bluuebunny/crossref_metadata_2025_split huggingface dataset:
O024 Sodium oxybate for refractory narcolepsy and idiopathic hypersomnia: clinical and employment outcomes
Authors: Hernest A , Armstrong J , Vekaria S , Kosky C 
Published: October 2023

Abstract

Background
Sodium oxybate (SOX) is an evidenced based treatment for narcolepsy. SOX is not available in Australia through the pharmaceutical benefits scheme. In 2018, Western Australia (WA) listed sodium oxybate on the state formulary for the treatment of refractory narcolepsy. We examine the demographics, clinical and employment outcomes of patients treated with SOX.

Methods
We undertook a retrospective study of patients treated with sodium oxybate in WA for refractory narcolepsy or idiopathic hypersomnia (IH). A database of SOX patients was cross checked with pharmacy prescribing data from across WA public hospitals. Electronic medical records were used to collect demographic, polysomnographic, prescribing and outcome data. Clinical outcomes were based on the Epworth sleepiness scale, clinical assessment and employment status. Patients that responded to SOX are to be compared to non-responders using appropriate statistical methodology.

Progress to date
The study has been registered as a hospital clinical audit (number 49852). A total of 50 patients prescribed SOX for the treatment of a central hypersomnia have been identified. A request for sodium oxybate dispensing data across WA has been made. Review of 10 patient’s records has been completed. Correspondence, sleep studies, MSLT, HLA testing and prescriptions are being reviewed for the remaining 40 patients.

Intended outcome and impact
Describe the characteristics of patients treated with SOX in WA.
Explore whether clinical or sleep study characteristics predict response to SOX.
Assess patient reported outcomes from treatment with SOX based on symptoms and changes in employment status.
O028 Worsened sleep and mood after initiating elexacaftor/tezacaftor/ivacaftor treatment in children with cystic fibrosis
Authors: Pham H , Ranganathan S , Vandeleur M 
Published: October 2023

Abstract

Background
CFTR modulator Elexacaftor/tezacaftor/ivacaftor (ETI) significantly improves lung function and but its effect on mental health and sleep remains poorly understood. We report sleep, mood and respiratory health outcomes of adolescents with CF with ETI therapy.

Methods
We conducted a prospective longitudinal study of 31 adolescents (aged 10 to 18 years) from July 2021 to October 2022. Data collected include demographics, pediatric daytime sleepiness scale (PDSS), sleep disturbance scale for children (SDSC), patient health questionnaire-9 (PHQ-9), generalised anxiety disorder-7 (GAD-7) scores and FEV1 percent predicted.

Results
Paired-T testing demonstrated a significant improvement in FEV1, whereas PDSS, PHQ-9, and GAD-7 scores worsened following ETI therapy, but did not reach statistical significance. SDSC scores marginally reduced. Ten percent of participants developed new onset sleep concerns and new mood concerns developed in 10% following ETI initiation.

Conclusion/Outcome
This is the first prospective longitudinal study of sleep and mood changes with ETI in adolescents with CF. ETI does not improve sleep and mood in the same way as respiratory health outcomes.
O036 Measuring Sleep-wake State Discrepancy in the Home across Multiple Nights
Authors: Bensen-Boakes D , Loffler K , Lack L , Perlis M , Drummond S , Kaambwa B , Paterson J , Scott H , Lovato N 
Published: October 2023

Abstract

Introduction
Sleep-wake state discrepancy, the mismatch between subjective and objective measurements of sleep/wake status, is estimated to affect 9-50% of individuals with insomnia, often undetected due to lack of objective measures. Consumer sleep devices allow efficient measurement of sleep-wake state across multiple nights in the habitual sleep environment. This study assessed sleep-wake state discrepancies obtained by two devices across multiple nights in individuals with insomnia.

Methods
Individuals with insomnia completed daily sleep diaries, wore a Fitbit Charge 4 device, and used a Withings Sleep Analyser under-mattress sensor for 14-days. Sleep metrics were obtained from all three data sources to calculate sleep-wake state discrepancy (device metric − diary metric).

