bluuebunny/crossref_metadata_2025 huggingface dataset:
O050 Associations between sleep-wake state discrepancy and clinical characteristics in older adults with chronic insomnia before and after Cognitive Behaviour Therapy (CBTi)
Authors: Bensen-Boakes D , Scott H , Lack L , Lovato N
Published: November 2022

Introduction

Individuals with chronic insomnia often self-report more wakefulness and less sleep than is derived from objective measures, which is called sleep-wake state discrepancy (SWSD). This study investigated associations between SWSD and clinical characteristics in older adults with sleep maintenance insomnia before and after Cognitive Behaviour Therapy (CBTi).

Method

Seventy-three adults (female=53%, mean age=63.2, SD=6.3) were recruited. Participants completed sleep diaries and wore actigraphy for one week, as well as questionnaires related to sleep quality and daytime functioning immediately before and after CBTi. SWSD was calculated as the difference between subjective (sleep diary reported) and objective (actigraphy derived) total sleep time (TST) at pre- and post-treatment.

Results

Before treatment, SWSD was not associated with age or any clinical variables, ps > .05. Following treatment, SWSD significantly reduced (p<.001), despite no improvement in objective TST, and was significantly associated with improvements in insomnia severity (r=-.57), fatigue (r=-.26), sleep self-efficacy (r=.33), and beliefs about sleep (r=-.38), ps < .05.

Discussion

These findings suggest SWSD does not correlate with any other routinely-measured clinical characteristic prior to treatment. Given the associations with treatment outcomes, the need to incorporate objective measures, in conjunction with sleep diary assessments, to determine the degree of discrepancy and therapeutically address using CBTi is warranted. Following treatment, the reduction in discrepancy was driven by sleep diary reported TST that more closely matched objective TST, which remained relatively unchanged from pre-treatment. This has important implications for CBTi and suggests improvements in the accuracy of perceived sleep is a major therapeutic mechanism.
O066 The Impact of Work Break Characteristics on Sleep Duration in Heavy Vehicle Drivers
Authors: Harris R , Beatty C , Cori J , Spitz G , Soleimanloo S , Peterson S , Naqvi A , Barnes M , Downey L , Shiferaw B , Anderson C , Tucker A , Clark A , Rajaratnam S , Howard M , Sletten T , Wolkow A
Published: November 2022

Introduction

Heavy vehicle drivers (HVDs) frequently experience reduced sleep due to travelling long distances under non-standard work hours. Short sleep in HVDs can increase risk of motor vehicle crashes and falling asleep while driving. This study sought to examine the influence of break duration between shifts, break onset time, and prior shift duration on HVDs’ total sleep time (TST) between consecutive work shifts, and the interaction between break duration and break onset time.

Methods

Twenty-seven HVDs’ sleep and shift work were monitored for up to nine weeks through actigraphy, sleep diaries, and work diaries. Differences in TST between consecutive shifts and days off were assessed. Linear mixed models and pairwise comparisons evaluated the impact of break duration, break onset time, and prior shift duration on TST between shifts.

Results

TST was significantly lower between consecutive shifts (M=6.38-hours) compared to days off (M=7.63-hours), p<.001. Longer break durations were associated with more TST, p<.001. Break durations up to 7-, 9-, and 11-hours resulted in, on average, 4.76-, 5.66-, and 6.41-hours of sleep, respectively. Breaks starting between 00:01-08:00h led to shorter TST compared to breaks starting between 16:01-20:00h, p<.05. Prior shift duration and the interaction between break duration and break onset time were not associated with TST.

Discussion

HVDs’ TST between workdays are independently impacted by break duration and break onset time. Break durations between 7-11-hours, reflecting Australian and European break guidelines, result in insufficient sleep. Work regulations must evaluate appropriate break durations and break onset times to allow adequate sleep in HVDs.
P006 Case study: Dancing eyes post COVID-19 vaccination
Authors: Aiyappan V , Windler S
Published: November 2022

INTRODUCTION

We describe a case of rapid eye movements in NREM sleep in a patient who had Guillain-Barre Syndrome (GBS) post AstraZeneca ( AZ) COVID-19 vaccine. This has not been reported previously.

METHOD

An 81-year-old male with recent diagnosis of GBS secondary to AZ COVID-19 vaccination was referred of investigation of sleep disordered breathing. A Level 2 PSG showed rapid eye movements in the absence of atonia predominantly during N1 sleep. A second study one month later confirmed the persistence of the eye movements.

RESULTS

Study 1 revealed mild supine and REM-predominant obstructive sleep apnoea (AHI = 14.9/hr) with reduced REM latency (44.5 minutes) & slow wave sleep (1.6%). Study 2 showed normal REM latency (61.5 minutes). REM indices were 0.33 per minute of N1 sleep and 0.12 for N2 sleep. REM density was 3% during N1 and 0.55% in N2.

