bluuebunny/crossref_metadata_2025_split huggingface dataset:
P038 Insomnia - Going backward to go forward
Authors: Fothergill T , Cunnington D 
Published: October 2021

Abstract

Background
Although there are common features in people with insomnia, for each individual there are possible different contributing factors and pathophysiological processes; each needing specific tailoring of treatment. We aim to understand treatments undertaken prior to specialist referral, common features on presentation and contributing factors in individual cases identified as part of their assessment.

Methods
We will undertake a retrospective audit of consecutive patients presenting with insomnia to a single private practice with a high insomnia case-load. We are collecting demographic data, details of prior and current treatments, clinical characteristics at presentation, outcomes of investigations and classification insomnia sub-type using the International Classification of Sleep Disorders-2 (ICSD-2). Data will be descriptive to allow understanding of the type and nature of patients presenting with insomnia and a deconstruction of contributing factors to the presenting problem of insomnia.
Progress to date
Low-risk ethics approval submitted via St Vincent’s Human Research Ethics Committee.
Literature review in progress.
Intended outcome and impact
The umbrella term “insomnia” belies its heterogeneity. Although there are common factors in most insomnia presentations, recognised in the simplification of diagnostic criteria in ICSD-3 and DSM 5, in managing individual patients it is also important to understand characteristics that are particular to the person. Whilst generic cognitive behavioural therapy for insomnia (CBTi) has been proven to be effective, in expert hands the response rate is still in the region of 60%, potentially reflecting a role for more tailored treatments for individuals to complement CBTi.
P041 The Impact of Simulated Night Shifts on Executive Functioning
Authors: Greer E , Matthews R , Centofanti S , Yates C , Stepien J , Dorrian J , Wittert G , Noakes M , Banks S 
Published: October 2021

Abstract
Nightwork is associated with fatigue, decreased sleep quality, and impairments in cognitive function. While attentional tasks have been widely investigated, there are limited data on more complex tasks, such as executive functioning during nightwork. Workers often need to rapidly shift between tasks, adapting to new and complex situations. The aim of this study was to investigate the impact of nightwork on executive functioning.
Healthy, non-shift working individuals (N=8; 5F, 24.8±5.0y) participated in a 7-day live-in laboratory study. Participants underwent an 8h TIB baseline sleep, followed by 4 consecutive simulated nightshifts with 7h TIB sleep during the day and an 8h TIB recovery sleep. Participants were assessed for executive function at 2000h, 2200h, 0100h and 0400h. Executive functioning was assessed with a mental flexibility switching task where a 3D rotation and math task were displayed simultaneously with an arrow indicating which task to complete in a random order. Resulting throughput data were analysed using linear mixed models.
There was a main effect of time of night (F(3,77)=4.81,p=.004) on throughput such that there was a speed accuracy trade off over the night shift with slower switching ability later in the shift. There was also a main effect of nightshift (F(2,77)=54.33,p&lt;.001) where participants’ performance improved on the task with each nightshift.
This study suggests executive functioning is impaired on nightshift with worse performance at 0400h. Task improvements over consecutive nightshifts may have been due to learning or acclimation to nightwork. Understanding complex task performance on nightshift is important for tailoring countermeasures.
P043 Telehealth-supported Level 2 paediatric home polysomnography
Authors: Griffiths A , Mukushi A , Adams A 
Published: October 2021

Abstract

Introduction
The gold standard for diagnosis of paediatric obstructive sleep apnoea (OSA) is attended in-laboratory level 1 polysomnography (PSG). In our service, we select some children for unattended home level 2 PSG (HPSG) with telehealth support. We audited our HPSG service from 2013 to 2020.

Methods
We retrospectively audited level 2 home PSG reports in children aged 5–18 years referred for suspected OSA between 2013 and 2020. Tests were performed with the Compumedics Somte PSG acquisition device. The primary outcome was % of studies achieving a technically adequate diagnosis. Secondary outcomes included sleep duration, sleep efficiency and parental acceptance by non-validated service-specific questionnaire. Data was analysed using descriptive & inferential statistics. χ² tests were used for categorical variables.

