bluuebunny/crossref_metadata_2025_split huggingface dataset:
P054 The effect of head up bed-tilt (HUT) on sleep disordered breathing (SDB) in patients with supine dominant sleep apnoea (SDOSA): an exploratory study
Authors: Horadagoda C , Kairaitis K , Amis T 
Published: October 2021

Abstract
SDB severity is reduced in SDOSA when posture changes from supine to lateral. Sleeping with a head up bed-tilt(HUT) is known to reduce SDB in some OSA patients. In this exploratory study, we tested whether HUT could be used to reduce SDB in SDOSA patients who had refused continuous positive airway pressure therapy(CPAP).
We studied 5 male patients (age: 60 to 72years, BMI: 25.8 to 32.2kg/m2). Standard, in-laboratory, overnight-polysomnography was performed (Compumedics Ltd, Australia). Posture was monitored, but not restricted, and bed position was set at horizontal(HB) for half the night and at 7° HUT for the remainder (randomised). Polysomnograms were scored by a sleep technician using AASM criteria. SDB severity was quantified using the apnoea hypopnoea index(AHI) and apnoea index(AI). For this analysis, we focus on periods of supine, stage 2 sleep (S2S) only.
Participants spent 23 to 60minutes (range) in S2S with HB and 11 to 36minutes with HUT. AHI was 49 to 138events/hr with HB and 24 to 120events/hr with HUT, representing a fall of 2 to 62events/hr across all patients. AI was 19 to 111events/hr with HB and 0 to 48 events/hr with HUT, a fall of 15 to 96events/hr across all patients.
In these CPAP non-compliant, SDOSA patients, S2S in HUT was associated with a reduction in SDB severity that varied between individuals. Notably apnoeic events were reduced in all patients and eliminated in two patients. We conclude that HUT warrants further investigation as a potential alternative therapy for SDOSA patients intolerant of CPAP.
P057 Virus aerosol propagation by CPAP is proportional to mask leak and can be prevented by use of a hood and air filtration system
Authors: Landry S , Barr J , MacDonald M , Hamilton G , Mansfield D , Edwards B , Joosten S 
Published: October 2021

Abstract

Introduction
Nosocomial transmission of SARS-CoV-2 has caused significant morbidity/mortality in the COVID-19 pandemic. Because patients auto-emit aerosols containing viable virus, these aerosols can be further propagated when patients undergo certain treatments including continuous positive airway pressure (PAP) therapy. This study aimed to assess the degree of viable virus propagated from mask leak in a PAP circuit.

Methods
Bacteriophage PhiX174 (108copies/mL) was nebulised into a custom PAP circuit. Mask leak was systematically varied to 0, 7, 21, 28 and 42 L/min at the mask interface. Plates containing Escherichia coli assessed the degree of viable virus settling on surfaces around the room. In order to contain virus spread a ventilated headboard and high efficiency particulate air (HEPA) filter was tested.

Results
Increasing mask leak was associated with virus contamination in a dose response manner (χ2= 58.24, df=4, p&lt;0.001). Clinically relevant levels of leak (≥21 L/min) were associated with virus counts equivalent to using PAP with a standard vented mask. Viable viruses were recorded on all plates (up to 3.86m from source). A plastic hood with HEPA filtration significantly reduced viable viruses on all plates. HEPA exchange rates of 170 and 470m3/hr eradicated all evidence of virus contamination.

Discussion
Mask leak from PAP circuits may be a major source of environmental contamination and nosocomial spread of infectious respiratory diseases. Subclinical levels of leak should be treated as an infectious risk. Cheap and low-cost patient hoods with HEPA filtration are an effective countermeasure.
P058 Neural aperiodic activity as a novel objective measure of daytime somnolence
Authors: Kang T , Sarkar P , Cross Z , Chatburn A , Singh P , Johnston S , Lushington K , Yeo A 
Published: October 2021

Abstract

Background
Current assessment of excessive daytime somnolence (EDS) requires subjective measurements like the Epworth Sleepiness Scale (ESS), and/or resource heavy sleep laboratory investigations. Electroencephalographic (EEG) measures index intrinsic properties of the central nervous system. One such component is aperiodic neural activity which is thought to reflect excitation/inhibition ratios of neural populations and is altered in various states of consciousness. From this perspective, resting-state aperiodic activity may be a potential biomarker for hypersomnolence. We aim to analyse retrospective EEG data from patients who underwent a Multiple Sleep Latency Test (MSLT) and determine if aperiodic activity is predictive of subjective and objective measures of EDS.

