bluuebunny/crossref_metadata_2025_split huggingface dataset:
P082 Lesson's learnt from an AOD team delivering a stepped-care intervention for sleep
Authors: Newman P , Oldenhof E , Swierzbiolek B , Andersonwurf J , Szeto J , Staiger P 
Published: November 2022

Abstract
Insomnia is a prevalent issue in AOD settings. Many use substances for their sedative effect or experience insomnia as a consequence of substance use, insomnia is a common feature of withdrawal and often linked to relapse.
In this study, a community-based AOD service is piloting a stepped-care intervention for insomnia. Nine AOD clinicians underwent CBT-I training to deliver a 3-step intervention: (1) a 60-minute information session, (2) A guided self-help booklet + ≤ 3 sessions with an AOD clinician, and (3) an 8-week CBT-I Group. The primary outcome is the insomnia severity index (ISI) and secondary outcomes relate to mental health and substance use. Focus groups and online questionnaires are being used to evaluate its implementation.
This presentation will outline how a stepped-care model for sleep treatment was integrated within an AOD setting and discuss the available evidence on its effectiveness, feasibility and acceptability. Of the 299 enrolled to date (M=57.4 years ±14.3yrs; 74.6% women), initial findings show significant improvements in ISI scores after Step 1 (17.5 to 15.6; P &lt; 0.01) (d = 0.33), and 54% of eligible participants have moved into Step 2. So far, participant engagement and retention rates suggest good feasibility. Clinicians report high levels of satisfaction with the program, perceiving that it addresses an otherwise inconsistently met need, and enjoy the contrast in work to their usual role. Barriers to delivering the program include limited time and resources. Findings demonstrate this stepped-care program has the potential to improve outcomes and enhance recovery in AOD settings.
P083 Longitudinal changes in the sleep of patients of a multidisciplinary sleep clinic during the COVID-19 pandemic
Authors: Ng Y , Nguyen E , Bei B , Hamilton G , Rajaratnam S , Saunders W , Wellecke C , Mansfield D 
Published: November 2022

Abstract

Introduction
This study aimed to describe longitudinal changes of sleep in adult patients at a multidisciplinary sleep clinic throughout the COVID-19 pandemic.

Methods
Participants completed six self-report online surveys between October 2020 (during increased COVID-19 restrictions) and March 2022 (after easing of restrictions).

Results
Of 746 patients invited to participate in this study, 38 completed the initial and final surveys (mean age 53.9 years, range 21-83, 63.2% female). No participants had contracted COVID-19 at study commencement but 3 (7.9%) had been diagnosed with COVID-19 by the end of the study. In late 2020, 10 participants (26.3%) described reduced sleep quantity whilst 15 (39.5%) had worse sleep quality than pre-pandemic. Changes in dreams were reported by 13 participants (34.2%). In early 2022, 10 participants (26.3%) described worse sleep whereas 13 (34.2%) reported unaltered sleep and 3 (7.9%) experienced better sleep than pre-pandemic. Remaining patients were uncertain if their sleep had changed. No significant changes were detected in Insomnia Severity Index scores (initial survey mean 13.07, final survey mean 12.61, mean difference -0.47 [95%CI -2.29, 1.34], p=0.60) or PROMIS Sleep-Related Impairment 8a T-scores (initial survey mean 56.07, final survey mean 54.23, mean difference -1.84 [95%CI -4.12, 0.43], p=0.11).

Discussion
42% of patients experienced deterioration in sleep quantity and/or quality within the first year of the pandemic. Despite the easing of COVID-19 restrictions, there was no significant change in symptoms of insomnia and sleep-related impairment, and a quarter of patients reported that their sleep remained worse compared with before the pandemic.
P085 OSA-Onset: An algorithm for predicting the age of OSA onset
Authors: Olaithe M , Peppard P , Ravelo L , Barnet J , Hagen E , Eastwood P , Bucks R 
Published: November 2022

Abstract

Objectives
There is currently no way to estimate the period of time a person has had obstructive sleep apnoea (OSA). Such information is important in both clinical and research settings as it would allow identification of people who have experienced OSA for an extended period. People who are therefore, at greater risk of a range of other medical disorders; and enable consideration of the length of disease in the study of OSA pathogenesis or treatments.

