bluuebunny/crossref_metadata_2025_split huggingface dataset:
O030 Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years
Authors: Stevens D , Barr C , Bassett K , Oh A , Lord S , Crotty M , Bickley K , Mukherjee S , Vakulin A 
Published: November 2022

Abstract

Objectives
Falls in older people can lead to serious injury and significant societal health and financial burden. Obstructive sleep apnoea (OSA) is associated with impaired gait/balance and may increase fall risk, yet few studies examined whether treating OSA reduces fall risk. This study examined the effect of continuous positive airway pressure (CPAP) on fall risk markers in people over 65yrs diagnosed with OSA.

Design
Single arm intervention study

Setting
University and tertiary care CPAP clinic.

Participants
Individuals over 65 years diagnosed with OSA and recommended CPAP.

Intervention
3-6 months CPAP therapy

Measurements
All participants had a physiological profile assessment (PPA) at baseline and following 3-6 months of CPAP. The PPA examines visual contrast sensitivity, lower limb proprioception, knee extension strength, reaction time and postural sway to generate a fall risk score (FRS). t-tests were used to determine difference between pre- and post-treatment FRS. Regression was used to examine the associations between CPAP use and daytime sleepiness with FRS.

Results
CPAP significantly reduced the FRS ([Mean±SD] 0.59±1.0 vs 0.04±1.1, p=0.016), contrast sensitivity and lower limb proprioception (P&lt;005). Increased CPAP use was associated with improvement in FRS in unadjusted analysis (β=-0.213, 95%CI -0.371 to -0.056, p=0.01). Reduction in Epworth sleepiness score was associated with a reduction in FRS in unadjusted (p=0.02) and adjusted analysis (p&lt;0.03).

Conclusions
CPAP may reduce fall risk in people over 65yrs, possibly related to better CPAP adherence and reduced daytime sleepiness. Future controlled trials and mechanistic studies are needed to elucidate how CPAP may reduce fall risk.
O035 Elevated liver enzymes in paediatric sleep disordered breathing
Authors: Noone A , Lao Y , Crawford T , Kennedy D , Martin J , Ferrante A , Wabnitz D , Kontos A 
Published: November 2022

Abstract

Introduction
Paediatric sleep disordered breathing (SDB) is associated with adverse cardiovascular outcomes. Non-alcoholic fatty liver disease (NAFLD) and dyslipidaemia are potential modifiable risk factors for cardiovascular disease, often coexisting in adults with SDB. Increases in lipid outputs from the liver have been identified in obese adults and children with SDB. Whether children with SDB compared to healthy non-snoring controls have evidence of elevated serum lipids and associated liver enzyme changes were assessed.

Methods
Seventy-five children (SDB=49, controls=26) between the ages of 6-17 years matched for age, gender and BMI underwent overnight polysomnography to measure SDB severity and provided a fasting blood sample to assess lipid and liver panels.

Results
OAHI was significantly increased in children with SDB compared to healthy non-snoring controls (p &lt; 0.05). Serum potassium, alanine aminotransferase and lactate dehydrogenase were significantly increased in children with SDB, while albumin was significantly decreased (p &lt; 0.05). No differences were found between serum lipid levels.

Conclusion
The presence of paediatric SDB may increase the risk of developing NAFLD. Further investigation is required to determine whether routine assessment of liver enzymes should be implemented in paediatric SDB. Whether surgical removal of the adenoids and tonsils to treat paediatric SDB can stabilise liver enzyme levels requires further research.
O036 Melatonin down-scheduling: An exploration of caregiver and pharmacist perspectives towards melatonin use in school-aged children and adolescents
Authors: Lee S , Tan E , Cairns R , Smith L , Cheung J 
Published: November 2022

Abstract

Background
Melatonin is a widely used paediatric sleep-aid. Recent regulatory changes in Australia have widened public access to proprietary melatonin products through community pharmacies. Yet little is known about how pharmacists and caregivers have responded to these regulatory changes. This study aims to explore the impact of melatonin down-scheduling on caregivers and pharmacists.

Methods
A mixed-methods study was conducted in a convenience sample of caregivers with school-aged children/adolescents taking melatonin, and community pharmacists/interns. Participants completed an online questionnaire and were given an option to participate in an in-depth semi-structured interview. The interviews were digitally recorded, transcribed verbatim and analysed using the Framework Approach to identify emergent themes.