DISCUSSION

COVID-19 vaccinations have been associated with various side-effects, some of which have been attributed to autoimmune response. A previous study on GBS patients reported sleep architecture abnormalities including sleep onset REM periods and abnormal eye movements in NREM sleep, during acute phase attributed to autonomic dysfunction and transitory hypocretin-1 transmission reduction . Our patient had almost completely recovered from GBS when we performed Study 1. We believe this to be the first case of abnormal eye movements in sleep being identified on polysomnography in a patient with GBS following AZ Covid-19 vaccination
P012 The content and impact of dreams during late pregnancy – a qualitative exploration
Authors: Baddock S , Patterson J , Bilous E , Miller S
Published: November 2022

Background

While dreams are part of healthy sleep there remains controversy about their interpretation - whether intertwined with waking life or as structurally distinct. During pregnancy, dreaming has been correlated with emotional state and is often more frequent, vivid and disturbing, but there is little qualitative exploration of the content and impacts of pregnancy dreams.

Objective

The aim of this study was to explore dreaming experiences during late pregnancy.

Methods

Ten pregnant people (32-39 weeks gestation) with no diagnosis of a sleep disorder were recruited for a qualitative study describing experiences of sleep in late pregnancy, including exploration of their dreams. Following informed consent, semi-structured interviews were conducted face-to-face or via videoconference. Interviews were audio-recorded, transcribed, and analysed thematically. Analysis of dreaming data is presented.

Results

Participants were of New Zealand European (8) and European (2) background. Several experienced more frequent, often intense and impacting dreams, which included more sexual dreams, dreams perceived to be preparing for the future (for birth, baby and parenthood) and dreams associated with anxiety (about birth or losing the baby). These dreams were often disturbing and sometimes led to ongoing stressful thoughts the next day.

Conclusion

Dreams during late pregnancy tend to be more frequent and graphic, and may represent underlying anxieties or impact on emotional wellbeing. Whilst for some, intense dreams may be seen as a normal part of pregnancy, for others dreams in pregnancy can be disturbing and warrant discussion and exploration with health professionals to potentially resolve anxieties around pregnancy and birth.
P015 Improving sleep health management in primary care: A potential role for community nurses?
Authors: Basheti M , Bawa Z , Grunstein R , Grivell N , Saini B , Gordon C
Published: November 2022

Background

Community nurses commonly care for a diverse patient population, often with complex chronic diseases. Sleep health is a key contributor to overall wellbeing and sleep disturbances/disorders frequently co-exist with comorbidities and can hasten disease progression. Community nurses are therefore ideally situated to care for sleep disturbed patients, but to what degree this is currently being undertaken is not known.

Objectives

To explore community nurses’ current sleep health practices and to look into their perspectives around potential change that can improve sleep health care provision.

Methods

Qualitative semi-structured interviews were conducted with nurses working in community settings. Interviews were audio recorded, transcribed and thematically analysed.

Results

Twenty-three Australian community nurses were interviewed. Participants frequently encountered patients with sleep disturbances/disorders with insomnia and sleep apnea being the most common presentations. Data analysis yielded three themes: 1) Sleep health in the community serviced, 2) Sleep health awareness and management, 3) Community nurses A to ZZZ of improving sleep health. Whilst sleep apnea appeared to be managed appropriately, insomnia was often mismanaged. Participants described their sleep health knowledge as deficient with the majority advocating for increased sleep-related education. Other important factors for improved sleep health care were standardised treatment/referral pathways, increased health professional collaboration and sufficient patient consult time.

Conclusion

Community nurses commonly care for patients requiring increased sleep health care. However, they are currently underequipped to do so. Providing community nurses with appropriate resources, such as sleep-related education and standardised treatment frameworks could enable them to better manage sleep disturbance/disorder presentations.
P032 The Health Belief Model for Shift Workers Scale: The development and validation of a novel metric for use in shift working populations
Authors: Crowther M , Ferguson S , Gupta C , Reynolds A
Published: November 2022

Introduction

Shift work is associated with circadian misalignment, sleep loss and suboptimal health behaviours, which may contribute to longer term negative health outcomes. interventions based on behavioural models may improve health behaviours in shift workers. To implement and evaluate these interventions, a validated metric based on behavioural theory specifically for use with shift workers would be beneficial. The present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale.

Methods

The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and administration to pilot sample of shift workers (n=153). Validation of the HBM-SW was compared to Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire and Food Frequency Questionnaire.

Results

Utilising exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief

Model

Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-Efficacy and Health Motivation. The HBM-SW showed good – excellent (α =0.74-0.93) internal consistency and moderate – good (ICC =0.64-0.89) test re-test reliability. Using health behaviour outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability.

Conclusion

Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis. The Health Belief Model for Shift Workers scale is likely to be beneficial for in future studies of interventions for shift workers.
P055 Hospital admission rates and mortality among Indigenous patients with OSA – Top End Northern Territory perspective
Authors: Howarth T , Heraganahally S
Published: November 2022

Obstructive sleep apnoea (OSA) is highly prevalent among the Australian Indigenous population. Among other populations OSA has been linked to an increased risk of cardiac and respiratory disease and hospital presentations. It is plausible that CPAP adherence would reduce this risk. However, no such literature exists pertaining to the Indigenous Australian population.

Indigenous Australian patients with OSA (assessed 2011-2020) and at least one hospital recorded (assessed 2011 – 2021) were included. ICD codes were used to assess hospital presentations and defined as Respiratory, Circulatory or Metabolic.