Methods
Participants having undergone laboratory polysomnogram (PSG) and next day MSLT will be grouped into those with and without sleepiness (mean sleep latency (MSL) of &lt; 8min and &gt; 10min respectively). Forty patients in each group (n=80) will be assessed. The primary objective is to compare the aperiodic slope between these groups, and secondary objectives comparing aperiodic activity with ESS and time of day.
Data will be analysed using linear mixed-effect models. Simple linear regressions will be performed between the aperiodic slope and MSL and ESS, with R2 values used to estimate of effect size.
Progress: Formal ethics approval has been submitted and is pending.

Intended Outcome and Impact
In this exploratory study we hypothesise that EDS is associated with a lower aperiodic exponent/flatter slope, and hope to provoke further investigation of this metric as a novel biomarker for sleepiness.
P061 The effect of anxiety on symptom burden in patients with obstructive sleep apnoea
Authors: Kelley L , Hamilton G 
Published: October 2021

Abstract

Background
There is a high prevalence of anxiety in patients with obstructive sleep apnoea and such patients often describe fatigue in addition to sleepiness. We currently use the Epworth Sleepiness Scale (ESS) to quantify sleepiness in our patients, but we do not have useful tools for assessing fatigue. Fatigue is a common symptom in patients with many medical conditions but has not been well studied in patients presenting to sleep services.
Our hypothesis is that patients with obstructive sleep apnoea who have a comorbid anxiety disorder, as measured by the Hospital Anxiety and Depression Scale (HADS) are likely to have increased symptom burden such as fatigue or poorer functional outcomes of sleep.

Methods
Analysis of prospectively collected data from 128 adult patients referred for suspected obstructive sleep apnea to Monash University Health Sleep Clinic. All patients have completed a comprehensive questionnaire prior to their first clinical review assessing their symptom burden at baseline. Questionnaires completed include extensive symptom and medical history assessment, the Fatigue Severity Scale (FSS), ESS, HADS, Functional Outcomes of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI) and Global Fatigue Score. All patients were subsequently reviewed by a clinician and have overnight polysomnography data available.
Progress to date; Data collected for all 128 participants. Preliminary analysis currently underway.
Intended outcome & impact; We intend to examine whether the comorbidity of anxiety results in an increased or different symptom burden in patients referred for suspected obstructive sleep apnoea when compared to patients without a history of anxiety.
P113 An Exploration of Factors that Affect Perceived Onset Latency during the MSLT Test
Authors: Puglia M , Turton A , Stonehouse J , Rossely A , Grbic A , Packer K , Stupar D , Lemarrec J , Howes J , Hamilton G 
Published: October 2021

Abstract
It is assumed that during the MSLT test, the sleep laboratory environment will be appropriately resourced to facilitate sleep. However, anecdotal evidence suggests that a variety of factors may actually hinder sleep onset, although this possibility has not been formally investigated in the literature. Thirty-four MSLT participants, who attended the sleep unit between 2018 and 2019, completed a questionnaire that was designed to test perception of sleep onset latency by asking them how easy/difficult it was for them to fall asleep on 17 items that came from four categories. The four categories were the 1. sleep unit environment, e.g. noise/ room temperature; 2. the MSLT procedure, e.g. wires/fixed nap times; 3. the MSLT staff e.g. manner/ clarity of explanations and 4. pain/distress unrelated to the test. All items were rated on a five-point Likert scale. Space was provided for written comments for each category. Overall, the relationship with staff had the greatest impact on perceived sleep onset latency. Forty-one percent of participants reported that the provision of a thorough explanation of the day’s procedure helped them fall asleep in naps. Thirty-five percent reported that their own pain and discomfort affected their ability to sleep. Light and noise had little impact. This research indicates that the staff-patient relationship plays a significant role in patient’s experience of the MSLT and may potentially affect test outcomes.
P121 Comparison of Actigraphy versus PSG and Perception of Sleep in Patients with Excessive Daytime Sleepiness
Authors: Roebuck T , McDermott E , Cuesta R , Nguy R , Spiteri M , van Braak E , Ho S , Davies S 
Published: October 2021

Abstract

Actigraphy is used as a validated measure of rest and sleep, however, there are reported differences in WASO in healthy individuals (Chinoy, 2021).

