bluuebunny/crossref_metadata_2025_split huggingface dataset:
P038 Autonomic cardiovascular control is unaffected in children referred for assessment of excessive daytime sleepiness.
Authors: Plunkett G , Francis J , Shetty M , Davey M , Nixon G , Walter L , Horne R 
Published: December 2024

Abstract

Introduction
There is conflicting evidence for impaired autonomic control of heart rate (HR) in adults with narcolepsy and idiopathic hypersomnolence (IH). Despite these conditions primarily being diagnosed around the age of puberty, there are limited studies in children. The present study investigated cardiovascular control using heart rate variability (HRV) and the extent of nocturnal HR dipping during sleep in children and adolescents with narcolepsy and IH.

Methods
All children having an overnight polysomnographic study followed by a multiple sleep latency test (MSLT) for investigation of excessive daytime sleepiness (EDS) between May 2010 to December 2023 were included: 28 children diagnosed with narcolepsy, 11 with IH and 26 subjectively sleepy children who did not meet the diagnostic criteria for either narcolepsy or IH. Each clinically-referred child was matched for age and sex with a control. Time domain and frequency domain HRV were calculated from ECG recorded at 512 Hz.

Results
There were no differences in either time domain or spectral analysis of HRV between clinical groups or between clinical groups and their control group. The expected sleep state differences in HRV were observed in all groups. There was also no difference in HR nocturnal dipping between groups.

Conclusion
Despite evidence for abnormal autonomic function in adults with narcolepsy and IH, our study did not identify any abnormalities in HR, HR control or nocturnal dipping of HR in children referred for assessment of EDS. This suggests that autonomic dysfunction may be a feature of these conditions that develops in later life.
P039 Families’ experiences of having a child with neurodisability and sleep problems
Authors: Cooke E , O’Neil M , Langdon G , Vandeleur M ,   Waters, Chawla J 
Published: December 2024

Abstract

Introduction
This qualitative study investigates families’ experiences of having a child with neurodisability (ND) and sleep problems, and is a subset of a broader mixed-method study entitled Early Sleep Interventions to Improve Outcomes in Children with Neurodisability

Methods
We surveyed 294 parents of children with ND and sleep problems. This qualitative study focuses on the free-text responses to questions about what parents consider to be important areas for research priority, and how they and their family members are affected by their child with ND’s sleep problems. We conducted a reflexive thematic analysis of parents’ responses.

Findings
We identified five key themes in parents’ reports. Firstly, child sleep problems are compounded by physical medical conditions and have adverse effects on child functioning. Secondly, child sleep problems negatively impact the whole household, with heightened parental concern for siblings’ sleep and wellbeing. Thirdly, parents experience detrimental impacts on their emotional, mental, physical, social, and work-related wellbeing. Fourthly, parents primarily seek out medical intervention to address their child’s sleep problems but also emphasise the importance of understanding their individual child’s needs. Finally, parents desire better sleep service supports, resources, sensitivity, and awareness of sleep issues among non-specialists.

Discussion
These findings raise concerns for the health and wellbeing of children with ND and sleep problems and their parents and families. There is a need for improved awareness, education, and treatment of sleep problems in this group, which would not only benefit the children themselves, but also their parents and siblings.
P042 Comparing NOX auto-analysis of sleep staging and quality parameters in a paediatric cohort
Authors: Roberts C 
Published: December 2024