Method
The ‘age of OSA Onset’ algorithm’ (OSA-Onset) was developed in participants of the Wisconsin Sleep Cohort (WSC) who had ≥2 sleep studies and were not using continuous positive airway pressure (n=696). The algorithm was tested in subsets of participants from the WSC (n=154) and the Sleep Heart Health Study (SHHS; n=705) who had an initial sleep study showing no OSA (apnea-hypopnea index (AHI) &lt;15 events/hr) and a later sleep study showing presence of OSA (AHI≥15 events/hr).

Results
Regression analyses were performed to identify variables that significantly predicted change in AHI over time (BMI, sex, and AHI) and beta weights and intercept used in the subsequent algorithm. In the WSC and SHHS subsamples, OSA-onset was able to estimate disease onset with a mean absolute error of 7.8 and 5.5 years, respectively.

Conclusions
Future studies are needed to determine whether the years of exposure derived from the OSA-Onset algorithm is related to worse prognosis, poorer cognitive outcomes, and/or poorer response to therapy.
P090 Acceptability, Feasibility and Accuracy of Home Sleep Studies in Children with Neuromuscular Disorders
Authors: Pettigrew G , Lam J , Withers A , Wilson A 
Published: November 2022

Abstract

Introduction & Aims
Nocturnal hypoventilation may indicate declining pulmonary function in children with Neuromuscular Disorders (NMD). Hypoventilation is diagnosed with polysomnography (PSG), but there are significant barriers to the routine performance of PSG in this population. Home-based sleep studies (HSS) may reduce burden on patients and their families. We assessed the acceptability, feasibility and diagnostic accuracy of HSS for children with NMD.

Methods
11 participants, aged 5-15, underwent PSG. A HSS was conducted within two weeks for comparison that included measurement of transcutaneous carbon dioxide. Hypoventilation was defined as pCO2 &gt;50mmHg for &gt;25% of total sleep time. Acceptability was assessed by a survey completed by the families.

Results
Preliminary analysis shows HSS feasibility of 91% (10/11). Of 10 technically acceptable HSS, there was a concordant diagnosis in 9 (90%). Exploratory analysis shows higher total sleep time (529 vs. 431 minutes, p&lt;0.05), slow wave sleep (132 vs. 99 minutes, p&lt;0.05) and REM sleep (115 vs. 83 minutes, p&lt;0.05) during HSS. Correlation was excellent between the percentage of total sleep time with pCO2 &gt;50mmHg (κ=0.94, p&lt;0.05) for PSG and HSS. 93% of families preferred HSS to laboratory PSG.

Conclusion
Preliminary analysis suggests home sleep studies that include transcutaneous carbon dioxide monitoring are feasible, acceptable and accurate when compared to PSG for diagnosing hypoventilation in children with NMD. These results imply that children may sleep better in the home environment. Further work is required to verify the diagnostic accuracy of home sleep studies in this group.
P091 Three generations of a family diagnosed with congenital central hypoventilation syndrome: A case series
Authors: Pimenta M , Saddi V , Thambipillay G , Teng A , Blecher G , Martin B 
Published: November 2022

Abstract

Introduction
Congenital central hypoventilation syndrome (CCHS) is an autosomal dominant disorder characterized by alveolar hypoventilation and autonomic dysregulation secondary to mutations of the PHOX2B genes.The disorder results in ventilatory impairment characterized by alveolar hypoventilation which worsens in sleep and occurs in individuals with otherwise normal pulmonary mechanics.Diagnosis is based on identification of a pathologic variant in the PHOX2B gene in absence of primary pulmonary, cardiac or neuromuscular disease or a causative brainstem lesion. We present five cases from three generations within the same family with varying degrees of phenotypic expression of the PHOX2B gene mutation.

Methods
The identification of CCHS in the index case after birth prompted evaluation of other family members.Genetic testing and counselling were performed for all family members. All family members with a confirmed diagnosis of CCHS underwent a complete assessment.

