bluuebunny/crossref_metadata_2025_split huggingface dataset:
P069 Health professionals’ perceptions of sleep in palliative care: A qualitative study
Authors: Lalor A , Laurie R , Parikh D 
Published: October 2021

Abstract

Introduction
Sleep is vital for all individuals however sleep difficulties are highly prevalent for those receiving palliative care. Impaired sleep impacts their everyday participation and overall health and wellbeing. Although sleep is recognised as an important factor for care, limited evidence exists regarding health professionals’ perceptions of sleep for patients receiving palliative.

Methods
A qualitative research design was used to investigate the perceptions and roles of health professionals in identifying and addressing sleep difficulties in patients receiving palliative care. In-depth semi-structured interviews were conducted with ten health professionals across six disciplines with minimum six months experience working in palliative care. Interviews were audio recorded, transcribed verbatim and thematically analysed. Pseudonyms were used to de-identify participants.

Results
Five themes were identified: (1) patient’s sleep is highly valued; (2) sleep in palliative care is complex; (3) perspectives and approaches to sleep management vary; (4) challenges in addressing sleep; and (5) health professionals desire for sleep knowledge.

Discussion
Findings highlight health professionals’ perceptions of sleep difficulties and consequential implications, and the importance of sleep for both patients and caregivers. Participants perceive priorities of care and limited resources and training in sleep management hindered their clinical practice in addressing sleep. Health professionals working in palliative care could benefit from reorienting practice, development of and access to up-to-date resources regarding sleep, and support to provide sleep education for patients and caregivers.
P082 Gender moderates the effects of total sleep deprivation and sleep restriction on risk preference
Authors: Lim J , Boardman J , Drummond S , Dickinson D 
Published: October 2021

Abstract

Introduction
Total sleep deprivation (TSD) affects risk preference in decision-making. However, little work has examined the effects of sleep restriction (SR), or the potentially moderating role of gender, on risk preference. Here, we investigate the effects of TSD, SR, and gender on risky decision-making.

Methods
47 healthy adults (age=24.57±5.26 years, 24F) were randomly assigned to either of 2 counterbalanced protocols: 1) well-rested (WR: 9-hours time-in-bed for 6 nights) and 30hours TSD; or 2) WR and SR (4-hours time-in-bed for 4 nights). Participants performed the Lottery Choice Task (LCT) on the last day of each week. LCT requires a series of choices between two risky gambles with different risk levels. In one block, participants sought to maximise monetary gain (GAINS), and in another block, they sought to minimise losses (LOSSES). A trial-level analysis evaluated participants’ likelihood of choosing the “safer” gamble under influence of each sleep condition.

Results
The version*condition*gender interaction was significant. GAINS: everyone became more risk averse during TSD. Females also became more risk averse during SR, but males did not. LOSSES: everyone became more risk seeking during SR. During TSD, females became relatively more risk averse, while males became relatively more risk seeking.

Conclusion
TSD and SR had similar impacts on risk preference. However, gender moderated some effects. Women generally became more risk averse during sleep loss for both GAINS and LOSSES. Men were more risk averse for GAINS and risk seeking for LOSSES. This has implications for real-world situations where individuals are required to make risky decisions.
P088 Presence versus absence of flow limitation during stable breathing in patients with obstructive sleep apnoea
Authors: Mann D , Georgeson T , Landry S , Azarbarzin A , Vena D , Wellman A , Sands S , Terrill P 
Published: October 2021

Abstract

Introduction
Flow limitation is the distinguishing characteristic of obstructive sleep apnoea. Critically, periods of flow limitation can occur without overt reductions in airflow (e.g. disproportionate increase in ventilatory drive vs. achieved ventilation), however, such periods are ignored by clinical scoring. Here we investigate flow limitation during so-called “stable breathing”, i.e. periods of sleep without scored events, by applying our recently-validated model to estimate flow limitation from the airflow signal.

Methods
Flow limitation was visually-scored (N=117,871 breaths) from N=40 participants attending an overnight sleep study for suspected sleep apnoea. Scoring was aided by physiological signals (e.g. intra-oesophageal diaphragm EMG). Model flow limitation classification used features extracted from the pneumotach signal (cross-validated accuracy=92.4%). We applied this method to investigate the occurrence of flow limitation during stable breathing, defined as periods of sleep &gt;3 min duration without scored arousals or respiratory events.

