bluuebunny/crossref_metadata_2025 huggingface dataset:
P002 CPAP therapy compliance and changes in cognitive function in patients with obstructive sleep apnoea
Authors: Adams R , Georgeson T , Szollosi I , Coulson E
Published: November 2022

Aims

Obstructive sleep apnoea (OSA) has been implicated in the pathophysiology of Alzheimer’s disease (AD). Intermittent hypoxia and arousals may contribute to mechanisms leading to accumulation of amyloid beta plaques and intraneuronal neurofibrillary tangles seen in AD. Treatment with Continuous Positive Airway Pressure (CPAP) improves symptoms and cardiovascular sequalae of OSA, and may also mitigate the progression of AD. We investigated, in patients with moderate to severe OSA, whether CPAP compliance altered cognitive test scores.

Methods

Cognitive testing with the Addenbrooke’s Cognitive Examination-Revised Version (ACE-R) was performed before commencing CPAP and repeated after 3 to 5 years. Student’s independent t-test was used to compare changes in ACE-R between compliant and non-complaint groups based on usage greater than 4 hours/day.

Results

30 subjects, mean age 67 years (SD=6.4), had baseline ACE-R of 90 (SD=4.75). At follow up, treatment compliant subjects demonstrated improvement in cognitive test scores in the memory and visuospatial cognitive domains with a mean improvement in memory of 1.5 points p=0.01 95% CI [0.33, 2.67], and mean improvement in visuospatial cognition of 0.95 points p=0.01 95% CI [0.23, 1.7]. Scores for CPAP non-compliant subjects showed no significant difference over time.

Conclusion

Sustained use of CPAP over time results in a statistically significant improvement in ACE-R test scores, in the subdomains of memory and visuospatial cognition. However, the clinical significance of these findings is unclear and requires further research, as the scores remained in the normative range.
P003 The Effect of Centella Asiatica on Inactive Frequency and Movement Distance in Insomnia Zebrafish (Danio rerio) Larvae Model
Authors: Afif Z , Santoso M , Khotimah H , Satriotomo I , Iskandar D , Hakimah A , Andriani N , Agustina K
Published: November 2022

Introduction

Insomnia is a global health problem. Zebrafish (Danio rerio) is an ideal model for studying sleep disorder due to its diurnal cycle. Centella Asiatica (CA) is thought to have an anti-insomnia effect, but its mechanism is not clearly understood. The aim of this study is to evaluate the effect of CA on insomnia zebrafish larvae model by observing sleep parameters including inactive frequency and movement distance.

Methods

This experimental study is divided into five groups of zebrafish larvae consisting of control group, insomnia group with 24 hours of light exposure for 7 days, insomnia group with CA concentration of 2.5, 5, and 10 µg/mL. Observation of zebrafish larval movement was carried out on 5, 6, and 7 dpf (day post fertilization) during 30 minutes before and after turning off light exposure.

Results

There were significant differences on 5, 6, and 7 dpf between the normal group, insomnia group, and all treatment groups with CA addition on inactive frequency and movement distance in light and dark conditions (p<0.05).

Discussion

This study showed that CA has an anti-insomnia effect. CA can improve sleep quality of insomnia zebrafish larvae model by increasing inactive frequency and shortening movement distance.

Keywords

Centella Asiatica, zebrafish, inactive frequency, movement distance.
P005 A two-night randomised controlled cross-over trial of AVAPS AE auto-titrating bi-level ventilation vs standard in-lab titration in patients with motor neurone disease commencing overnight ventilatory support
Authors: Aiyappan V , Catcheside P , Grivell N , Hansen C , Keighley James G , Schultz D , Allcroft P
Published: November 2022

Introduction

Sleep disordered breathing in motor neurone disease (MND) is heterogeneous. Auto-adjusting AVAPS-AE mode of non-invasive ventilation (NIV) could simplify NIV setup and use in MND. This pilot study assessed NIV titration and longer-term outcomes with AVAPS AE auto-pressure support versus standard S/T mode NIV titration in patients with MND.

Methods

10 MND patients commencing NIV consented to a 2 consecutive night randomised controlled cross-over trial of auto-titrating AVAPS-AE versus standard S/T mode NIV titrated according to current clinical practice. Patients underwent in-laboratory polysomnography (PSG) on both nights before continuing on the second allocated mode of NIV.

Results

8 patients completed both cross-over nights and 9 subsequently continued on home NIV (4 on S/T and 5 on AVAPS-AE mode). Compared to baseline, both S/T and AVAPS-AE modes significantly reduced apnea hypopnea index (AHI; mean [95%CI] 14.8 [6.8-22.8] to 1.2 [0-2.7] and 3.6 [0-7.1] /h respectively), with no significant differences between modes on other PSG outcomes. Maximum EPAP (15.4 [13.4-17.4] vs 8.3 [4.9-11.6] cmH2O, p=0.003) and pressure support levels (16.3 [11.2-21.3] vs 6.6 [5.9-7.4] cmH2O, p=0.003) were higher with AVAPS-AE versus S/T mode respectively, although average pressure support levels were not different. Over 6 months of follow-up, average daily use was similar in both treatment groups (AVAPS-AE 7.3 [3.2-11.3]; S/T mode 7.8 [3.5-12] h/day).

