bluuebunny/crossref_metadata_2025_split huggingface dataset:
P088 Screening for Paediatric Sleep Disordered Breathing in Dental Settings: A scoping review
Authors: Baskar R , Silva M , Vandeleur M 
Published: December 2024

Abstract

Introduction
Sleep-disordered breathing (SDB) can have a significant impact on a child’s growth and neurocognitive development. The gold standard for the diagnosis of SDB is an overnight polysomnography (PSG). However, challenges such as the limited availability, accessibility and cost of diagnostic services along with limited parent/caregiver awareness of symptoms can contribute to diagnostic delays. Screening questionnaires offer a simple and cost-effective method to identify at-risk paediatric patients and can guide referrals to sleep specialists. Dental appointments represent an opportunity for screening in the community. This scoping review aims to explore the existing literature on paediatric SDB screening in dental settings and identify knowledge gaps.

Methods
Using a scoping review framework, a comprehensive search was undertaken using Medline, Embase, and PubMed. The search strategy included broad search terms relating to questionnaires, sleep-disordered breathing, dentists and children.

Progress to Date
The scoping review protocol was registered on Open Science forum on 15th April 2024. Of the total eligible 482 peer-reviewed publications included in the original search, 40 studies have been included in the final analysis. The author is currently in the process of data extraction.

Intended Outcome and Impact
The intended outcomes are to identify current screening tools for SDB in dental settings, describe their components, advantages, disadvantages, and pinpoint gaps in the literature.
P089 Mental Health and Health-Related QoL in Central Disorders of Hypersomnolence vs Unexplained Excessive Daytime Sleepiness
Authors: Bild E , Winter S 
Published: December 2024

Abstract

Introduction
Central Disorders of Hypersomnolence (CDH) (Narcolepsy Type 1, Narcolepsy Type 2, and Idiopathic Hypersomnolence) have an essential element of excessive daytime sleepiness (EDS) despite an adequate duration of sleep. CDH significantly impact mental health and health-related quality of life (QoL). However, less is known about the impact of unexplained EDS (i.e., not better explained by CDH, insomnia, or uncontrolled Obstructive Sleep Apnoea (OSA)) on mental health and health-related QoL. The objective of this study was to compare the mental health and QoL of patients diagnosed with CDH vs unexplained EDS.

Methods
Patients referred to a sleep psychology service in a major tertiary hospital from January 2022 to May 2024 for management of CDH or unexplained EDS were included. Exclusion criteria were a referral for insomnia, OSA, or circadian rhythm disorder. Data included were the number of sessions and initial Depression Anxiety Stress Scales (DASS-21), Kessler Psychological Distress Scale (K10), EQ-5D-5L, and Insomnia Severity Index (ISI).

Results
During the assessed period, the service received 31 referrals for EDS (CDH = 19, unexplained EDS = 12). The average number of sleep psychology sessions attended was 4 (range = 0-12). Although the sample was too small to achieve adequate power for analysis, patients with unexplained EDS trended towards higher scores across all mental health and health-related QoL measures than patients with a CDH diagnosis.

Discussion
This study highlights the importance of studying patients with unexplained EDS and the benefits they may gain from accessing sleep psychology services.
P092 Māori Sleep Health across the Lifespan: A scoping review of the literature
Authors: Baddock S , Campbell A , Love R , Paine S 
Published: December 2024

Abstract

Introduction
In Aotearoa New Zealand, Māori experience poorer health outcomes than non-Māori and these inequities extend into sleep health. Our aim was to summarise the peer reviewed literature on Māori sleep health to understand the equity gaps to inform policy and future research.

Methods
A broad systematic search of widely used literature databases was conducted using the keywords: “sleep”, “insomnia” “sleep initiation and maintenance disorders” combined with “Māori”; “New Zealand” or “Oceanic Ancestry Group”. Studies providing information on Māori sleep health were reviewed for Māori versus non-Māori results. Sleep outcomes were tabulated against Buysee’s five sleep health dimensions along with variables such as socioeconomic deprivation. Sleep data summaries were presented for each life stage.

Results
Eighty seven articles published between 1982 and 2021 met the inclusion criteria. Data collection measures were mostly self or parental-report utilising rating scales or validated questionnaires. Inequities in sleep health between Māori and non-Māori were identified across all life stages. Adult studies demonstrated inequities over all five sleep health dimensions of sleep duration, efficiency, timing, alertness, and sleep quality. Socio-economic deprivation and unemployment were associated with poorer sleep health outcomes.