Results
15 people participated in the study. Fitbit data were available for 12 and mattress data for 11 participants. There were no significant differences between the sleep-wake state discrepancy values derived from Fitbit and Withings devices for total sleep time (−78.7±111.8 and −95.7±124.4 minutes respectively; p .123) or wake after sleep onset (−15.4±52.9 and −17.6±110.6 minutes respectively; p .826). Significant differences were found in the sleep-wake state discrepancy values derived from Fitbit (−17.5±23.3, p &lt;.001) and Withings devices for number of awakenings (3.2±23.1, p .175).

Discussion
Both devices comparably detected sleep-wake state discrepancy in people with insomnia, noting a device-difference for number of awakenings. These preliminary findings suggest that consumer devices may be useful to detect sleep-wake state discrepancy. Larger studies may reveal devices do so with different levels of sensitivity. Future studies should include polysomnography to assess relative magnitudes across devices.
O038 Obstructive Sleep Apnoea Prevalence and Severity in a Specialist Heart Failure with Preserved Ejection Fraction (HFpEF) Clinic
Authors: Stewart G , O’Sullivan J , Lal S , McClintok S , Tong B , Yee B , Cistulli P 
Published: October 2023

Abstract
Heart Failure with Preserved Ejection Fraction (HFpEF) is a debilitating, incurable form of HF associated with a normal left ventricular ejection fraction and elevated ventricular filling pressures. While Obstructive Sleep Apnoea (OSA) is common in HFpEF and OSA treatment may be associated with improved outcomes, the causal role of OSA in the pathophysiology of HFpEF remains unclear. Accordingly, accurate diagnosis and tracking of OSA in HFpEF patients is emerging as a potentially important approach for impacting prognosis. This study sought to identify the prevalence and severity of OSA in consecutive patients referred to a recently established tertiary hospital HFpEF clinic. All patients were confirmed to have HFpEF using standard clinical approaches and completed the Epworth Sleepiness Scale (ESS) to screen for sleep-disordered breathing and a level 2 polysomnogram to confirm OSA presence and severity. To date 28 patients have been assessed for OSA (9M/27F; Age 67±2y; BMI 35.0±1.6kg/m2; BNP 214±64ng/L). All 28 patients (100%) were diagnosed with OSA (AHI≥5 events/h), while 16 (57%) had moderate-severe OSA (AHI≥15 events/h). Average ESS was 7±1, with only 6 patients (21%) identified at risk for sleep-disordered breathing (ESS&gt;9). These preliminary data confirm a very high prevalence of OSA in HFpEF patients when assessed via polysomnography. Furthermore, these patients appear asymptomatic in terms of sleepiness, as measured by the ESS. The nature of the association between OSA and HFpEF and the potential benefit of OSA treatment warrant study. Given that the ESS did not effectively identify OSA risk in HFpEF, alternative screening tools warrant consideration.
O039 A Novel Approach to Quantify Breathing effort in Obstructive Sleep Apnoea
Authors: Nguyen P , Lechat B , Reynolds K , Eckert D , Catcheside P 
Published: October 2023

Abstract

Introduction
Breathing effort is an important component of obstructed breathing and determinant of arousal in obstructive sleep apnoea (OSA). However, relative effects of hypopnoea versus apnoea on effort and work of breathing (WOB) are largely unknown. This study applied a novel modelling approach to quantify breathing effort, WOB and obstruction severity to evaluate differences between hypopnoea and apnoea events in OSA.

Methods
1659 apnoea and hypopnea events from six obese males (BMI: 30-41 kg/m2; age: 34-56 years; AHI: 31-114 events/hr) with severe OSA were evaluated using conventional sleep measures and a 3-compartment (nasal, collapsible upper airway and lungs) respiratory mechanics model using mask airflow and pressure, and oesophageal and epiglottic pressures. Attempted airflow and WOB, and WOB loss to obstruction (attempted minus measured WOB), were estimated breath-by-breath via the model for comparisons between hypopnoea and apnoea events and sleep stages.

Results
The model explained most of the variance in attempted flow (Pearson r= 0.91 [95% CI 0.71 to 0.98]). Compared to hypopnoea events, WOB loss during obstructive apnoeas was 3.5 [95%CI 1.7 to 5.4] times higher. WOB losses were also higher during deep versus N2 sleep. Visualising breath-by-breath WOB loss revealed a significant number of flow- limited breaths not detected using traditional human scoring. Over 30% of breaths not classified as hypopnoeas or apnoeas exhibited WOB loss higher than for hypopnoea events.

