bluuebunny/crossref_metadata_2025 huggingface dataset:
The Anatomy of AI Audits
Authors: Raji Inioluwa Deborah
Published: October 2023

A key element in AI governance is the development of standards and regulatory assessments to evaluate claims of performance—when such evaluations are executed with the objective of accountability, I refer to them as AI audits. The nature of such audits can take on multiple forms, depending on the context and the intent of those designing them. Through a discussion of several audit case studies, I break down the key characteristics and function of an audit within the broader structure of AI governance. In particular, I present the key differences between audits conducted by internal stakeholders and those executed by external stakeholders, and demonstrate how, in each case, the goals, perspectives, and challenges faced by the auditor actively inform audit design and feed into audit processes, outcomes, and consequences.
Machine Learning for Detection, Prediction, and Treatment of Nonsuicidal Self-Injury
Authors: Wang Shirley B. , Dempsey Walter , Hunt Rowan A. , Nock Matthew K.
Published: October 2023

This chapter describes current progress, challenges, and future directions in machine learning (ML) for the detection, prediction, and treatment of nonsuicidal self-injury (NSSI). It highlights the importance of identifying individuals at risk for NSSI for prevention and early intervention efforts. ML methods are increasingly accurate at the task of detection, which expanded into the mental health domains. Additionally, researchers have begun to harness ML algorithms to improve clinical decision-making in predicting treatment outcomes for depression, anxiety, smoking cessation, and substance disorders. The chapter also notes the issues of ethics behind ML, such as data leakage that could occur when researchers fail to make a-priori decision during the model training and evaluation stage.
Early Childhood Trauma and Nonsuicidal Self-Injury
Authors: Serafini Gianluca , Cipriani Nicolò , Costanza De Angelis Laura , Amore Mario
Published: October 2023

This chapter discusses the interplay between early childhood trauma and nonsuicidal self-injury. It defines early childhood trauma as the experience of a traumatic event by children aged 0–6 years. A traumatic event primarily refers to an emotionally painful, distressful, or violent event that poses a threat to a child’s life, bodily integrity, or sense of safety. The chapter elaborates on different types of childhood trauma, citing how maltreatment consistently presents as the antecedent to psychopathology. It then looks into several childhood trauma prevention and trauma-focused therapeutic approaches, which include trauma-informed care, Dialectical Behavior Therapy, and Acceptance and Commitment Therapy.
Medical and Pharmaceutical Interventions in NSSI
Authors: Plener Paul L.
Published: October 2023

There is growing evidence for the efficacy of psychotherapeutic interventions to target nonsuicidal self-injury (NSSI), yet fewer studies have investigated psychopharmacological treatment of NSSI. Although several agents such as selective serotonin reuptake inhibitors (SSRIs), antipsychotics, mood stabilizers, and benzodiazepines have been tested, the evidence for pharmaceutical interventions remains limited. This is especially true for the treatment of minors. There is a general lack of randomized controlled trials in this field of research, with the limited evidence often building on case series and open trials. To date, there is not a licensed psychopharmacological treatment for NSSI. With regard to other “biologically oriented” treatment methods, different modes of stimulation have been tested in populations showing NSSI. These methods include transcranial repetitive magnetic stimulation, transcranial direct current stimulation, and transauricular vagal nerve stimulation. However, evidence for these methods is scarce and reports are mostly based on open label trials. In summary, psychotherapeutic interventions remain the primary method of intervention in NSSI, which can be supported by psychopharmacological interventions to treat comorbid conditions (e.g., depression). There is to date not enough evidence to support specific treatment of NSSI using primarily biologically oriented therapeutic approaches.
Application of the Unified Protocol for Treatment of Nonsuicidal Self-Injury
Authors: Bentley Kate H. , Jaroszewski Adam C.
Published: October 2023

Nonsuicidal self-injury (NSSI) is a prevalent and clinically significant behavioral health problem. Novel therapeutic approaches to treating NSSI are needed, especially given the many well-established barriers to seeking and accessing evidence-based psychological treatment, including for self-injuring individuals specifically. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a cognitive-behavioral protocol designed to address underlying functional mechanisms of the full range of emotional disorders and related problems. This broadly applicable and flexible protocol was developed in part to facilitate dissemination of and training in evidence-based psychological treatment, as therapists have the potential to learn one set of therapeutic strategies that can be used across a wide range of presenting problems and comorbid disorders and symptoms. This chapter presents a rationale for using the UP to treat patients engaging with NSSI—including high rates of co-occurrence NSSI and the emotional disorders and shared functions of NSSI and key emotional disorder features—and the growing empirical support for the UP in the treatment of NSSI. An overview of the core UP therapeutic strategies is provided, with an emphasis on the applicability to targeting NSSI, followed by a detailed illustrative case example. The chapter also addresses significant clinical considerations and makes suggestions for future research on the UP for targeting NSSI.
Conclusion and Future Directions
Authors: Lloyd-Richardson Elizabeth E. , Baetens Imke , Whitlock Janis L.
Published: October 2023

This chapter considers the possible directions of the field of NSSI research in the future. It details the development of the NSSI field that started from a diverse array of unaligned terms and measures of self-injury. The epidemiological outlines of NSSI presented several notions over the past 20 years, which include the recognition of NSSI as a clinical disorder and the relationship between NSSI and suicidal thoughts and behaviors. Moreover, future research could also look into themes of populations, lived experiences, operationalization, assessment of NSSI, novel research methods, and bio-neuro processes. The chapter also explores themes correlated with prevention, intervention, and treatment.
Understanding the Link Between Direct and Indirect Self-Injurious Behavior
Authors: Møhl Bo , Rubæk Lotte
Published: October 2023

