIV. In our centre, there appears to be an increase in the prescription of long term NIV to patients over time, with 60% of all active long term NIV patients commencing therapy from 2017 onwards. In this study we will determine if (i) there has been increased provision of long term NIV to ward patients recovering from acute T2RF, (ii) there has been an increase in patients with COPD and T2RF commenced on long term NIV, (iii) there are patients with OHS and comorbid OSA who can be changed from NIV to CPAP and (iv) there is adequate follow up for patients who initiated NIV in the ward acutely.

Methods

Retrospective, observational study using a pre-existing database of all current and previous patients commenced on NIV from July 2016 to July 2020.

Progress to date

All active long term NIV patients have been identified and a database (n= 220) created containing all relevant information including date and place of NIV initiation and indication.

Intended outcome and impact

This audit will objectively assess the growth of our NIV service to facilitate better allocation of resources. It will also determine if our commencement and management of those on long term NIV is aligned with current evidence and best practice guidelines.
P123 Accuracy and Reliability of the Transcutaneous Carbon Dioxide (TcCO2) Signal in the Sleep Laboratory
Authors: Rossely A , Turton A , Roebuck T , Ho S , Naughton M , Mansfield D , Hamilton G
Published: October 2021

Carbon Dioxide (CO2) monitoring is an essential part of assessing and treating disorders of hypoventilation in the sleep laboratory. While reliablity issues have been previously reported with the Transcutaneous Carbon Dioxide (TcCO2) signal, there is limited data assessing the validity of this signal or its trend in the sleep laboratory context. Therefore, this study aimed to investigate the change in TcCO2 accuracy from the beginning to the end of the sleep study in real world conditions across two different Victorian public hospital sleep laboratories that used two different TcCO2 monitors. The sample included 13 consecutive patients from Monash Health and 44 consecutive patients from Alfred Health with an average age of 64 and 56 years respectively. Arterial Blood Gas (ABG) measurements were taken prior to and following each sleep study and compared concurrently with the TcCO2 value. Bland-Altman analysis revealed an average difference between TcCO2 and PaCO2 of 3.29mmHg with agreement between -11.44 and 16.64mmHg for the TCM4 device and 1.31mmHg with agreement between -7.64 and 9.05mmHg for the TCM5 device. When accuracy was compared across time points for each patient, 46% of patients had an overnight accuracy change of ≥ 8mmHg when using the TCM4 compared with 20% when using the TCM5. It was concluded that the TcCO2 signal was un-reliable across the different monitors and that the TcCO2 trend may be difficult to interpret with confidence without blood gas calibration at the commencement and conclusion of the sleep study.
P131 The impact of an online sleep education program on university students’ sleep knowledge, attitudes, and behaviours
Authors: Semsarian C , Rigney G , Cistulli P , Bin Y
Published: October 2021

Introduction

Sleep is essential for optimising health and academic performance, yet university students consistently report poor sleep quality. We conducted a before-and-after study to determine if an interactive, online sleep course improved sleep (1) knowledge, (2) attitudes, and (3) behaviours among university students.

Methods

Undergraduate students completed the course from August-November 2020. The course involved activities that encouraged students to reflect on their own sleep behaviours and goals. Baseline data was collected through course surveys and students were invited to complete a 6-month follow-up survey via email.

Results

N=212 students completed the baseline questionnaires and n=75 (35%) completed the follow-up survey. Students retained at follow-up possessed higher baseline sleep knowledge and received higher grades. At 6-months follow-up, sleep knowledge increased from baseline (mean quiz score: 60 vs 84%, p<0.001). 85% of students aimed to increase their sleep knowledge at baseline and 91% reported that they were more knowledgeable at follow-up. 83% of students aimed to improve their sleep at baseline and 37% reported improvement at follow-up. 53% of students’ attitudes towards their sleep behaviours had changed from baseline. There was reduction in sleep latency (mean 33.3 vs 25.6min, p=0.015), but no change in total Pittsburgh Sleep Quality Index score at follow-up.

Discussion

Completion of an interactive sleep education course led to increased sleep knowledge and changes in sleep attitudes, with no meaningful change in sleep behaviours. Future interventions require careful design and evaluation, and should consider components of behavioural change (e.g. motivation, triggers) that go beyond the knowledge-attitudes-behaviour continuum.
P143 Sleep-dependent declarative memory consolidation and NREM sleep EEG oscillations in older adults with obstructive sleep apnea
Authors: Teh J , Grummit L , Haroutonian C , Cross N , Bartlett D , Yee B , Grunstein R , Naismith S , D’Rozario A
Published: October 2021

Objectives

To compare overnight declarative memory consolidation and NREM sleep EEG oscillations in older adults with OSA to an age-matched control group, and to assess the quantitative sleep EEG features as correlates of memory consolidation.

Methods

46 participants (24 without OSA and 22 patients with OSA) were recruited. Participants completed a word-paired associates declarative memory task before and after an 8-hour sleep opportunity with full polysomnography. Power spectral analysis was performed on all-night EEG recorded at frontal and central electrode sites. We calculated slow wave activity (slow oscillations absolute power 0.25–1 Hz; and delta EEG power (0.5–4.5 Hz) in NREM sleep. Slow spindle density (11–13 Hz, events p/min) and fast spindle density (13–16 Hz, events p/min) in stage N2 was derived using an automated spindle detection algorithm.

Results

Patients with OSA showed no significant differences in overnight memory recall and recognition compared to individuals without OSA. The OSA group showed reduced slow spindle density at the central region and fast spindle density at the frontal region relative to controls. No differences were observed in SWA. Within group correlations showed slow and fast spindle density were correlated to percent recognition in the control group.