Conclusion

Automated AVAPS-AE mode of BiPAP support appears to achieve similar control of sleep disordered breathing when compared to standard S/T mode, and to be well tolerated and used in patients with MND.
P008 The relationship between REM Sleep prior to Analogue Trauma and Intrusive Memories
Authors: Alkalame L
Published: November 2022

Intrusive memories are a core feature of posttraumatic stress disorder (PTSD). They both predict the onset of the disorder and drive broader PTSD symptomology. Outside PTSD, disruptions in REM sleep contribute to emotional dysregulation and an amplified reaction to negative emotional stimuli. The current study examined the association between REM sleep prior to analogue trauma and intrusive memories.

To manipulate REM sleep, 22 healthy adults (MAge = 26.05, SD = 5.22) were randomised to either to a circadian misalignment (CM) condition or normal control (NC) condition for four nights. In CM, participants slept normally for two nights followed by a 4-hour phase advance on night three and an additional 4-hour phase advance on night four. In NC, participants slept 8 hours. On the day after night 4, participants watched a trauma film in a controlled laboratory setting. Participants kept an intrusive memory diary for three days following viewing of the film.

Greater REM sleep percentage across 4 nights prior to analogue trauma was significantly associated with fewer intrusive memories independent of group in the 3 days after viewing of the film (p = .015).

Findings suggest REM sleep may serve to protect individuals against experiencing intrusive memories. This is consistent with evidence suggesting REM sleep influences the encoding of emotional memory. Occupations (e.g., emergency service workers/military personnel) who experience circadian disruptions likely to decrease REM sleep (e.g., from shift work) may be at heightened risk of experiencing intrusive memories after trauma exposure, and thus at increased risk of developing PTSD.
P009 The effects of low-dose morphine on sleep and breathlessness in chronic obstructive pulmonary disease
Authors: Altree T , Loffler K , Toson B , Currow D , Eckert D
Published: November 2022

Introduction

Low-dose morphine is prescribed for refractory breathlessness in chronic obstructive pulmonary disease (COPD). Preliminary investigations suggest improved perceived sleep quality, although concerns exist regarding opioid-induced sedation. This study assessed the effects of morphine on subjective sleep quality and alertness, and potential links between sleep quality and breathlessness.

Methods

Analysis of sleep questionnaire and breathlessness data at baseline and after one week of low-dose slow-release morphine versus placebo according to a double-blind randomised controlled design was performed. Participants were randomised to placebo, 8mg or 16mg/day oral morphine for one week (before further dose escalation). Epworth Sleepiness Scale (ESS), Karolinska Sleep Score (KSS), Leeds Sleep Evaluation Questionnaire (LSEQ) and breathlessness severity scores were assessed. Dose effects on sleep measures were assessed via linear regression (including baseline sleep measures). Drug effects on the relationship between sleep quality and breathlessness were assessed via linear mixed models with random effects and three-way interaction between sleep measures, dose, and visit.

Results

156 patients were randomised as follows: 8mg, n=55; 16mg, n=51; placebo n=50. Overall, there was a neutral effect of morphine on ESS, KSS, and LSEQ (all p>0.05). Morphine did not modify the relationship between sleep measures and breathlessness.

Discussion

Despite safety concerns, one week of morphine did not negatively impact subjective sleep or daytime alertness measures. There was no clear relationship between morphine’s effects on sleep and next-day breathlessness perception. Objective data assessing sleep and next-day alertness are required to further explore potential links between sleep and breathlessness in people with COPD.
P010 Success and failure rates of ambulatory home sleep studies (Level 2) among Indigenous patients
Authors: Atos C , Heraganahally S , Howarth T
Published: November 2022

Introduction/Aim

Level 2 sleep studies are being increasingly performed worldwide in order to minimise the cost and access to level1 in-lab polysomnography. However, their accuracy and validity remain disputed. For populations residing in regional and remote localities, access to level1 sleep studies are further compromised, such as among Indigenous people of Australia, where 80% reside in remote communities. There is limited information in the literature regarding the efficacy of level2 sleep studies among Indigenous patients. Hence, in this study we evaluated the efficacy of level2 sleep studies amongst an Indigenous population.

Methods

552 level2 sleep studies from Indigenous patients recorded between 2011-2020 were included. Sleep studies were analysed and scored manually by registered polysomnographic technologist as per standard guidelines. The studies were also assessed to determine the soundness of the study. Demographic and clinical information of patients was also collected.

Results

50% of the patients were female, and 51% resided in remote or very remote locations. Of the 552 studies, 47(8.5%) were failed. There was no significant differences in demographic factors between failed and successful studies. The most common reason for failure was intolerance of the sensors which resulting in removing the device.

Conclusion

Level 2 sleep studies showed high success rate amongst this Indigenous population with just 8.5% failure rate. As there is limited access to level 1 sleep studies among the Indigenous Australian population due to remoteness, this study shows that level 2 sleep studies are a feasible alternative in the diagnosis for the presence of sleep disorders.
P014 IgLON5 Disease – A Review of 2 Cases and Sleep Manifestations
Authors: Banks J , Sachs G
Published: November 2022

Background

IgLON5 disease is a novel autoimmune tauopathy with diverse sleep and neurologic manifestations. Sleep disorder is a common initial presentation and may precede disease progression. Neurological symptoms frequently overlap with extrapyramidal syndromes, motor neuron disease and dementia.

Diagnosis is confirmed by anti-IgLON5 IgG in CSF and/or serum. Strong HLA-DRB1*1001 and HLA-DQB1*0501 association supports autoimmune mechanism. Video-PSG is recommended to identify treatable sleep-disordered breathing and parasomnia, present in up to 90% of cases.