Results
There were 235 (140 male, 59.6%) patients studied between 2013 and 2020 (7 years). The mean age was 10.8 (SD 3.6) years. 69 patients (29.4%) had co-morbidities. Repeat studies were indicated in 10.2% (24/235) due to technical failure. There was no significant difference between failed studies set up by HITH nurses compared with Sleep scientists (p=0.1). A technically acceptable diagnosis was made in 87% (205/235) patients, with no reason for under-estimation in 74.9%, and potential under-estimation in 17.9%. No diagnosis was achieved in 7.2%. 6 hrs or more sleep was obtained in 83%. Parental questionnaires revealed 89% perceived high-level care, 91% perceived increased convenience and 76% good/excellent telehealth support.

Discussion
Telehealth-supported paediatric HPSG achieves a technically adequate diagnosis in 87%, with 83% achieving ≥6 hrs sleep duration, and excellent family acceptability.
P046 More teaching, less sleeping: The impact of stressful periods of the school year on the sleep of Australian schoolteachers
Authors: Friday M , Gupta C , Ferguson S 
Published: October 2021

Abstract

Introduction
There are approximately 270,00 schoolteachers in Australia and this population experience multiple stressors at work. This can lead to poor sleep quality and quantity and, consequently, adverse outcomes for both schoolteachers and students. While it is well-established that certain periods of the year may lead to increased stress for schoolteachers, the impact of this on sleep is unknown. The current study aimed to investigate the effect of stressful periods of the school year on the sleep of schoolteachers.

Methods
The Pittsburgh Sleep Quality Inventory (PSQI) and questions on stressful school periods (including report writing, standardised testing, school appraisal, and teacher performance) were completed online by 775 Australian primary and secondary schoolteachers (89.1% female, 29.9% 25–34 years). Pearson Chi-square analyses were performed.

Results
Scores on the PSQI indicated that 611 (79.0%) of participants were experiencing poor sleep quality. There were significant relationships between each of the stressful periods of the year and PSQI score, such that increased stress during periods of report writing (p&lt;0.001), standardised testing (p&lt;0.001), school appraisal (p&lt;0.001), and teacher performance (p&lt;0.001) was associated with poor sleep quality.

Discussion
Australian schoolteachers are at risk of poor sleep quality and quantity, and this is exacerbated by stressful periods of the school year. Given the vital role schoolteachers play in the community, organisations should be mindful of these periods of the year in order to improve the sleep of schoolteachers.
P051 SLEEP SPINDLES AND SWA DIFFERENTIALLY CORRELATE WITH OVERNIGHT EPISODIC AND VISUOSPATIAL MEMORY CONSOLIDATION IN OLDER ADULTS WITH AND WITHOUT MILD COGNITIVE IMPAIRMENT
Authors: Haroutonian C , D’Rozario A , Terpening Z , Lewis S , Naismith S 
Published: October 2021

Abstract

Introduction
Sleep microarchitecture disruption is a feature of ageing that is further altered in neurodegenerative disorders. Sleep-memory links in younger adults have been established, however mechanistic pathways of this uncoupling in ageing is poorly understood.

Method
Our sample consisted of n=46 mild cognitively impaired (MCI) older adults and n=32 cognitively-intact controls who underwent overnight polysomnography and episodic (Rey Auditory Verbal Learning test) and visuospatial (Rey-Osterrieth Complex Figure task) memory tasks that were administered before and after sleep. We examined group differences in overnight memory % retention and associations with NREM slow oscillations (SO, 0.25–1 Hz), delta power (0.5–4 Hz), N2 spindle events (occurrence [11–16 Hz] and slow [11–13 Hz] and fast [13–16 Hz] spindle density p/min) and REM theta power (4.5–8 Hz).