Conclusion

Older adults with OSA had deficits in slow and fast sleep spindles compared to controls. OSA patients showed preserved sleep-dependent declarative memory consolidation despite sleep fragmentation and intermittent hypoxemia. Sleep spindles were positively correlated with overnight memory consolidation in controls but not OSA patients. Targeted interventions to boost spindles may enhance memory consolidation in older adults.
P145 Assessing the Performance of Automatic Analysis During Routine Intralab Conordance Activities
Authors: Teuwen P , Eriksson N , Mateus E , Dalman M , Yau Y , Scott A
Published: October 2021

Introduction

This study aims to retrospectively assess the performance of somnolyzer against trained scientist performance of PSG analysis, under routine interlab concordance conditions in an Australian laboratory.

Methods

Retrospective study (2016 – 2018). Study data included 200 epoc fragments with SWS, REM and NREM. PSG data sets (n = 36) consisted of type 1 (n = 31) and type 2 (n = 5) studies. Individual scorers were compared to a master scoreset set by consensus from two experienced sleep scientists. The automatic analysis system used was Somnolyzer 24x7. Data analysis involved; Group 1: intraclass correlations and Bland-Altman plots, Group 2: Paired T-tests.

Results

Human analysis was shown to outperform automatic analysis in each major metric assessed, except sleep latency. Automatic analysis performed to a similar level in 6 out of 9 of the major metrics assessed (r > 0.9), however the 95% limit of agreement range was found to larger. Automatically analysed RDI’s were more likely to be lower than the master score sets, as were arousal indices.

Conclusions

These findings support using caution with automatic analysis, particularly with medical interpretation and practice. Automatic analysis performance can vary dramatically between PSG data sets. This output can vary from one that is comparable to a human analysis through to a level that is well below that of human scorers, under concordance conditions. Consideration should be given to the accuracy of automatic analysis when making scientific conclusions with borderline cases.
P147 Solriamfetol Titration & AdministRaTion (START): Characteristics of patients with obstructive sleep apnoea (OSA) and prescriber rationale for starting treatment with solriamfetol
Authors: Singh H , Hyman D , Parks G , Chen A , Foley C , Ito D , Thorpy M
Published: October 2021

Introduction

Solriamfetol (Sunosi) is a dopamine/norepinephrine reuptake inhibitor approved (EU/US) to treat excessive daytime sleepiness (EDS) in adults with OSA (37.5–150 mg/day) or narcolepsy (75–150 mg/day). This study examined characteristics of patients with OSA initiating solriamfetol and prescribers’ rationales.

Methods

This descriptive study included a retrospective patient chart review among US-based physicians prescribing solriamfetol for patients with OSA/narcolepsy. Solriamfetol initiation strategies were classified as de novo (no prior EDS medication), transition (switched/switching from existing EDS medications), or add-on (adding to current EDS medication).

Results

Physicians (n=24) entered data from 50 patients with OSA (mean+/-SD age, 52+/-9.1 years; 62% male). EDS was primarily moderate (56%) or severe (36%). Mean+/-SD Apnea-Hypopnoea Index at OSA diagnosis was 33.1+/-19.7 (n=37). The most common nonpharmacologic treatment was positive airway pressure (n=39, 78%); 36/39 (92%) were considered adherent. Common comorbidities included obesity (BMI>/=30) (n=25, 50%), cardiovascular disorders (n=16, 32%), and type 2 diabetes (n=14, 28%). Twenty-two (44%) patients were de novo, 26 (52%) transitioned (primarily from wake-promoting agents [18/26, 69%]), and 2 (4%) added solriamfetol (to stimulants). The efficacy of solriamfetol prompted most discussions to prescribe de novo (18/22, 82%); a desire for improved efficacy and/or augmentation of other medications prompted most transitioning (15/26, 58%) and add-on (2/2, 100%) therapy. At data collection, 48 (96%) patients were stable on solriamfetol; one each discontinued due to lack of efficacy and side effects.

Discussion

Efficacy was a key consideration for physicians prescribing solriamfetol for EDS in a real-world sample of patients with OSA.

Support

Jazz Pharmaceuticals
P164 Back to school - Supporting invasively ventilated children to return to the classroom
Authors: Wood C , Waters K , Gray K
Published: October 2021

Introduction

Integration of children with high health needs into the education system, such as those who are invasively ventilated, requires careful planning.

Methods

We retrospectively reviewed data bases and medical records from January 2004 until December 2020 to profile school age children who, following insertion of a tracheostomy to facilitate invasive ventilation, required assistance in entering or returning to the education system.

Results

44 children received invasive respiratory support. Five (11%) remain under the legal school age of 6 years. Fourteen (32%) children entered main stream education – Private or state schools. Three (7%) children attended main stream schools with extra assistance in a support unit. Eighteen (41%) children attended Special Schools that met their individual underlying health care needs. Four (9%) children received either home schooling or attended hospital school. All children received appropriate education according to cognitive ability and none were placed in an inappropriate school setting due to their need for extra support with respiratory health.

Discussion

High use of health technologies can be perceived as a barrier to the normal classroom so negotiation with education authorities should be part of the patient journey. Support for (re-)integration to the school system includes recruitment and training of support staff and appropriate assessments of ability to provide a safe environment whilst maintaining appropriate level of supervision. Collaboration between the hospital and the education facility is key to the successful integration of children into the education system.