Treatment is empirical immunomodulation plus supportive cares. Mortality is high due to sudden cardiorespiratory arrest

Methods

Case reports.

Progress to date

Case 1 - 70-year-old male with recurrent respiratory arrests of apparent mixed aetiology and progressive dysphagia over 6 months. Preliminary investigations were unremarkable. Tracheostomy was inserted and immunoglobulin empirically commenced. IgLON5 antibodies were identified on CSF. HLA-DRB1*1001 and HLA-DQB1*0501 were positive. Pulse methylprednisolone and rituximab were administered. Intermittent respiratory failure subsided but bulbar symptoms progress. PSG showed NREM and REM parasomnia plus ataxic breathing.

Case 2 - 58-year-old man presenting with altered level of consciousness. Examination findings included unsteady gait, strabismus, myoclonus, and truncal instability. IgLON5 IgG was identified on CSF. Sleep study showed ataxic breathing. Patient was treated with IVIG plus rituximab and CPAP. History is suspicious for evolving parasomnia.

Intended outcome and impact

IgLON5 disease is a newly recognized disorder with sleep manifestations. The ataxic breathing has not been well described. IgLON5 disease teases a novel association between autoimmunity and neurodegeneration.
P017 A Model for Behavioural Sleep Intervention via Telehealth for Children Diagnosed with Autism Spectrum Disorder
Authors: Bennett-Stewart A
Published: November 2022

Approximately 1 in 150 people in Australia are diagnosed with Autism Spectrum Disorder (ASD) (Australian Institute of Health and Welfare, 2017). Studies suggest up to 80% of children diagnosed with ASD experience sleep difficulties (Cortesi et al., 2010). Behavioural sleep intervention is effective to improve sleep difficulties for children diagnosed with ASD (Jin, Hanley & Beaulieu, 2013). Additionally, caregiver support via telehealth can provide clients with greater access and flexibility of services. This paper will explore the current research on behavioural sleep intervention from a Behaviour-Analytic perspective and provide a model for behavioural sleep intervention via telehealth. This three-phase model includes: (1) an initial comprehensive behavioural sleep assessment, including the Sleep Assessment and Treatment Tool (Hanley, 2005) and baseline data collection to gather information on the child’s current sleep schedule and behaviours, (2) supporting caregiver implementation of an individualised behavioural sleep intervention via telehealth, including daily data collection and graphing to monitor efficacy throughout the intervention, and (3) ongoing review and revision alongside the caregiver until their and their child’s sleep goal has been achieved. By providing evidence-based behavioural sleep intervention via telehealth, children diagnosed with ASD can achieve healthy sleep.
P018 Effect of CBT-I on sleep-wake state discrepancy in individuals with co-morbid insomnia and sleep apnoea: A randomised controlled trial
Authors: Bensen-Boakes D , Osman A , Lack L , Catcheside P , Antic N , Smith S , Chai-Coetzer C , O'Grady A , Dunn N , Robinson J , McEvoy D , Sweetman A
Published: November 2022

Introduction

Cognitive behavioural therapy for insomnia (CBT-I) is the recommended treatment for insomnia and improves insomnia symptoms. However, CBT-I effects on sleep-wake state discrepancy have not previously been examined in a sample of individuals with co-morbid insomnia and sleep apnoea (COMISA). This randomised controlled trial investigated the effect of CBT-I, versus no-treatment control, on sleep-wake state discrepancy in people with COMISA.

Methods

145 participants had their subjective and objective sleep parameters recorded at pre- and post-treatment via overnight sleep diaries and polysomnography.

Results

Pre-treatment, individuals with COMISA significantly (p < 0.05) underestimated their sleep duration (M min = −51.9, SD = 94.1) and sleep efficiency (M % = −9.6, SD = 18.3) and significantly (p < 0.05) overestimated sleep onset latency (M min = 34.5, SD = 86.1). Post-treatment, there were significant reductions in sleep-wake state discrepancy parameters in both groups, but no significant interaction effects to support any differences between CBT-I versus waitlist control groups (all interactions, p > 0.367).

Discussion

These findings suggest that treating the insomnia aspect of COMISA through CBT-I first may not be an effective method of reducing sleep-wake state discrepancy. This is possibly due to sleep apnoea being untreated, contributing to frequent awakenings and the discrepancy between perceived and polysomnography derived sleep parameters. Future studies could involve a COMISA group that receives treatment for their sleep apnoea symptoms before CBT-I.
P019 Automatic Detection of Patient-Ventilator Asynchrony during Non-Invasive Ventilation using Matrix Profiles
Authors: Juliandri M , Aicklin U , Ristanoski G , Hannan L , Sheers N , Howard M , Berlowitz D
Published: November 2022

Automated Patient-Ventilator Asynchrony (PVA) detection and classification has been described previously, however most approaches target specific asynchrony types, are not applicable in non-invasive ventilation, and require manual pre-processing, removing the opportunity for real-time analysis.

During our previous study of polysomnography-assisted NIV implementation (Hannan 2019), each participants’ sleep studies were manually, breath-by-breath scored for PVA. The data were collected over approximately 8 hours and included > 650,000 breath cycles. The source data for the machine learning consisted of the 21 recorded signal traces exported as text files.