Metabolic related hospital presentations were the most common (3,111 presentations, 66% of patients) followed by Circulatory system (1,900 presentations, 51% of patients) and Respiratory system (1,373 presentations, 45% of patients). Among the patients who had at least one of each respective presentation, the median number and rate of presentations was highest for Metabolic issues (median 4 presentations, rate 1.19/year), followed by Circulatory issues (median 3.5 presentations, rate 0.91/year) and Chronic Respiratory issues (median 3 presentations, rate 0.7/year). Adherence to CPAP significantly decreased the rate of Respiratory related presentations (beta -1.07 (95% CI -1.9, -0.2)).

A high rate of hospital presentations exists among Indigenous Australian patients with OSA. Promoting the use of CPAP among Indigenous Australian patients may aid in reducing morbidity and mortality.
P056 REducing Sleep Apnoea for the PrEvention of Dementia (REShAPED): The protocol of a multi-site feasibility randomised controlled trial
Authors: Hoyos C , Phillips C , Yaffe K , Martins R , Marshall N , Lagopoulos J , Jackson M , Mowszowski L , Grunstein R , Naismith S
Published: November 2022

Background

Obstructive sleep apnoea (OSA) is estimated to occur in up to 70% of older adults. There is accumulating evidence linking OSA with increased risk of cognitive decline and dementia. Here, we present the protocol for a pilot multi-site randomised controlled, parallel open-label trial which will evaluate the feasibility for a full-scale trial investigating the effects of treating OSA on cognitive decline in older adults at risk for dementia with OSA within memory clinic settings.

Methods

We will randomise 180 older adults to either the intervention group or to the control group for 2 years. Inclusion criteria include: 50-75 years; mild-severe OSA (defined average ODI≥10 with 3% oxygen desaturation determined by wrist oximetry over two nights); and subjective cognitive complaints or mild cognitive impairment. The treatment intervention arm intends to achieve an optimal treatment response based on reducing hypoxic burden with either CPAP, mandibular advancement splint, positional therapy, or oxygen therapy. Furthermore, participants will receive up to 8 sessions which involve motivational interviewing and collaborative goal setting to support OSA treatment adherence, and behavioural sleep management. The control arm will not receive OSA treatment as part of this trial, however there will be no OSA treatment restrictions, and any treatment pursued outside the trial will be documented. Primary outcomes are 1) acceptability of the trial participants; 2) alleviating hypoxic burden by reducing OSA severity; 3) tolerability of the outcome assessments. Secondary outcomes include safety and cognitive function. Outcomes will be collected at 0, 6 and 24-months.
P061 RAPID-OSA Study: Remote ApneaLink Providing Immediate Diagnosis of Obstructive Sleep Apnoea
Authors: Kafili D , Tay G
Published: November 2022

Introduction

In-laboratory polysomnography (PSG) is the gold standard for diagnosis of obstructive sleep apnea. However, studies showed portable sleep monitoring devices can reliably substitute PSG in patients with a high pre-test probability of moderate-to-severe OSA. In this prospective study, we assessed utility of ApneaLink for diagnosis of OSA in patients living in rural and remote QLD.

Method

Thirty-five patients, living in rural and remote QLD were included in the study. ApneaLink device with clear instructions was sent to patients via registered post for being worn for a single typical night. Results were analysed and patients were reviewed post study.

Progress to date

The study population included thirty five patients (58.8%) male with a mean age of 53.2 years old and median body mass index of 36 kg/m2. The mean time between receiving referral to concluding ApneaLink study was 56 days. This is statistically significant compared to our previous experience in 2017 with mean wait time of 153 days for in-laboratory sleep study (p-value 0.0001).

There was significant reduction in expenses in patients underwent level three sleep study compared to PSG. Total postage cost of our study was 1107 Aud with each AL device price of 350$ while in-laboratory study costs 2338$ per night.

Conclusion

AL has shown substantial cost effectiveness in diagnosis of OSA in patients with uncomplicated moderate to high pre-test probability by eliminating travel cost and reducing in-laboratory sleep study requirement. Full results to follow.
P068 Computational fluid dynamic study in Obstructive Sleep Apnea patients
Authors: Lee Y , Lim W , Jung S , Lee D
Published: November 2022

Introduction

Obstructive sleep apnea (OSA) is a common disorder which may need surgery to widen the airway. However, the success rate of surgery is variable. Thus, it is necessary to predict the outcome of the surgery preoperatively. The purpose of this study is to evaluate the mechanical parameter of upper airway airflow in OSA patients using computational fluid dynamics (CFD) method.

Method

We conducted a study on the patients with snoring, underwent the full night polysomnograpny (PSG) and paranasal sinus computed tomography(CT). The patients with past history of previous trauma or surgery were excluded. Three-demensional reconstructions of the upper airway were created in the medical imaging software Mimics 16.0 using paranasal CT. The reconstructions extended from nasopharynx to hypopharynx. Steady-state, turbulent, inspiratory airflow simulations were conducted in Fluent 17.0 with following boundary conditions The mechanical parameters (wall shear stress, pressure, plane velocity) were calculated in the three levels of nasopharynx, retropalatal, retrolingual area.

