bluuebunny/crossref_metadata_2025_split huggingface dataset:
P042 Lean Six Sigma Approach to Improve Non-Invasive Ventilation Patient Care
Authors: Hartnett C , Angliss M , Leclerc M , Williams G 
Published: October 2023

Abstract

Introduction
A lean six-sigma (LSS) approach to clinical redesign looks at aspects of patient flow, value to consumer and process inefficiencies. We used LSS quality management approach for clinical redesign of our non-invasive ventilation patient care.
Current recommendations suggest that patients using non-invasive ventilation (NIV) require therapy for a minimum of 4 hours per night for optimal health benefits, with less than this amount defined as low adherence. This information is collated for each patient at each clinic visit. The aims of this study were to improve the identification of patients on non-invasive ventilation that are poorly adherent to paediatric specialist support, decrease the time taken for entry of NIV adherence data for all patients and evaluate process/es for scalability for future growth.

Methods
A LSS approach was used with identification of variation, waste and patient flow concerns in diagnostic stage. Rapid improvement events, diagnostic and solution design workshops were conducted to determine root cause, key issues and possible solutions. A preferred solution was adopted through team collaboration.

Results
A diagnostic stage identified two key areas: a 45% increase in telehealth and 162 man-hours of manual data entry for patient care. The solution initiated was to extract NIV machine data remotely and automate data collection.

Discussion
Healthcare is well suited to using the lean six-sigma approach to facilitate team collaboration in all aspects of clinical redesign of a healthcare pathway. Automating aspects of patient care may improve patient health and staff satisfaction.
P046 Knowledge of REM Behaviour Disorder Among Sleep Technicians in Australia
Authors: Coussens S , Cava M 
Published: October 2023

Abstract
Rapid Eye Movement (REM) Behaviour Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis during REM sleep, leading to the enactment of dream content. The accurate identification and management of RBD requires expertise and knowledge among sleep technicians. This study aims to assess the knowledge and awareness of RBD among sleep technicians in Australia.
A survey-based investigation was conducted among sleep technicians working in sleep clinics, hospitals, and research centres across Australia. The survey questionnaire consisted of multiple-choice and open-ended questions covering various aspects of RBD, including its definition and diagnostic criteria as well as their knowledge, training and lab practices. The survey was distributed electronically, and responses were collected anonymously.
Preliminary findings from a sample of 30 sleep technicians revealed a significant variability in knowledge regarding RBD. While 68% of participants demonstrated a solid understanding of RBD, 22% displayed limited knowledge, and 10% had minimal awareness of the disorder. Interestingly, the majority of participants reported that their workplace investigated patients with potential RBD symptoms but also the majority reported that they lacked the knowledge and resources to detect the condition appropriately.
These findings emphasize the need for targeted educational interventions and training programs to enhance the knowledge and competence of sleep technicians in identifying and managing RBD. By addressing these knowledge gaps, sleep technicians can play a vital role in early detection, timely referral, and appropriate management of RBD, thereby improving patient outcomes and quality of life.
P055 Maintaining effectiveness and mitigating sleepiness: A tailored digital CBT-i approach.
Authors: Sweetman A , Richardson C , Reynolds C 
Published: October 2023

Abstract

Background
Bedtime restriction therapy, a core component of cognitive behavioural therapy for insomnia (CBT-i), often leads to an acute increase in daytime sleepiness. To mitigate the effect of bedtime restriction on accident-risk, we aimed to develop and test a 5-session self-guided digital CBT-i program that incorporates self-reported sleepiness into personalised treatment algorithms.

Methods
We recruited people with insomnia symptoms (ISI≥15) reporting no excessive daytime sleepiness (ESS&lt;16) to a clinical trial. We assessed weekly self-reported sleepiness (ESS), nocturnal insomnia severity (Range: 0 [no symptoms] to 12 [worst symptoms]), and self-reported sleep/wake parameters during each digital CBT-i session. Intention-to-treat mixed models were used to investigate changes in weekly symptoms.