In this chapter, the authors examine the factors that might explain why individuals who engage in direct self-injurious behavior (SIB) have a higher likelihood of also engaging in indirect SIB, and vice versa. As there are no general models to describe a transdiagnostic understanding of the potential underlying mechanisms of both direct and indirect SIB, the authors rely on a modified version of the “Conceptual model of interactive risk factors for both NSSI and ED” to describe the etiological factors underlying direct and indirect SIB more broadly. The model distinguishes between distal risk factors (e.g., temperament, family environment, and traumatic experiences) and proximal risk factors (e.g., emotional dysregulation, body disregard, and psychiatric disorders) and their mutual interaction. In both direct and indirect SIB, the motivation to self-injure is related to the function (benefits) of the behaviors. Hence, the behaviors are largely controlled by events that immediately precede and follow them (i.e., antecedents and consequences). In the authors’ review of the shared functions and functional equivalence of direct and indirect SIB, they find that they often serve the same purpose (e.g., affect regulation) and thus may replace or stand in for one another (symptom shifting). Although the two forms of the behavior largely share etiology and functions, the authors still find it useful to maintain the separation between the two phenomena.
Encasted Formalism
Authors: Narayan Vivek V.
Published: October 2023

This chapter seeks to invoke the spirit of encasted formalism, which reads literature through caste scripts to investigate the entangled relationships between encasted forms and encasted experience. This critical style remains ever alert to the potential of caste to remain hidden in plain view, to be protean in form, and, above all, to be understood only through situated thick descriptions of everyday life. In providing thick descriptions of the encounter between reader and text against a historical backdrop, encasted formalism seeks to be reflexive of caste as encounter and attempts an analysis of the deep dramaturgy of caste. These political readings unpack the assignations of value enacted by caste scripts in both human lives and literary forms to explore the ways in which caste intersects with conceptions of experience and form, the everyday and the event, and, more broadly, the social and the aesthetic.
The Village in Bengali Modernity
Authors: Chaudhuri Supriya
Published: October 2023

This chapter argues that it is the village, rather than the city, that emerges in Bengali literature and art of the past century as the crucible of modernity—the site where conflicts of land and capital, science and religion, work and property, and language and education must be worked out, and the ideology of nation-building understood. The realities of the village—inhabited, escaped, or returned to—are held in tension with the destructive, confusing, half-imaginary allure of the city. This opposition serves as a paradigm of the modern itself, in its contradictions, failures, and unexpected conjunctions. Moreover, rural or regional histories cannot be understood without reference to the deep ecologies of the Bengal delta, with its constantly shifting land-water-human relations. This chapter examines the complexities of this task of representation in three major novels of the period: Putulnācher Itikathā (The Tale of the Puppet-Dance, 1936) by Manik Bandyopadhyay (1908–1956), Hāñsulī Bāñker Upakathā (The Tale of Hansuli Bend, 1946) by Tarashankar Bandyopadhyay (1898–1971), and Titās Ekti Nadīr Nam (Titas is the Name of a River, 1956) by Advaita Mallabarman (1914–1951).
William Jones, George Grierson, and Verrier Elwin
Authors: Devy G. N.
Published: October 2023

This chapter brings three iconic Indologists into the discussion of modern Indian literature: Sir William Jones, the founder of the Asiatic Society (18th century); Sir George Abraham Grierson, the architect of the first-ever linguistic survey of India (19th century); and Dr. Verrier Elwin, the architect of India’s policy for the indigenous (20th century). The chapter presents their work as a continuation of a single intellectual project, which made an invisible India visible to the world. India’s past, its linguistic landscape, and the communities of India, made visible by the three, conclusively shaped the horizons of self-perception in India. The collective impact of their life’s work has formed an unchallenged substratum of modern Indian literature.
Romance, Aesthetics, and Progressivism in Marathi Literary Culture
Authors: Sarwate Rahul
Published: October 2023

This chapter explores the interplay between sexuality, caste, and power in early-20th-century Marathi literary culture by engaging with the works of Narayan Sitaram Phadke (1894–1978), a renowned Marathi novelist. Phadke’s writings emphasized materiality and body, rationality, and individualism, all of which came to be associated with the idea of Maharashtrian progressivism in the literary and intellectual culture of this era. Phadke transformed the idioms of romance, inaugurated earlier by “Ravikiran Mandal” (1923–1939), an association of poets, to pave the way for a new moral aesthetic. Likewise, he imagined literary and aesthetic emancipation as a sovereign space. The chapter seeks to show that the cultural politics of the first half of 20th-century Maharashtra revolved around the categories of the body, rationality, masculinity, and modern ways of being Hindu, which became pivotal for the construction of Maharashtrian progressivism.
Next-Generation Seizure Therapy
Authors: Deng Zhi-De , Lisanby Sarah H.
Published: October 2023

