bluuebunny/crossref_metadata_2025_split huggingface dataset:
O039 Differential effects of sleep deprivation and sleep restriction on error awareness
Authors: Boardman J , Bravo M , Andrillon T , Anderson C , Drummond S 
Published: October 2021

Abstract

Introduction
The ability to detect and subsequently correct errors is important in preventing the detrimental consequences of sleep loss. We report the first study to compare the effects of total sleep deprivation (TSD) and sleep restriction (SR) on error awareness.

Methods
Thirteen healthy adults (11F, age=26.8±3.4y) underwent a 34h TSD protocol, completing the Error Awareness Task (EAT: a combined Stroop/1-back/GoNogo task) at 4h and 27h post-wake. Twenty healthy adults (11F, age=27.4±5.3y) were studied both well-rested (WR: 9h sleep) and following SR (3 nights of 3h sleep), completing the EAT once/day (8-9h post-habitual wake). The EAT required participants to withhold responding to “nogo” stimuli and signal, via a button press, whenever they realised they made an error on these nogo trials.

Results
TSD did not significantly affect error rate (p=.712) or error awareness rate (p=.517), however, participants were slower to recognise errors after TSD (p=.004). In contrast, SR increased error rate (p&lt;.001), decreased error awareness (p&lt;.001), and slowed recognition of errors (p&lt;.01).

Discussion
Three nights SR impaired the ability to recognise errors in real-time, despite a greater number of errors being made. Thus, impaired error awareness may be one mechanism underlying increased sleep loss-related accidents and errors in occupational settings, as well as at home. Interestingly, 1-night TSD did not lead to more, or impaired recognition of errors. TSD participants were slower to recognise errors, which may be problematic in safety critical settings. Technological and/or operational solutions may be needed to reduce the risk of errors going unrecognised.
O044 PROMISing questionnaires to measure sleep disturbance and impairment
Authors: Antonov A , Hamilton G 
Published: October 2021

Abstract

Background
Obstructive sleep apnoea (OSA) is highly prevalent in Australia with significant health and economic impacts. OSA severity as measured by Apnoea Hypopnoea Index (AHI) does not reliably predict symptom burden as measured by questionnaires such as the Epworth Sleepiness Scale (ESS) or Functional Outcomes of Sleep Questionnaire (FOSQ). Our hypothesis is that utilising the standardised, scenario-agnostic, evidence-based Patient-Reported Outcomes Information System (PROMIS) questionnaires would yield better clinical utility. The primary aim was to validate PROMIS questionnaires in detecting symptom burden of OSA and its relationship to AHI. Secondary outcomes were to investigate the relationship between PROMIS questionnaires and other commonly used measures of sleep impairment and disturbance, and the relationship between PROMIS questionnaires and surrogate markers of sleep impairment on a Polysomnogram.

Methods
Analysis of prospectively collected data from 122 adult patients referred to an Australian University and Tertiary Hospital associated sleep apnoea clinic. All adult patients who completed extensive pre-assessment questionnaires and subsequently underwent polysomnography following clinician review were included in this study. Questionnaires included: PROMIS Sleep Disturbance, Sleep Related Impairment and Cognitive Function-Abilities questionnaires, FOSQ, ESS, Insomnia Severity Index (ISI) and Hospital Anxiety and Depression Scale (HADS).

Progress to date
Data collected for all 122 participants. Preliminary analysis currently underway. Intended outcome and impact: Examine utility of the novel PROMIS scales in measuring symptom burden in patients referred for suspected OSA and its relationship to AHI. Investigate the relationship between PROMIS scales, surrogate markers of sleep impairment and other validated sleep disorder questionnaires.
P029 Home video sleep recording as a screening tool for paediatric obstructive sleep apnoea
Authors: Daniels C , Kapur N , Gauld L 
Published: October 2021

Abstract

Introduction
Polysomnography (PSG) remains gold standard for assessment of paediatric OSA, despite limitations. Home-based video sleep recordings offer a promising screening tool that would be relatively simple and inexpensive but have been minimally investigated. This study aims to assess the ability of short home-based video sleep recordings to predict PSG-diagnosed OSA in a population of healthy children.

Methods
Healthy children aged 1–18 years undergoing PSG to assess for OSA were recruited. Those with comorbidities likely to cause/exacerbate OSA, aside from adenotonsillar hypertrophy and obesity, were excluded. Thirty-minute video recordings of sleep shortly after sleep onset capturing the face and exposed torso were obtained. A previously validated scoring system was modified to include six parameters: snore, inspiratory noise, respiratory events, respiratory effort, mouth breathing and neck extension.