Discussion
We report the unique occurrence of CCHS among five members of a single family in three generations with a varying degree of penetrance and expressivity resulting in diverse clinical manifestations.Early diagnosis and adequate ventilatory management can prevent associated neurologic morbidity and improve long-term outcomes. Providing positive pressure ventilation (PPV) in infants and children with CCHS poses many challenges.Consistency is important as patients with CCHS require lifelong assisted ventilation, at least during sleep, and weaning of ventilation is not advisable.These five cases not only highlight the challenges of managing CCHS, but also the importance of genetic counselling and screening among first-degree relatives and extended family members.
P097 Sleep, Fatigue and Depression in Young Autistic Adults
Authors: Richdale A , Morris E , Chetcuti L , Hayward S , Abdullahi I , Lawson L 
Published: November 2022

Abstract

INTRODUCTION
Poor sleep and fatigue are common in autistic adolescents and adults, who also experience increased depression compared with the general population. We examined the relationships between sleep quality, fatigue and depression in autistic young adults.

METHOD
Participants were 114 autistic young adults (15-25 years) from the Study of Australian School Leavers with Autism baseline survey (n=112; 57.1% male). From the survey we examined relationships between age, sex and the Autism Quotient-Short (AQ-S; autistic traits), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS-D) and the Flinders Fatigue Scale (FFS) using Spearman’s Correlation. We then investigated whether FFS mediated the relationship between the PSQI and HADS-D (PROCESS macro; 1000 bootstrapped resamples). Due to missing data, not all individuals are included in reported analyses.

RESULTS
38% (n=83) of participants had depression, 57% (n=94) poor sleep, and 36% (n=73) fatigue. HADS-D was positively associated with PSQI (p&lt;.001) and FFS (p&lt;.001). Increased PSQI and FFS were associated with sex (female) and increased AQ-S (all p&lt;.01). The full mediation model accounted for 25% of variance in depression (p&lt;.001) with a significant indirect effect of sleep quality on depression through fatigue. The direct effect of sleep quality on depression was not significant after fatigue was included in the model.

CONCLUSIONS
Findings indicate poor sleep and fatigue play a role in the maintenance of depression in autism. Further replication in larger and longitudinal cohorts is needed. Like non-autistic individuals with depression, sleep and fatigue may be important treatment targets for treating depression in autism.
P098 "It's just [complicated] sleep": Discourses of sleep and ageing in the media
Authors: Ross I , Breheny M , Ladyman C , Signal L , Dew K , Gibson R 
Published: November 2022

Abstract

Background
Sleep disturbances have been reported to increase with older age. However, sleep-related beliefs and practices also appear to change with ageing and disease, having implications for measurement and management of sleep among older people. Analysis of sleep-related messaging within mainstream media contributes to understanding social discourses of sleep and ageing.

Method
Texts from New Zealand’s main free online news source “Stuff” were collated using key words “sleep” together with ''ageing'', ''older'', ''elderly'', or ''dementia'' between December 2018 and December 2021. A total of 38 relevant articles were collated. A critical discourse analysis was used to describe the texts then interpret them in relation to discursive practices and wider social explanations.

Findings
Texts were categorised under basic contextual themes: general ageing, disease, beauty, and treatments. Discursive constructions described an inevitable decline of sleep with ageing, including the tensions between a likely physiological decline alongside individual failures to achieve good sleep; sleep’s role as both a remedy and risk for diseases (such as dementia); and the simplification of solutions for self-managing sleep alongside recognition of the complexity of sleep.

Conclusions
Social discourses of sleep and ageing within the mainstream New Zealand media were subtle and contradictory. Punctured with tensions between endorsing sleep practices and purchases to prevent age-related decline whilst also asserting that decline is inevitable due to the complexity of the ageing body and modern society. Findings will inform future research in the field of sleep as a concept and practice among older people.
P102 Sleep health management practices in Australian residential aged care facilities: The perspective of registered nurses
Authors: Chen E , Fernandez T , Basheti M , Gordon C , Saini B 
Published: November 2022

Abstract

Background
Sleep disturbances are commonly experienced by older people living in residential aged care facilities. Non-pharmacological approaches have a strong evidence base, however research shows that medications (sedatives, antidepressants, antipsychotics) are often used inappropriately. However, little is known about healthcare professionals’ current sleep health management approaches in residential aged care facilities.

Aims and objectives
This study aimed to explore the current sleep health management practices in Australian residential aged care facilities and investigate potential ways to improve non-pharmacological and pharmacological sleep health practices in the future.