Electroconvulsive therapy (ECT) is highly effective in treating severe psychiatric conditions, but its cognitive side effects have been a limiting factor in its clinical use. Fortunately, decades of research have led to improvements in ECT technique that have improved its risk:benefit ratio. Insights derived from the relationships among treatment technique (including electrode placement, pulse width, and other parameters of stimulation) and clinical outcomes (such as antidepressant efficacy and adverse cognitive side effects) have advanced scientific understanding regarding the roles of the induced electric field and resultant changes in brain structure and function. These insights have paved the way for the next generation of seizure therapy devices which seek to further enhance the safety and efficacy of ECT, including more focal electrode configurations and magnetic seizure induction. This chapter reviews the latest developments in the modernization of the oldest somatic therapy still in use in psychiatry today, and highlights areas for future development.
Introduction to Diversity of Human Diets in the Past
Authors: Katzenberg M. Anne
Published: October 2023

The dispersal of modern Homo sapiens around the globe necessitated adaptation to locally available plants and animals. People developed detailed knowledge of these food sources and modified their environments to enhance growth of plants and access to animals. Methods for revealing the development of local dietary adaptations include analyses of plant and animal remains, food residues, chemical signatures in preserved human tissues, and changes in human disease experience. This introduction touches on these topics, which are covered in depth in the chapters that make up part two of the volume.
O020 Twitch in the Night: Periodic Limb Movements during Sleep in Children with Neuromuscular Disease or Cerebral Palsy
Authors: Nisbet L , Nixon G , Davey M
Published: October 2023

Introduction

Poor sleep is frequently reported in children with neuromuscular diseases (NMD) or cerebral palsy (CP) however ventilation is often the clinical focus. Periodic limb movements (PLMs) are frequently underdiagnosed in the paediatric population (prevalence of 5-8% in clinic-referred studies) and occur in up to 33% of children with Down syndrome. We assessed the prevalence of PLMs in children with NMD or CP.

Methods

Retrospective review of the first polysomnogram with leg electromyography in children with NMD (including Duchenne muscular dystrophy, myotonic dystrophy, and spinal muscular atrophy) or CP between 2005-2022.

Results

Leg electromyography was available in 238 children (124 NMD, 114 CP) with consent. 72 (30%) were female with a median age 9y (range 1-18y), BMI z-score 0.4 (-3.5 to 2.7), RDI 3.5/h (0-100/h) and arousal index of 11.7/h (1.3-65.6/h). Median PLM index was 0 (range 0-33/h) with %PLM arousals 0 (0-74%). The prevalence of elevated PLMs (>5/h) was 9.7% and 10.5% in the NMD and CP groups respectively, with median PLM arousals of 8.5% and 4.5% respectively. There were no differences in age or sex between those with or without elevated PLMs (p>0.05).

Discussion

Elevated PLM index occurred at a higher prevalence in children with NMD and CP than reported in the general paediatric population, though at lower rates than in Down syndrome. It is important that PLMs are not overlooked as identification and treatment may help improve sleep outcomes in this population. Further research is required to understand the pathophysiology of PLMs specifically in this population.
O033 Is Sleeping and Waking Important for the Cortisol Awakening Response?
Authors: Grosser L , Yates C , Dorrian J , Matthews R , Banks S
Published: October 2023

Introduction

The rapid rise in cortisol after waking is known as the cortisol awakening response (CAR). However, as part of its normal circadian rhythm cortisol also rises in the morning independent of awakening. If CAR is a direct response to awakening, it should be eliminated in conditions of sleep deprivation (SD). Given that an atypical CAR is associated with several psychiatric and medical disorders, understanding the factors that influence CAR is of clinical relevance. This study explored cortisol during the normal waking period prior, during, and post-SD.

Methods

N=21 (11F 22.80±4.40y) completed 62h of SD in the laboratory. Salivary cortisol was collected across 5-time-points (07:00h, 07:15h, 07:30h, and 07:45h) on 2-pre-at-home-study days, 4-in-lab-study days, and 2-post-at-home-study days. Mixed-effects ANOVAs tested for fixed effects of day, time, and their interactions on cortisol, and cortisol area under the curve (AUCi, AUCg).

Results

SD produced significant effects of time*day (p<0.001). Cortisol levels at +30 and +45min post-awakening were lower on SD days. Cortisol levels on awakening (0mins) did not differ between any study days. There were significant effects of day (p<0.001). AUCi and AUCg were greater on in-laboratory-baseline and recovery days compared to other study days.

Discussion

This study found CAR is not present during periods of SD when there is no ‘waking’ from sleep. It showed for the first time that CAR recovers to baseline levels following recovery sleep. While the role of the CAR remains unclear this study identified factors that future research should consider to advance understanding of its purpose.
O051 Comparison of standard CPAP therapy and the RACer airway device for the treatment of obstructive sleep apnoea: A randomised clinical trial
Authors: Neill A , Campbell A , Miller J
Published: October 2023

The nasal cycle is a normal ultradian physiological phenomenon where each nasal airway alternates conducting dominance. The nasal cycle occurs in obstructive sleep apnoea (OSA). Rest-Activity-Cycler positive airway pressure (RACer-PAP) is a novel treatment aiming to maintain the innate nasal cycle.

Methods

PAP naïve OSA patients were randomly assigned in a crossover design to 4 weeks RACer or control humidified CPAP (3 day wash-out). Treatment pressure determined by in-lab Auto-titration. Adherence, Epworth Sleepiness Score (ESS), quality of life (SF 36), nasal symptoms, side effects, sleep quality compared by SAS 9.4 or Likert scale.