Results
We report interim results of this ongoing study. Of the 51 children meeting inclusion criteria, videos for 44 (28M, mean (SD) age 8.58 (2.96) years) were deemed satisfactory and analysed. Four (9%) children had OAHI &gt;5 episodes/h on PSG and median Total Video Score (TVS) was 0 (IQR 0–1). TVS and OAHI &gt;5 episodes/h on PSG showed a statistically significant association (OR 2.782, p=0.006) with area under the curve of 0.847. TVS ≥4 showed sensitivity of 75% and specificity of 100% for OAHI &gt;5 episodes/h.

Discussion
This video scoring system, when applied to short home-based video sleep recordings, showed acceptable diagnostic accuracy for PSG-diagnosed OSA. Full data analysis will further clarify the role of this modality as a screening tool for paediatric OSA.
P042 Five-year review of a tertiary paediatric sleep service for complex patients
Authors: Griffiths A , Preston S , Adams A , Vandeleur M 
Published: October 2021

Abstract

Introduction
Our paediatric sleep unit commenced service for children with complex medical problems in July 2015. Service capacity includes 12 inpatient level 1 studies (two neonates) and one home study per week. FTE includes senior scientists 2.6, sleep technologists 1.7, administration 1.0, nursing 0.7 and medical 1.2. The primary aim of this study was to evaluate activity during the first 5-years. The secondary aim was to document the impact of the COVID-19 pandemic.

Methods
Sleep unit operational & diagnostic data were collected from sleep booking sheets, sleep study reports, electronic medical records. Descriptive statistics are presented.

Results
A total of 2186 sleep studies were performed (July 2015 to June 2020) with a range of 368–472 studies per annum. Overall, 61.7% were diagnostic studies, 20.8% titration studies (CPAP, oxygen, bi-level or invasive ventilation), 10% neonatal and 7.5% home studies. Between 2016–2020, the average waiting time (days) for a neonatal study was 16, a titration study was 106, a diagnostic study was 110 and a home study was 76. Further delays were caused by the COVID19 pandemic. Mean waiting time rose 229% from 108 days (Feb 2020) to 355 days (Feb 2021). Referrals for sleep studies have exceeded bed capacity since the beginning of the pandemic.

Discussion
This audit describes activity in a tertiary complex paediatric sleep service during the first 5 years. The service has struggled on current FTE and bed capacity to manage waiting times, exacerbated further by the COVID-19 pandemic. A new business and clinical model are warranted.
P060 Hypoxia-induced overexpression of Rev-Erb-alpha and NPAS2 proteins in obstructive sleep apnea patients - possible mechanism of DM2 development
Authors: Karuga F , Turkiewicz S , Ditmer M , Sochal M , Białasiewicz P , Gabryelska A 
Published: October 2021

Abstract
Circadian clocks are endogenous coordinators of 24-hour behavioral and molecular rhythms, which disruption may be caused by obstructive sleep apnea (OSA). It is composed of a set of genes, function as activators (CLOCK, BMAL) or repressors (PER, CRY). Neuronal PAS Domain Protein 2 (NPAS2) can substitute CLOCK in its function. Orphan nuclear receptor (Rev-Erb-α) is another protein supporting the CLOCK-BMAL1 complex, forming the loop which helps to regulate their expression. There are studies suggesting the significant influence of circadian disruption mediated via NPAS2 and Rev-Erb-α on DM2 development. The aim of the study was to determine the role of NPAS2 and Rev-Erb-α in DM2 for OSA patients.
All participants underwent polysomnography (PSG) examination. Based on apnea-hypopnea index accompanied by clinical data the recruited individuals (n=40) were assigned to one from 3 groups: OSA (severe OSA, no DM2; n=17), DM2 (severe OSA + DM2; n=7) and control group (no OSA, no DM2; n=16). Serum protein levels of Rev-Erb-α and NPAS2 were assessed with ELISA immunoassay.
Analysis between the groups revealed the statistically significant difference only in NPAS2 protein level (p=0.037). Further post-hoc analysis revealed significant differences between OSA and the control group (p=0.017). Moreover, a statistically significant correlation between AHI and NPAS2 serum protein level was observed (r=-0.478, p=0.002).
NPAS2 protein levels are associated with a number of apneas and hypopneas during the REM phase of sleep and might have a significant role in the development of OSA complications. However, further studies are needed to understand its role.
P063 Optogenetics for Obstructive Sleep Apnea
Authors: Knapman F , Burke P , Cohen M , McMullan S , Bilston L 
Published: October 2021