Results
53 surveys were returned (caregivers, n=41; pharmacists, n=12). Caregivers (mean age=44.5±5.6; 98.0% female) reported moderate carer burden (18.8±6.8 points) and commonly cared for children (mean age=11.7±2.9) with comorbid autism spectrum disorder (n=18;43.9%) and ADHD (n=17;41.5%). Pharmacists (mean age=28.9±9.6; 71.4% female) handled 12.9±12.4 sleep-related enquires/day and received direct requests for melatonin 19.5±15.9 times/week. Preliminary analyses identified three key themes: (1) product cost and formulation availability; (2) differing safety endpoints; and (3) gaps in patient/clinical education. Caregivers and pharmacists highlighted the need for affordable proprietary products with flexible dosing options. The “naturalness” of melatonin was often conflated with long-term safety by caregivers, and lower abuse/misuse potential by pharmacists. Targeted melatonin education resources were needed for both caregivers and pharmacists.

Conclusion
Findings allude to the need to further refine existing educational, clinical and distribution/supply processes involved around melatonin products used in school-aged children/adolescents.
O037 Understanding ventilatory control in children with Prader-Willi syndrome
Authors: Patoglu O , Davey M , Nixon G , Edwards B , Horne R 
Published: November 2022

Abstract

Background
Children with Prader-Willi syndrome (PWS) are at risk of both central and obstructive sleep apnoea (OSA), and have abnormal respiratory control during wakefulness. Many children with PWS are treated with growth hormone (GH) however, GH has been associated with the development of OSA. In this pilot study, we aimed to determine whether sleep and respiratory control (i.e. loop gain, LG) characteristics were altered by GH in children with PWS.

Methods
Pre- and post-GH polysomnographic data in children (aged 0-18 years) were retrospectively collected. LG was quantified in periods of NREM sleep by fitting a model of ventilatory control to the respiratory pattern following spontaneous sighs.

Results
Results (n=15, range 5-134 months, 46.7%F) were compared pre- and post-GH. No significant differences in total sleep time (474 [447, 498] vs 475 [451, 495.5]; p=0.81), percentage time in NREM and REM sleep, the obstructive apnoea-hypopnoea (OAHI) index (0.0 [0.0, 0.4] vs 0.3 [0.0, 0.7]; p=0.15) or the central apnoea-hypopnoea index (CAHI) (3.0 [0.7, 6.3] vs 2.8 [1.4, 4.6]; p=0.63) were found however, 1 child developed OSA. GH had no impact on LG (0.4 ± 0.1 vs 0.4 ± 0.1; p=0.99) and the change in OAHI/CAHI showed no correlation with the change in LG.

Conclusions
In this small cohort of children, the administration of GH had no impact on sleep and respiratory characteristics (including LG). A larger sample size maybe required to gain a more comprehensive understanding of the impacts of GH on ventilatory control in children with PWS.
O040 Associations between Sleep Irregularity and Hypertension: Sleep Sensor Data from Over Two Million Nights
Authors: Scott H , Lechat B , Reynolds A , Lovato N , Escourrou P , Catcheside P , Eckert D 
Published: November 2022

Abstract

Introduction
Irregular sleep has been associated with worse cardio-metabolic health compared to regular sleep, but prior studies are limited in sample size and have assessed sleep irregularity over short assessment periods (7-14 days). This study investigated associations between sleep irregularity and hypertension in a large, global sample over multiple months.

Methods
Data from 12,300 participants (Mean ± SD; 50 ± 12 years, 12% females) who used an under-mattress sleep device and a portable blood pressure monitor between July 2020 and March 2021 were included. Each participant had ~180 nights of recordings and ~70 blood pressure entries. Sleep duration regularity was assessed as the standard deviation of device-assessed total sleep time. Sleep timing regularity was assessed as the standard deviation of sleep onset time and sleep midpoint. Logistic regressions were conducted, controlling for age, sex, BMI, and mean total sleep time.

Results
Across total sleep time quartiles, sleep duration irregularity was consistently associated with a 9-15% increase in hypertension risk. A 38-minute increase in sleep midpoint irregularity was associated with an 11% (1.11 [1.03, 1.20]) increase in hypertension risk, independent of mean total sleep time and mean sleep midpoint. Similarly, a ~31-minute increase in sleep onset time irregularity was associated with a 29% increased risk of hypertension (1.29 [1.18, 1.42]).