Results

The maximum wall shear stress values were shown at the retropalatal plane in all patients. There is a tendency for the wall shear stress value of the retropalatal area to increase as the AHI increases. The maximum velocity values were shown at the retropalatal plane in all patients. The maximum pressure values were shown at the nasopharynx plane in all patients.

Conclusion

the maximum wall shear stress values were shown at the retropalatal plane and the wall shear stress value of the retropalatal area increased as the AHI increased. Thus, the palatal surgery might help the OSA patients.
P078 Predicting initial AutoPAP pressures in children - how do we perform ?
Authors: Mihai R , Nisbet L , Ellis K , Davey M , Nixon G
Published: November 2022

Introduction

Auto-titrating positive airway pressure (APAP) with remote monitoring provides valuable information on pressure requirements during acclimatisation to APAP in children. However there are no reliable predictors of pressure requirements in children to help guide clinician prescribing upon commencement of APAP.

Methods

Retrospective review of children commencing outpatient APAP in tertiary hospital from 2017-2022. Initial APAP prescription was at treating physician discretion and changes over subsequent days were based on review of remote monitoring data.

Results

111 children commenced APAP (86 male; median 13.7y; range 3.7-19.3y). Initial minimum APAP pressure ranged from 4-6cmH2O (median 4cmH2O), and maximum pressure ranged from 6-16cmH2O (median 12cmH2O). 69 (62%) required no pressure changes; 42 (38%) required 1 or more changes. Children who required ≥1 change had a lower initial maximum pressure than those not requiring change (median 10cmH2O versus 12cmH2O, p<0.01) and were younger (median 9.6y versus 14.8y, p<0.01). There was no significant difference between the two groups for minimum initial pressure, OAHI on diagnostic PSG or BMI z-score. Median days from initiation to the first change was 4d (IQR 2,11). Pressure adjustments were typically conservative increases in APAP maximum (median +2cmH2O; range -4 to +5cmH2O). The main indication for change was remote monitoring data showing pressures frequently approaching APAP maximum pressure.

Discussion

This study shows that clinicians are more likely to under-prescribe initial maximum APAP pressure in young patients, leading to a higher number of adjustments required to reach satisfactory therapy. Further investigations will assess the impact of prescription changes on adherence.
P096 Objective Measures of Sleep Architecture in Adults and Older Adults with Depression: A Systematic Review and Meta-Analysis
Authors: Ricciardiello A , Teh J , Lam A , Marshall N , Naismith S , D'Rozario A
Published: November 2022

Depression is intrinsically linked to sleep, however, the exact nature of sleep disturbances has been poorly defined, especially for older adults over 50 years with depression. We examined published articles with overnight EEG recordings in adults with and without depression to determine if objective measures of sleep macro and micro architecture differ. We also examined differences in these outcomes in older adults.

2135 papers were identified through four databases. Two reviewers, using the PICO structure, removed 2062 papers at abstract review and 58 at full text review. Fifteen articles met inclusion criteria and reported macroarchitecture. Three reported microarchitectural outcomes but were not meta-analysed. RevMan 5.4 software was used to perform a random effects model meta-analysis. NICE case-control guidelines were used for risk of bias.

Fifteen studies were assessed (406 depressed and 432 control). Two papers examined older adults (31 depression and 31 controls). Within the total population, adults with depression had less total sleep time, lower sleep efficiency(SE), delayed sleep onset latency, higher wake after sleep onset, shorter rapid eye movement latency(ROL) and greater REM density than controls. No differences in stage 1(N1), stage 2(N2), stage 3(N3) or REM sleep were observed. In older adults, the depressed group had greater N1, less N2, shorter ROL, greater REM density and no difference in SE or in REM sleep duration.

REM latency and REM density outcomes were consistent across older and younger depressed groups, whereas younger adults with depression had worse sleep continuity. Differences in sleep phenotype may relate to underlying neuropathology.
P100 Different effect of sleep loss paradigms on various pain types in healthy subjects: A systematic review and meta-analysis
Authors: Rouhi S , Topcu J , Egorova Brumley N , Jordan A
Published: November 2022

Introduction

Sleep disturbances are comorbid with chronic pain, exacerbating pain conditions. Experimental studies have implemented different sleep loss paradigms combined with quantitative sensory testing to better understand the sleep-pain relationship. However, knowledge of which sleep loss paradigms are most detrimental regarding hyperalgesia is lacking. The current review aims to differentiate the effect of fragmented sleep from partial or total sleep deprivation and determine whether sleep-loss-related hyperalgesia is due to curtailed/deprived consolidated sleep or sleep continuity disruption.

Methods

We searched the databases, including EBSCO, MEDLINE, Psychological Information Database (Psych INFO), Science Direct, and Web of Science, to identify 36 experimental studies involving 928 participants. The studies implemented different sleep loss paradigms, such as total sleep deprivation, sleep restriction, and disrupted sleep continuity on heat, cold, pressure, and mechanical pain thresholds in the general population. In addition, we considered the sex-dependent effect of sleep loss on various pain types.