Conclusion
Evidence from Aotearoa New Zealand clearly shows that Māori children and adults experience significant inequities in sleep health over all sleep health dimensions with strong links to socioeconomic deprivation.
We conclude that a public health policy for sleep that prioritises Māori and targets long-term, sustainable achievement of sleep health equity goals is required. Future sleep health research should involve Māori at all stages.
P094 How parasomnias challenge different expertise and forensic evidence: The awareness of legal judgment, the development of neuroscience, and the practice of sleep medicine
Authors: Cheong M 
Published: December 2024

Abstract
When coming across parasomnia correlated with murder is whether there is a valid legal defense. There were cases acquitting defendants of murder who claimed just because of sleepwalking. As sleepwalking is an unconscious activity; actus reus and means rea are both requirements in criminal charges and contain voluntary acts. Not all experts agreed with the parasomnia defense because of a lack of convincing history of sleep disorders. Forensic evidence plays a vital role in proving and assisting the crime to support either the prosecution or the defendant and to determine whether the defense can persuade juries. A question arises involving what happens in the brain activity during parasomnia when committing a crime and convincing the crime is automatism and not murder. This research involves, firstly, how sleep works and how the human brain works with and without parasomnia. There are types of sleep-related crime and their application in criminal law. Secondly, how many objective sleep data are needed to convince parasomnia as a legal defense? Thirdly, the significance of exploring both neuroscientists and sleep forensic experts when they are involved in crime solving. The forensic evidence at the crime scene plays a crucial role. Any advanced techniques are required to support the verdicts to prevent any ununiform. How neuroscientists through new technology may identify the brain function when committing a crime. The research brings awareness that will bring to a legal evaluation in the future and better determine the intermediate line between automatism and murder in parasomnia-related violence.
P098 A case of successful adaptation to continual positive air pressure therapy (CPAP) with fixed pressure set at 4cmH2O in a patient with severe obstructive sleep apnea (OSA)
Authors: Giovas L , Rosentengel A , Dalman M 
Published: December 2024

Abstract

Introduction
Noncompliance to continual positive air pressure (CPAP) therapy remains a major concern in the treatment for obstructive sleep apnea (OSA). Case description: 35-year-old female with a body mass index (BMI) 38.2 and Epworth Sleepiness Score (ESS) 8. Presented with snoring, excessive daytime sleepiness (EDS), poor concentration, nocturnal headaches and occasional dizziness. Diagnosed with severe OSA AHI 45.3, REM AHI 54.6, mean awake SpO2 96%, nadir SpO2 86%. Initial trial of automatic positive air pressure (APAP) over two-nights demonstrated usage of 8:08 hours, 95th percentile 11.2cm, AHI 0.4, nadir SpO2 89%. Fixed CPAP at 11cmH2O prescribed.

Method
Due to significant CPAP intolerance (side-effects including: light-headedness, and increased pressure behind the eyes), the treating Sleep Physician individulaised the CPAP therapy prescription prioritizing patient acclimatization in the short-term with a fixed pressure of 4cmH2O. Once acclimatized (usage exceeding &gt;4hours) pressure would be gradually increased to control events. Close clinical follow up with early data download reviewed by Sleep Scientist weekly, with monthly Sleep Physician review.

Results
4 week review: 100% compliance with CPAP 4cmH2O (avg. usage 8.5hours, 1.8/min leak, AHI 0.6). Significant subjective improvement to daytime symptoms reported. 10 month review: 99% compliance with CPAP 4cmH2O (avg.usage 8.5 hours, 0.6L/min leak, AHI 0.7).
Successful adaptation to therapy with efficacious treatment.

Discussion
This case study highlights the importance of acknowledging the individuality of the patient, in this example CPAP pressure, for optimal care. Further analysis with a larger sample size would provide more insight into the future of pressure titration for patients who are reluctant to adhere to CPAP treatment.
P100 Can extending the time between last meal of the day and bedtime improve sleep regularity? A pilot study in Australian adults
Authors: Gupta C , Nordien N , Khalesi S , Vincent G , Coates A , Shah M , Ferguson S 
Published: December 2024