Results
Peri-treatment data from 52 people were used (Age M [sd] = 54.2 [15.7]; 81% female). Average ESS scores did not change from session one (M [±95%CI] = 5.9 [1.1]) to sessions two (6.2 [1.1]), three (6.2 [1.2]), four (5.4 [1.2]), or five (5.2 [1.2]). Improvements from sessions one to five were observed in; nocturnal insomnia severity (M [±95%CI] reduction = 4.0 [1.1], d = 2.3), and self-reported sleep onset latency (M reduction = 26.1 minutes [16.5], d = 0.6), wake after sleep onset (M reduction = 73.6 minutes [29.2], d = 1.0), sleep duration (M increase = 36.2 minutes [31.0], d = 0.5), and sleep efficiency (M increase = 17.9% [6.6], d = 1.2).

Conclusion
This digital CBT-i program improved insomnia symptoms without increasing average daytime sleepiness during any session. Further research is required in people commencing treatment with excessive daytime sleepiness.
P069 Assessing the prevalence of anatomical abnormalities amongst patients with sleep disordered breathing and high non-invasive ventilation pressure requirements.
Authors: Dixon O , Ellender C 
Published: October 2023

Abstract

Background
Adherence and tolerance of positive airway pressure (PAP) therapy is thought to be lower in individuals with sleep-disordered breathing and high pressure requirements. Patients occasionally have physical anatomical abnormalities that can contribute to these high pressure requirements. These anatomical abnormalities may have reversible contributors, which may reduce pressure requirements and thus improve tolerance of positive airway pressure.

Methods
A retrospective single centre cohort study of patients with sleep-disordered breathing was performed. Inclusion criteria was prescription of non-invasive ventilation with inspiratory pressure IPAP &gt;25 cmH2O between 01/01/2013-01/01/2023. All indications for PAP were included. Patient demographics, indications for PAP, sleep study results and anthropomorphic details were assessed. Primary outcome will be the proportion of patients assessed for anatomical abnormalities of the upper airway.

Progress to date
To date, 116 patients with high pressure requirements have been identified and data collection is in progress.

Intended outcome and impact
Amongst our local cohort, we aim to describe the proportion, demographic and clinical features of patients with sleep-disordered breathing on bilevel positive airway pressure therapy with high pressure requirements. Ultimately, we hope to use this research to inform decision-making with regards to referral to ENT.
P070 Efficacy of the ExVent Accessory with the O2Vent Optima Oral Appliance in the Treatment of Obstructive Sleep Apnea – A Clinical Trial
Authors: Sharma S , Reiter H , Conflitti A 
Published: October 2023

Abstract

Introduction
The study assessed the efficacy of oral appliance device O2Vent Optima and ExVent, an oral Expiratory Positive Airway Pressure (EPAP) accessory in the treatment of OSA.

Methods
A prospective, open-label study conducted at 3 sites in mild to moderate OSA (AHI ≥ 5 and ≤ 30).
Screening Phase
A diagnostic in-lab PSG study confirmed a diagnosis of mild to moderate OSA.
Treatment I
Subjects used O2Vent Optima for 6 weeks and underwent a PSG sleep night while using the O2Vent Optima.
Treatment II
Subjects used O2Vent Optima + ExVent for 6 weeks and underwent a PSG sleep night while using the O2Vent Optima + ExVent
Primary Effectiveness Measure: Change in AHI between baseline vs. O2Vent Optima MAD vs. O2Vent Optima + ExVent

Results
Treatment with Optima, Optima + ExVent reduced AHI from 22.5±6.4/hr to 12.6±4.5/hr to 5.9±2.7 (p&lt; 0.005 baseline vs. Optima and Optima + ExVent; p&lt;0.05 Optima MAD vs. Optima + ExVent). Average reduction in AHI with Optima was 43% and with Optima + ExVent was 72%. The lowest oxygen during sleep increased from 84.6±2.7% to 88.6±2.9% to 91.6±3.2% (p&lt; 0.005 baseline vs. Optima and Optima + ExVent; p&lt;0.05 Optima vs. Optima + ExVent). During the trial patients on treatment with Optima and Optima + ExVent demonstrated no excessive adverse events or device malfunction.