We employed an outlier detection approach to detect asynchrony with Artificial Intelligence (AI) models as the core engine. The fully automated approach starts with pre-processing to filter and de-noise the polysomnography data, with AI models, including Multidimensional Matrix Profiles, employed to find asynchronies from a signal subset.

We initially investigated the best features for PVA and arousal detection in a subset of the 59 participant sleep studies with the highest number of labelled asynchronies and arousals. These six participants had a total of 6,942 events: 799 Arousal, 3,026 Ineffective Triggering, 1,983 Double Triggering and 1,134 Auto Triggering. All events were used in the training/testing stage. The best-balanced model employed a denoising technique with 300 milliseconds as the aggregating data points interval across: mask pressure, ventilator measured flow, abdominal, and thoracic band traces. This approach resulted in 0.80 for both sensitivity and specificity.
P021 Associations between Virtual Reality (VR) Ocular Assessments and Vigilance during Extended Wakefulness – Preliminary Analysis
Authors: Bickley K , Adams R , Anderson C , Cori J , Howard M , Lack L , Lovato N , Stevens D , Vakulin A
Published: November 2022

Introduction

Sustained vigilance is essential for safety in high-risk workplaces, making rapid and accessible alertness failure vulnerability assessments extremely desirable. We are piloting existing technology, the NeuroFlex® Platform, which takes ocular performance measurements of both prosaccade and antisaccade eye-movements using a portable Virtual Reality (VR) headset. We’ve conducted preliminary comparisons between these measures and Psychomotor Vigilance during extended wakefulness.

Methods

Sixteen young-adults (females= 8; age M= 25.13, SD= 4.30) completed five test batteries starting 1-hour post-wake where repeated testing encapsuled more than 24-hours of extended wakefulness. Each battery consisted of two 10-minute visual Psychomotor Vigilance Tasks, in addition to three administrations of 60-second prosaccade and antisaccade assessments using the NeuroFlex® VR platform.

Results

Time main effects occurred for reciprocal reaction time, F(3.83,57.37) = 20.54, p <.001, and proportions of lapses/trials, F(3.55,48.33) = 7.36, p <.001. Vigilance troughs occurred around the circadian nadir (19-hours post-wake) with some recovery at final administrations (25-hours post-wake). No associations were found between prosaccade latency and vigilance metrics. Moderate negative (r=-.63, p=.01 & r=-.54, p=.03) associations were found between antisaccade latency and reciprocal reaction time near the nadir, but not the number of lapses per trial.

Discussion

This preliminary analysis has demonstrated potential sensitivity of the NeuroFlex® platforms ocular measurements to vigilance. Though we have not detected associations between lapses and eye-movement latency, we were limited to the existing output generation of the NeuroFlex® platform in this preliminary investigation. With refined data analyses, we see promise in the NeuroFlex® platforms capability of predicting alertness failure.
P022 Obstructive sleep apnoea and cancer risk: preliminary results of a case-control analysis using data from the Cancer Lifestyle and Evaluation of Risk Study (CLEAR) study
Authors: Bin Y , Cook K , Nair-Shalliker V , Sutherland K , Cistulli P
Published: November 2022

INTRODUCTION

Animal and cellular models suggest that obstructive sleep apnoea (OSA) plays a role in the development of cancer. Epidemiological studies have found inconsistent associations and typically lack control for lifestyle risk factors contributing to both OSA and cancer. We examined associations between OSA and common cancers in a case-control study.

METHODS

We analysed data from the New South Wales CLEAR Study which recruited adults with newly diagnosed cancer (n=8551 cases) and cancer-free controls (n=2230). Self-reported OSA was compared in women and men with a verified cancer diagnosis and controls of the same gender. Covariates included age, body mass index, smoking, passive smoking, alcohol intake, physical activity, skin colour, and time spent outdoors.

RESULTS

OSA was more common in cancer cases than controls: 2.9% vs. 1.9% in women and 7.9% vs. 5.9% in men. For women, OSA was not significantly associated with melanoma (AOR 1.58, 95% CI 0.76-3.29), lung (1.54; 0.59 - 3.99), breast (1.35; 0.79-2.31), or bowel cancer (1.26, 0.61 - 2.59) after adjustment for potential confounders. For men, OSA was not significantly associated with bowel (1.37; 0.92-2.03), prostate (1.31; 0.94 -1.82), lung (0.96; 0.45-2.01), or melanoma (0.92; 0.58-1.48) after control for covariates.

DISCUSSION

Further analysis will consider rarer cancers and the role of shiftwork, sleep duration, and napping. Preliminary results support a link between OSA and common cancers only through shared risk factors. Information on OSA treatment is missing from this study. OSA treatment together with self-reported OSA may lead to under-estimation of any OSA-cancer association.
P029 Examining the Efficacy of Two Apps on Sleep and Anxiety in Children with Autism
Authors: Hunt S , Leahy R , Conduit R
Published: November 2022

INTRODUCTION

Children with Autism Spectrum Disorder (ASD) frequently experience a range of comorbidities alongside their condition. Particularly, sleep problems and anxiety disorders are highly prevalent, and often co-occur. The present study aimed to determine if using a mindfulness app before bed could reduce overall anxiety and improve sleep quality in children with ASD.

METHOD

Twelve children aged 7 to 12 with an ASD diagnosis participated in a blinded two-week controlled trial testing the use of two apps before bed. Children were allocated to the experimental mindfulness app or the active sleep melodies control app via counterbalancing.