Results
Model predicted flow limitation frequency was strongly correlated with visual scoring (R²=0.84 p&lt;0.001). The median flow limitation frequency during stable breathing ranged from 8–91%, with an overall median of 59% (IQR 37%-75%). Flow limitation frequency during stable breathing was only modestly associated with the apnoea-hypopnea index (R²=0.12 p&lt;0.05).

Discussion
Flow limitation occurs surprisingly frequently during stable breathing. While some individuals achieve stable breathing with minimal flow limitation, others demonstrate substantial flow limitation. Heterogeneity in frequency of flow limitation (within and between individuals) may provide further insights into emergent phenotypic variability within sleep disordered breathing. Finally, this model performed similarly in nasal pressure (88.2% accuracy), indicating potential application to clinical studies.
P097 Incidence of abnormal dreams and nightmares with lemborexant in adults with insomnia: results from two Phase 3 studies
Authors: Roth T , Yardley J , Pinner K , Kumar D , Cheng J , Moline M 
Published: October 2021

Abstract

Introduction
Abnormal dreams and nightmares have been reported by insomnia patients before and after treatment with sedative-hypnotics. Since dual-orexin-receptor-antagonists such as lemborexant (LEM; approved in multiple countries for adult insomnia) increase REM sleep, during which dream content is more likely to be recalled, we assessed the frequency of nightmares/abnormal dreams in Phase 3 studies.

Methods
Study 303 (SUNRISE-2) was a 12mo, randomized, double-blind, placebo (PBO)-controlled (first 6mo [Period 1]), phase 3 study that enrolled subjects ≥18y with insomnia disorder and ISI scores ≥15. During Period 1, the safety analysis set (SAS) included: PBO, n=319; LEM 5mg, (LEM5), n=314; LEM 10mg (LEM10), n=314. Study 304 (SUNRISE-1) was a 1mo, randomized, double-blind, PBO- and active-controlled (zolpidem tartrate extended-release 6.25mg [ZOL-ER]) study of LEM5 and LEM10. The SAS included: PBO, n=209; ZOL-ER, n=263; LEM5, n=266; LEM10, n=268.

Results
In Study 303, Period 1, 28/947 subjects (3.0%) reported nightmares (n=12; PBO-1; LEM5-4; LEM10-7) or abnormal dreams (n=17; PBO-6; LEM5-7; LEM10-4) as treatment-emergent adverse events (TEAEs). In Study 304, 12/1006 subjects (1.2%) reported nightmares (n=4; PBO-1; ZOL-ER-0; LEM5-2; LEM10-1) or abnormal dreams (n=8; PBO-1; ZOL-ER-3; LEM5-0; LEM10-4). 32/40 subjects (80.0%) reporting these events were female (% females in the studies: 303=67.9%; 304=86.4%). In the LEM groups, 11/28 subjects (39.3%) reported the TEAE within 3 days of treatment initiation. There were 2 TEAEs of nightmare/abnormal dreams during the PBO run-in prior to randomization.

Conclusion
Abnormal dreams/nightmares were not common events in either study. Incidence was slightly higher with LEM10 and proportional to enrollment based on sex.
P098 Predicting delays in or failure to initiate CPAP therapy: A retrospective cohort study
Authors: Moore S , Duce B , Ellender C , Hukins C 
Published: October 2021

Abstract

Background
Suboptimal CPAP usage is associated with negative outcomes and inefficient use of medical resources. Demographic and polysomnographic characteristics are well established predictors of poor adherence, however the literature regarding patients who fail to initiate treatment is limited. This audit aimed to identify features associated with the delayed commencement or failure to initiate CPAP therapy.

Methods
A single institution, retrospective cohort study was performed. The cohort comprised adults with obstructive sleep apnoea prescribed CPAP between 2017 and 2018. The demographic, clinical and polysomnographic features of this cohort were identified. Comparisons were conducted between patients who initiated therapy and those who did not, as well as between early and delayed initiators of treatment, which was defined as uptake after one month. Multiple logistic regression was performed with significance defined as a p&lt;0.05.