Abstract
Sleep regularity is important for health and wellbeing. Food intake close to bedtime negatively impacts sleep regularity by lengthening sleep onset and reducing sleep duration. Extending the time between the last meal of the day and bedtime could improve sleep regularity. This pilot study investigated whether extending the time between last meal and sleep onset through time-restricting eating (TRE) impacts sleep regularity. Adults (n=6, 18-38 y, 5 female) completed 2-weeks baseline with usual eating timing followed by 6-weeks of TRE (10-hours between first and last meal, with last meal by 8pm), and a daily sleep diary. The standard deviations of sleep onset and sleep duration were calculated to indicate sleep regularity. Interviews were conducted to understand lived experience of TRE and sleep regularity. A one-way ANOVA revealed differences in time between last meal of the day (p=0.04), with 2.04hours between last meal and sleep onset during baseline and 4.00hours during TRE. There were no significant differences in sleep variables between baseline, 3-weeks TRE, and 6-weeks TRE (onset p=0.54; duration p=0.85). Participants reported positive experiences of TRE on sleep, commenting that TRE is “more consistent…because if I finish eating at a certain time, then I tend to go to bed at a set time.” While there were no significant improvements to sleep regularity after TRE, participants found it easier to have a consistent sleep routine when there was a longer time between eating and sleep. The next step is to build on these findings with objective sleep measures.
P101 An audit of the clinical impact of mandatory urinary drug screening performed as part of Maintenance of Wakefulness and Multiple Sleep Latency Testing’
Authors: Henderson J , Teanau T , Cuesta R , Miller B , Naughton M , Dabscheck E 
Published: December 2024

Abstract

Study Objectives
Multiple sleep latency testing (MSLT) and maintenance of wakefulness testing (MWT) are validated objective assessments of excessive daytime sleepiness. However, both are open to the confounding effects of drugs. This study aims to determine the rates of detection of drugs with known effects of sleep architecture using both immunoassay (IA) and mass spectrometry (MS) urinary drug screens (UDS) during MSLT/MWT testing.

Methods
A retrospective audit was performed on all patients who underwent an MSLT/MWT test at a tertiary hospital sleep laboratory between 2013-2023. Data was collected on the rates of positive IA and MS UDS, disclosure of the drug to their treating physician, demographics, comorbidities, and polysomnographic variables.

Results
162 patients were included in the analysis, 137 MSLT patients and 25 MWT patients. 29/162 (17.9%) and 67/162 (51.3%) of patients had a positive IA-UDS and MS-UDS respectively. These drugs were disclosed in 44% of positive IA-UDS and 68% of MS-UDS positive patients. Patients with a positive IA and MS UDS during MSLT were more likely to have an elevated HADS-A questionnaire result and clinically diagnosed anxiety and depression, history of malignancy (IA-UDS) and chronic pain (MS-UDS). There was no correlation between positive UDS results and any variables in patients undergoing MWT.

Conclusions
There is limited data on the rates of positive UDS routinely performed as part of MSLT/MWT. This has made it difficult to determine the optimal screening method. This study demonstrates that in patients undergoing MSTL/MWT testing, positive IA and MS-UDS are common and frequently not disclosed.
P102 Can EEG spectral analysis distinguish children with narcolepsy from those with idiopathic hypersomnolence and subjective sleepiness?
Authors: Plunkett G , Shetty M , Davey M , Nixon G , Walter L , Horne R 
Published: December 2024

Abstract

Background
EEG spectral analysis provides a measurement of sleep micro-architecture and is a more sensitive measure of sleep disruption than conventional sleep macro-architecture. We aimed to examine the use of this technique in distinguishing children with narcolepsy and idiopathic hypersomnolence (IH) from subjectively sleepy children with a negative multiple sleep latency test.

Methods
Relative power, the absolute power in each frequency band divided by the total absolute power, was calculated for delta power (0.5 Hz–3.9 Hz), theta power (4 Hz–7.9 Hz), alpha power (8 Hz–11.9 Hz), sigma power (12 Hz–13.9 Hz) and beta power (14 Hz–30 Hz). A mean value for each frequency was calculated for each 30 s epoch then averaged for each sleep stage within each child.

Results
28 children with Narcolepsy, 11 with IH and 26 with subjective sleepiness were included and individually matched for age and sex with a control child. In N2, Theta power was higher in the Narcolepsy group (median 13.5%, IQR 11.2-15.5) compared to the subjectively sleepy group (11.1%, 9.0-12.8, p&lt;0.05). During N3, Delta power was higher in the subjectively sleepy group (93.3%, 91.9-93.9 vs 83.3%, 65.8-93.9, p&lt;0.001), and Theta power (4.8%, 4.2-6.3 vs 12.6% 4.8-22.5, p&lt;0.001), Alpha power (0.9%, 0.7-1.3 vs 2.8% 0.9-5.8, p&lt;0.001), and Beta power were lower (0.3% 0.3 -0.4 vs 1.1% 0.3-4.2, p&lt;0.05) compared to their controls.