Results

Total sleep deprivation exerted the strongest (SMD = -1.721; CI95: -2.358, -1.073; P<0.001), while fragmented sleep protocols induced the least (SMD = -0.294; CI95: -0.478, -0.110; P=0.007) hyperalgesic effect. The effect of sleep loss on heat pain was greatest, whereas on pressure pain was smallest. The sleep loss-related hyperalgesia on heat and pressure pain differed between men and women, while the cold pain threshold was sex-independent.

Conclusion

This meta-analysis confirms that depriving sleep entirely greatly affects pain perception while disrupted sleep continuity induces a small effect and requires two consecutive nights of disruptions.
P106 Where is the care in healthcare? Mother perspectives’ of caring for a child with narcolepsy
Authors: Schokman A , Cheung J , Klinner C , Milton A , Naehrig D , Thornton N , Bin Y , Kairaitis K , Glozier N
Published: November 2022

Introduction

When caring for a child with a chronic illness, primary caregivers become care coordinators, system navigators, and illness experts. There is limited research on the challenges faced by family/carers of a child with narcolepsy.

Methods

Twenty participants who self-identified as a family/carer of a child with narcolepsy were interviewed, all of whom were mothers. Prior thematic analysis of submissions made by family/carers to the parliamentary inquiry informed interview questions. Interviews were analysed using the framework approach by a team of six multidisciplinary researchers.

Results

Three themes were identified. ‘Adjustment, communication and coping’ encapsulates challenges associated with diagnosis, the mental health toll it has on the whole family, and the limited support available to mothers. ‘Healthcare journey of narcolepsy families’ described challenges faced in the healthcare system, with mothers speaking of dismissal of their concerns and experiences of a lack of equity when accessing quality healthcare services for their child. ‘Independence, support, and resources’ unveiled the challenges carers faced accessing disability and academic supports at school and the workplace, underscoring mothers’ concerns for the future independence of their child.

Discussion

Mothers felt they had limited control over the trajectory of their child’s healthcare journey and emphasized the adverse psychological effect narcolepsy had on the entire family. There was an expectation that clinicians should be providing more information and support than currently is provided, across areas that traditionally are not within the healthcare domain. This raises important questions around who is responsible for providing this information and where is sourced from.
P107 Cost, Control, Compromise: Exploring the lived experience of narcolepsy in Australia
Authors: Schokman A , Cheung J , Klinner C , Milton A , Naehrig D , Thornton N , Bin Y , Kairaitis K , Glozier N
Published: November 2022

Introduction

Persons with narcolepsy wrote of dissatisfaction with healthcare and unmet psychosocial needs in submissions made to the 2019 parliamentary inquiry on sleep. This study aimed to explore the needs, concerns, and barriers faced by Australians living with narcolepsy.

Methods

126 self-reported persons with narcolepsy were recruited from support groups, with one-on-one interviews randomly conducted until saturation (n=24). Interviews were transcribed and analyzed using the framework approach by a multidisciplinary team of five researchers.

Results

Preliminary analysis highlighted a large psychosocial burden that affected the daily life of those with narcolepsy. Participants described the pervasiveness of symptoms and daily unpredictability of not knowing when symptoms would occur. Subsequent behavioral changes related to self-preservation were identified, including avoidance and self-management of care to exert control. Self-perception and adjustment to living with narcolepsy were informed by external opinions (e.g. societal/workplace expectations, family/friend opinion). Management of narcolepsy involves daytime naps; however, participants feared being negatively judged and perceived as lazy/unproductive if they napped. This led to an unwillingness to disclose/seek accommodations post-diagnosis. Executive dysfunction was frequently described, including impaired ability to recall names, times/dates, and appointments that contributed to school/workplace disruption.

Discussion

Participants living with narcolepsy spoke of a complex and burdensome condition requiring multidisciplinary management. Significant functional/psychosocial impairment was described, yet participants were not able to access NDIS support. Despite being known for its sleep-related symptoms, participants highlighted cognitive impairment and the subsequent impact on daily function as a concern that many felt was inadequately addressed.
P111 Paediatric day-case adeno-tonsillectomy transfer to Hospital-in-the-Home: a new model of care
Authors: Simpson C , Holt M , Withers A , Smith A , Inglis E , Morrison S , Phillips D
Published: November 2022

Aims

Tonsillectomy and adenoidectomy (T&A) is one of the most common paediatric surgical procedures. Post-operatively, children are monitored in hospital for bleeding, SpO2 desaturation, pain and oral intake. We report a new model of care for low-risk children undergoing T&A to transfer to hospital-in-the-home (HITH) on the day of surgery, with the benefits of providing medically-supported recovery at home and reducing healthcare expenditure.

Methods

Children >/= 5yr, with normal pre-operative overnight oximetry, without co-morbidities/post-operative upper airway obstruction/bleeding and tolerating oral intake were eligible for HITH, between 4-6hr post-T&A. Families were educated on administering adequate pain relief and oral intake. Overnight oximetry was monitored on the first night. Patients were reviewed at home day 1 then via telehealth day 2, before discharge.