Results
Repeated measures ANCOVA, controlling for age, indicated greater memory scores in Controls compared to MCI on the episodic task, F=6.7 (p=.01), and no group differences in the visuospatial task (F=1.8, p=.17). In Controls, greater delta power was associated with increased episodic memory retention (r=.515, p=.006). In the MCI group, episodic memory was associated with fast spindle density (r=-.352, p=.04), and visuospatial memory was also associated with fast spindle density (r=-.385, p=.01) and spindle occurrence (r=-.479, p=.003).

Conclusion
Sleep spindles appear to be negatively associated with memory retention, specifically in MCI. However, given the heterogeneity of MCI, further analysis of its cognitive subtypes is warranted. Comprehensive cognitive and neural pathophysiology profiling are required to better delineate the function of spindles in ageing.
P053 Management of insomnia by Australian psychologists
Authors: Haycock J , Hoon E , Sweetman A , Lack L , Lovato N 
Published: October 2021

Abstract

Introduction
Insomnia is the most common sleep disorder, 10–30% of adults have regular difficulties falling and/or staying asleep that cause significant daytime impairments. General Practitioner (GP) clinical guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment rather than medications. However, most GPs do not have the time or training to administer CBTi, and consequently, many patients are prescribed sedative-hypnotic medicines. Psychologists have training in CBT and may be well placed to deliver behavioural therapy for insomnia. However, the amount of sleep-specific training, and knowledge of CBTi among Australian psychologists remains unknown. Identifying key barriers and enablers in the management of insomnia within psychology provides a first step in engaging with psychologists about the delivery of evidence-based insomnia treatment.

Methods
This qualitative study used a pragmatic inductive approach. Semi-structured interviews were conducted with 26 Australian psychologists. Interviews included case study scenarios to provide an in-depth exploration of psychologists’ knowledge and skills in the management of insomnia, and attitudes towards further training in CBTi. Interview transcripts were analysed using thematic analysis to identify themes.

Results
Preliminary themes identified in the data include; psychologists believe sleep is important for general well-being, insomnia is usually seen as secondary to other co-morbid disorders such as depression and anxiety that are the focus of treatment, most psychologists surveyed lack training and knowledge in CBTi.

Discussion
Most Australian psychologists are not well prepared to manage insomnia effectively with CBTi. Along with other primary health care professionals, psychologists need training in the management of insomnia.
P068 Improving patient streaming for Chronic insomnia: Single centre retrospective cohort study
Authors: Krebs L , Ellender C 
Published: October 2021

Abstract

Background
Insomnia is a common sleep disorder associated with significant morbidity and psychological distress. Cognitive Behavioural Therapy for insomnia (CBTi) is the gold standard intervention typically delivered by sleep psychologists. High demand has driven an interest in determining the case mix and characteristics of patients referred with insomnia to identify patients that may be suitable for an alternative direct-to-psychology model of care.

Methods
A retrospective cohort study was performed, including cases referred to the Princess Alexandra Hospital Sleep Centre in 2016 – 2020. Patients were categorised as either “suitable for direct-to-psychology” or “required medical review”. “Direct to psychology” patients were defined as (i) referred for insomnia; or (ii) Insomnia Severity Index score ≥15/28; or (iii) diagnosed with insomnia per ICSD-3 by treating specialist; or (iv) patients referred for sleep psychology. Exclusion criteria were significant sleep disordered breathing (mean SpO2 &lt;85%, Epworth sleepiness scale &gt;16, driving inattention), highly co-morbid patients (neuromuscular weakness, COPD) and diagnosis of hypersomnia. These patients were categorised as “requiring medical review”. The demographic and polysomnographic characteristics of these two groups were then compared.

Progress
The study protocol is complete, ethical approval obtained (EX/2021QMS/76783), and data extraction has been competed. Analysis underway currently.