Conclusions
Irregular sleep, regardless of average total sleep time, was associated with increased hypertension risk. Further assessment of day-to-day fluctuations in sleep duration and timing for potential effects on next-day blood pressure and cardiovascular health outcomes is warranted.
O043 Pre-trauma sleep difficulties and fatigue predict trauma-induced changes in mental health symptoms in police recruits
Authors: Wolkow A , Kaldewaij R , Klumpers F , Koch S , Drummond S , Roelofs K 
Published: November 2022

Abstract

Introduction
Police are at risk of trauma and related mental health outcomes. Sleep disturbances and fatigue predict poor mental health in other populations, thus it is critical we determine whether they represent risk factors for mental health problems in first responders. We examined if pre-trauma sleep and fatigue experienced by police recruits predicted trauma-related mental health changes.

Methods
This study utilised data from the Police-in-Action Study, a longitudinal study which assessed police recruits (n=340) pre- (baseline) and post-15 months of emergency work (follow-up). Participants self-reported depression (Beck Depression Inventory; BDI), PTSD (PTSD Checklist for DSM-5; PCL-5), anxiety (State-Trait Anxiety Inventory) and stress (Perceived Stress Scale). Baseline sleep was measured using sleep items on the BDI and PCL-5, and the BDI fatigue item assessed baseline fatigue. Linear regressions examined whether baseline sleep and fatigue predicted the development of mental health symptoms (i.e., change in symptoms over time) while controlling for demographics, baseline mental health and trauma severity. Analyses were restricted to participants experiencing their core traumatic event between time-points (n=225), determined using the Clinician Administered PTSD Scale.

Results
Sleep difficulties in police at baseline predicted the development of depression (b=0.371 [0.109,0.633], p=0.006) and stress (b=2.430 [0.756,4.484], p=0.021) post-trauma. Baseline fatigue predicted post-trauma development of depression (b=0.272 [0.045,0.500], p=0.019) and anxiety (b=0.060 [0.007,0.113], p=0.028).

Discussion
Poor sleep and fatigue are pre-trauma risk factors for the development of mental health outcomes in new police. This suggests the need to investigate interventions targeting sleep and fatigue to reduce trauma-related mental health outcomes in police.
O045 Sleep management strategies among medical students
Authors: Duthie C , Cameron C , Smith-Han K , Beckert L , Delpachitra S , Garland S , Sparks B , Wibowo E 
Published: November 2022

Abstract

Introduction
Medical students are undertaking an intense curriculum, the stress of which may cause or worsen insomnia and depressive symptoms. We aim to investigate factors which might affect the sleep of medical students, and how they currently manage their sleep.

Methods
A brief online survey was sent to medical students, consisting of validated questionnaires, and questions related to sleep management strategies.

Results
We recruited 828 participants—49.5% reported insomnia symptoms and 51.4% reported depressive symptoms. After adjusting for gender, ethnicity and age, depressive symptoms (Mild: odds ratio (OR) = 6.26; Moderate: OR = 18.13; Severe: OR = 15.57), and sleep hygiene (OR = 1.07) were associated with insomnia symptoms. Commonly endorsed strategies for sleep management by students were undertaking regular exercise (80.1%), having consistent sleep-wake time (71.3%), and limiting caffeine intake (70.3%). Few were willing to see a clinician (23.4%) or take medication (22.3%). Participants with insomnia symptoms were more likely to prefer limiting their alcohol intake (OR = 1.77), limiting daytime naps (OR = 1.5), seeing clinicians (OR = 1.86), and taking sleep medication (OR = 3.98), but less likely to prefer avoiding intense work (OR = 0.71) or minimizing using electronics (OR = 0.60) close to bedtime than those without insomnia symptoms. High sleep self-efficacy was associated with lower odds for having insomnia symptoms (OR = 0.74 (0.70, 0.77)).

Discussion
Self-reported insomnia and depression are common among medical students. Increased awareness and greater resources are needed to support the sleep health and emotional well-being of medical students.
O046 Poor sleep quality is associated with unemployment and lower levels of participation in people living with spinal cord injury
Authors: Graco M , Arora M , Berlowitz D , Craig A , Middleton J 
Published: November 2022

Abstract

Introduction
Poor sleep is common among people with spinal cord injury (SCI), yet little is known about its impact on employment and participation outcomes. This study aimed to describe the sleep quality of a large sample of Australians with SCI; examine associations between sleep quality and participant characteristics; and explore the relationship between sleep and outcomes.

Methods
Cross-sectional Australian survey, including 1579 community-dwelling people with SCI, aged 18 years and over. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Relationships between participant characteristics, sleep and other outcomes were examined with linear and logistic regression.