RESULTS

Results of 2x2 mixed model ANOVAs revealed significant pre-post improvements in both apps for parent-reported sleep problems (p < 0.05), and a significant interaction effect for parent-reported pre-sleep arousal (p <0.05). Simple main effects analysis of the interaction results revealed that these differences were due to significant improvements in the active control group (p < 0.05).

DISCUSSION

Potential reasons for significant improvements in the active control group may have been due to the personalised choice of sounds/melodies for the active control app, or difficulty with the comprehension of instructions in the mindfulness app for ASD children. Overall, these results provide preliminary evidence of the general benefits of using apps to aid with sleep in children with ASD.
P036 Rapid oscillatory ventilation seen during positive airway pressure titration studies: A case series
Authors: Duong V , Kee K , Stonehouse J , Wallbridge P
Published: November 2022

We have observed a phenomenon in some patients undergoing positive airway pressure implement/titration studies in our sleep lab, characterised by periods of extremely high respiratory rates of up to 80 breaths/min which appear to be device triggered. These episodes occur during periods of central apnoea and last up to 1.5-2.0 minutes. A possible related phenomenon has been reported in a case series of 4 patients published in the Journal of Clinical Sleep Medicine in 2018 (Gupta et al), however this was using a different CPAP device and respiratory rates were significantly lower than what we have observed. Apart from this, there are no reports in the literature that are consistent with the observations we have made in our lab.

Correspondence from the device vendor have suggested that the episodes are due to a rare state in the motor control system which maintains correct pressure in the mask circuit and may have been influenced by our lab not using the vendor’s proprietary heated tubing system. In addition, the incidence rate of this is said to be extremely low at 0.00087%, although our lab has already observed at least 5 cases of this in the 6 months from August 2021 to February 2022.

Our objective is to present a case series to inform the broader sleep community of our unique observations.
P040 Obstructive sleep apnea during REM sleep: Effects on morning and evening blood pressure
Authors: Falla C , Young A , Pope A , O'Driscoll D
Published: November 2022

Study Objectives

Obstructive sleep apnea (OSA) is linked to the emergence and progression of cardiovascular complications including hypertension, stroke, arrhythmias, coronary artery disease and heart failure. Epidemiological studies have reported that hypertension is associated with respiratory events during REM sleep. We examined the relationship between respiratory events during REM and morning and evening hypertension in a clinical sleep population.

Methods

This study included data from in-laboratory diagnostic polysomnographic studies (n=797) from adults attending for investigation of OSA. Hypertension was defined using blood pressure measurements taken in the evening before and morning after polysomnography, and use of anti-hypertensive medication. Regression modelling was undertaken to examine the probability of evening and morning hypertension according to REM apnea hypopnea index (AHI), NREM AHI, gender, age, body mass index (BMI), alcohol use, total sleep time (TST), sleep time SpO2 <90%, smoking and waist-to-hip ratio.

Results

The probability of morning hypertension was significantly independently associated with age (p<0.001), BMI (p<0.001) and REM AHI (p=0.012). No significant effect was found for male gender, NREM AHI, alcohol use, TST, sleep time SpO2 <90%, smoking or waist-to-hip ratio (p>0.05 for all). The probability of evening hypertension was only significantly associated with age (p<0.001), BMI (p<0.001) and TST (p=0.029).

Conclusions

Respiratory events during REM sleep are significantly associated with morning hypertension. Future research is needed to determine whether treatment of these events can prevent or reverse morning hypertension.
P044 “Get some sleep before baby”: Discourses of sleep and pregnancy in the media
Authors: Ladyman C , Signal L , Breheny M , Ross I , Dew K , Gibson R
Published: November 2022

Background

Physiological and psychosocial changes during pregnancy are often associated with altered sleep. Beliefs and expectations about sleep at this life-stage inform social discourses and help-seeking, in turn influencing women’s health and wellbeing. An understanding of discourses concerning sleep and pregnancy is required. Analysis of sleep-related messaging within mainstream media contributes to this understanding.

Method

Texts from New Zealand’s primary free online news source “Stuff” were identified using key words “sleep AND pregnancy” or “sleep AND pregnant” between December 2018 and December 2021. Forty-three relevant articles were collated. A critical discourse analysis was used to describe and interpret the texts in relation to discursive practices and wider social explanations.

Findings

Discursive constructions included: ‘banking’ sleep before baby; sleep’s role in ‘being the perfect mother’ (including ways to reduce risk of infant death through sleep practices); the inevitability that sleep will fail amongst the busy lifestyle of parenthood. Pregnant women were presented as responsible for good sleep yet not provided the knowledge of how to achieve it. Furthermore, pregnant women’s sleep situations were used to illustrate ‘desperate times’ associated with poor living or working situations.

Conclusions

Social discourses of sleep and pregnancy within mainstream media were sensationalised including tensions between discouraging ‘harmful’ sleep practices whilst also asserting that poor sleep is inevitable due to physiological changes and the negotiation of sleep with others, which would only worsen after birth. Findings will inform future research in the field of sleep as a social concept and practice among people during pregnancy.
P045 Profiles of Sleep Status in Older Adults and the Associated Characteristics
Authors: Jones C , Towers A , Gibson R
Published: November 2022

Introduction

Sleep problems become more prevalent in older adulthood having implications for healthy ageing. Characteristics of sleep status are under-explored among older populations.