Conclusions
Respiratory mechanics modelling is useful to assess breathing effort and upper airway obstruction severity and could provide novel mechanistic insights into sleep-related breathing problems and treatment outcomes.
O041 Exploring the Landscape of Sleep Data Resources: A Literature Survey
Authors: Chen L , Malagutti N , Miller S 
Published: October 2023

Abstract

Introduction
The complex physiologic interdependencies of sleep make sleep medicine a data-rich discipline. Emerging big data approaches hold promise for novel discoveries, however, scholars have suggested these advances may be hindered by dataset limitations. We conducted a review of the field to assess the drawbacks of available sleep data resources.

Methods
A systematic literature survey on PubMed. A keyword search identified studies based on sleep datasets which combined polysomnography records and contextual patient health information. For eligible studies, we extracted information on data provenance (existing repositories versus self-collected), data accessibility for onward research, dataset size, cohort characteristics, data/metadata inclusions, and use of systematic nomenclatures.

Results
Only approximately 40% of identified studies used public datasets, suggesting that these repositories only partially met current research needs. Alternative, self-collected cohorts were typically small, with just 20% having populations greater than 1000 subjects. Most were closed-source or lacking data access indications, which may impact the strength and reproducibility of study results. Large-size resources focussed predominantly on sleep apnoea, limiting the reach of research efforts targeting less prevalent conditions.
Datasets featuring comprehensive medical histories and long-term follow-up information were rare. Where available, this information generally lacked systematisation of nomenclatures and metadata, impairing the ability of users to extract meaning from data entities and their interrelationships.

Discussion
Limitations in current sleep data practices were substantiated by our review. There is a clear need to develop larger, diverse, multimodal and clinically representative sleep data collections that can be more easily shared, and analysed using emergent data-driven discovery tools.
O044 Are we Sleeping Enough? Short and Irregular Sleep is Common in a Large Global Community Sample with Objective, Multi-night, In-home Sleep Data
Authors: Scott H , Naik G , Lechat B , Manners J , Fitton J , Nguyen D , Hudson A , Reynolds A , Sweetman A , Escourrou P , Catcheside P , Eckert D 
Published: October 2023

Abstract

Introduction
Evidence-based guidelines recommend that adults should sleep 7-9hrs per/night. This study used multi-night, in-home, objective sleep duration monitoring to determine how often a large global community sample meets the recommended sleep duration range.

Methods
Data were analysed from registered users of the Withings Sleep Analyzer under-mattress device who had ≥28 nights of sleep recordings, averaging ≥4 per week. Sleep durations were assessed as the average and standard deviation of sleep duration across a ~9-month period. Proportions of participants within (7-9hrs) or outside (&lt;7hrs or &gt;9hrs) the recommended sleep duration range were calculated. Associations between age groups, sex, and sleep duration were assessed using linear and logistic regressions.

Results
In total, data were analysed from 67,254 adults (52,523 males, 14,731 females; aged Mean±SD 50±12y). About 30% of the sample showed an average sleep duration outside the recommended 7-9hrs per/night. Even in participants with an average sleep duration within 7-9hrs, about 40% of recorded nights were outside this range, and only 15% of participants slept between 7-9h for at least 5 nights per/week. Females had significantly longer sleep durations than males, and middle-aged participants had lower sleep durations than younger and older participants.

Discussion
A considerable proportion of adults in this sample were not regularly sleeping the recommended 7-9hrs per/night. Even amongst those who do, irregular sleep is prevalent. These novel data raise several important questions regarding sleep requirements, lifestyle factors, and the need for improved sleep health policy and advocacy.
O050 The Dose and Timing Relationship between Caffeine and Subsequent Sleep
Authors: Gardiner C , Weakley J , Johnston R , Fernandez F , Townshend A , Halson S 
Published: October 2023

Abstract

Introduction
There is currently a lack of evidence to guide recommendations for the consumption of caffeine to mitigate its effects on sleep. Therefore, the aim of this study was to investigate the effect of caffeine dose and timing combinations on subsequent sleep.