Results
916 patients were identified. 38.2% of patients did not uptake prescribed CPAP, with male gender (p &lt; 0.001), younger age (p=0.007) and lower pressure (p=0.016) identified as prognostic factors. Socioeconomic disadvantage (p=0.774) and Epworth Sleepiness Scale (p=0.111) were not associated with failure to start treatment. Of the 61.8% of patients who initiated CPAP therapy, 33% exhibited a delayed start to therapy, with indigenous status a significant feature of this cohort (p=0.002).

Discussion
A large portion of patients displayed either delayed commencement or failure to initiate CPAP therapy. Younger age, male gender and lower prescribed pressures were identified as negative predictive factors. These characteristics, as well as delayed treatment experienced in the indigenous population, provide focus points for intervention.
P100 Modified BRP and Tongue Channelling: Can we cure Friedman III?
Authors: Nasserallah M 
Published: October 2021

Abstract

Aim
The primary aim of this study was to determine the success rate of modified barbed reposition pharyngoplasty (BRP) and coblation tongue channelling (CCT) in adult patients with obstructive sleep apnoea (OSA). The secondary objective was to determine the anatomical sites that were most amenable to surgical intervention. We predicted that Friedman would be a poor predictor of success for this surgical technique and that a new prognostic index would be required.

Methodology
Adult patients with OSA underwent combined MODIFIED BRP and CCT (n = 40) in this prospective, 2-centre cohort trial. Data analysed included pre- and post-operative (3 months) polysomnography, Epworth sleepiness scale (ESS) and VOTE anatomy assessment (using awake nasoendoscopy) performed by a single investigator.

Results
40 participants have enrolled in this study. So far, 26 patients have pre- and post-operative data. 42% of these patients had Friedman 3 anatomy. Statistically significant decreases in AHI 20.3 + 24 to 4.9 + 8.6 (p=0.001) and ESS 12.4 + 4.9 to 4.8±3.4 (p=0.001) were observed in pre- to post-operative measurements. Friedman stage 3 patients had an 82% surgical success rate and 64% cure rate. Oropharyngeal lateral collapse and velum anteroposterior collapse were the most correctable forms of anatomical collapse.

Conclusion
MODIFIED BRP with CCT is a safe and effective surgical option for patients with OSA, as indicated by the reduction in AHI and ESS. Friedman stage III is no longer a barrier for surgical success, and therefore a newer staging system is required to help prognosticate success with modern sleep surgery techniques.
P108 Effects of different pillow designs on promoting sleep quality and spinal alignment by reducing neck pain, waking symptoms, neck disability in adults: a systematic review and meta-analysis
Authors: PANG J 
Published: October 2021

Abstract

Introduction
Poor sleep quality is more prevalent in patients with neck pain than in the control without neck pain. The effectiveness of using different pillows in the management of neck pain, waking symptoms and sleep quality is inconclusive.

Objectives
To identify the randomized controlled trials assessing the effect of different types of pillows on sleep quality, spinal alignment, neck pain, waking symptoms and neck disability.

Methods
A systematic review was conducted by searching CINAHL Complete, Cochrane Library, EMBASE, Medline, Pubmed and Psychinfo databases from inception to September 2020. Two reviewers independently assessed the articles and evaluated the methodological quality using the Physiotherapy Evidence Database (PEDro) scale.

Results
Thirty-five articles fulfilled the inclusion criteria of the study. There were nine high-quality studies involving 555 participants. The meta-analysis revealed significant differences favouring the use of rubber pillows to reduce neck pain [standardized mean difference (SMD: -0.263; P &lt; 0.001). Moreover, favourable outcomes by using rubber and spring pillows were found in waking pain (SMD: -0.228; P &lt; 0.001), neck disability (SMD: -0.506; P = 0.020) and pillow satisfaction (SMD: 1.144; P &lt; 0.001). However, pillow designs did not influence sleep quality (SMD = 0.047; P = 0.703) or spinal alignment at side-lying position (SMD=0.049; P=0.280) in patients with chronic neck pain.

Discussion
The use of spring and rubber pillows shows positive effects on reducing neck pain and disability. Although pillow designs do not change the sleep quality, waking symptoms can be reduced with positive pillow satisfaction in patients with chronic neck pain.
P139 Co-morbid insomnia and sleep apnoea (COMISA): Identifying patients that are responsive to continuous positive airway pressure therapy
Authors: Sweetman A , Lack L , Smith S , Chai-Coetzer C , Catcheside P , Antic N , Douglas J , O’Grady M , Dunn N , Robinson J , Paul D , McEvoy D 
Published: October 2021

Abstract

Introduction
Co-morbid insomnia and sleep apnoea (COMISA) is a prevalent and debilitating condition that is difficult to treat. COMISA patients have lower average adherence to continuous positive airway pressure (CPAP) therapy compared to patients with sleep apnoea alone. However, a sub-sample of COMISA patients may show adequate CPAP use that improves both the insomnia and sleep apnoea. It is important to identify this group of CPAP-responsive COMISA patients to guide personalised-medicine approaches.