Methods

Data from 13,309 adults ≥ 15 years was analysed from the 2013/2014 New Zealand Health Survey, 22% (2,932) were older adults (≥ 65 years; 56.51% female, 21.32% Māori). Five sleep profiles were established according to self-reported (a) presence of a sleep disorder; (b) excessive day-time sleepiness and (c) short sleep; (d) long sleep; and (e) typical sleep durations. Sociodemographic and health risk factors and health status were explored and multivariate multinomial models conducted to identify the factors associated with each sleep profile in older adulthood.

Results

Of the older adults, 27.8% were categorised within profiles that typified poor sleep (compared 19.35% of adults aged 15-64 years). Older adults were more likely to be classified within the ‘sleep disorder’, ‘excessive sleepiness’ or ‘long sleep’ profiles compared to the younger adults.

Among the older adults, multimorbidity and polypharmacy were independent predictors of the ‘sleep disorder’ profile, whereas ‘typical sleep’ was significantly associated with better health and socio-economic status. Inadequate nutrition, age and sex were significant predictors of ‘long sleep’. While age, sex, ethnicity, body mass index, and higher quantities of alcohol consumption were independently associated with ‘excessive sleepiness’.

Conclusions

This research helps establish a picture of the characteristics that coincide with profiles of poor sleep in older adulthood. Early recognition and management of sleep problems could improve physical and mental health status with aging.
P046 The Utility of Maintenance of Wakefulness Test (MWT) in Paediatric Narcolepsy
Authors: Gonski K , Thambipillay G , Williamson B , Teng A
Published: November 2022

Introduction

The Maintenance of Wakefulness Test (MWT) has been used as an objective measure of the ability to stay awake and can be used to assess effectiveness of treatment. There are no universally accepted guidelines for assessing effective treatment or driving readiness in adolescents with narcolepsy and there is only limited data published on the use of MWT in children. The purpose of this study is to present a single-centre experience recording the use of MWT in a paediatric series.

Methods

This study reviewed the charts of children with narcolepsy who had an MWT performed between April 2014-January 2022. Demographics, clinical characteristics, MWT findings, change in management and driving status were obtained.

Results

MWT-40 minute protocol was used on 12 children with narcolepsy (median age 16.38 years, range 15.92 – 18.97years), of which 9 (75%) had cataplexy and four (33%) were males. The MWT was used to assess response to treatment and driving suitability. Two (17%) fell asleep during the 4 wake-trials. The median mean sleep latency for all studies was 16.88 minutes (range 5.75-28 minutes). In these two patients, findings from the MWT resulted in changes in management. Eight obtained their learners-driver’s licence after the

MWT

Five signed “driving contracts” with their physician.

Discussion

Our result suggests that the MWT has clinical usefulness in evaluating responses to treatment in adolescents with narcolepsy. Changes in management occurred in all patients who failed MWT. This test was used in half patients to help determine readiness for driving in this group.
P050 Sleep, Eat, Comment, Repeat: Understanding the influence of sleep on the eating behaviours of shiftworkers through comments on Facebook
Authors: McIntosh E , Gupta C
Published: November 2022

Introduction

Shiftworkers experience altered sleeping patterns and eating habits compared to dayworkers. This leads to long-term negative health outcomes. While characteristics of shiftwork, such as work hours and food availability, impact eating habits, the impact of altered sleeping on the eating behaviour of shiftworkers is unknown. The aim of this study was to explore how sleep patterns impact the eating behaviour of shiftworkers through the analysis of Facebook comments.

Methods

The Facebook search function was used to identify posts relating to shiftwork, sleep, and food on public pages. Comments were collected if they were posted by self-identified shiftworkers, relatives of shiftworkers, or partners of shiftworkers. Thematic analysis was conducted on all comments to identify themes relating to sleeping and eating.

Results

144 comments were collected and analysed. Comments reported feelings of sleepiness as motivating the choice for unhealthy foods and the choice to eat large quantities of food. Multiple comments also discussed how unhealthy food on shift contributed to poor sleep post-shift.

Discussion

Given that, in a naturalistic environment like Facebook, shiftworkers display an understanding of an influence of sleepiness on food choice, interventions can move past making shiftworkers aware of poor sleeping and eating patterns and move to strategies that optimise the timing of these behaviours. Such strategies should consider the relationship between sleep and eating to inform strategies to promote healthy eating patterns together with healthy sleep, with the goal of improving shiftworker health and safety.
P052 Treatment preferences and help seeking behaviours of Australian adults with insomnia symptoms
Authors: Haycock J , Lack L , Hoon E , Sweetman A , Appleton S , Loffler K , Scott H , Lovato N
Published: November 2022

Introduction

Clinical guidelines for the treatment of insomnia recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment, ideally provided by a psychologist. However, previous research shows most people with insomnia are not referred to a psychologist, and many are prescribed sedative-hypnotic medicines. This study surveyed people seeking treatment for insomnia to better understand their help-seeking behaviours and treatment preferences.

Methods

A total of 745 Australian adults seeking treatment for insomnia (Age M = 54.46, SD = 13.39, 69% female) completed an online survey about sleeping difficulties, help seeking behaviours, and treatment preferences. Insomnia Severity Index (ISI) scores of 15+ were used to identify people with chronic insomnia. Open ended questions allowed participants to provide detailed qualitative information. Content analysis was used to analyse these data.

Results

Preliminary findings show 64% of participants with insomnia discussed sleep with their GP in the past year but only 16% received a referral to a psychologist or CBTi (7%). Reasons for not seeing a psychologist include GP had not referred (43%) and cost concerns (25%). Only 13% of participants who selected CBTi as their preferred treatment had been able to access this treatment.