Conclusions
Differences in sleep micro-architecture could not distinguish between children with narcolepsy and IH but may be able to distinguish children with narcolepsy from subjectively sleepy children.
P105 Positional OSA in children: single-centre prevalence and associated CPAP adherence
Authors: Kevat A , Suresh S , Chawla J , Collaro A 
Published: December 2024

Abstract

Background
Positional obstructive sleep apnoea (POSA) is an obstructive sleep apnoea (OSA) phenotype in which most obstructive events occur in supine sleep. For adults, recent guidelines and trials suggest positional OSA devices are suitable treatment alternatives to continuous positive airway pressure (CPAP). We sought to determine prevalence of POSA and associated rates of suboptimal CPAP adherence in children.

Methods
This single centre retrospective cohort study included all children &gt;2 years of age prescribed CPAP from 01/01/2020–01/01/2023 through Queensland Children’s Hospital (QCH) for moderate-severe OSA. Children were classified as having POSA or not through examination of obstructive events and sleep position determined by their diagnostic polysomnography. POSA was defined according to three different established diagnostic criteria (Cartwright’s, Bignold’s and Amsterdam POSA criteria), modified for paediatric use. CPAP adherence was defined as on average &gt;4 hours usage for ≥5 nights/week.

Results
Of 120 eligible participants (median age = 13 years), 34% were female, 62% were obese, 33% had a syndromic or neurodevelopmental diagnosis and 48% had undergone adenoidectomy +/- tonsillectomy. Depending on POSA definition, 34%-68% (41-73) of the 120 participants had POSA. Two-thirds (64-68%, depending on POSA definition used) of those with POSA had optimal CPAP adherence based on their first CPAP download.

Conclusion
A significant proportion of children with OSA prescribed CPAP at QCH have POSA, some of whom struggle to maintain CPAP adherence. Positional device therapy may represent an appropriate alternative management strategy. However, well-designed prospective trials in children are needed.
P108 Improving continuous positive airway pressure trial compliance in obstructive sleep apnea patients
Authors: Lim W 
Published: December 2024

Abstract

Background
Obstructive sleep apnea (OSA) is highly prevalent in Singapore (20-30%). Patients are enrolled into a CPAP trial after the diagnosis of OSA where they are provided with a CPAP machine for one month. However, CPAP compliance and uptake rates during and after the CPAP trial are often low as it is not well tolerated. As untreated OSA results in persistent daytime sleepiness and major adverse cardiac events in the long term, our aim is to improve CPAP trial compliance in OSA patients, which in turn improves long-term CPAP compliance and uptake rates.

Method
Our team identified factors that led to low CPAP compliance and developed a new practice of contacting patients via phone during their 1st week of CPAP trial to troubleshoot CPAP issues.

Results
Data analysis of CPAP trials was conducted pre- (Year 2020) and post-implementation (Year 2021) of this new practice of follow up calls during the 1st week of CPAP trial. We sampled 30 patients from Year 2020 and 2021 respectively to analyse their CPAP compliance and long-term uptake rates after completion of CPAP trial.

Outcomes achieved are
1. Increased CPAP compliance (overall % of days with &gt;4hours CPAP use) during CPAP trial.
2. Increased long-term CPAP uptake after completion of CPAP trial (46.7% in 2020 vs 86.7% in 2021).
3. Improved patient satisfaction

Discussion
Addressing CPAP issues early on during the CPAP trial significantly improved long-term CPAP compliance and uptake rates, which will improve quality of life and long-term cardiovascular health.
P112 Auto-titrating positive airway pressure in paediatric patients with obstructive sleep apnoea
Authors: Pham A , Adams A , Vandeleur M , Griffiths M 
Published: December 2024

Abstract

Background
Continuous positive airway pressure (CPAP) is the gold standard for treating obstructive sleep apnoea (OSA) in children. Standard practice involves in-laboratory titration polysomnography to determine the optimal treatment pressure for CPAP. Auto-titrating positive-airway-pressure (APAP) devices can automate this process. However, its use in children is not well studied.