Results

40 subjects (of 44 recruited) (29 M, 11 F) with a mean BMI 37.7kg/m2 aged 45 yrs (range 22-70 yrs) with severe OSA (mean AHI 56.4/ hr), ESS 13.6 (range 3-21) completed the study. Ethnicity included Maori (17 %), NZ European (67%), and Pacific (12.5%). The prescribed mean pressure 12.2 (range 8-18 cmH20). Adherence was greater in the humidified CPAP control than RACer- PAP arm (4:57h/night verse 4:14h/night p < 0.01). Both devices similarly improved subjective sleepiness, quality of life and adverse upper airway symptoms. Humidified CPAP improved to a greater extent nasal symptom scores (baseline – final: control CPAP 2.8 vs. RACer 2.3, p = 0.03), sleep quality and was preferred (55% vrs 22 %).

Conclusion

RACer PAP improved OSA symptoms and quality of life but adherence was lower and nasal symptoms more common. This could be explained by not using humidification, technical issues with prototype machine or the use of set nasal cycle length.
O052 Patient Preference and Acceptability of Sleep Diagnostic Tests during early Pregnancy
Authors: Clements F , Chung Y , Marshall N , Melehan K , Hennessy A , Makris A , Vedam H
Published: October 2023

Introduction

A range of test options are available to diagnose OSA. Test acceptability is measured via successful completion, though this fails to capture the patient preference. There is a paucity of data on acceptability particularly in pregnancy. We thus developed questionnaires to assess test preference and acceptability of Apnealink-Air, Somte and Grael tests, in pregnancy till 24 weeks gestation.

Methods

Eighty-four pregnant women by 24 weeks gestation were invited to complete home Apnealink-Air, unattended-self-applied-Somte-PSG and attended-Grael-PSG. Questionnaires were beta-tested by hospital staff (unaffiliated with study). Using a 5-point Likert scale, questionnaires assessed ease of use, convenience and acceptability of repeating test. A ranking scale was used to determine test preference. Following completion of tests, participants completed questionnaires.

Results

Of 59 participants that completed any test, 35 completed any questionnaire (Apnealink(n=33), Somte(n=33), Grael(n=30), preferred test (n=29)). Ranking of test preference demonstrated Apnealink ranked 1st/72.4%, Grael 2nd/20.7% and Somte 3rd/6.9%. Apnealink, Somte and Grael questionnaire data responses were assessed for ease of use (very easy (51.6%), easy / neutral (34.4/34.4%) and very easy (33.3%) respectively), convenience (very convenient (51.6%)), neutral (36.7%) and convenient (50%) respectively), and acceptability to repeat test (very acceptable (41.9%), neutral (43.3%) and neutral(43.3%)), respectively.

Discussion

Pregnant women being assessed for OSA by 24 weeks gestation preferred Apnealink to Somte and Grael PSG. Participants reported Apnealink easiest to use, most convenient and most acceptable to repeat in a future pregnancy. Patient autonomy is an important principle; womens’ preferences should be taken into consideration in clinical sleep services and research.
O054 What Measure of CPAP Treatment is most closely Associated with Reduced Risk of Future Major Cardiovascular Events (MACE)?
Authors: Reynor A , Singh B , Maddison K , Eastwood P , Shenoy B , Walsh J , Harvey C , Dhaliwal S , McArdle N
Published: October 2023

Introduction

Obstructive sleep apnoea (OSA) is associated with future Major Adverse Cardiovascular Events (MACE). Continuous positive airway pressure (CPAP) is the standard treatment for OSA, but it is not known which measure of CPAP treatment is most closely associated with reduction in future MACE. We compared associations between a novel and a commonly used measure of CPAP treatment and future MACE.

Materials and Methods

Participants: 2717 adults with moderate-severe OSA attending a tertiary sleep clinic 2006-2010 completed baseline assessments and followed-up for 7years.

CPAP treatment: Month-long CPAP trial and periodic review post-trial.

Outcomes

Time to cardiac death or non-fatal hospitalisations due to MACE, or end of follow-up, using Cox proportional hazards models.

Predictors

Average nightly CPAP use and the SARAH index (Sleep-Adjusted Residual AHI), using all available device downloads

SARAH index=([AHITreatment×HoursTreatment]+[AHIUntreated×HoursUntreated])/HoursTotalSleepTime

Covariates

Demographics/comorbidities associated with MACE.

Results

MACE occurred in 18% participants.

Average nightly use: Compared to zero use, each tertile of increasing use predicted reduction in risk of MACE (tertile-0:ref, tertile-I:HR 0.632, 95%CI 0.484-0.824, p<0.001, tertile-II:HR 0.772, 95%CI 0.602-0.990, p=0.042, tertile-III:HR 0.708, 95%CI 0.553-0.905, p=0.006).

SARAH

A dose-response decreasing risk of MACE with decreasing SARAH index tertiles (tertile-I:ref, tertile-II:HR 0.827, 95%CI 0.658-1.039, p= 0.102, tertile-III:HR 0.772, 95%CI 0.614-0.969, p=0.026).

Conclusions

Average nightly CPAP use and SARAH index were associated with a decreased risk of future MACE. The SARAH index showed a dose-response relationship with MACE; suggesting that it may be a better estimate of residual OSA-related cardiovascular stress.
O060 Loop gain as a measure of respiratory instability in premature infants
Authors: Mann D , Mammel D , Kemp J , Carroll J , Terrill P , Edwards B
Published: October 2023

Introduction

Respiratory control is often unstable in premature infants, with periodic breathing, and intermittent hypo- and hyper-oxemia. Understanding how respiratory control changes after premature birth may lead to fewer and less severe events. The aim of this study was to quantify respiratory pattern instability in preterm infants during their first weeks of life.