Abstract

Introduction
We propose a novel sleep apnea therapy whereby a viral vector construct induces opsin expression and therefore light sensitivity to the upper airway muscles. Pulsed light to these muscles during sleep will enhance muscle contractions resulting in airway dilation and apnea prevention. Here we investigate the therapy’s feasibility, and determine whether a muscle-specific promotor induces superior expression and light-evoked EMG responses compared to a non-specific promotor. Superiority will be determined by the strength and specificity of opsin expression as restricting expression to the tongue minimises the likelihood of immune responses and unwanted sensation, movement or pain with light application.

Methods
10 rats received an intramuscular injection of a viral vector construct to induce opsin expression in the tongue. 4 rats received a non-specific construct and 6 received a muscle-specific construct. Pulsed light was applied directly to the tongue, and genioglossus EMG activity was recorded. Confocal imaging of the brainstem and tongue quantified the strength and specificity of opsin expression.

Results
Despite the greater titer of the non-specific construct, the muscle-specific construct consistently drove stronger expression in the tongue and subsequently greater light-evoked EMG activity. Additionally, whilst the non-specific construct drove retrograde gene expression in hypoglossal motor neurons, no retrograde expression was induced by the muscle-specific construct.

Conclusions
This study provides proof-of-concept of a non-invasive optogenetic stimulation-based therapy for OSA. The superior expression and light induced EMG activity generated by the muscle-specific promotor indicates that it is the preferred promotor for future studies employing direct optogenetic stimulation of skeletal muscle.
P064 The Impact of Artefact-free Recording Time on the Diagnosis of Sleep Disordered Breathing
Authors: Knowles A , Stibalova M , Gajaweera H , Hill C , Evans H 
Published: October 2021

Abstract

Background
Overnight studies are used to diagnose sleep disordered breathing (SDB), however the minimum artefact-free recording time (AFRT) has not been established in children.

Aim
To determine the impact of AFRT on SDB diagnoses.

Methods
Patients attended overnight cardiorespiratory polygraphy/polysomnography, alongside pulse oximetry sleep studies. Respiratory parameter reports were generated using the first 4, 5, 6 and 7 hours of AFRT. Predetermined clinically relevant cut-off (CRCO) values were defined: Obstructive AHI (OAHI; CRCO≥2); Central Apnoea-Hypopnoea Index (CAHI; CRCO≥5); 3% Oxygen Desaturation Index (ODI3%; CRCO≥6); 4% Oxygen Desaturation Index (ODI4%; CRCO≥4). Studies crossing CRCO across different AFRTs were described as ‘Cases of Change’ (COC). Receiver operating characteristic (ROC) curves determined ranges at 4 hours which predicted COC across subsequent AFRTs.

Results
137 children (0.39–17.98 years) were consecutively recruited. Mean OAHI, CAHI, ODI3% and ODI4% were 1.54 (σ=2.66), 1.56 (σ=3.43), 5.21 (σ=6.53) and 2.77 (σ=4.42) respectively. For children achieving 7 hours AFRT (n=103), COC from 4 hours were: OAHI≥2 =9.7% (10/103); CAHI≥5 =2.9% (3/103); ODI3%≥6 =3.7% (4/109); ODI4%≥4 =1.8% (2/109). For OAHI≥2, optimal points on ROC curves for predicting COC provided a range of 0.875 (AUC= 0.733; 50% sensitivity; 93% specificity) - 3.125 (AUC= 0.968; 100% sensitivity; 81% specificity).

Conclusion
Four hours AFRT yields diagnostic results in &gt; 90% cases when commonly used cut-off criteria are applied. For OSA, ranges at 4 hours within which diagnostic change is most likely with longer periods of AFRT are provided. Consideration should be given to repeating short studies where values lie within these ranges.
P072 The Association Between Snoring and Hearing Loss in Patients with Obstructive Sleep Apnoea
Authors: Lawton E , Jurisevic M , Hobart K , Polasek J , Fon A 
Published: October 2021

Abstract

Background
Snoring is the commonest symptom of OSA, occurring in 70%-95% of patients. Snoring noise in severe OSA can reach, and exceed, peaks of 80 decibels(dB). This is a noise level at which permanent hearing loss can occur.
Given the chronicity of OSA, patients may be exposed to harmful noise levels daily for many years.