Methods
This study compares the sleep parameters from PSG with simultaneous overnight actigraphy on patients the night prior to MSLT. We also compare the actigraphy data collected on the week prior to the PSG with the patient’s sleep diary.
22 subjects, age 38.7 ± 3.1 years, BMI 23.5 ± 1.4 kg/m2, 40.1% male, 4 participants were treated with CPAP.

Results
WASO was found to be under estimated by actigraphy versus PSG (y=-0.957x+18.014, R2=0.51), there is an increase in underestimation beyond 18minutes. Our data also show on overestimation of sleep onset latency by actigraphy versus PSG when sleep latency is longer than 12 minutes (y=0.27x-12.04, R2=0.08). Total sleep time was perceived to be longer on the PSG night than the PSG data shows (y=0.68x-4.65, R2=0.21). Data demonstrated participants to overestimate their sleep period in their sleep diary compared to the actigraphy data (y=-0.87x+6.58, R2=0.21). T-tests showed a significant difference between WASO (minutes) detected by PSG and the actigraphy data (67.4 ± 8.9 vs 33.3 ± 3.9 p=0.0007). There were no other significant differences in the datasets.

Conclusion
Actigraphy uses activity data and light detection to estimate rest and sleep periods in wearers. Our data reflects expected differences reported in the literature of actigraphy data versus PSG due to the limitation of actigraphy being able to differentiate between sleep and motionless wakefulness.
P146 Assessing the Performance of Automatic Analysis During Routine Polysomnography
Authors: Teuwen P , Eriksson N , Mateus E , Denovan T , Scott A 
Published: October 2021

Abstract

Introduction
This study aims to retrospectively assess the performance of automatic analysis (AA) during routine type 1 & 2 PSG studies. A literature review identified a gap in the current research for assessing the use of automatic analysis in routine clinical practice. Routine scientific practice often involves multiple scorers analysing data sets from a variety of study types with varied signal derivations and signal quality.

Methods
Retrospective study (2018–2020). All PSG data were analysed by experienced scientists (ES). The automatic analysis system used was Somnolyzer 24x7. All relevant parameters were analysed using paired T-tests with significance level of α = 0.05. PSG data sets included: Type 1 studies (n = 1370) split into two groups: Group 1 (n= 1148) included studies with automatic analysis only and Group 2 (n = 222) which included studies with automatic analysis and scientist review (SR) overnight. Type 2 studies (n = 235) included studies only with automatic analysis.

Results
Significant differences were found in 13 parameters between AA and ES in type 1 PSG (including total RDI), but with only 4 parameters in type 2 PSG studies.

Conclusions
There were statistically significant differences between automatic analysis and human scoring with routine scientific practice, however there were no differences when involving interscorer variances. These differences may have clinical significance, particularly with medical interpretation and practice.
P168 Pre and postnatal factors associated with periodic breathing in preterm infants
Authors: Yee A , Siriwardhana L , Nixon G , Wong F , Horne R 
Published: October 2021

Abstract

Introduction
Immature cardio-respiratory control in preterm infants often manifests as periodic breathing (PB). A number of pre- and postnatal demographic and clinical factors, such as exposure to maternal smoking, respiratory support and medications may affect respiratory control. We aimed to identify specific factors affecting the frequency of PB in preterm infants before hospital discharge.

Methods
32 healthy preterm infants (14M, 18F) born between 28–32 weeks of gestational age were studied for 2–3 hours with daytime polysomnography at 31–36 weeks (when they had been off respiratory support for ≥ 3 days). % sleep time spent in PB was calculated. Variables are reported as median (IQR) and were compared with Mann-Whitney U and Chi square tests, between infants who spent greater or less than the median time in PB.

Results
29 infants (91%) exhibited at least one episode of PB. Median sleep time in PB was 9.6% (IQR 0.6, 15.6%). Infants with time in PB above the median spent fewer days on respiratory support (4.0 days (1.0, 7.5) vs 9.0 (6.5, 21.5) days, p=0.035), and were younger (post-menstrual age 33.8 (IQR 32.1, 34.5) vs 35.1 (IQR 32.4, 35.6) weeks, p= 0.039).