Methods
Seventy-three COMISA patients (AHI≥15; ICSD-3 insomnia; 55% male, Age M=57y) completed questionnaires, home-based polysomnography, and one-week sleep diaries before and 6-months after commencing CPAP therapy. No patients accessed CBTi. We investigated baseline predictors of CPAP adherence (min/night) and overall change in Insomnia Severity Index (ISI) scores during treatment.

Results
Average CPAP adherence was 205 minutes/night (SD=153). 56% of patients used CPAP at least 4h/night. Average CPAP adherence was predicted by higher baseline AHI (r=0.39), arousal index (r=0.28), N1 sleep (r=0.32) and age (r=0.26), and lower N3 sleep (r=-0.28). The ISI decreased from baseline (17.9, CI=1.2) to 6-month follow-up (11.6, CI=1.3; p&lt;0.001). There was a significant positive association between ISI reduction and CPAP use (r=0.31). 26% of patients reported an ISI&lt;8 at 6-month follow-up.

Conclusion
Approximately half of COMISA patients show CPAP adherence of ≥4h/night and one quarter experience insomnia remission with CPAP. CPAP use is positively associated with AHI, light sleep, and age at baseline, and reduction of insomnia severity during treatment. Future randomized controlled trials are required to confirm the results of this small un-controlled study.
P157 Modelling the developmental trajectory of infant and child sleep
Authors: Webb L , Phillips A , Roberts J 
Published: October 2021

Abstract

Introduction
Sleep is important for infant and child neurodevelopment, yet there is a lack of mechanistic understanding of what drives the changes in sleep over the early years of life. While sleep in the adult brain has been studied and modelled extensively, very little has been done in infants and children, mainly limited to descriptive studies of sleep behaviour.

Methods
We adapted an existing, physiologically based model of adult sleep to study infant and child sleep behaviour. We compared modelled sleep behaviour to published data on sleep characteristics over a range of ages, both cross sectional from 0 to 5 years and densely-sampled individual data in the first year of life. We performed Bayesian inference to estimate the likely physiological parameters underpinning population-level diversity in sleep characteristics as a function of age from 0 to 5 years. We also fitted the model to individual sleep architecture in the first year of life.

Results
The empirically observed decrease in total sleep duration and consolidation of sleep bouts with increasing age are well explained by decreases in the constant inhibitory input to the ventrolateral preoptic nucleus and increases in the characteristic somnogen clearance time during sleep. Further, our model produced realistic sleep-wake dynamics consistent with early maturation of sleep in the heavily sampled, single infant data.

Discussion
Our results show that a greater understanding of the neurophysiology of sleep in infants and children can be achieved through the use of physiologically based models.
P159 Successful treatment of sleep disordered breathing improves comorbidities in patients with nocturia
Authors: Wilson C , Goldin J , Bower W , Stonehouse J , Perkins A , Kee K 
Published: October 2021

Abstract

Introduction
Sleep disordered breathing (SDB) has been shown to increase nocturia (waking with the need to void urine) frequency. Nocturia negatively affects sleep, autonomic dysfunction, mental health and mortality. Nocturia and these co-morbidities share central control areas in the brainstem. We hypothesised that treatment of SDB would decrease nocturia frequency and impact these co-morbidities.

Methods
A prospective repeated measures study with participants ≥40 years, naïve to treatment, with an AHI ≥30/hr and experiencing ≥1 episodes of nocturia was conducted. Participants undertook two months of CPAP with before and after measures of lower urinary tract symptoms (Overactive Bladder Symptom Score (OABSS) and urine volume), sleep quality (PSQI and actigraphy), autonomic dysfunction (blood pressure and orthostatic change) and wellbeing (Nocturia quality of life score (NQoL) and the Hospital anxiety and depression scores (HADS)).