Design
Qualitative inductive thematic analysis of semi-structured interviews guided by COREQ guidelines.

Methods
Semi-structured interviews were to be conducted with registered nurses and aged care pharmacists recruited using a convenience-sampling and snowballing approach. Interviews were audio-recorded, transcribed verbatim and inductively analysed for emergent themes.

Results
Fourteen interviews were conducted with registered nurses in New South Wales. Thematic analysis derived three main themes: 1) Awareness and observations of sleep health, 2) Healthcare approach to sleep health management in residential aged care facilities and, 3) Organisational constraints to evidence-based sleep health care provision.

Conclusion
Registered nurses assess residents’ sleep health and attempt to manage sleep health through both non-pharmacological and pharmacological strategies. Organisational culture and staffing ratios negatively impact the delivery of best evidence-based practice but effective communication between the multidisciplinary team appears to facilitate management of sleep disturbances. Participants emphasized the need for sleep health educational programs and the development of national sleep health management guidelines across aged care in Australia.
P103 Associations between sleep regularity, OSA and hypertension in a middle-aged community population
Authors: Sansom K , Reynolds A , Windred D , Phillips A , Walsh J , Maddison K , Singh B , Eastwood P , McArdle N 
Published: November 2022

Abstract
Little is known about the association of irregular sleep patterns with obstructive sleep apnoea (OSA) and hypertension. This study examined whether irregular sleep patterns determined by the sleep regularity index (SRI) were associated with OSA and hypertension, and whether SRI modified the known association between OSA and hypertension. 635 adults (age mean[range]=57[42-77]years, female=58.6%) from the community-based Raine Study who were not current shift workers were assessed for OSA (in-laboratory polysomnography, AHI ≥5events/hour; time spent with oxygen saturation &lt;90% (T90) ≥median), hypertension (doctor diagnosed or systolic BP ≥140mmHg and/or diastolic ≥90mmHg) and sleep (maximum 7 days of wrist actigraphy). The SRI was calculated from actigraphy (≥4 days) based on variation in usual sleep and wake times. Participants were categorised as regular sleepers (first tertile), average sleepers (second tertile), or irregular sleepers (third tertile). Logistical regression models examined the independent and combined associations between SRI, OSA and hypertension. Covariates included age, sex, body mass index, actigraphy sleep duration, insomnia, depression, activity, alcohol, smoking and anti-hypertensive medication. Compared to regular sleepers, irregular sleepers had increased odds of OSA defined by the AHI (OR 1.77 95% CI 1.10-2.83) and T90 (OR 1.69 95% CI 1.10-2.61) but not hypertension. There was no difference in hypertension odds for regular and irregular sleepers when the data were stratified by participants with and without OSA.
Individuals with OSA are more likely to have irregular sleep patterns, which might exacerbate associated adverse health outcomes. However, irregular sleep patterns do not appear to modify the association between OSA and hypertension.
P108 Association of drowsiness events with a combination of sleep loss and other work metrics
Authors: Shekari Soleimanloo S , Sletten T , Clark A , Cori J , Wolkow A , Beatty C , Shiferaw B , Barnes M , Tucker A , Anderson C , Rajaratnam S , Howard M 
Published: November 2022

Abstract

Introduction
Heavy vehicle drivers (HVDs), carrying approximately 75% of non-bulk domestic freight on Australian roads, are at risk of drowsiness due to night-time, long drives, or short sleep. Drowsiness comprises 46% of all driver-impairment-related factors in HVDs fatalities. However, the specific role of sleep loss in HVDs' drowsiness is less known. This study assessed the association of sleep loss, independent of other work metrics, with real-time drowsiness in HVDs.

Methods
Eight HVDs aged 49.8± 8 years, 27± 10.3 years of experience, worked for 3-28 (13± 6) shifts. A composite ocular measure of drowsiness (John's Drowsiness Score) and drivers' sleep-wake was monitored by Optalert glasses and Actiwatches, respectively. The drowsiness event (response variable) was defined as at least one event of JDS≥ 2.6 /h, and sleep loss (exposure) as the variation of sleep opportunity pre-shift from the 9-hour recommended rest break in Europe. Multivariate logistic regression assessed the odds of drowsiness events under sleep loss when adjusted for time of day, shift start time and hours of drive.