Conclusions
Of the large number of maternal and infant demographic and clinical variables examined, we found few associations with the time preterm infants spent in PB. Greater % time spent in PB was associated with earlier discontinuation of respiratory support, however larger studies are required to confirm these findings and to investigate if there are any long-term consequences.
Jurassic mammaliaform petrosals from Western Siberia (Russia) and implications for early mammalian inner-ear anatomy
Authors: Schultz Julia A , Ruf Irina , Averianov Alexander O , Schellhorn Rico , Lopatin Alexey V , Martin Thomas 
Published: October 2021

Abstract
Five partially preserved mammaliaform petrosals recovered from Middle Jurassic sediments of the Berezovsk coal mine (Krasnoyarsk Krai, Russia) show similarities to other early mammaliaforms like the morganucodontan Morganucodon and the docodontan Haldanodon in having an inflated promontorium and a curved and apically inflated cochlear canal, but they are distinct from dryolestoid and derived mammalian petrosals by the weak coiling of the cochlear duct and the presence of a perilymphatic foramen with an open perilymphatic sulcus. The two larger and robust specimens exhibit striking similarities to docodontan petrosals. Inside the bone an intricate circumpromontorial venous plexus was discovered, as recently described for the docodontan Borealestes, confirming that this structure is consistently present in basal non-mammalian mammaliaforms. The three smaller and slender petrosals probably belong to haramiyidans and are unique in showing a septum-like structure medially along the cochlear nerve entrance. The protruding perforated bony bar, which is preserved in two of the three, is interpreted here to be a remnant of a bony septum with multiple foramina for cochlear nerve fibres, representing an autapomorphic feature of Haramiyida. This newly described passageway for nerve fibres shows that the formation of the osteological structure surrounding the nervous pathways of the cochlea is more plastic among the non-mammalian mammaliaforms than previously thought.
Comparison of Radiation Exposure Between Anterior, Lateral, and Posterior Interbody Fusion Techniques and the Influence of Patient and Procedural Factors
Authors: Striano Brendan M. , Xiong Grace X. , Lightsey Harry M. , Crawford Alexander M. , Pisano Alfred J. , Schoenfeld Andrew J. , Simpson Andrew K. 
Published: October 2021

Study Design.
Retrospective cohort.

Objective.
The aim of this study was to elucidate the relative influence of multiple factors on radiation usage for anterior, lateral, and posterior based lumbar interbody fusion techniques.

Summary of Background Data.
There has been substantial global growth in the performance of lumbar interbody fusions, due to evolution of techniques and approaches and increased attention to sagittal alignment. Utilization of intraoperative imaging guidance has similarly expanded, with a predominance of fluoroscopy and consequent increased radiation exposure. There have been no larger-scale studies examining the role of patient and procedural factors in driving radiation exposure across different interbody techniques.

Methods.
We used a clinical registry to review all single-level lumbar interbody fusions performed between January 2016 and October 2020. Operative records were reviewed for the amount of radiation exposure during the procedure. Patient age, biologic sex, body mass index (BMI), operative surgeon, surgical level, surgical time, and fusion technique were recorded. Multivariable adjusted analyses using negative binomial regression were used to account for confounding.

Results.
We included 134 interbody fusions; 80 performed with a posterior approach (TLIF/PLIF), 43 via an anterior approach (ALIF) with posterior pedicle fixation, and 9 performed with a lateral approach (LLIF/XLIF). Average radiation per case was 136.4 mGy (SE 17.3) for ALIF, 108.6 mGy (16.9) for LLIF/XLIF, and 60.5 mGy (7.4) for TLIF/PLIF. We identified lateral approaches, increased BMI, minimally invasive techniques, and more caudal operative levels as significantly associated with increased radiation exposure.

Conclusion.
We identified several novel drivers of radiation exposure during interbody fusion procedures, including the relative importance of technique and the level at which the fusion is performed. More caudal levels of intervention and lateral based techniques had significantly greater radiation exposure.

Level of Evidence: 4
Association and Risk of Axial Spondyloarthritis of Scoliosis Patients
Authors: Yong Jocelyn Huan , Hong Jia-Pei , Lee Yu-Hao , Huang Chi-Chang , Huang Shih-Wei , Lin Hui-Wen 
Published: October 2021

Study Design.
Retrospective longitudinal cohort study.

Objective.
To investigate the incidence and risk of axial spondyloarthritis (axSpA) in patients with scoliosis in Taiwan.

Summary of Background Data.
Scoliosis and axSpA causes back pain which reduces quality of life in many patients. Both scoliosis and axSpA had attracted numerous research attention, but the association between the two was hardly known.