Methods
Twenty-three healthy adult males with a moderate habitual caffeine intake (&lt;300mg/d) participated in a randomised, repeated-measures study. Participants completed seven conditions, including a placebo and two caffeine doses (100mg and 400mg) consumed at three different time points (12, eight, and four hours prior to habitual bedtime) with a 48-hour washout period. Sleep was measured using in-home partial polysomnography and subjective sleep diaries. Linear mixed effects models were used to estimate the effect of each caffeine condition on sleep characteristics.

Results
Caffeine negatively impacted sleep when compared to the placebo. The largest impact was observed when the highest dose of caffeine (400mg) was consumed closest to bedtime, with a 54.0 minute reduction in total sleep time (p=&lt;0.001), a 10.2% reduction in sleep efficiency (p= &lt;0.001), a 14.4 minute increase in sleep onset latency (p=0.047), a 25.3 minute increase in wake after sleep onset (p=&lt;0.001), a 5.5% increase in the proportion of light sleep (N1&N2)(p=0.029), and a 4.55% reduction in deep sleep (N3)(p=0.026).

Discussion
The largest decrements in sleep occurred when caffeine was consumed at a high dose in close proximity to bedtime. These findings highlight the importance of considering the amount and timing of caffeine intake when aiming to minimise the effect of caffeine on subsequent sleep.
O053 Cardio-metabolic Health Effects of CPAP Treatment for Sleep Apnoea during Weight Loss: A Randomised Controlled Pilot Trial.
Authors: Hoyos C , Cayanan E , Yee B , Postnova S , Marshall N , Markovic T , Twigg S , Grunstein R , Phillips C 
Published: October 2023

Abstract

Introduction
This study assessed whether the addition of CPAP during weight loss would enhance cardiometabolic health improvements in patients with obesity and OSA.

Methods
Patients with overweight or obesity, pre-diabetes and moderate-severe OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). Primary outcome: 2-hour glucose assessed by OGTT. Trial registration: ANZCTRN 12617000823370.

Results
17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Mean CPAP compliance was 5.29 hrs/night. Participants lost ~12 kg which reduced OSA severity by ~45%. The primary analysis showed no between group differences for any of the assessed outcomes. Despite this, most outcomes improved with weight loss including insulin sensitivity (.000965 units, p=.008), wake diastolic BP (-4.3mmHg, p=.03), sleep systolic BP (-16.2 mmHg, p=.0003), sleep diastolic BP (-9.8 mmHg, p=0.02), and sleepiness (Epworth Sleepiness Score -3.2, p=.0003). Two-hour glucose levels did not improve (p=0.33), but the glucose area under the curve (AUC) was reduced (-230 units, p=.009). In addition, total (-0.86mmol/L, p=0.006) and LDL cholesterol (-0.58mmol/L, p=0.007), triglycerides (-0.75mmol/L, p=0.004), fat mass (-7.6kg, p&lt;.0001) and abdominal fat (-310cm3, p&lt;.0001) were all reduced.

Conclusions
We did not establish any cardio-metabolic benefit from CPAP therapy during weight loss. In contrast, weight loss had a robust positive effect on cardio-metabolic health. The magnitude of weight loss improvements far exceeded those from trials assessing the impact of CPAP alone, suggesting that weight loss should be the primary focus of treatment for patients with OSA and obesity.
O056 Is Obstruction Obstructing Survival? Long-term Mortality in Patients with Chronic Obstructive Pulmonary Disease (COPD) requiring Acute Non-invasive Ventilation (NIV) with and without Obstructive sleep apnoea (OSA).
Authors: Nguyen B , Menadue C , Yee B , McGuiness O , Wong K , Marshall N , Lau E , Piper A 
Published: October 2023

Abstract

Introduction
COPD/OSA overlap syndrome (OVS) is associated with poor outcomes in studies conducted in ambulatory settings. However, little is known about the prognosis of patients hospitalised with acute hypercapnic respiratory failure (ARF) requiring NIV. The aim of this study was to compare the long-term prognosis of OVS patients compared to patients with COPD.