Intended outcome/impact
We aim to establish the characteristics of patients suitable for a direct to psychology pathway. This data will be used for service provision planning, could reduce patient waiting list times, and improve patient care. This model could then be explored for safety and efficacy and form the basis of future service provision work.
P070 Oronasal masks are associated with increased airway collapsibility and increased therapeutic CPAP requirements
Authors: Landry S , Mann D , Beare R , Joosten S , Hamilton G , Edwards B 
Published: October 2021

Abstract

Introduction
Continuous positive airway pressure (CPAP) delivered via oronasal masks are associated with lower adherence, higher residual AHI and CPAP requirement in comparison to nasal masks. Mechanisms contributing to increased CPAP requirement are not well understood. This physiological study aimed to assess the effect of mask type on upper airway anatomy and collapsibility.

Methods
13 OSA patients, underwent a sleep study during which they wore both nasal and oronasal mask for half the night each (order randomized). CPAP was manually titrated to determine therapeutic pressure. Passive upper airway collapsibility was assessed using the Pcrit technique. Participants then underwent an MRI wearing both the nasal and oronasal mask. Cine MRI was used to dynamically assess cross-sectional area of the retroglossal airway across the respiratory cycle with each mask interface. Scans were repeated at 4cmH2O, as well as at the nasal and oronasal therapeutic pressures.

Results
The oronasal mask was associated with both higher therapeutic pressure requirements (∆M±SEM; +2.6±0.5, p&lt;0.001) and higher Pcrit (+2.4±0.5cmH2O, p=0.001) compared to the nasal mask. The change in therapeutic pressure between masks was strongly correlated with the change in Pcrit (r2= 0.73, p=0.003). Preliminary MRI analyses indicate robust increases in cross-sectional area associated with increasing pressure. After controlling for pressure and breath-phase, the retroglossal area was larger when using a nasal compared to an oronasal mask (+12.42±5.87mm2, p=0.03).

Conclusions
These preliminary findings suggest that oronasal masks worsen the collapsibility of the airway which likely contributes to the need for an elevated therapeutic pressure relative to nasal masks.
P071 Listening to Beyoncé: factors associated with non-attendance at an outpatient sleep clinic
Authors: Lau H , O’Brien D , Hundloe J , Samaratunga D 
Published: October 2021

Abstract

Introduction
Patient non-attendance at outpatient sleep clinics is common and costly. Little is known about the factors associated with sleep clinic non-attendance, especially in an Australian context. The goal of our audit was to identify the patient, referral, and appointment factors that may affect attendance at an outpatient sleep clinic.

Methods
A case-control study was performed in 171 patients (57 cases / non-attenders and 114 controls / attenders) who had a sleep clinic appointment between September 20th, 2020 and March 21st, 2021. Statistical analysis was performed using the two-sided chi-square test with a 5% significance level.

Results
The overall rate of non-attendance was 10.8%. The rates of non-attendance between new and review cases were similar. Being single (odds ratio [OR]: 2.49; p = 0.010), middle-aged (OR: 4.39; p &lt; 0.001 vs. older-aged), or female (OR: 2.08; p = 0.026) was associated with a higher rate of non-attendance. English was the primary language for all non-attenders. A higher proportion of non-attenders than attenders were born in Australia. For new cases, the source of referral, reason for referral, and triage category did not affect attendance rates. Likewise, the patient’s primary sleep disorder and treatment status did not affect attendance for review cases.

Conclusion
Factors associated with non-attendance at an outpatient sleep clinic include being single, middle-aged, or female. By identifying patients at higher risk of clinic non-attendance, a more tailored approach can be developed to mitigate this issue.
P074 Night-to-night variability in obstructive sleep apnoea severity is associated with hypertension and high misdiagnosis rates
Authors: Lechat B , Naik G , Reynolds A , Aishah A , Scott H , Loffler K , Vakulin A , McEvoy R , Adams R , Catcheside P , Eckert D 
Published: October 2021

Abstract

Introduction
The impact of night-to-night variability in obstructive sleep apnoea (OSA) severity on important health outcomes such as blood pressure is unknown. This study aimed to determine the effects of night-to-night variability in the apnoea/hypopnoea index (AHI) on hypertension risk and OSA misdiagnoses.