Methods

As part of a larger study (PreVent, NHLBI U01 HL133708 & HL133700. Dennery et al., Pediatr Res 2019:85(6),769), 55 infants (born 24w1d-28w6d weeks post-menstrual age, PMA) were studied at one or more timepoints (28, 32, 36, 40 and 52 weeks PMA). Respiratory effort (thorax and abdomen bands) and SpO2% were recorded. Airflow was derived from effort bands. Respiratory instability was quantified by a previously described loop gain (LG) model fit to visually identified artefact-free spontaneous sigh breaths during quiet sleep (Edwards et al., SLEEP, 2018:41(11)).

Results

In N=1042 sighs, LG varied considerably within and between individuals across the timepoints studied. However, mixed effects modelling revealed a significant trend for increasing LG at each timepoint (R2=.2, p<0.0001, PMA fixed effect, random intercept per infant).

Discussion

On average, loop gain increased across the first ~12 weeks of life in very preterm infants. This pattern is dissimilar to that among term infants, where LG peaks between 2 and 4 postnatal weeks. In very preterm infants, understanding the PMA-specific ventilatory control instability and its typical developmental trajectory will better elucidate the challenges in maintaining SpO2% within target range through better description of expected need for respiratory support.
O064 Screen Time, Sleep, and Behavioural Development in Preschool Children: Relationships Caregiver Rules and Perceptions of Screen Time
Authors: Axelsson E , Metse A , Nanthakumar S , Robson A , Paeach G , Asis A , Purcell K
Published: October 2023

Sleep is highly important for children’s behaviour (Touchette et al., 2007). However, screen time is associated with poorer sleep (Janssen et al., 2020), and greater behavioural difficulties (Hinkley et al., 2018), but they are rarely investigated together. Caregivers’ rules and perceptions about screen time are also associated with children’s engagement with screens. Caregivers of preschoolers completed online questionnaires about children’s screen time, sleep-related behaviours (Child Sleep-Wake Scale), behaviour (Child Behavior Checklist (CBCL, 1.5-5)), person-social development (Ages and Stages Questionnaire-3 (ASQ-3)), and questions about their rules and perceptions of screen time. Greater screen times predicted lower personal-social scores, and better sleep-related behaviours predicted lower internalising scores. Greater screen times were predicted by caregivers’ tendency to disagree about limits on screen time and a greater inclination to think limits cause conflict. Lower child personal-social scores predicted caregivers’ tendency to disagree about screen time limits. Greater child externalising behaviours predicted caregivers’ belief that screen time helps calm their child and that time limits cause conflicts. Poorer child sleep also predicted caregivers’ tendency to think screen time limits cause conflict. Therefore, caregivers’ rules and perceptions are associated with children’s screen times, but also children’s behaviours are associated with caregivers’ rules and perceptions about screen time. This is concerning as screen time predicted poorer personal-social behaviours in children. Providing caregivers with alternative ways to manage behaviours and conflicts surrounding time limits could also help in managing children’s screen times. This could have long-term implications for healthy sleep, social, and behavioural development in children.
O078 A Comparison of Subjective Sleepiness and Subjective driving Performance between People Vulnerable Versus Resistant to Driving Impairment following Extended Wakefulness.
Authors: Nguyen K , Dunbar C , Guyett A , Bickley K , Nguyen P , Scott H , Reynolds A , Hughes M , Adams R , Lack L , Catcheside P , Cori J , Howard M , Anderson C , Stevens D , Lovato N , Vakulin A
Published: October 2023

Introduction

Subjective sleepiness and driving performance are generally associated but show inter-individual variability. Specifically, some people are more vulnerable, while others are more resistant to driving impairment during extended wakefulness. We examined the relationship between subjective sleepiness and driving performance in groups resistant versus vulnerable to driving impairment during extended wakefulness.

Methods

Thirty-two adults (female=18, mean age=33.0yrs, SD=14.6) completed five 60-minute driving simulator assessments across 29 hours of extended wakefulness. Perceived sleepiness (Karolinska sleepiness scale, KSS) and driving performance (nine-point Likert scale) were assessed at 10-minute intervals while driving. Through cluster analysis, participants were categorised as vulnerable (n=16) or resistant (n=16) using steering deviation and crash data. Correlations, stepwise regressions, and ROC curves were used to identify predictors of driving impairment.

Results

Perceived sleepiness and driving impairment increased across the drives during wakefulness and within drives, regardless of grouping (p<0.001). The exception was the drive at 25-hours into wakefulness, where the vulnerable group showed higher perceived driving impairment within the drive (p=0.001). Pre-drive KSS, total sleep time, age and gender were not significant predictors of crashes at drives undertaken at 1-hour, 7-hours, 13-hours, or 25-hours, but were significant at 19-hours into wakefulness, together explaining 44% of the variance in crashes.

Discussion

Self-reports are sensitive to driving impairment but not differential vulnerability to performance decrements during extended wakefulness. However, the findings support that both groups can perceive their sleepiness and ideally employ appropriate countermeasures (e.g., stop driving, nap, caffeine). Future studies should target more objective predictors of vulnerable versus resistant groups.
P003 Home-based sleep study paediatric model of care
Authors: Toriola E
Published: October 2023

Introduction

An innovative service that was developed within a tertiary paediatric centre, involved the use of a home-based sleep study model of care (MOC) between March 2022 to September 2022. This MOC allowed low risk children to be able to undergo a sleep study earlier than, when compared to the traditional in-house sleep studies conducted within the hospital setting.