Results
The PSQI was completed by 1172 individuals; 68.4% reported poor sleep (PSQI&gt;5). Subjective sleep quality in people with SCI was poor (mean(SD) PSQI global score=8.5(4.5). Financial hardship and problems with other secondary health conditions were significantly associated with worse sleep quality (p&lt;0.05). Poor sleep quality was strongly associated with lower emotional wellbeing and energy, and greater problems with participation (p&lt;0.001). Individuals engaged in paid work reported better sleep quality than unemployed individuals (mean(SD) PSQI=8.1(4.3) vs 8.7(4.6), p&lt;0.05). Following adjustment for age, pre-injury employment, injury severity and years of education, better sleep quality remained strongly associated with being employed (OR=0.95, 95% CI=0.92-0.98), p=0.003).

Conclusions
This study has demonstrated pervasive and impactful relationships between sleep quality and important SCI outcomes. Poor sleep quality was strongly associated with worse emotional wellbeing and vitality, unemployment and lower participation. Determining whether treating sleep problems can improve outcomes for people living with SCI deserves more attention.
O048 Help seeking behaviours of Australian adults with insomnia in a community sample
Authors: Haycock J , Lack L , Hoon E , Sweetman A , Appleton S , Reynolds A , Gill T , Adams R , Lovato N 
Published: November 2022

Abstract

Introduction
Chronic insomnia negatively impacts quality of life for millions of Australians. Most people with insomnia do not receive the recommended treatment Cognitive Behavioural Therapy for insomnia (CBTi), and many are prescribed sedative-hypnotic medications. This study aims to better understand the help seeking behaviours of people with insomnia, and to identify barriers to treatment and improve access to evidence-based care.

Methods
A total of 2044 people in a community sample (Age M = 46.6, SD = 17.3, 51.3% Female) completed the 2019 Sleep Health Foundation Insomnia Survey which included questions on sleeping difficulties, daytime impairment and help seeking behaviours. Chronic insomnia was identified using the ICSD-3 diagnostic criteria.

Results
Preliminary analysis shows 37% of participants with chronic insomnia (N=303) discussed sleep with their GP in the past year. The most common help seeking behaviours for participants with insomnia are strict sleep habits (50%), adjusting time in bed (47%), relaxation (40%), alcohol (39%), and meditation (37%). Participants with undiagnosed insomnia (N=275) are much less likely to engage in help seeking behaviours than those with a diagnosis. Most participants who discussed sleep with a psychologist (N=104) reported a diagnosis of depression (77%) or anxiety (80%), rather than insomnia (30%).

Discussion
Despite evidence-based guidelines recommending CBTi as the ‘first line’ treatment for insomnia, in Australia most people manage their insomnia with strict sleep habits or relaxation techniques. These findings highlight the importance of GPs discussing sleep with patients, and having knowledge and access to appropriate treatment and referral pathways for management of insomnia.
O052 Association of co-morbid insomnia and sleep apnoea (COMISA) symptoms with all-cause mortality: Analysis of the NHANES 2005-2008 data
Authors: Sweetman A , Lechat B , Appleton S , Reynolds A , Adams R , Melaku Y 
Published: November 2022

Abstract

Introduction
Co-morbid insomnia and sleep apnoea (COMISA) is a highly prevalent condition associated with negative health outcomes. This population-based study aimed to investigate the association between COMISA and all-cause mortality.

Methods
Sleep data in 6,877 participants (Age median [IQR]=45 [33,57], 50.1% male) were drawn from the National Health and Nutrition Examination Survey (2005-2008). Insomnia was defined as difficulties initiating sleep, long awakenings, and/or early morning awakenings on ≥16 nights/month, with daytime impairment. The STOP-Bang questionnaire was used to identify participants at high risk of obstructive sleep apnoea (OSA). COMISA was defined if participants met criteria for insomnia and high risk of OSA. The median (IQR) follow-up for mortality was 8.6 (7.8, 9.8) years. Cox regression models were used to determine the association between COMISA and all-cause mortality, controlling for socio-demographic characteristics, behavioural factors and chronic conditions.

Results
The prevalence of no insomnia/OSA, insomnia-alone, OSA-alone, and COMISA were 73.5, 3.0, 20.1, and 3.3%, respectively, and 6.7% of participants died by 11-year follow-up. Compared to participants with no insomnia/OSA, higher mortality risk was observed in participants with COMISA (HR=1.9; 95%CI=1.3-2.8) and insomnia alone (HR=1.5; 95%CI=1.0-2.3) after adjusting for socio-demographic characteristics, and behavioural factors. The relationship between COMISA and mortality persisted after additionally controlling for chronic conditions, sleep duration and sleeping pill use (HR=1.6; 95%CI=1.1-2.3), but the relationship between insomnia-alone and mortality did not (HR=1.4; 95%CI=0.9-2.3).