Methods.
In this retrospective study, the data of 25,566 patients were obtained from Taiwan's National Health Insurance Research Database. We identified patients diagnosed with scoliosis and included them in the study cohort. We included age- and sex-matched patients without scoliosis in the control cohort. The total follow-up period was 7 years. Cox proportional hazards models were used to analyze the retrieved data. Hazard ratios (HRs) and adjusted HRs were calculated.

Results.
The study and control cohorts included 4261 and 21,305 patients, respectively. The incidences of axSpA were 141 and 46 per 100,000 person-years in the study and control cohorts, respectively. The crude HRs and adjusted HRs for patients with scoliosis were 2.98 (95% confidence interval, 1.87–4.73; P < 0.001) and 2.78 (95% confidence interval, 1.74–4.43; P < 0.001), respectively. The prevalence of comorbidities such as chronic obstructive pulmonary disease, osteoporosis, depression, autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus), and thyroid disease was significantly higher in the study cohort.

Conclusion.
Our findings indicate an association between scoliosis and axSpA. Additional studies should be performed to explain this phenomenon.

Level of Evidence: 3
A Web-based System to Assist With Etiology Differential Diagnosis in Children With Arterial Ischemic Stroke
Authors: Karthik Anjini , Jiang Bin , Li Ying , Hills Nancy K. , Kuchherzki Maria , deVeber Gabrielle A. , Barkovich A. James , Fullerton Heather J. , Wintermark Max 
Published: October 2021

Abstract

Background and Purpose:
The diagnosis of childhood arteriopathy is complex. We present a Web-based, evidence-backed classification system to return the most likely cause(s) of a pediatric arterial ischemic stroke. This tool incorporates a decision-making algorithm that considers a patient's clinical and imaging features before returning a differential diagnosis, including the likelihood of various arteriopathy subtypes.

Methods:
The Vascular Effects of Infection in Pediatric Stroke study prospectively enrolled 355 children with arterial ischemic stroke (2010–2014). Previously, a central panel of experts classified the stroke etiology. To create this tool, we used the 174 patients with definite arteriopathy and spontaneous cardioembolic stroke as the “derivation cohort” and the 34 with “possible” arteriopathy as the “test cohort.” Using logistic regression models of clinical and imaging characteristics associated with each arteriopathy subtype in the derivation cohort, we built a decision framework that we integrated into a Web interface specifically designed to create a probabilistic differential diagnosis. We applied the Web-based tool to the “test cohort.”

Results:
The differential diagnosis returned by our tool was in complete agreement with the experts’ opinions in 20.6% of patients. We observed a partial agreement in 41.2% of patients and an overlap in 29.4% of patients. The tool disagreed with the experts on the diagnoses of 3 patients (8.8%).

Conclusions:
Our tool yielded an overlapping differential diagnosis in most patients that defied definitive classification by experts. Although it needs to be validated in an independent cohort, it helps facilitate high-quality, and timely diagnoses of arteriopathy in pediatric patients.
Surgical Correction of Lower Lid Epiblepharon With Skin-Only Resection Using a Novel Design
Authors: Chae Woojung , Kim Chang Hoi , Park Jongyeop , Kim Hochang 
Published: October 2021

Abstract:
This study is to report the surgical outcome of lower lid epiblepharon repair with skin-only resection using a newly designed incision line. A retrospective, noncomparative, interventional case series analysis of 134 eyes of 67 patients, who underwent surgical correction of lower lid epiblepharon with skin-only resection using the new incision design, was performed. After marking the 4 vertical lines at the medial canthus, punctum, midpoint, and lateral canthus, the upper and lower incision lines were drawn from the medial canthus through punctum to the lateral canthus with novel design. After incising the skin along the marked line, gentle dissection of the skin flap from the underlying orbicularis muscle was performed. Only skin flap was excised and closed. The patients were followed up for more than 6months. The mean age of patients was 7.9 ± 3.7 years (range 4–13 years) and the mean follow-up period was 18.0 ± 5.7 months (range 13–31 months). During the follow-up period, recurrence of the epiblepharon was not observed. There was no occurrence of complications such as lower lid ectropion or retraction. Skin-only resection using a newly designed incision line is a simple and effective method to fully correct the medial portion of the lower lid epiblepharon and prevent dog-ear formation or overcorrection at the lateral portion, and prominent lid crease.