Results
Data comprised 1061 observations of work metrics or JDS and 694 records of sleep duration. Sleep loss ranged from 1 to 6.3 hours (3.4 ± 1.1h). Compared with a 1- 2.5-hour sleep loss, sleep loss&gt; 4 hours doubled the likelihood of drowsiness events when controlled for other covariates (p=0.019).

Discussion
Sleep loss increases the odds of drowsiness events in HVDs with similar work schedule metrics. Further research should assess if Australia's 7-h minimum break provides adequate sleep under different schedule conditions.
P109 Predicting major adverse cardiovascular events using symptom subtypes of severe obstructive sleep apnoea
Authors: Shenoy B , McArdle N , Walsh J , Cadby G , Hillman D , McQuillan B , Hung J , Dhaliwal S , Mukherjee S , Palmer L , Singh B 
Published: November 2022

Abstract

Background
Obstructive sleep apnoea (OSA) is a complex heterogeneous disorder, and patients with similar disease severity present with different symptom profiles and outcomes. It is unclear whether OSA symptom subtypes independently predict incident major adverse cardiovascular events (MACE).

Method
Consecutive patients attending a tertiary sleep clinic from 2006 to 2010 were prospectively investigated and linked to administrative health data. Data from 1,767 patients with severe OSA (apnoea-hypopnoea index ≥30 events/hour) were used in latent class analysis to identify symptom subtypes. Associations between symptom subtypes and incident MACE were assessed using Cox proportional hazards models, with adjustment for known cardiovascular risk factors.

Results
On average, patients were middle-aged (mean±

SD
52.5±13.2 years), obese (BMI, 35.4±7.9 kg/m²), and male (71.7%). Four symptom subtypes were identified: high symptom burden: severe sleepiness (26.0%), high symptom burden: sleep onset insomnia (34.8%), moderate symptom burden (18.4%), and minimal symptoms (20.7%).
Over a median follow-up of 7 years, 330 (18.7%) patients developed MACE. After adjustment for covariates, the high symptom burden: sleep onset insomnia subtype was associated with increased risk for MACE relative to those with moderate (HR, 1.59; 95%CI, 1.12–2.25; P=0.010) or minimal (HR, 1.47; 95%CI, 1.07–2.03; P=0.018) symptom burden.

Discussion
Distinct symptom subtypes can be identified among severe OSA patients. In symptomatic patients, those with a high prevalence of sleep onset insomnia were at increased risk of MACE, relative to those with moderate or minimal symptom burden. Our findings suggest that symptom subtypes may be clinically relevant in risk stratification for MACE in severe OSA.
P114 How should we classify on-call workers? A proposed taxonomy for modern working arrangements
Authors: Sprajcer M , Appleton S , Adams R , Gill T , Ferguson S , Vincent G , Paterson J , Reynolds A 
Published: November 2022

Abstract

Introduction
Research and guidance materials addressing on-call work typically focus on a narrow set of industries (e.g., emergency services, healthcare). However, modern working arrangements are changing. The casualisation of many industries, combined with the rise in online and app-based working arrangements, means that many workers who can be called to work are not included in current on-call literature. We therefore present a proposed taxonomy for classifying a broader range of on-call workers, based on the work and sociodemographic characteristics of on-call workers in Australia.

Methods
Work arrangements and sociodemographic factors of 1057 Australian adults were assessed in a survey. Questions addressed on-call work undertaken in the previous three months, occupation, work hours, and any non-standard working conditions.

Results
At least one workday characterised as ‘on-call’ was reported by 45.5% of respondents, with a higher prevalence in younger individuals (63.1% of respondents aged 18–24 years reported working on-call). On-call work was reported in a range of industries, including management, community and personal service workers, sales workers, machinery operators, and drivers.

Discussion
Findings suggest that previous reports of on-call work prevalence (typically based on traditional on-call industries such as emergency services) likely underestimate the proportion of individuals who consider themselves on-call workers. As a result, on-call work requires a novel classification system that is able to capture non-traditional on-call work and can differentiate between types of on-call working arrangements. A taxonomy including traditional on-call work, gig economy work, relief, or unscheduled work, and out of hours work is presented.