Conclusion
Treatment with O2Vent Optima and O2Vent Optima + ExVent significantly improved OSA compared to the baseline. Even greater benefit was observed with addition of ExVent to the Optima in mild to moderate OSA.
P074 Sleep-Related Predictors of Road and Workplace Safety in Young Adults: Results from a Community Representative Sample
Authors: Sansom K , Eastwood P , Brown B , Crowther M , Wanstall S , McArdle N , Adams R , Reynolds A 
Published: October 2023

Abstract
Young adults are at increased risk of road and workplace incidents. Sleep-related predictors of increased risk include short sleep duration, sleep disorders and shift work. It is unknown which predictors are the most impactful, or whether they are interrelated. To address this, sleep-related predictors were concurrently examined in young adults. Participants were young adults (22 years) from the Raine Study, who were employed, assessed for common sleep disorders (obstructive sleep apnoea by polysomnography, insomnia and restless legs syndrome symptoms by validated questionnaires), provided information on shift work status and habitual sleep duration. Two sub-groups were analysed: participants with a driver’s licence and self-reported information on road incidents (n=519) and those with information on workplace incidents, regardless of driver’s license status (n=575). Poisson regression models adjusted for sex and comorbidities were used to examine sleep-related predictors of road and workplace incidents. A total of 15% reported ever falling asleep behind the wheel and 23% reported ever having at least one near-miss road accident due to sleepiness. Diagnosis of a sleep disorder predicted near-miss road accidents (risk ratio, 3.0; 95%CI 1.7–5.3), independent of sleep duration and shift work. A total of 11% reported ever falling asleep on the job and 12% reported ever having an accident at work that required seeing a doctor or nurse, neither of these were associated with sleep duration, sleep disorders or shift work status. Sleep disorder diagnosis may be important in young adults given road incidents are strongly associated with the presence of a sleep disorder.
P075 Strategies to improve sleep disorder diagnosis and management in the workplace: Perspectives of future shift workers living with sleep disorders
Authors: Brown B , Adams R , Wanstall S , Crowther M , Rawson G , Vakulin A , Rayner T , Eastwood P , Reynolds A 
Published: October 2023

Abstract
Shift workers with untreated sleep disorders face greater risk of negative health and safety outcomes. A population of particular concern is early-career shift workers, as 20% of young adults live with, largely undiagnosed, sleep disorders.
This study aimed to explore what structures and qualities future shift workers would value in prospective workplaces regarding sleep disorder support and management. The study aims to inform the development of interventions that are acceptable to workers.
Undergraduate paramedicine students were invited to complete an online survey and participate in a health services trial. The survey included validated sleep disorder screening questionnaires, with those identified at risk of a sleep disorder being offered further diagnostic testing or treatment. Participants completed a qualitative interview upon completion of the trial to discuss their experience and recommendations to improve screening and management of sleep disorders for shift workers.
Seventeen paramedicine students (mean age 22.5±8.3 years, 59% female) with an undiagnosed sleep disorder were recruited into the trial. Early thematic analysis identified two key themes: Increasing education and awareness of sleep disorders and supporting access to health services. Almost half of the participants discussed the importance of increased awareness of sleep and sleep disorders during pre-employment training and in the workplace. Participants also identified convenience as an important factor in facilitating the management of sleep disorders.
Facilitating access to sleep health services before workers are exposed to shift work and during early employment were suggested to improve sleep disorder identification and management for early-career shift workers.
P085 Early Childhood and Adolescent Predictors of Sleep Problems and Sleep Disorders in Adulthood: A Systematic Review of Longitudinal Observational Studies
Authors: Desalegn G , Rawson G , Melaku Y , Abitew Z , Eastwood P , Reynolds A 
Published: October 2023

Abstract

Background
By middle-age, 43% of Australian adults live with a clinical sleep disorder. Sleep disorders are linked to chronic illnesses which are a leading cause of premature mortality. The aim of this review was to identify, appraise and synthesise evidence from longitudinal observational studies to clarify childhood and adolescence risk factors associated with sleep disorders in adulthood.