Discussion

Most people in Australia who are seeking treatment for insomnia discuss sleep with their GP, but do not receive a referral to a psychologist. Understanding the help seeking behaviours and treatment preferences of people with insomnia symptoms will help identify barriers in the management of insomnia, and ensure more people have access to evidence-based treatment.
P054 Effects of treatment of sleep disordered breathing on actigraphic sleep measures and daytime functioning in children with Down syndrome
Authors: Horne R , Shetty M , Davey M , Walter L , Nixon G
Published: November 2022

Background

Children with Down syndrome (DS) are at increased risk of obstructive sleep disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. We examined the effects of treatment of SDB on sleep and daytime functioning in children with DS.

Methods

Children with DS and SDB (n=34) completed a baseline and follow-up study which included 7 days of actigraphy in conjunction with a parental sleep diary. Parents also completed a number of questionnaires assessing sleep, behaviour, daytime functioning and quality of life (QOL). All children had overnight polysomnography (PSG) at baseline and 24 had PSG at follow-up.

Results

15 children (44%) were treated. At baseline the treated group had more severe SDB at baseline compared to the untreated group: obstructive apnoea hypopnoea index (OAHI) 29.3 ± 38.2 events/h vs 3.3 ± 5.2 events/h (p<0.01). Actigraphy showed no significant differences in total sleep time or sleep efficiency from baseline to follow up in either the treated or untreated group. Wake after sleep onset increased at follow-up in the untreated group (p<0.01). The sleep disturbance (p<0.01) and total problems (p<0.05) scales on the OSA-18 and the SDB subscale on the Pediatric Sleep Problem Survey Instrument (p<0.01) improved in the treated children. No changes were seen in any of the measures in the untreated children.

Conclusions

Treatment of SDB improves QOL, despite treatment having no demonstrable impacts on actigraphic sleep measures. In contrast despite having less severe SDB children who were untreated had no improvements in QOL and increased sleep disruption.
P064 Process O May Contribute to the 90 min NREM/REM Sleep Cycles
Authors: Lack L , Lovato N
Published: November 2022

The mechanism responsible for the ubiquitous NREM/REM sleep cycles of approximately 90-min period length in humans remains largely unknown. It was originally said to be a product of the 90-minute Basic-Rest-Activity-Cycle (BRAC) assumed to pervade throughout sleep and wakefulness. However, the evidence for the existence of the BRAC during wakefulness is weak and questionable. It is important to consider other possible contributors to this fundamental sleep cycle process.

Process O (state onset, offset) has been suggested to account for empirical data inexplicable by Processes S and C. The data in question is the significant increase in alertness following a brief nap (<10min sleep) and the longer than predicted sleep episodes (40-90 min) following a brief awakening towards the end of a normal sleep period.

Process O is proposed to operate similarly to Process S but with a build-up of inhibition to an ongoing state (wake or NREM sleep or REM sleep) that is rapid but self-limiting after 1-2 hours. It also has a rapid (~10min) dissipation of inhibition to the previous state with the offset of that state such that resuming the previous state (onset) rejuvenates the functions of that previous state (wakefulness, NREM, or REM sleep).

In operation during the sleep period Process O accumulates inhibition to NREM sleep over the first 80-100 minutes enough to flip the ‘sleep switch’ to another state (REM sleep). Only a brief period (5-10min) is needed to dissipate NREM inhibition such that NREM, still stronger than REM, can resume another cycle.
P066 A randomised, double-blind, placebo-controlled, single-dose, crossover, pilot study investigating the effects of cannabinol (CBN) 30 mg and 300 mg on sleep architecture and next-day function in insomnia disorder
Authors: Lavender I , Suraev A , McCartney D , Irwin C , Kevin R , D'Rozario A , Gordon C , Marshall N , Saini B , McGregor I , Grunstein R , Yee B , Hoyos C
Published: November 2022

Introduction

There is a clear need for novel interventions for insomnia disorder. Growing evidence suggests a role of the endogenous cannabinoid system in regulating circadian sleep-wake cycles, highlighting a potential avenue for novel therapeutics. Cannabinol (CBN), a trace cannabinoid formed through oxidation of delta-9-tetrahydrocannbinol (THC), is hypothesised to impact sleep. Despite anecdotal and preclinical evidence, the effects of CBN isolate on sleep have never examined through well-designed clinical trial procedures.

Methods

This randomised, double-blind, placebo-controlled, three-arm, crossover, single-site, pilot study will investigate the acute effects of oral dose CBN at 30 and 300 mg in twenty patients with clinician-diagnosed insomnia disorder (and Insomnia Severity Index [ISI] Score ≥15). Across three treatment sessions, each separated by two-weeks washout, participants will receive two doses of CBN and matched placebo, at random. Participants will undergo overnight sleep assessment using in-laboratory polysomnography and next-day neurobehavioral function tests. The primary outcomes are CBN (30 and 300 mg) effects on sleep continuity (wake after sleep onset minutes), compared to placebo, measured using polysomnography. Secondary outcomes include changes to sleep micro-architecture, traditional sleep staging, and absolute spectral power during non-rapid eye movement sleep. Various other subjective and objective safety measures will be obtained.