Methods

The MOC involved a sleep technician travelling to the patients’ home and then attaching sensors onto the child’s body. The at home sleep system used is a full, portable polysomnography system that gently simplifies the task of performing a sleep study while delivery secure and precise measurements from the comfort of the patient’s home. The system provides data collection via the use of electrocardiogram (ECG), electroencephalography (EEG), oximeter, plethsmography belts and facial electroculargraphs which are attached comfortably onto the patient’s body.

An outpatient’s service run by Clinical Nurse Consultants then provided 24 hour support to families for troubleshooting overnight.

Results

A total of 49 home based sleep studies were performed during this period. Almost 90% of children tested had an abnormal sleep study result and 1 in 3 had moderate to severe findings. Eight studies (19%) were below the expected quality. This is comparable to in-hospital poor quality sleep study rates.

Discussion

The MOC reduced hospital admission for a diagnostic sleep study, provided quicker assessment and in the comfort of the child’s home.
P017 The Sleep and Sleep Environment of Shift Workers in Extractive Industries: Methodology to Assess the On-Site and At-Home Sleep Environment
Authors: Beranek P
Published: October 2023

Shift work in extractive industries, such as mining, oil and gas, harvesting, and quarrying industries, often involves long working hours, shifts scheduled opposite the biological rhythm, and a variety of roster designs. Initial studies indicate that shift workers in extractive industries experience poor sleep, including short sleep duration and poor sleep quality. Sleep loss may result in fatigue, increasing the risk of accidents and productivity loss. The sleep environment may be a crucial factor impacting sleep, therefore, warranting investigation and potential optimisation.

This study aims to 1) characterise the sleep environment of shift workers in extractive industries, and 2) determine sleep environment factors that negatively affect the sleep of shift workers in extractive industries. This study consists of a self-report and an objective assessment of sleep environment and sleep, utilising a large sample and a subsample, respectively. This study applies survey instruments, wearables, and data loggers to obtain data on sleep quantity and quality, and sleep environment, including light and temperature. Generalised linear modelling will be applied to examine the relationships between sleep environment factors and sleep metrics. Various covariates, known to influence sleep, will be included in the statistical models.

The results from this study will contribute to the understanding of the impact of the on-site and at-home sleep environments on the sleep of shift workers in extractive industries. Furthermore, the results will inform strategies for the development and improvement of on-site accommodation and at-home sleep environment.
P031 A Novel Oral Appliance Implementation Protocol Using Nightly Portable Monitoring for OSA Patients Failing CPAP therapy
Authors: Ling I , Christoforou J , Chin G , Currie P
Published: October 2023

Introduction

Oral Appliance Therapy (OAT) is an effective second line treatment for OSA. However, OAT devices do not have active efficacy monitoring, hence little is known about methods to best identify the optimal degree of mandibular advancement.

Methods

Consecutive OSA patients undergoing OAT at a sleep disorders service were recruited to participate in a novel titration protocol using nightly monitoring via a portable device (NightOwl®, Ectosense, Belgium). Demographic & sleep study (PSG) data, and key NightOwl® metrics were collected. A treatment PSG was conducted at conclusion of OAT implementation using identified optimal point of mandibular advancement.

Results

80 subjects were recruited (52 male, 65%) with mean (±SD) age 49±12 years, BMI 28±4.4 kg/m2, Epworth score (ESS) 9.1±4.9. Baseline PSG showed mean AHI 28±20 events/hr, nadir SpO2 84±21%, time SpO2<90% 8.3±30 minutes. Blood pressure monitoring at baseline showed mean day BP 123/70mmHg and night BP 106/57mmHg. The mean mandibular advancement implemented was 2.9±1.7mm.

Post treatment mean ESS was 5.1±3.5 (p<0.001). 62/68 (91%) subjects reported perceived benefit on OAT, 49/53 (92%) reduced snoring, 51/62 (82%) improved sleep, 49/62 (79%) increased energy. Treatment PSG on completion of the protocol showed AHI 14±10 events/hr (p<0.001), nadir SpO2 82±33% (p>0.05), time SpO2<90% 1.2±21 minutes (p=0.04). 48/63 (76%) met the AHI definition of OAT success.

Discussion

This study demonstrates a novel OAT protocol which led to minimal degree of mandibular advancement, resulting in high rates of symptom benefit and effective treatment of OSA.
P040 Comparisons of Heart Rate Variability Indices Derived from the Sheet-type Device beneath the Mattress with those from the Electrocardiogram
Authors: Yanagisawa N , Nishizaki Y , Kasai T
Published: October 2023

Introduction

A sheet-type device beneath the mattress was developed for non-invasive monitoring of cardiac rhythm during sleep and in bedridden end-of-life elderly patients, enabling the acquisition of ballistocardiography (BCG) signals. BCG represents minute vibrations in the body associated with cardiac ejection of blood and has recently been utilized to estimate heart rate variability (HRV) indices. This study aimed to compare HRV indices derived from BCG with those obtained from simultaneously measured electrocardiogram (ECG) and assess their agreement.