Method
Four databases (Web of Science, Medline, SCOPUS, and PSYCINFO) were searched using predefined inclusion and exclusion criteria for studies which were longitudinal, including at least one risk factor measured before 18 years of age, and an assessment of sleep problems or disorders in adulthood. This study was registered with PROSPERO (CRD42022301342).

Result
A total of 13,712 studies were screened, with 51 studies meeting criteria for data extraction. Sleep problems in childhood (n=9), childhood mental health (n=7), family environment (n= 2), adverse childhood experience (n=5), and lifestyle factors (n=9) were reported to be associated with sleep problems in adulthood. However most studies (n=30) only considered one or two measurements time points in childhood or adolescence as a predictor of adult sleep problems, and the age of sleep problem measurement in adulthood varied considerably (18 – 42 years). Further, heterogeneous sleep outcomes were reported across the studies, making quantitative synthesis of the data extremely challenging.

Discussion
Sleep problems in adulthood may be a result of cumulative risk factors in early childhood and adolescence. Consideration of childhood and adolescent trajectories are needed to better understand the biopsychosocial predictors of sleep problems in adulthood.
P090 How do Australian Shiftworkers and Non-Shiftworkers Prioritise Sleep, Diet, and Physical activity?
Authors: Gupta C , Duncan M , Ferguson S , Rebar A , Vandelanotte C , Sprajcer M , Khalesi S , Booker L , Rampling C , Rigney G , Vincent G 
Published: October 2023

Abstract

Background
Increasing engagement with sleep, diet, and physical activity (PA) is critical for populations who are at higher risk of poor health, such as shiftworkers. To increase engagement in sleep, diet and PA, it is critical to first understand which of these behaviours Australians currently prioritise and whether this prioritisation relates to actual behaviour. Therefore, this study aimed to investigate how Australians prioritise sleep, diet and PA.

Methods
A cohort of 1151 Australian adults (54% female, aged 18-65 years) completed a phone interview, and a cohort of 588 Australian shiftwork-only adults (76% female, 18-72 years) completed an online survey. All participants were asked which health behaviour (sleep, diet or PA) they prioritised. Behavioural correlates of sleep, diet, and PA, and questions on shiftwork experience were also collected.

Results
Diet was prioritised by the adults (49%), whereas sleep was prioritised by the shiftwork-only sample (68%). Multinomial logistic regressions revealed that adults who prioritised diet were significantly more likely to report less fast-food consumption (p&lt;0.002) and more fruit consumption (p&lt;0.002) compared to those that prioritised sleep. For the shiftwork-only sample, those with 16-30 years of shiftwork experience were significantly more likely to prioritise sleep compared to diet (p&lt;0.05).

Conclusions
While prioritising diet was associated with healthier diet behaviour in Australian adults, overall, across both cohorts, behaviour prioritisation did not relate to actual behaviour. This suggests that there are factors other than behaviour prioritisation that influence engagement in healthy behaviours. These factors, such as workplace barriers, should be the focus of future research.
P095 Factors associated with sleep and mental health problems following athletic retirement
Authors: Montero A , Adams R , Baranoff J , Drummond M 
Published: October 2023

Abstract

Introduction
Despite growing research on the sleep and mental health of athletes, there is limited literature on their sleep health following retirement from sport. The aim of this study was to investigate potential factors associated with symptoms of sleep and mental health disorders in former athletes.

Methods
Former athletes (N=173, 50% women) who retired from any sport or competition level ≤20 years ago completed an online survey, consisting of the Athlete Sleep Screening Questionnaire (ASSQ), Personal Wellbeing Index-Adult (PWI-A), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and Generalised Anxiety Disorder Assessment (GAD-7).