Abstract
The comparison of NOX auto-analysis (NOXAA) and manual score is well documented in adult populations. This is not well defined in paediatric populations due to nuances in staging criteria, as children &lt;9years have lower posterior dominant rhythm (3.5-9.5Hz) compared to children &gt;9years (8-13Hz). This study will compare the accuracy of the NOXAA with a highly trained manual reference score, and asses the reliability of NOXAA in a paediatric setting.
A retrospective analysis compared NOXAA (A) (V6.3.1.34324) and manually scored (J) paediatric polysomnography data. 52 studies were assessed with 16 analysed post exclusion. Exclusion criteria: ages &lt;1, oxygen studies, moderate-severe OSA and EEG impedance &gt;200Hz. Two data sets were separated based on age: data-set 1 = &lt;9years and data-set 2= &gt;9years. Parameters compared: sleep stage (N1, N2, N3 and REM)%, total sleep time (TST)(hours), sleep efficiency (SE)%, sleep latency (SL)(min), REM latency (RL)(min), arousal index (AI) and apnoea hypopnea index (AHI).
Data set 1 (J)/(A): N1=1.525%/0.25%*, N2=26.275%/25.425%*, N3=34.9%/64.475%*, REM=27.3%/9.925%*, SL=49.2625/7.1375*, RL=143.45/98.8875, TST=8.16/8.48, SE=80.625%/82.225%, AI=7.8375/5.775*AHI=2.7375/5.325*
Data set 2(J)/(A): N1=5.4375%/21.3%*, N2=45.1125%/44.7375%, N3=26.7125%/34.1875%*, REM=22.725%/18.4%*, SL=15.5125/9.5875, RL=143.325/82.025, TST=8.05/8.16, SE=90.4%/89.05%, AI=7.6625/7.7, AHI=4.775/7.675*
*indicates statistical difference between J and A
There was a significant difference between J and A in N1, N3 and REM for both data sets. TST and SE showed no difference. The data suggests NOXAA is not reliable for paediatric sleep staging, however there may be clinical utility for quality parameters such as TST and SE. Further statistical analysis with larger populations is needed to further validate NOXAA’s accuracy in a paediatric setting.
P043 Sleep disruption in children with hepatic glycogen storage diseases: a prospective correlational study using CGMS
Authors: Agnoletto L , Adams A , Halligan R , Peters H , White M , Vandeleur M 
Published: December 2024

Abstract

Background
Hepatic glycogen storage diseases (GSDs) are characterized by enzyme defects affecting liver glycogen metabolism, where carbohydrate supplementation to prevent overnight hypoglycaemia is common. Concerns around sleep quality in hepatic GSDs relate to emerging evidence that overnight dysglycaemia impacts sleep quality.

Methods
This prospective descriptive study reported sleep quality and duration in children with hepatic GSDs over seven days utilising: actigraphy (Actiwatch 2 by Phillips Respironics), sleep diaries, proxy reported age-appropriate sleep and quality-of-life questionnaires, in the context of nocturnal glycaemic profiles continuous glucose monitor (CGM, Dexcom G6) and nocturnal dietary management strategies. Significant hypo- and hyperglycaemia were defined as ≥1% of sleep diary documented nocturnal period, recording &lt;3.5mmol/L and &gt;10.0mmol/L, respectively.

Results
Seven children with hepatic GSD (aged 1-17 years) participated. Objective sleep quality was poor, with actigraphy demonstrating that no child achieved the minimum sleep duration recommended for age. Subjective sleep quality was also poor, with 4/5 documenting significant daytime sleepiness and 6/6 reporting poor sleep hygiene. Children prescribed overnight bolus feeds (OBF)(n=2) had shorter sleep duration compared to other nocturnal management strategies. Parent-reported quality-of-life (QoL) suggested poor disease-related QoL outcomes for this cohort.

Conclusion
Objective and subjective sleep disturbances and reduced QoL are common within our sample of children with hepatic GSD. These outcomes were related to nutritional overnight interventions, especially OBFs, rather than overnight glucose levels. Consideration of the impacts of overnight feeding strategies on sleep quality and QoL in children with hepatic GSD should inform future management strategies.
P044 Impact of hospital environment on sleep during recovery from acquired brain injury: A systematic review
Authors: Greenslade R , Hayes N , Barlow K 
Published: December 2024

Abstract

Introduction
People with acquired brain injury (ABI) commonly report trouble sleeping. Sleep problems during acute admission are associated with delayed recovery and hospital discharge. The hospital environment influences sleep and may lead to chronic sleep problems and impact long-term outcome. We evaluated the current literature investigating the effect of environmental factors on sleep after ABI.

Methods
Six database searches were performed with MeSH headings and keywords (PROSPERO CRD42023479979). Children and adults with ABI, all settings, exposures and interventions were included. Case reports, animal studies and populations with prenatal ABI, vascular dementia, genetic and neurodegenerative conditions were excluded.

Results
The review identified 1302 articles with 610 duplicates, 692 abstracts were screened, and 114 full texts were assessed. Nine adult studies were included (n=581). Noise was ≥ 50dB and mean light levels 1.74-9 lux. There were 5.43 - 18.24 episodes of nursing care overnight. Sleep quality was poor; sleep efficiency range 72-73%, wake bouts range 21-41, and wake after sleep onset range 72-83 minutes. Four hospital sleep hygiene initiatives (n=340) improved sleep quality, quantity and decreased sedative use. Nursing practices of clustering cares and safeguarding sleep times promoted sleep.