Methods

Healthy subjects (14 males, 11 females; age 40.6±12.8 yrs.) were recruited between August 2022 and April 2023. Subjects laid on a bed with the device placed under their pillow, while ECG was recorded for 20 minutes. Time-domain indices (mean normal-to-normal (NN) interval) and frequency-domain indices (low frequency (LF) and high frequency (HF)) were calculated, and linear associations were examined by correlation analysis. Bland-Altman analysis was employed to evaluate the agreement between the indices.

Results

Significant positive associations were observed between BCG and ECG indices in mean NN interval (r=0.994, p<0.001) and LF (r=0.685, p<0.001) and HF (r=0.687, p<0.001). Bland-Altman analysis demonstrated good agreement in mean NN (mean of pairwise difference (MPD): 1.07; limits of agreement (LA): -12.57-14.70; ratio: 0.01), but poor agreement in LF (MPD: -4.32; LA: -30.42-21.78; ratio: 0.63) and HF (MPD: 4.29; LA: -21.70-30.28; ratio: 0.45) based on the ratios (> 0.2).

Conclusion

The high correlation and good agreement between mean NN intervals suggest that the BCG device can serve as an alternative to HRV for estimating NN interval.
P042 Lean Six Sigma Approach to Improve Non-Invasive Ventilation Patient Care
Authors: Hartnett C , Angliss M , Leclerc M , Williams G
Published: October 2023

Introduction

A lean six-sigma (LSS) approach to clinical redesign looks at aspects of patient flow, value to consumer and process inefficiencies. We used LSS quality management approach for clinical redesign of our non-invasive ventilation patient care.

Current recommendations suggest that patients using non-invasive ventilation (NIV) require therapy for a minimum of 4 hours per night for optimal health benefits, with less than this amount defined as low adherence. This information is collated for each patient at each clinic visit. The aims of this study were to improve the identification of patients on non-invasive ventilation that are poorly adherent to paediatric specialist support, decrease the time taken for entry of NIV adherence data for all patients and evaluate process/es for scalability for future growth.

Methods

A LSS approach was used with identification of variation, waste and patient flow concerns in diagnostic stage. Rapid improvement events, diagnostic and solution design workshops were conducted to determine root cause, key issues and possible solutions. A preferred solution was adopted through team collaboration.

Results

A diagnostic stage identified two key areas: a 45% increase in telehealth and 162 man-hours of manual data entry for patient care. The solution initiated was to extract NIV machine data remotely and automate data collection.

Discussion

Healthcare is well suited to using the lean six-sigma approach to facilitate team collaboration in all aspects of clinical redesign of a healthcare pathway. Automating aspects of patient care may improve patient health and staff satisfaction.
P046 Knowledge of REM Behaviour Disorder Among Sleep Technicians in Australia
Authors: Coussens S , Cava M
Published: October 2023

Rapid Eye Movement (REM) Behaviour Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis during REM sleep, leading to the enactment of dream content. The accurate identification and management of RBD requires expertise and knowledge among sleep technicians. This study aims to assess the knowledge and awareness of RBD among sleep technicians in Australia.

A survey-based investigation was conducted among sleep technicians working in sleep clinics, hospitals, and research centres across Australia. The survey questionnaire consisted of multiple-choice and open-ended questions covering various aspects of RBD, including its definition and diagnostic criteria as well as their knowledge, training and lab practices. The survey was distributed electronically, and responses were collected anonymously.

Preliminary findings from a sample of 30 sleep technicians revealed a significant variability in knowledge regarding RBD. While 68% of participants demonstrated a solid understanding of RBD, 22% displayed limited knowledge, and 10% had minimal awareness of the disorder. Interestingly, the majority of participants reported that their workplace investigated patients with potential RBD symptoms but also the majority reported that they lacked the knowledge and resources to detect the condition appropriately.

These findings emphasize the need for targeted educational interventions and training programs to enhance the knowledge and competence of sleep technicians in identifying and managing RBD. By addressing these knowledge gaps, sleep technicians can play a vital role in early detection, timely referral, and appropriate management of RBD, thereby improving patient outcomes and quality of life.
P055 Maintaining effectiveness and mitigating sleepiness: A tailored digital CBT-i approach.
Authors: Sweetman A , Richardson C , Reynolds C
Published: October 2023

Background

Bedtime restriction therapy, a core component of cognitive behavioural therapy for insomnia (CBT-i), often leads to an acute increase in daytime sleepiness. To mitigate the effect of bedtime restriction on accident-risk, we aimed to develop and test a 5-session self-guided digital CBT-i program that incorporates self-reported sleepiness into personalised treatment algorithms.

Methods

We recruited people with insomnia symptoms (ISI≥15) reporting no excessive daytime sleepiness (ESS<16) to a clinical trial. We assessed weekly self-reported sleepiness (ESS), nocturnal insomnia severity (Range: 0 [no symptoms] to 12 [worst symptoms]), and self-reported sleep/wake parameters during each digital CBT-i session. Intention-to-treat mixed models were used to investigate changes in weekly symptoms.

Results

Peri-treatment data from 52 people were used (Age M [sd] = 54.2 [15.7]; 81% female). Average ESS scores did not change from session one (M [±95%CI] = 5.9 [1.1]) to sessions two (6.2 [1.1]), three (6.2 [1.2]), four (5.4 [1.2]), or five (5.2 [1.2]). Improvements from sessions one to five were observed in; nocturnal insomnia severity (M [±95%CI] reduction = 4.0 [1.1], d = 2.3), and self-reported sleep onset latency (M reduction = 26.1 minutes [16.5], d = 0.6), wake after sleep onset (M reduction = 73.6 minutes [29.2], d = 1.0), sleep duration (M increase = 36.2 minutes [31.0], d = 0.5), and sleep efficiency (M increase = 17.9% [6.6], d = 1.2).