Methods
All patients underwent an overnight diagnostic sleep study. Exclusion criteria included occupational noise exposure or previously diagnosed hearing loss or head injury. Calibrated and standardised Tecpel 332 Sound-Pressure-Level meters recorded quantitative sound data. In addition to standard analysis and reporting, a customised report generated snoring and sound indices during sleep time.
Participants then underwent otoscopy, tympanogram and pure tone audiometric examination.
Progress to Date
To date 14 eligible patients have been enrolled. 3/14 have completed all investigations. 3/3 have hearing loss. AHI range was 8.5–39.5 and maximum snore sound range was 78.4–98.3dB. The average snores per hour was 340.3 and mean total snores during sleep time 1741. Mean oxygen saturation nadir 87.6%.
These initial results suggest a correlation between snore noise and hearing loss. We aim to include 25 patients in this pilot study.
Intended Outcome and impact
We hypothesise a direct relationship between snoring loudness and exposure in patients with OSA, and hearing loss due to prolonged noise exposure.
Noise-induced hearing loss is irreversible, but the extent of loss may be reduced with intervention. This pilot study has the potential to benefit patients by demonstrating the effects of snoring in OSA on hearing.
P077 Reliability of the Clinical Characterization of Isolated REM Sleep Behavior Disorder
Authors: Levendowski D , Lee-Iannotti J , Shprecher D , Guevarra C , Timm P , Angel E , Mazeika G , St. Louis E 
Published: October 2021

Abstract

Purpose
Compare agreements between polysomnography-based (PSG) diagnosis of isolated REM-sleep-behavior-disorder (iRBD) and Non-REM-Hypertonia (NRH), a novel biomarker independently associated with synucleinopathy-related neurodegenerative diseases.

Methods
Sixteen patients with histories of dream-enactment-behavior (DEB)(women=38%; age:64.6±13.0) underwent PSG with simultaneously-recorded Sleep Profiler (SP).
Two boarded sleep neurologists independently characterized iRBD. Physician1 combined abnormal qualitative REM-sleep-without-atonia (RSWA) by submental electromyography, with video-confirmation of probably DEB. Physician2 relied solely on qualitative RSWA. SP was auto-staged, technically reviewed, and reprocessed for automated abnormal NRH detection. Kappa scores measured physician and NRH agreements.

Results
In the 14 records with REM sleep, iRBD was characterized in: Physician1=64%, Physician2=79%, NRH=71% of the records. Across the three methods, unanimous iRBD agreement occurred in 57% of the records (positive=7, negative=1).
The between-physician agreement in iRBD classifications was fair (kappa=0.32). The agreement between NRH and Physician1 was moderate (kappa=0.52) versus slight with Physician2 (kappa=0.05).
NRH comparisons to consensus physician agreement yielded one false-positive and one false-negative iRBD finding. Physician2 classified: a) iRBD in two cases that were negative by Physician1 and NRH, and b) one negative case that Physician1 and NRH characterized as iRBD. Physician1 identified one negative case that was classified iRBD by Physician2 and NRH. Additionally, NRH was abnormal in one of the two records with no REM sleep.

Discussion
NRH may assist in iRBD risk assessment, given it agreed with at least one physician in 86% of the cases and the between-physician iRBD agreement was only fair. NRH also characterized iRBD-risk in patients with insufficient REM sleep for RSWA assessment.
P080 An embedded pathway to mandibular advancement splint (MAS) construction in a tertiary hospital reduces barriers to care for low-income individuals
Authors: Lim B , Yap T , Lim M , Gikas A 
Published: October 2021

Abstract

Introduction
The aim of this study was to report the outcomes of patients referred within and to a tertiary hospital dental unit for subsidised construction of a MAS over a 5-year period.

Methods
Medical records of patients referred from 2015–2020 were examined for reason for referral, details of diagnosis, pathway to diagnosis, treatment, compliance, clinician-reported and lab-based outcomes and follow-up reviews.