Results

Sixteen patients with mean age 8.2yr (5-13yr) transferred to HITH post-day-case T&A. There were no episodes of desaturation, bleeding or readmission. One patient presented to Emergency day 1 with fever, pain and vomiting, received symptomatic treatment and transfer back to HITH, with discharge day 2. Two patients required one additional telehealth assessment of hydration (1) and pain control (1) on day 3, before discharge.

Conclusions

This new model of care provides a safe, cost-saving, supported management pathway for low risk paediatric post-T&A cohorts. Eligibility criteria will now expand as we increase virtual monitoring in the low risk cohort, freeing up HITH beds for younger and more complex post T&A patients, and hospital beds for higher risk patients, enabling greater throughput for overwhelmed surgical wait lists.
P112 Non-invasive ventilation in motor neurone disease, an audit of a tertiary centers practice
Authors: Slader S
Published: November 2022

Background

MND is a progressive neurodegenerative disorder with significant morbidity and mortality. The prevalence in Australasia is the second highest in the world with 12.9 cases per 100 000. Impairment of respiratory function contributes to and correlates with QOL. Respiratory complications are the most common causes of death.

NIV improves or maintains QOL in patients with MND and prolongs median survival by up to 205 days in patients with normal to moderately impaired bulbar function. NICE guidelines recommend considering a trial NIV in those with symptoms, signs or evidence of impaired respiratory muscle strength.

Methods

A single centre, retrospective database and chart review of all incident and prevalent cases with two clinical interactions at the Princess Alexandra Hospital MND service between 2013-2021 was conducted.

The primary aim was to determine the proportion of patients who trialed NIV. Secondary outcomes include: concordance with NICE Guidelines regarding NIV commencement, proportion of patients treated with riluzole and received PEG. Survival will be estimated by constructing Kaplan-Meier curves for those established on NIV compared with those that were not.

Progress to date

A total of 211 patients were included in analysis. 62.1% males, 37.9 % female, mean age at diagnosis 62.8 years. Limb phenotype was most common (52.5%) followed by bulbar phenotype (35.9%). 36.5% of the cohort trialed NIV. Further analysis to follow.

Intended outcome and impact

The outcomes will be compared with those published in the literature facilitating benchmarking of the service and identification of facets of patient care that can be improved.
P113 A detailed analysis of multicentric sleep staging inter-rater variabilities
Authors: Somaskandhan P , Terrill P , Korkalainen H , Kainulainen S , Leppänen T , Islind A , Grétarsdóttir H , Nikkonen S
Published: November 2022

Introduction

Correct identification of sleep stages is important in sleep disorder diagnosis; but is subject to high inter-scorer variability. Thus, we aimed to systematically analyse sleep staging agreements between ten scorers in a multicentric environment to better understand areas that possess high scoring variations.

Method

Polysomnographic recordings of 50 individuals (mean (±SD)

AHI

12.0±13.2) were independently scored by ten sleep technologists from seven sleep centres (

Europe

six,

Australia

one). The epoch-based majority sleep stage was identified from all scorings; then the mean scorer agreement with this majority score was calculated. We also investigated how sleep-state transitions affect the mean scorer agreement.

Results

In total, 48556 epochs were analysed. The mean (±SD) scorer agreement with majority score was 86.3±2.9% (Randolph’s kappa κ=0.74) overall; and 86.3±9.5% (κ=0.74), 65.6±13.5% (κ=0.39), 86.1±6.2% (κ=0.74), 88.8±11.2% (κ=0.78), and 91.7±4.5% (κ=0.83) for Wake, N1, N2, N3, and REM respectively. Across the ten scorers, 20.0% of epochs were unanimously scored as N2, and the most frequent disagreement was between N2 and N3 (19.7% of epochs). Only 0.3% of epochs were unanimously scored as N1. There was a negative association between the sleep stage transition frequency of the majority score and the mean scorer agreement (r=-0.61).

Discussion

High mean scorer agreements were obtained with the majority score except for N1. Surprisingly, considerable disparities were observed among scorers in distinguishing N2 and N3; this may reflect both the discrepancy associated with N2/N3 transitions and potentially different scoring perceptions. Greater scoring discrepancies were identified in individuals with more frequent sleep-state transitions.
P132 Self-reported indicators of sleep health in Australia: a cross-sectional population-based study
Authors: Way J , Cistulli P , Bin Y
Published: November 2022

Introduction

Poor sleep health is associated with adverse physical and mental health outcomes. This study aims to examine the indicators of sleep health in an Australian-based population and to analyse the relationship between sleep and sociodemographic characteristics and health conditions.

Method

We investigated a nationally representative sample of adults aged over 18 (n = 21,562) who participated in the 2011-2013 Australian Health Survey (AHS). Participants in the AHS were assigned to either the National Health Survey (NHS) or the National Nutrition and Physical Activity Survey (NNPAS). The NHS collected data on sleeping tablets taken for a mental health condition. Sleep duration was self-reported in the NNPAS which we categorised into three groups: short sleep (< 7 hours), recommended sleep (7 to 9hours) and long sleep (> 9 hours).

Progress to Date

Prevalence of sleeping tablets use among Australian adults who had a mental health condition was 9.5%. The majority used sleeping tablets for a duration of 6 months or more (73.9%) and many took it every night (42.0%). On a typical night, a majority self-reported having the recommended amount of sleep for adults (67.2%). The sociodemographic characteristics and health conditions are currently being analysed.