Methods
In-home nightly monitoring of 67,278 participants from 151 countries, over ~170 nights per participant between July 2020 to March 2021 using a validated under mattress sleep analyser. Blood pressure measurements were available in 12,295 participants. OSA was defined as a mean nightly AHI &gt;15events/h. Night-to-night variability was assessed as the standard deviation of AHI across nights.

Results
22.6% (95% CI: 20.9–24.3) of the cohort (13% of women, 25% of men) had an average AHI&gt; 15 events/h sleep. The average nightly AHI variability ranged from 3±1 in people without OSA to 14±6 in people with severe OSA. Higher mean AHI (OR [95% CI], 1.44 [1.29, 1.61]) and greater nightly variability in AHI (1.57 [1.39, 1.76]) were associated with hypertension. In people with a mean AHI of ≥5 events/h, high night-to-night AHI variability was associated with a ~30% increased risk in hypertension, independent of OSA severity category. Likelihood of misdiagnosis of OSA based on a single night compared to the mean across all nights was ~20%; this decreased with more monitoring nights.

Conclusions
These findings highlight the novel, important information that simple multi-night monitoring of OSA can yield. This includes the potential importance of night-to-night variation and its contribution to hypertension and increased confidence of OSA diagnoses.
P083 Age of Nap Cessation and Short-term Social-Emotional Functioning in Early Childhood
Authors: Loeffler A , Rankin P , Thorpe K , Staton S 
Published: October 2021

Abstract

Background
Daytime nap cessation, in which sleep transitions from biphasic to monophasic sleep, is a common feature of early childhood sleep patterns. Yet, to date, understanding of the meaning of this transition for children’s development is not well understood. The aim of this study is to investigate the relationship between the age of nap cessation and behavioral and social functioning in young children.

Methods
Parent report data from the Effective Early Educational Experiences (E4Kids) study of N=1700 children from across Queensland and Victoria is analysed. Data on age of nap cessation, Strengths and Difficulties Questionnaire (SDQ), and Social Skills Improvement Scale (SSIS) is examined to determine whether age of nap cessation is associated with internalizing and externalizing behaviour and social skills in early childhood.
Progress to date
Data collection and cleaning are complete. Initial descriptive analyses and identification of significant covariates are underway, and final regressions will be run shortly.
Intended outcome/ Impact
This study provides new evidence on the relationship between age of napping cessation and social-emotional outcomes in young children. Such evidence is important for building an understanding of the role of sleep cessation in children’s early development, and to inform practitioners and parents responsible for supporting children’s sleep.
P085 Body composition effects of High Intensity Functional Exercise training during rapid weight loss in obese patients with obstructive sleep apnoea: A pilot randomised controlled trial
Authors: Lowrie F , Phillips C , Yee B , Gordon C , Marshall N , Cayanan E 
Published: October 2021

Abstract

Introduction
While Very Low Energy Diets (VLEDs) have been proven to reduce weight in patients with obstructive sleep apnoea (OSA) and co-morbid obesity, they can also result in excessive loss of muscle mass which adversely impacts health. Concurrent exercise training is considered an effective method of preventing muscle mass loss.

Methods
This prospective randomised controlled trial will recruit 30 overweight and obese men with untreated moderate-to-severe OSA to undergo a 12-week VLED with or without high-intensity functional exercise (HIFE) training. HIFE will be delivered through a commercially available supervised exercise program and incorporates interval training with a combination of progressively graded aerobic and anaerobic exercise.
The primary outcome measures are changes in body composition, assessed by dual x-ray absorptiometry (DEXA), and OSA severity (measured by apnoea hypopnea index). Secondary outcomes include glucose tolerance, ventilatory response, and peak oxygen uptake.
Data will be analysed on an intention-to-treat basis. Paired T-tests will be used to test the treatment effect of exercise compared to control. Confidence intervals will be used to analyse change in muscle mass and other secondary outcomes.

Results
Only one participant has completed the protocol to date. No results are available at this time.

Discussion
The results of this pilot study will look to confirm whether HIFE can protect against muscle mass loss, and additively benefit OSA severity during VLED, compared to VLED alone. It will also inform estimation of feasibility for a larger definitive study.