Results
Self-disclosed lifetime diagnosis of sleep disorder(s) and mental health disorder(s) was reported by 28.3% and 45.1% of former athletes, respectively. Binary logistic regressions showed that age (OR=0.95[95% CI:0.92, 0.99], p=.007) and gender (OR=2.28[95% CI:1.09, 4.79], p=.029) were associated with anxiety symptoms, with women and younger ex-athletes presenting greater risk. Increased BMI was associated with risk for sleep disordered breathing (OR=1.20[95% CI:1.10, 1.30], p&lt;.001), sleep difficulty (OR=1.13[95% CI:1.03, 1.23], p=.008), and poor wellbeing (OR=0.91[95% CI:0.85, 0.98], p=.010). Those who placed a lower priority on sport whilst competing had greater risk for sleep disordered breathing (OR=2.00[95% CI:1.05, 3.80], p=.035). Recency of retirement was not associated with any measures.

Discussion
Findings indicate that former athletes are not exempt from poor sleep and mental ill-health. Results provide preliminary insight into predictive factors for difficulty transitioning out of sport. Future longitudinal research should consider the interplay between sport reintegration and the timing of sleep and mental health problems.
P100 Acceptance, Compliance and Efficacy of Oral Appliance Therapy by Patients Suffering from Sleep Apnoea.
Authors: Rather N , Shankumar R , Nizamuddin A , Mansfield D 
Published: October 2023

Abstract

Background
Obstructive Sleep Apnoea (OSA) represents an established risk factor for several medical conditions. The evidence demonstrates that OSA can be effectively treated by an oral appliance. However, there less information about the role of an oral appliance in a clinical care model in terms of uptake and efficacy. This study aimed at examining the efficacy of an intervention in dental public health settings in Melbourne, Australia.

Methods
Data were collected from the 2018-2021. Participants who fitted inclusions criteria completed two instruments. The Epworth Sleepiness Score (ESS) was used to assess the Subjective daytime sleepiness, and the Apnoea Hypopnea Index (AHI) objectively evaluated the severity of OSA. Participants were further asked to self-report felt improvements post intervention. Paired t-tests were used to compare pre-test and the post-test results.

Results
34 participants had complete before and after data recorded. The mean age of the final samples of 66.4 (s.d., 14.2), the majority were female (67.7%). Participants unanimously acknowledged improvements after the intervention. Findings also indicated that after the intervention, participants had significantly lower EES scores compared to their baseline scores (6.9 vs 12.7; p&lt;0.001). Regarding the AHI, at post-test, participants had significantly lower AHI scores compared to their baseline scores (13.8 vs. 19.2; p&lt;0.001).

Conclusions
Present results indicate the use of oral appliance will ultimately benefit public patients who suffer from OSA. After the intervention, there were both objective and subjective improvements in OSA. Thus, findings provide valuable inputs and guidance for the design and implementation for larger efficacy trial.
P102 Sleep Quality, Depression, and Anxiety in People with Spinal Cord Injury and Traumatic Brain Injury Undergoing Inpatient Rehabilitation.
Authors: Saravanan K , Downey L , Graco M 
Published: October 2023

Abstract

Introduction
Poor sleep, depression, and anxiety are prevalent secondary complications of spinal cord injury (SCI) and traumatic brain injury (TBI), and may interfere with recovery. This observational, exploratory study aimed to describe subjective and objective sleep quality, and levels of depression and anxiety in people with SCI and TBI undergoing inpatient rehabilitation; and to explore associations between sleep quality, depression, and anxiety.

Methods
Twenty-four patients admitted to two neurorehabilitation facilities following SCI (n =18) or TBI (n = 6) completed the Pittsburgh Sleep Quality Index, the Depression, Anxiety, and Stress Scale-21, and one week of actigraphy monitoring.

Results
Most participants reported poor subjective sleep quality (83%). Average depression and anxiety scores were within normal levels. Higher anxiety scores correlated with lower subjective sleep quality, longer sleep onset latency, and lower subjective total sleep time.

Discussion
The findings suggest that targeting anxiety may improve sleep quality in inpatients with SCI or TBI, and vice-versa. Longitudinal and interventional studies are required to understand whether these relationships are reciprocal, and whether therapies targeting both sleep and mental health during inpatient rehabilitation can improve patient outcomes.