Intended Outcome and Impact

Adequately monitoring the domains of sleep health can potentially improve the overall health and wellbeing of a population. This study will highlight the current gap in the surveillance of sleep health in Australia. With limited Australian data available, there is a need to prioritise sleep-related indicators in future national health surveys.
Assessing Surgical Approaches for Acoustic Neuroma Resection: Do Patients Perceive a Difference in Quality-of-Life Outcomes?
Authors: North Monique , Weishaar Jeffrey , Nuru Mohammed , Anderson Douglas , Leonetti John P.
Published: November 2022

Objective

The objective of this study is to further patient-physician discussion regarding postoperative quality of life expectations after surgical acoustic neuroma resection.

Study Design

This study is retrospective prospective. Qualifying patients were identified and administered Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale.

Setting

The setting was Loyola University Chicago Health System.

Patients

Three hundred twenty-six patients at our center with surgically resected acoustic neuroma between January 1990 and July 2021 completed the PANQOL.

Intervention(s)

During postresection follow-up visits, patients were administered the PANQOL survey.

Main Outcome Measure(s)

The total PANQOL is comprised of questions addressing quality of life in seven domains of hearing, balance, face, energy, pain, health, and anxiety. Univariate and multivariable analyses were performed to test for associations between surgical approach and/or patient characteristics.

Results

Patients who were treated with retrosigmoid approach reported slightly higher PANQOL pain scores when compared with translabyrinthine approach. No association was found between responses on hearing PANQOL and surgical approach. No association was found between approach and total PANQOL score. However, on average female patients reported lower total PANQOL compared with male patients.

Conclusion

The lack of association between patient response on hearing PANQOL and surgical approach illustrates the impact of preoperative patient counseling in appropriately setting patient expectations. The difference in pain PANQOL response may be due to a higher rate of occipital neuralgia due to incision placement and soft tissue retraction in the retrosigmoid patient group. Surgeons may consider alternative surgical incisions and soft tissue dissection to improve patient's quality of life with respect to postoperative pain.
Preoperative Reading Efficiency as a Predictor of Adult Cochlear Implant Outcomes
Authors: Moberly Aaron C. , Afreen Hajera , Schneider Kara J. , Tamati Terrin N.
Published: November 2022

Hypotheses

1) Scores of reading efficiency (the Test of Word Reading Efficiency, second edition) obtained in adults before cochlear implant surgery will be predictive of speech recognition outcomes 6 months after surgery; and 2) Cochlear implantation will lead to improvements in language processing as measured through reading efficiency from preimplantation to postimplantation.

Background

Adult cochlear implant (CI) users display remarkable variability in speech recognition outcomes. “Top-down” processing—the use of cognitive resources to make sense of degraded speech—contributes to speech recognition abilities in CI users. One area that has received little attention is the efficiency of lexical and phonological processing. In this study, a visual measure of word and nonword reading efficiency—relying on lexical and phonological processing, respectively—was investigated for its ability to predict CI speech recognition outcomes, as well as to identify any improvements after implantation.

Methods

Twenty-four postlingually deaf adult CI candidates were tested on the Test of Word Reading Efficiency, Second Edition preoperatively and again 6 months post-CI. Six-month post-CI speech recognition measures were also assessed across a battery of word and sentence recognition.

Results

Preoperative nonword reading scores were moderately predictive of sentence recognition outcomes, but real word reading scores were not; word recognition scores were not predicted by either. No 6-month post-CI improvement was demonstrated in either word or nonword reading efficiency.

Conclusion

Phonological processing as measured by the Test of Word Reading Efficiency, Second Edition nonword reading predicts to a moderate degree 6-month sentence recognition outcomes in adult CI users. Reading efficiency did not improve after implantation, although this could be because of the relatively short duration of CI use.
The Effectiveness of Video Decision Aid on Advance Care Planning With Adult Patients
Authors: Shu Xiao , Chen Qian , Zhou Yulan , Yang Zijing , Zhang Qi
Published: November 2022

The purpose of this review was to examine the effect of video decision aids on adult patients' advance care planning–related outcomes. Seven English electronic databases (PubMed, Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, OpenGray) and 3 Chinese databases (CNKI, WanFang, and VIP) were searched to identify relevant studies. Fourteen randomized controlled trials were included. The results of the meta-analysis showed that video decision aids reduced patients' preferences for life-prolonging care (risk ratio [RR], 0.43; 95% confidence interval [CI], 0.31-0.61; P < .01), cardiopulmonary resuscitation (RR, 0.54; 95% CI, 0.46-0.64; P < .01), and intubation tube placement (RR, 1.65; 95% CI, 1.09-2.48; P = .02) and increased patients' willingness to have a goals-of-care conversation (RR, 1.87; 95% CI, 1.32-2.65; P = .0004) and knowledge of advance care planning (RR, 0.80; 95% CI, 0.50-1.09; P < .01). However, because of the variability among the studies, the results have limitations. Future research needs to increase the sample size and improve the experimental design to confirm the impact of video decision aids on advance care planning.
Greater variability in rhesus macaque (
Macaca mulatta
) endocranial volume among males than females
Authors: Colby Abigail E. , DeCasien Alex R. , Cooper Eve B. , Higham James P.
Published: November 2022