Results
490 diagnostic studies screened, 36 patients met criteria, and 30 participants (57% male) were recruited. 15 patients completed treatment with 55% of completed participants meeting the required compliance of &gt;4 hours. Significant changes in OABSS (p=0.035), nocturnal voiding frequency (p=0.007), nocturnal urine volume (p=0.013) and nocturnal diuresis (p=0.013). Improvement was observed in PSQI perceived sleep quality (p=0.018) and actigraphy derived sleep efficiency (p=0.002). NQoL global score also showed significant improvement (p=0.037).No change was observed in autonomic dysfunction measurements.

Conclusion
With appropriate treatment of SDB an improvement was observed in nocturia frequency and associated co-morbidities in a sample of relatively healthy individuals. These results suggests that significant nocturia should prompt the assessment for and treatment of SDB.
P162 Heated humidified high flow nasal cannula versus continuous positive airway pressure therapy for obstructive sleep apnoea in children: the patients’ perspective
Authors: Wong M , Taylor E , Longland R , Leclerc M , Williams G , Neylan M , Kilner D , Chawla J 
Published: October 2021

Abstract

Introduction
Approximately 30% of otherwise healthy children will have residual obstructive sleep apnoea (OSA) after first line therapy with adenotonsillectomy (AT) with lower success rates in children with risk factors. Continuous positive airway pressure (CPAP) is often the next treatment option and, whilst highly effective therapy, can be challenging to sustain in children. A pilot study is underway at our centre to evaluate the efficacy of heated humidified high flow nasal cannula therapy (HFNC) compared to CPAP in children with residual OSA. A secondary aim of this study is to determine which therapy (HFNC versus CPAP) the patients prefer. This abstract will report preliminary findings.

Methods
Children under 18 years old identified as requiring a CPAP trial for residual OSA management were invited to undergo an additional polysomnography, where they underwent a trial of HFNC overnight, which was undertaken in a similar manner to the CPAP trial. Participants and caregivers completed a questionnaire regarding comfort level following both the HFNC and CPAP titration nights.

Results
11 participants (4 males) between 4 months and 15 years old have completed the study to date. Using an 11-point Likert scale, the average reported comfort level grading for HFNC was 1.5 points higher than CPAP.

Discussion
This preliminary data suggests that on average caregivers and participants found HFNC more comfortable than CPAP. Alternative therapies such as HFNC may be effective in managing OSA and may be better tolerated in children non-adherent to CPAP.
P169 Comparison of Work of Breathing: Heart failure versus Interstitial Lung Disease
Authors: Yu C , Heng A , Cuesta R , Roebuck T , Prasad J , Naughton M 
Published: October 2021

Abstract

Background
Heart failure with central sleep apnoea and Cheyne Stokes respiration (HF-CSA-CSR) and interstitial lung disease (ILD) are characterised by tachypnoea, reflecting an increased work of breathing (WOB). Whilst tachypnoea is continuous in ILD, it is periodic in HF-CSA-CSF. Our hypothesis is that the periodicity reflects adaptive efficiency.

Methods
We assessed polysomnograms of male patients attending for either heart transplant or ILD assessment. WOB during non-REM sleep was estimated by the breath to breath interval (BBI), from which respiratory rate (RR) was calculated. An age matched control group with snoring, AHI&lt;5 and neither HF or ILD was included.
Progress to date: Four patients (mean age 70 years) were identified in each group. The HF-CSA-CSR and ILD groups had similar awake PaCO2. The HF-CSA-CSR group had a lower LVEF and higher TLCO than the ILD group. There was similar BBI in the HF-CSA-CSR group during hyperpneic phase mean = 3.4±0.1 seconds and ILD group mean = 3.5±0.3 seconds, p=0.31. However, the RR during slow wave sleep was significantly lower in the HF-CSA-CSR group compared with ILD and control groups: HF-CSA-CSR mean = 10.3±0.8 breaths/min, control mean = 14.3±1.0 breaths/min, ILD mean 18.2±2.3 breaths/min, P=0.0002.
Intended outcome and Impact: This data would suggest that both HF-CSA-CSR and ILD have similar severities of tachypnoea (aka work of breathing) compared with controls, however the RR is significantly lower in the HF-CSA-CSR group compared with ILD, despite similar PaCO2. This would indicate HF-CSA-CSR has similar WOB, yet greater efficiency, than ILD during non-REM sleep.