Conclusion

This digital CBT-i program improved insomnia symptoms without increasing average daytime sleepiness during any session. Further research is required in people commencing treatment with excessive daytime sleepiness.
P069 Assessing the prevalence of anatomical abnormalities amongst patients with sleep disordered breathing and high non-invasive ventilation pressure requirements.
Authors: Dixon O , Ellender C
Published: October 2023

Background

Adherence and tolerance of positive airway pressure (PAP) therapy is thought to be lower in individuals with sleep-disordered breathing and high pressure requirements. Patients occasionally have physical anatomical abnormalities that can contribute to these high pressure requirements. These anatomical abnormalities may have reversible contributors, which may reduce pressure requirements and thus improve tolerance of positive airway pressure.

Methods

A retrospective single centre cohort study of patients with sleep-disordered breathing was performed. Inclusion criteria was prescription of non-invasive ventilation with inspiratory pressure IPAP >25 cmH2O between 01/01/2013-01/01/2023. All indications for PAP were included. Patient demographics, indications for PAP, sleep study results and anthropomorphic details were assessed. Primary outcome will be the proportion of patients assessed for anatomical abnormalities of the upper airway.

Progress to date

To date, 116 patients with high pressure requirements have been identified and data collection is in progress.

Intended outcome and impact

Amongst our local cohort, we aim to describe the proportion, demographic and clinical features of patients with sleep-disordered breathing on bilevel positive airway pressure therapy with high pressure requirements. Ultimately, we hope to use this research to inform decision-making with regards to referral to ENT.
P070 Efficacy of the ExVent Accessory with the O2Vent Optima Oral Appliance in the Treatment of Obstructive Sleep Apnea – A Clinical Trial
Authors: Sharma S , Reiter H , Conflitti A
Published: October 2023

Introduction

The study assessed the efficacy of oral appliance device O2Vent Optima and ExVent, an oral Expiratory Positive Airway Pressure (EPAP) accessory in the treatment of OSA.

Methods

A prospective, open-label study conducted at 3 sites in mild to moderate OSA (AHI ≥ 5 and ≤ 30).

Screening Phase

A diagnostic in-lab PSG study confirmed a diagnosis of mild to moderate OSA.

Treatment I

Subjects used O2Vent Optima for 6 weeks and underwent a PSG sleep night while using the O2Vent Optima.

Treatment II

Subjects used O2Vent Optima + ExVent for 6 weeks and underwent a PSG sleep night while using the O2Vent Optima + ExVent

Primary Effectiveness Measure: Change in AHI between baseline vs. O2Vent Optima MAD vs. O2Vent Optima + ExVent

Results

Treatment with Optima, Optima + ExVent reduced AHI from 22.5±6.4/hr to 12.6±4.5/hr to 5.9±2.7 (p< 0.005 baseline vs. Optima and Optima + ExVent; p<0.05 Optima MAD vs. Optima + ExVent). Average reduction in AHI with Optima was 43% and with Optima + ExVent was 72%. The lowest oxygen during sleep increased from 84.6±2.7% to 88.6±2.9% to 91.6±3.2% (p< 0.005 baseline vs. Optima and Optima + ExVent; p<0.05 Optima vs. Optima + ExVent). During the trial patients on treatment with Optima and Optima + ExVent demonstrated no excessive adverse events or device malfunction.

Conclusion

Treatment with O2Vent Optima and O2Vent Optima + ExVent significantly improved OSA compared to the baseline. Even greater benefit was observed with addition of ExVent to the Optima in mild to moderate OSA.
P074 Sleep-Related Predictors of Road and Workplace Safety in Young Adults: Results from a Community Representative Sample
Authors: Sansom K , Eastwood P , Brown B , Crowther M , Wanstall S , McArdle N , Adams R , Reynolds A
Published: October 2023

Young adults are at increased risk of road and workplace incidents. Sleep-related predictors of increased risk include short sleep duration, sleep disorders and shift work. It is unknown which predictors are the most impactful, or whether they are interrelated. To address this, sleep-related predictors were concurrently examined in young adults. Participants were young adults (22 years) from the Raine Study, who were employed, assessed for common sleep disorders (obstructive sleep apnoea by polysomnography, insomnia and restless legs syndrome symptoms by validated questionnaires), provided information on shift work status and habitual sleep duration. Two sub-groups were analysed: participants with a driver’s licence and self-reported information on road incidents (n=519) and those with information on workplace incidents, regardless of driver’s license status (n=575). Poisson regression models adjusted for sex and comorbidities were used to examine sleep-related predictors of road and workplace incidents. A total of 15% reported ever falling asleep behind the wheel and 23% reported ever having at least one near-miss road accident due to sleepiness. Diagnosis of a sleep disorder predicted near-miss road accidents (risk ratio, 3.0; 95%CI 1.7–5.3), independent of sleep duration and shift work. A total of 11% reported ever falling asleep on the job and 12% reported ever having an accident at work that required seeing a doctor or nurse, neither of these were associated with sleep duration, sleep disorders or shift work status. Sleep disorder diagnosis may be important in young adults given road incidents are strongly associated with the presence of a sleep disorder.