Methods
In this retrospective cohort study, 129 patients with COPD and 52 OVS patients were treated with NIV for ARF and followed up for a median of 1.8 years (IQR 3.8). We compared patient characteristics and overall survival.

Results
Compared to patients with COPD alone, OVS patients had higher prevalence of hypertension and type-2 diabetes mellitus. There was no difference in arterial pH, PaCO2 or serum bicarbonate at hospital presentation. Mortality was lower in OVS (HR 0.57, 95% CI 0.38-0.85) and remained lower after adjustment for age, gender, BMI, FEV1%predicted and comorbid cardiovascular disease. Median survival in OVS patients discharged home on NIV was significantly higher compared to OVS not discharged on therapy, as well as COPD patients, irrespective of home therapy prescription (p&lt;0.01).

Discussion
OVS patients discharged on NIV had lower mortality compared to OVS patients not discharged on NIV. Patients with COPD and ARF requiring NIV have overall higher mortality rates compared to OVS patients. These findings suggest that following hospital admission with ARF, OVS patients may benefit from ongoing home NIV.
O058 Are short central apnoeas in preterm infants really benign? Effects on cardiovascular control.
Authors: Yee A , Shetty M , Siriwardhana L , Walter L , Wong F , Horne R 
Published: October 2023

Abstract

Introduction
Preterm infants frequently experience respiratory instability in the form of short apnoeas and periodic breathing. Animal studies have shown that repetitive hypoxia associated with periodic breathing can alter autonomic control. We aimed to elucidate if apnoea and periodic breathing were associated with autonomic cardiovascular control, thus exacerbating the consequences of respiratory disturbance longitudinally over the first 6 months after hospital discharge.

Methods
Preterm infants born between 28-32 weeks gestational age (GA) were studied during supine daytime sleep at 32-36 weeks post menstrual age (PMA) (n=29), 36-40 weeks PMA (n=27), 3-months corrected age (CA) (n=20) and 6-months CA (n=26). The percentage total sleep time (%TST) spent having central apnoeas at each study was calculated. Autonomic control was assessed using heart rate variability in ranges of total power, low frequency (LF, reflecting sympathetic + parasympathetic activity) and high frequency (HF, parasympathetic activity), and LF/HF ratio (sympathovagal balance).

Results
The amount of time spent with short central apnoeas decreased with increasing postnatal age in both active sleep (AS) and quiet sleep (QS). In both sleep states, total, LF and HF power increased with postnatal age, while LF/HF decreased in AS. In both AS and QS %TST spent with short central apnoeas was negatively correlated with Total, LF and HF power (p&lt;0.001 for all) and positively correlated with LF/HF (p&lt;0.05).

Conclusion
This study provides new evidence that short apnoeas, particularly periodic breathing, which is currently not detected or treated in the neonatal unit can affect autonomic cardiovascular control.
O059 Exploring Environmental Light Exposure in Children: A novel pilot spectrometer study
Authors: Pattinson C , Mann D , McKenzie J , Rossa K , Edmed S , Westwood E , Smith S 
Published: October 2023

Abstract

Introduction
Light plays an important role in the timing of children’s circadian system. Artificial manipulation of the timing, intensity, spectra, and duration of light exposure has increased, but with little consideration of the impact on children’s development, health, and wellbeing. Children are exposed to brighter nights, darker days, and less natural light environments than prior generations. Exploring the 24-hour light environment is a critical first step in understanding how light affects children.

Methods
We conducted a pilot feasibility and acceptability study. The study is of children aged 5 – 8 years. Children wore a miniature spectrometer and an actigraph for 48-hours. During this period, their parents completed a survey and daily time-use diary. At the end of the study, children undergo a short evaluation interview, as this is a new form of wearable not previously used with children. This study examines the feasibility and potential utility of this form of measurement.

Results
5 children have been recruited into the study (3 boys, 2 girls). Initial feasibility testing with children supports high acceptability and adherence to the study protocol. This presentation will focus on both the technology development aspects, useability and feasibility in children, and preliminary results.

Discussion
This study presents preliminary data that supports the feasibility of novel light exposure metrics. Understanding the impact of increased use of digital devices by children, and increased control and manipulation of their light environments, requires new measures and protocols. These tools will help improve understanding of the effects of light on children’s sleep.