Methods
Children receiving CPAP therapy for OSA were invited to participate in this study. They made two visits to the sleep laboratory within 4 weeks; the first was for CPAP titration, and the second was for unattended APAP titration. Parents/caretakers of participants completed the OSA-18 questionnaire during the second visit. Participant demographic and medical information was recorded. Optimal treatment pressures and polysomnography data from both visits were compared.

Progress to date
2 children completed the pilot study; female (9 years) and male (15 years). Comparison by the sleep physician determined optimum CPAP pressure on the manual titration and APAP unattended titration being identical in the first case and 2cmH20 higher on the manual titration in the 2nd case. Recruitment and data analysis is ongoing.

Intended Outcome and Impact
Optimisation of treatment for paediatric OSA may become more accessible if it is found that APAP titration (unattended) is just as effective as CPAP titration (in-laboratory). Patient parameters identifying appropriate patients for APAP titration may also be determined from OSA-18 responses and medical history.
P113 Prevalence of Periodic Limb Movements During Sleep in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Analysis
Authors: Pillay L , Altree T , Fon A , Mercer J 
Published: December 2024

Abstract

Introduction
This study aims to determine the prevalence of periodic limb movements during sleep (PLMS) in individuals with chronic obstructive pulmonary disease (COPD) by analysing polysomnography (PSG) data from The Queen Elizabeth Hospital (TQEH) over the past five years. Secondary endpoints include the rate of PLMS stratified by the severity of obstructive sleep apnoea (OSA) and COPD.

Background
Periodic limb movements of sleep (PLMS) are repetitive limb movements during sleep, often linked with fragmented sleep and excessive daytime sleepiness. PLMS are common in various medical conditions and increase with age. COPD patients often suffer from disturbed sleep, exacerbated by comorbid sleep disorders like OSA and restless legs syndrome (RLS). Despite the known poor-quality sleep in COPD, the prevalence of PLMS in this population remains unexplored.

Methods
This retrospective observational study includes PSG data from COPD patients who underwent diagnostic PSG at TQEH between March 2019 and March 2024. We will analyse data from approximately 200 PSG reports. Inclusion criteria are adults (≥18 years) with COPD, defined as a post-bronchodilator FEV1/FVC ratio &lt; 0.70. Participants with significant post-bronchodilator response or inadequate medical records will be excluded. Data will be collected retrospectively and de-identified to ensure confidentiality.

Progress to Date
We are currently awaiting ethics approval to commence data collection.

Intended outcome and impact
This study will provide insights into the prevalence of PLMS in COPD patients and its correlation with the severity of OSA and COPD. The findings could inform clinical management and improve the quality of life for COPD patients experiencing sleep disturbances.
P114 Influence of sleeping position on frequency of awakenings and arousals
Authors: Rayward L , Ho S , Green D , Little P 
Published: December 2024

Abstract

Introduction
Little is known about the physiological and biomechanical factors that determine individual preferences in lying posture during sleep. This study investigated relationships between position preference and position specific arousals and awakenings to explore mechanisms by which biomechanical factors influence position preference.

Methods
41 healthy mature aged adults (Age: 61.6 ± 5.9 years) including 25 females and 16 males, underwent two nights of home polysomnography ~2 weeks apart, on a standardised firm foam mattress, measuring sleep architecture and position. Lateral-supine ratio (LSR) was calculated for each night of sleep as:
LSR=(Duration Lateral)/(Duration Supine+Duration Lateral)*100
Restlessness measures specific to lateral and supine positions including arousal frequency, and wake frequency were calculated and analysed for relationship with LSR via linear mixed effects regression.

Results
Wake frequency was greater in supine with greater inter-subject standard deviation (mean ± standard deviation: 4.80 ± 3.87 wakes/hr), in comparison to lateral (2.31 ± 1.05 wakes/hr). There was strong statistically significant correlation between LSR and wake frequency in supine (β = 1.9, p = 0.0013), while effect of LSR on wake frequency in lateral was weaker and not statistically significant (β = -1.1, p = 0.60). Strong significant correlation between LSR on night 1 and LSR on night 2 (β = 0.95, p &lt; 0.001) was found indicating strong consistency in sleep preference.

Discussion
The findings suggest that some individuals have low tolerance to supine posture, represented by a comparatively high wake frequency in supine. These individuals compensate for high wake frequency in supine by sleeping a greater proportion in lateral.