Results
One hundred patients referred from: The Hospital Sleep Unit 40, other Tertiary Hospitals 27, Private Sleep Clinics 13, Medical GPs 10. 76 patients were confirmed health care card holders. 30 patients did not proceed for reasons of cost or poor oral health. 59 patients were newly fitted with a MAS (27F,32M), 17 severe, 21 moderate, 17 mild OSA, mean age 52.9(+13.9) years, BMI 30.2(+6.3) kg/m2, ESS 11.4(+5.3). 22 of 36 patients with serial ESS scores had excessive daytime sleepiness upon initial presentation. 15/22(68%)(p&lt;0.005) of patients had resolution of their excessive daytime sleepiness following MAS wear. 8/15(53%) of patients had a subsequent AHI &lt;50%. 33 patients (56%) continued MAS wear, mean follow-up time 13.8(±14.6) months with an average of 5.8(+3.0) visits. 6 were lost to follow up, 20 patients (33%) ceased MAS wear with 10(50%) of these stopping because routine dental treatment affected the device fit or discomfort later developed.

Conclusion
Subsidised expert construction of MAS embedded in a tertiary hospital is a well-utilised and effective service which reduces barriers for patients. The referrals to this service appear to be appropriate, with most patients proceeding to MAS construction.
P089 Loneliness and sleep duration among healthy older adults in Southeast Queensland, Australia
Authors: Lam J , Mann D , Pattinson C , Allan A , Smith S , Baxter J 
Published: October 2021

Abstract

Introduction
The relationship between sleep duration and loneliness among healthy older adults is not fully understood. Shorter sleep duration and increased variability of sleep timing (sleep onset and wake time) have recently been shown to have adverse health outcomes in younger adults. While physiological stressors associated with loneliness are likely distinct, we hypothesise that older adults who identify as lonely have reduced sleep duration and increased variability of sleep timing.

Methods
Older individuals (N=60) without significant co-morbidities were recruited via convenience sampling. Participants completed the de Jong Giervield Loneliness Scale and wore an actigraph for up to 2 weeks. Sleep metrics from actigraphy (sleep onset and wake times, and SD) were determined by algorithm assisted human scoring.

Results
Valid data was retrieved from N=37 participants (age 83±6.8 years [mean±SD]). There were no significant differences in demographics between those in the lonely (N=19) and not lonely (N=18) groupings. There was substantial heterogeneity in individual participant’s sleep metrics, both within and between groupings. The average sleep onset time was similar between groups, however lonely participants typically woke earlier resulting in slightly shorter sleep duration. Variability in sleep onset and wake times was reduced in lonely participants.

Discussion
While shorter sleep duration was expected, we did not anticipate the reduction in sleep timing variability amongst those defined as lonely; more regular sleep periods have previously been associated with better outcomes. We did not see statistically significant differences between our groups, possibly due to sample size limitations, however, the unexpected trend warrants further investigation.
P093 A Systematic Review of Adherence to Cognitive Behavioural Therapy for Insomnia (CBT-I) - Key Findings
Authors: Mellor A , Kavaliotis E , Drummond S 
Published: October 2021

Abstract

Introduction
Research into factors influencing adherence to CBT-I and how adherence impacts treatment outcomes remains scarce. Through a systematic review, we aimed to determine how adherence is assessed; which factors predict adherence; and which treatment outcomes are predicted by adherence.

Methods
Included publications met the following criteria: adults with insomnia; an intervention of CBT-I, including sleep restriction (SRT) and/or stimulus control (SCT); a reported measure of adherence; and written in English.

Results
Final n=103 papers. Measures assessed either global adherence or adherence to specific components of CBT-I via questionnaires, sleep diaries, interviews, or actigraphy. Most common measures were sleep diary-derived CBT-I components for therapist-led studies, and module completion for digital studies. Twenty-eight papers (27.2% of total) examined predictors of adherence. Depression, pre- and post-session sleep, psychosocial support, and dysfunctional beliefs about sleep predicted adherence. Demographic variables, other psychological comorbidities, insomnia severity, and sleep questionnaires did not predict adherence. Twenty-eight papers (27.2%) examined whether adherence predicted treatment outcomes. Neither global adherence nor adherence to any specific component of therapist-led CBT-I reliably predicted sleep outcomes. For digital CBT-I, completion of treatment modules was linked to improvements in ISI, however there were only five studies.

Conclusion
There was a high degree of heterogeneity in how adherence was measured, and in predictors and outcome variables assessed. This heterogeneity likely explains why adherence does not appear to predict treatment outcome. The field needs to develop a standardised method for assessing each specific adherence construct to fully understand the role of adherence in CBT-I.