The greater male variability (GMV) hypothesis proposes that traits are more variable among males than females, and is supported by numerous empirical studies. Interestingly, GMV is also observed for human brain size and internal brain structure, a pattern which may have implications for sex-biased neurological and psychiatric conditions. A better understanding of neuroanatomical variability in non-human primates may illuminate whether certain species are appropriate models for these conditions. Here, we tested for sex differences in the variability of endocranial volume (ECV, a proxy for brain size) in a sample of 542 rhesus macaques (
Macaca mulatta
) from a large pedigreed free-ranging population. We also examined the components of phenotypic variance (additive genetic and residual variance) to tease apart the potential drivers of sex differences in variability. Our results suggest that males exhibit more variable ECVs, and that this pattern reflects either balancing/disruptive selection on male behaviour (associated with alternative male mating strategies) or sex chromosome effects (associated with mosaic patterns of X chromosome gene expression in females), rather than extended neurodevelopment among males. This represents evidence of GMV for brain size in a non-human primate species and highlights the potential of rhesus macaques as a model for sex-biased brain-based disorders.
Marine heatwaves of differing intensities lead to distinct patterns in seafloor functioning
Authors: Kauppi Laura , Villnäs Anna
Published: November 2022

Marine heatwaves (MHWs) are increasing in frequency and intensity due to climate change. Several well-documented effects of heatwaves on community structure exist, but examples of their effect on functioning of species, communities or ecosystems remain scarce. We tested the effects of short-term, moderate and strong MHWs on macrofauna bioturbation and associated solute fluxes as examples of ecosystem functioning. We also measured macrofaunal excretion rates to assess effects of temperature on macrofauna metabolism. For this experiment, we used unmanipulated sediment cores with natural animal communities collected from a muddy location at 32 m depth in the northern Baltic Sea. Despite the mechanistic effect of bioturbation remaining unchanged between the treatments, there were significant differences in oxygen consumption, solute fluxes and excretion. Biogeochemical and biological processes were boosted by the moderate heatwave, whereas biogeochemical cycling seemed to decrease under a strong heatwave. A prolonged, moderate heatwave could possibly lead to resource depletion if primary production cannot meet the demands of benthic consumption. By contrast, decreased degradation activities under strong heatwaves could lead to a build-up of organic material and potentially hypoxia. The strong variability and the complexity of the response highlight the context dependency of these processes complicating future predictions.
The risk of drug resistance during long-acting antimicrobial therapy
Authors: Nande Anjalika , Hill Alison L.
Published: November 2022

The emergence of drug resistance during antimicrobial therapy is a major global health problem, especially for chronic infections like human immunodeficiency virus, hepatitis B and C, and tuberculosis. Sub-optimal adherence to long-term treatment is an important contributor to resistance risk. New long-acting drugs are being developed for weekly, monthly or less frequent dosing to improve adherence, but may lead to long-term exposure to intermediate drug levels. In this study, we analyse the effect of dosing frequency on the risk of resistance evolving during time-varying drug levels. We find that long-acting therapies can increase, decrease or have little effect on resistance, depending on the source (pre-existing or de novo) and degree of resistance, and rates of drug absorption and clearance. Long-acting therapies with rapid drug absorption, slow clearance and strong wild-type inhibition tend to reduce resistance caused by partially resistant strains in the early stages of treatment even if they do not improve adherence. However, if subpopulations of microbes persist and can reactivate during sub-optimal treatment, longer-acting therapies may substantially increase the resistance risk. Our results show that drug kinetics affect selection for resistance in a complicated manner, and that pathogen-specific models are needed to evaluate the benefits of new long-acting therapies.
Transport of symbiont-encoded cellulases from the gill to the gut of shipworms via the enigmatic ducts of Deshayes: a 174-year mystery solved
Authors: Altamia Marvin A. , Distel Daniel L.
Published: November 2022

Shipworms (Bivalvia, Teredinidae) are the principal consumers of wood in marine environments. Like most wood-eating organisms, they digest wood with the aid of cellulolytic enzymes supplied by symbiotic bacteria. However, in shipworms the symbiotic bacteria are not found in the digestive system. Instead, they are located intracellularly in the gland of Deshayes, a specialized tissue found within the gills. It has been independently demonstrated that symbiont-encoded cellulolytic enzymes are present in the digestive systems and gills of two shipworm species,Bankia setaceaandLyrodus pedicellatus, confirming that these enzymes are transported from the gills to the lumen of the gut. However, the mechanism of enzyme transport from gill to gut remains incompletely understood. Recently, a mechanism was proposed by which enzymes are transported within bacterial cells that are expelled from the gill and transported to the mouth by ciliary action of the branchial or food grooves. Here we usein situimmunohistochemical methods to provide evidence for a different mechanism in the shipwormB. setacea, in which cellulolytic enzymes are transported via the ducts of Deshayes, enigmatic structures first described 174 years ago, but whose function have remained unexplained.