Discussion
Co-morbid insomnia and high-risk OSA is associated with increased risk of all-cause mortality. More research is needed to identify effective treatments for COMISA.
O054 Genioglossus neural drive and upper airway dilation in people with obstructive sleep apnoea during wakefulness
Authors: Jugé L , Liao A , Yeung J , Knapman F , Burke P , Brown E , Gandevia S , Eckert D , Butler J , Bilston L 
Published: November 2022

Abstract

Introduction
Genioglossus neural drive and the ensuing tongue dilatory movement may be dissociated in obstructive sleep apnoea (OSA), but this has not been studied. This study aimed to investigate this relationship and its potential role in OSA pathophysiology.

Methods
During awake nasal breathing in the supine position, inspiratory tongue dilatory movement, quantified with tagged magnetic resonance imaging, and inspiratory peak genioglossus electromyography (EMG) normalised to the maximum voluntary contraction (tongue protrusion), were measured in 4 tongue neuromuscular compartments from 8 controls [apnea-hypopnea index (AHI)&lt;5 events/h] and 34 patients with untreated OSA [AHI&gt;10 events/h].

Results
Although larger inspiratory dilatory movement was associated with increased drive to genioglossus (partial Spearman, r=0.23, p=0.016, n=115/68% of compartments), in 14% of the compartments (n=16), there was a large dilatory (&gt;1mm) movement but minimal EMG (&lt;4th percentile). This occurred only in the horizontal compartment. In another group of 18 compartments (16%), there was a large peak EMG (&gt;4th percentile) but minimal dilatory movement (&lt;1mm). This occurred more commonly in the oblique compartments. Dissociation between the amplitude of the peak EMG and inspiratory tongue dilatory movement was most commonly seen in severe OSA patients (AHI&gt;30 events/h, Fisher's exact test, p=0.047).

Conclusions
Inspiratory tongue dilatory function generally remains closely linked to muscle drive during wakefulness, with larger movement associated with higher peak EMG. However, for approximately one-third of the neuromuscular tongue compartments, neural drive was dissociated from the dilatory motion in severe OSA patients. This may contribute to OSA pathogenesis and have implications for neural stimulation therapy targets.
O055 Flow limitation and sleepiness in individuals without sleep apnea
Authors: Mann D , Georgeson T , Azarbarzin A , Wellman A , Redline S , Terrill P , Sands S 
Published: November 2022

Abstract

Introduction
Moderate-Severe Obstructive Sleep Apnea (OSA, AHI&gt;15) disturbs sleep through frequent bouts of apnea and is associated with daytime sleepiness. However, many individuals without moderate or severe OSA (i.e. AHI≤15) also report sleepiness. We propose that sleepiness may be a consequence of substantial flow limitation, even in the absence of overt reductions in airflow (apnea/hypopnea).

Methods
2060 participants from the MESA sleep cohort were analysed using our validated method to estimate frequency of certain flow limitation from the airflow signal. Individuals with Epworth Sleepiness Scale ≥11 points were considered ‘sleepy’. Logistic regression was conducted to investigate the association between sleepiness (binary dependent variable) and frequency of flow limitation (continuous) in individuals without moderate-to-severe OSA AHI≤15. Models were adjusted for age, sex, race, BMI and self-reported sleep duration.

Results
N=832 individuals with AHI≤15 were included in primary models: The odds ratio (OR) for flow limitation predicting sleepiness was 2.14 (CI 1.27-3.61, per 2SD increase in flow limitation frequency i.e. +11% of sleep) and 2.08 (1.19-3.64) when adjusted for AHI. No association between flow limitation and sleepiness was observed in moderate-severe OSA (AHI&gt;15, OR=1.01, 0.7-1.46).

Discussion
In individuals with few scored respiratory events (non-OSA and mild-OSA), increased flow limitation frequency by 2 SD (11% of sleep) is associated with a 2-fold increase in risk for sleepiness. Increasing flow limited breaths by 11% increases the odds for being sleepy equivalent to 1.2 hrs less sleep. Flow limitation may be an independent target for ameliorating sleepiness even in the absence of OSA.