Discussion

This study will provide novel preliminary data on the effects of CBN on sleep and next-day function in adults living with insomnia disorder which will inform the design of larger clinical trials.
P071 Actigraphy-Derived Rest-Activity Rhythms Predict Sleep-Related Self-Report Outcomes in Women Receiving Chemotherapy for Breast Cancer
Authors: Maccora J , Bean H , Phillips A , Diggens J , Ftanou M , Alexander M , Stafford L , Francis P , Bei B , Wiley J
Published: November 2022

Introduction

Circadian rest-activity rhythms (RARs) disruption is common during chemotherapy for breast cancer, but little is known regarding its association with sleep and daytime functioning. In this study, we evaluated whether objectively-assessed RARs prospectively predict self-reported insomnia and fatigue symptoms, daytime sleep-related impairment, and sleep disturbance.

Methods

This is a secondary analysis of a trial. Participants (N=101) were randomized to cognitive behavioural plus light therapy or relaxation audios. Participants wore an actigraph continuously throughout the 6-week intervention. RAR indices (interdaily stability, intradaily variability, relative amplitude, least active 5h period [L5], most active 10h period [M10]) were calculated based on two weeks (4 & 5). Self-reported outcomes were assessed at weeks 3 and 6. Self-reported outcomes at week 6 were predicted by RAR indices controlling for self-reported outcomes at week 3 and intervention condition.

Results

Lower L5 predicted lower self-reported insomnia and fatigue symptoms, sleep-related impairment, and sleep disturbance (all p<.05). With the exception of insomnia symptoms (p>.05), higher inter-daily stability predicted lower symptoms of fatigue, sleep-related impairment and sleep disturbance (all p<.05). Similarly, excluding sleep disturbance (p>.05), higher relative amplitude predicted fewer endorsed symptoms on self-reported measures (all p<.01). Neither M10 nor intradaily variability predicted self-reported outcomes (all p>.05).

Discussion

RAR disruption demonstrated the most reliable association with daytime sleep-related complaints. The entrainment of a robust diurnal rhythm may reflect a novel intervention target. Direct intervention on distinct RAR characteristics may yield secondary gains on several self-reported sleep-related outcomes, particularly those related to daytime functioning.

Trial Registration

ACTRN12618001255279
P072 Predicting vigilance in a shift-work context with under-mattress sensor data from the preceding sleep
Authors: Manners J , Guyett A , Stuart N , Nguyen P , Lechat B , Eckert D , Kemps E , Catcheside P , Scott H
Published: November 2022

Introduction

Performance impairments are risky in many industries, including healthcare and defence. Predicting when impairments are more likely to occur is critical to reduce costly workplace accidents and errors. This study created models for predicting vigilance during simulated night shift-work from under-mattress sleep sensor data.

Methods

The parent study compared two conditions for phase delaying individuals to adjust to night shift-work. Participants (N=11) attended the laboratory for eight days per condition, one month apart. After a baseline sleep (10PM-7AM), participants remained awake for 27hrs, then slept from 10AM-7PM for the next four days with sleep metrics recorded by an under-mattress sensor (the Withings Sleep Analyzer). At night, participants completed simulated night shifts, including six psychomotor vigilance tasks (PVTs) per shift (48 resulting datapoints per participant). The current study predicted PVT performance from the preceding daytime sleep based on 27 sleep variables using machine learning (Extra trees) models. Data were randomly split into a 67% subset for model training and variable reduction, and a 33% subset for testing model fit.

Results

12 variables were retained following feature reduction. The final models demonstrated good fit for reaction time <500ms (R² = 0.79, RMSE = 20.4ms), reciprocal reaction time (R² = 0.70), and number of lapses (R² = 0.69).

Discussion

These preliminary findings are comparable to current fatigue prediction models, supporting that vigilance can be predicted from unobtrusively collected sleep data. Further research will confirm whether these models may assist in the safer delegation of work tasks and self-management of shift-workers.
P075 Feasibility of 12 weeks melatonin supplementation in Mild Cognitive Impairment
Authors: Menczel Schrire Z , Phillips C , Duffy S , Marshall N , Mowszowski L , LaMonica H , Gordon C , Naismith S , Grunstein R , Hoyos C
Published: November 2022

Introduction

Melatonin has been hypothesised to slow cognitive decline in older adults due to its proposed multiple therapeutic benefits.

Methods

Participants with Mild Cognitive Impairment (MCI) were recruited from the community for a pilot 12-week randomised placebo-controlled trial of 25mg oral melatonin to target brain oxidative stress and cognition. Primary outcomes were feasibility, acceptability, and tolerability. Secondary outcomes were brain oxidative stress (magnetic resonance spectroscopy) and cognition at 12 weeks.

Results

The study recruited 40 participants who were randomised to receive melatonin or placebo. Feasibility of recruitment, calculated by the percent of individuals who met inclusion and exclusion criteria on screening, was 42/389, 11%. The most common exclusion criteria met was age. Acceptability of intervention, defined as the number of participants who agreed to be randomised, was 40/42, 95%. At 12 weeks, adherence data collected by both medication diaries and pill counting was over the 80% threshold for all participants. Additionally, 38 participants completed MRI scans and 40 participants completed the cognitive assessment battery, providing preliminary data to support future trials.

Discussion

The results of this feasibility trial demonstrate challenge to find individuals in the general community that fit the criteria for MCI. However, once recruited, this population has shown the ability to follow the protocol and adhere to the trial medication. These results will inform a future definitive randomised controlled trial to specifically test the efficacy of melatonin on modifiable risk factors of dementia, as well as cognition and brain function.