Discussion
Relatively few studies have explored the effect of the environment on sleep after ABI and none included children. Sleep in can be improved, however sleep still receives little attention. Standardized ieMR tools, policy to support practice and increased clinical education may help.
P051 A customised 3D-printed nasal mask for enhancing CPAP compliance in the treatment of obstructive sleep apnoea
Authors: Tong B , Cistulli P , Ledger S , Chan A 
Published: December 2024

Abstract
Current practices of continuous positive airway pressure (CPAP) mask fitting involve a trial and error approach based on two-dimensional fitting guides which fail to account for variations in facial features resulting in suboptimal mask fit. This study aimed to assess the performance of a novel three-dimensionally (3D)-printed customised nasal mask on patient compliance to CPAP therapy for the treatment of obstructive sleep apnoea (OSA).
Patients prescribed CPAP therapy for OSA with suboptimal CPAP compliance using a conventional CPAP mask (&lt;70% of nights with ≥ 4 hours per night over 4 weeks) were recruited. A 3D-facial mapping scan was conducted to fabricate a customised nasal mask which was trialed for four weeks. Data download of CPAP compliance over four weeks was collected with patients using their pre-existing conventional CPAP mask and a customised nasal mask.
Thirty patients (22 males; age 63±13 years) were studied. Patients used CPAP on a greater proportion of nights with a customised mask compared to a conventional mask (85.7 [66.1, 98.2]% versus 63.2 [13.1, 96.8]%, P=0.009). Hourly CPAP usage was higher with a customised mask compared to a conventional mask (3.8 [2.7, 5.8] versus 2.4 [0.3, 5.0] hours; P=0.016). Mask leak was not different between mask types (P&gt;0.05). Patients preferred the customised mask (P=0.008) for which they reported less mask-related side effects.
A customised 3D-printed nasal mask improved CPAP use in patients with suboptimal CPAP compliance. Customised CPAP masks may have an important role in personalising CPAP therapy with the aim of optimising treatment effectiveness for OSA.
P053 Implementing rehabilitation-led management of obstructive sleep apnoea in a spinal cord injury rehabilitation centre: results of a mixed-methods evaluation
Authors: Graco M , Saravanan K , Weber G , Phyland T , Joffe D , Berlowitz D , Pryor J 
Published: December 2024

Abstract

Introduction
Obstructive sleep apnoea (OSA) is the most common sleep disorder in spinal cord injury (SCI), yet it is under-diagnosed and under-treated. A SCI rehabilitation centre in Sydney adapted and implemented an alternative rehabilitation-led model of managing OSA. The aim of this project was to evaluate the feasibility of this care model.

Methods
The model was implemented in July 2022 and piloted for 12 months. The mixed-methods evaluation included analysis of clinical data to assess reach and effectiveness, and qualitative interviews with staff and patients to explore acceptability and barriers and enablers to implementation.

Results
48 inpatients were screened; 24 were assessed for OSA, 12 were diagnosed and recommended treatment, six were treated with continuous positive airway pressure (CPAP), and four were discharged with CPAP. Staff reported improvements to their knowledge, skills, and confidence in managing sleep and respiratory issues, and significant benefits to patient care. Coordinating assessments was initially challenging and additional nursing time was allocated to support this. Staff experienced significant barriers to initiating CPAP, including limited opportunities for skill development, high staff turnover, and high workload pressures. Local respiratory physician support with diagnosis and treatment plans was essential.

Conclusions
This is the first time an Australian SCI rehabilitation centre has implemented a rehabilitation-led OSA management model. Assessing and diagnosing OSA was feasible. For CPAP initiation to be feasible, additional staff time and training would be required. This care model could substantially improve access to OSA treatments for people living with SCI.
P055 Identifying Sleepiness Profiles in Obstructive Sleep Apnoea
Authors: Duce B , Hukins C 
Published: December 2024

Abstract

Aim
Sleep clinics frequently measure the patient’s subjective sleepiness, but these measurements often conflict with more objective measures of sleepiness. This suggests that subjective and objective sleepiness have distinct properties and may have different causes in OSA. Using cluster analysis, we aimed to classify OSA patients into subgroups based on measures of objective and subjective sleepiness and assess each subgroup’s characteristics.

Methods
The study divided all patients diagnosed with OSA between 2015 and 2018 into four clinical presentation phenotypes: no sleepiness (ESS-/PVT-), subjectively sleepy only (ESS+/PVT-), objectively sleepy only (ESS-/PVT+), and subjectively and objectively sleepy (ESS+/PVT+).

Results
K means clustering of 1038 patients produced 4 groups of 463, 371, 126, and 78 patients for ESS-/PVT-, ESS+/PVT-, ESS-/PVT+, and ESS+/PVT+, respectively. Each group had no differences in AHI or BMI. The ESS-/PVT- cluster was associated with shorter sleep duration and poor sleep efficiency. The ESS+/PVT-cluster had a longer sleep duration and were younger than the rest of the groups. The ESS-/PVT+ cluster also had shorter sleep duration and poorer sleep efficiency, similar to ESS-/PVT-, but had a greater comorbidity than all the other clusters. The ESS+/PVT+ cluster exhibited a higher female prevalence and was linked to more severe desaturations compared to the other clusters.

Discussion/Conclusion
Sleep duration, comorbidity, sex, and hypoxic burden seem to be the biggest predictors of sleepiness in patients. Further work is required to explore the influence of OSA phenotypic characteristics on patient sleepiness.
P056 Comparison of Breas Vivo 45 LS and ResMed Lumis ventilators in three simulated disease conditions
Authors: Hone R , Churchward T , Sheers N , Rautela L , Tolson J , Howard M , Berlowtiz D 
Published: December 2024

Abstract

Background
Ventilator performance has been shown to vary across conditions, ventilator type, and in common scenarios such as mask leak. Aim: This study sought to compare the performance of a Breas Medical AB (Mölnlycke, Sweden) Vivo 45 LS™ and ResMed (San Diego, CA, USA) Lumis™ ventilator.

Methods
Pressure, flow and volume waveforms were sampled for each ventilator at analogous settings, under three simulated clinical conditions using an ASL5000™ (Ingmar Medical, Pittsburgh, PA, USA) respiratory simulator: (A) Kyphoscoliosis (very low compliance), (B) Obesity Hypoventilation (low compliance), (C) Motor Neuron Disease (normal compliance, low muscle strength).

Results
Qualitative visual comparisons of representative breaths revealed similar delivered inspiratory and expiratory pressures. Flow profiles and volumes differed, with the Lumis showing shorter breath durations (range 0.1 - 0.5s) and correspondingly lower volumes compared to Vivo 45LS. Peak flows varied among the conditions, with the Vivo 45LS higher in condition A (27 vs 31 L/min) similar in condition B (45 L/min), but lower in condition C (27 vs 24 L/min). Mean inspiratory pressures were similar except in condition A, where the Vivo 45LS was lower by around 4 cmH2O. Expiratory volumes and peak pressures were comparable across both devices.

Conclusions
Comparative analysis of the Breas Vivo 45LS and ResMed Lumis ventilators under simulated clinical conditions highlights differences in breath duration, delivered volumes, and peak flow for analogous settings. Future research should better quantify and explore the impact of these performance variations between ventilators on clinical outcomes including ventilation efficacy, patient-ventilator synchrony, user comfort, and usage.
P059 Sport dentists’ role in dental sleep medicine: examination, screening and evaluation for sleep-related breathing disorders
Authors: Suzuki H , Sawa A , Nakayama T , Komiyama O , Chow C 
Published: December 2024

Abstract
Obstructive sleep apnea (OSA) in athletes cannot be overlooked because they contribute to daytime sleepiness and could increase the risk of cardiovascular morbidity. This study reports on the role of sports dentists in clinical examination, screening and evaluation for OSA.
Forty-four male rugby league athletes (27.1±3.3y; 176.2±5.8cm; 89.7±11.6 kg; BMI 28.8±3.1; neck circumference, 42.6±3.3 cm) were administered the Epworth Sleepiness Scale [ESS], Pittsburgh Sleep Quality Index [PSQI], and the Level III sleep test (SAS-2200). Intraoral cavity was examined using the modified Mallampati grade (MM).
A total of 90.9% (40/44) of the athletes had respiratory event index (REI) ≥5. Thirty athletes had mild OSA (68.2%), eight had moderate OSA (18.2%), and two had severe OSA (4.5%). Nineteen athletes (43.2%) reported ESS ≥ 10, and 25 athletes (56.8%) reported poor sleep quality (PSQI &gt; 5.5). The minimum SpO2 was reduced to 90.3±3.5%. The MM and REI were strongly correlated with body weight (p&lt;0.001), BMI (p&lt;0.001), and neck circumference (p=0.004). MM was moderately correlated with REI (p=0.014). The REI was strongly but negatively correlated with SpO2 (p&lt;0.001) and strongly with PSQI (p=0.002). The ESS was strongly correlated with age (p=0.004) and PSQI (p=0.001). The examination revealed that 86.3% of the athletes were eligible for oral appliance treatment.
This study suggests dentists managing athletes should assess OSA risks through anthropometric measurements, examination of the intraoral cavity for a narrow airway or enlarged tonsils/tissue blocking the airway, evaluation of daytime sleepiness and sleep quality, and an in-home sleep testing.
P064 Sleep EEG characteristics of sleep misperception in insomnia: A large community-based cohort analysis
Authors: Kao C , D’Rozario A , Gordon C 
Published: December 2024

Abstract

Introduction
Sleep misperception, where individuals report discrepancy between subjective and objective sleep, is common in insomnia. This study aimed to identify sleep electroencephalographic (EEG) features in insomnia and controls using a large dataset to elucidate the neural mechanisms underlying sleep misperception in insomnia.

Method
The Sleep Heart Health Study (SHHS) dataset with one-night of polysomnography was used. Under-estimated and over-estimated sleep perception was identified using the 5th percentile of the mean total sleep time (TST) for control and insomnia groups. EEG spectral power for sleep stages and sleep cycles were calculated. Analysis included slow oscillation (SO; 0.5-1.25 Hz) and sleep spindle (12–15 Hz) activity, and slow wave dynamics defined as the decline rate in delta power (1-4.5 Hz) from the first to last NREM sleep period.

Result
Data from 2024 controls (60 years old) and 284 insomnia (62 years old) were analysed. Insomnia had shorter TST (352.8 vs. 389.3 mins, p&lt;0.001) and longer WASO (62 vs. 51.1 mins, p&lt;0.001) and longer sleep latency (27 vs 20.8 mins, p&lt;0.001) than controls. Insomnia showed lower NREM delta activity but higher theta, alpha, sigma, and beta activity. Insomnia Under-estimators (n=22) had lower SO activity (p=0.03) and attenuated slow wave dynamics (p=0.01) compared to Control Under-estimators (n=87). There was no significant difference in NREM EEG activity or SWA dynamics between Over-estimator groups.

Conclusion
Deficits in NREM slow oscillation activity and altered slow wave dynamics across the night suggests that an abnormal sleep homeostatic process may underlie sleep misperception in insomnia.
P065 Breath of Fresh Data: Enhancing NIV Patient Care in State-wide Service
Authors: Berlowitz D , Churchward T , Michael C , Ruehland W , Longo C , Rautela L , Sheers N , Chao C , Howard M , Conti S 
Published: December 2024

Abstract

Background
The Victorian Respiratory Support Service (VRSS) provides long-term management for patients with chronic respiratory failure. An expanding patient base (497 in 2000, 2,031 in 2024) necessitates service development. Integration of non-invasive ventilator (NIV) data from ResMed Airview™ (San Diego, CA, USA) presented an opportunity to review these data at a “whole of service” level.

Aim
To pilot a summarised, data visualisation system for the VRSS.

Methods
Airview™ data were ingested daily into the hospital data warehouse and queried. Categories of adherence were; average usage/month, days used/month and average leak/month. Hours of NIV use was categorised as sufficient, moderate, or insufficient (&gt;6, 4-6, or &lt;4 hrs/day), days used/month as sufficient or insufficient (&lt;80%&gt;), and mask leak (&lt;24&gt; L/min) as acceptable or excessive.

Results
This analysis included 748 patients. 557 patients had sufficient usage, but only 290 patients had both sufficient NIV usage and acceptable leak. Conversely, 107 patients had insufficient NIV use with 59 having both insufficient NIV usage and excessive mask leak.

Discussion
These data are consistent with previous literature suggesting that while poor NIV adherence may be observed in people who experience “excessive” leak, “excessive” leak as determined by manufacturer limits does not always align with inadequate NIV adherence.(1) Data such as these enable novel models for participant care, especially triaging of ongoing clinical needs, to be proposed.

Conclusion
The interactive report provides opportunities for comparison of real-life data with the literature and enables planning for trials of novel service models.
1. Jeganathan. BMJ Open Respir Res. 2021