ORCID Profile
0000-0002-9014-1397
Current Organisation
Macquarie University
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Publisher: Springer Science and Business Media LLC
Date: 27-11-2020
Publisher: Oxford University Press (OUP)
Date: 22-03-2013
DOI: 10.1093/AJE/KWS308
Abstract: Short (≤6 hours) and long (>9 hours) sleep durations are risk factors for mortality and morbidity. To investigate whether the prevalences of short and long sleep durations have increased from the 1970s to the 2000s, we analyzed data from repeated cross-sectional surveys of 10 industrialized countries (38 nationally representative time-use surveys n = 328,018 adults). Logistic regression models for each country were used to determine changes in the prevalence of short and long sleep durations over time, controlling for s ling differences in gender, age, number of weekend days included, and season of data collection. Over the periods covered by data, the prevalence of short sleep duration increased in Italy (adjusted odds ratio = 2.64, 95% confidence interval (CI): 2.41, 2.89) and Norway (adjusted odds ratio = 2.33, 95% CI: 1.77, 3.08) but decreased in Sweden, the United Kingdom, and the United States. The prevalence of long sleep duration increased in Australia (adjusted odds ratio = 1.14, 95% CI: 1.05, 1.25), Finland (adjusted odds ratio = 1.30, 95% CI: 1.14, 1.48), Sweden (adjusted odds ratio = 1.51, 95% CI: 1.35, 1.69), the United Kingdom (adjusted odds ratio = 2.03, 95% CI: 1.68, 2.46), and the United States (adjusted odds ratio = 1.50, 95% CI: 1.36, 1.65) but decreased in Canada and Italy. No changes were observed in Germany or the Netherlands. Limited increases in short sleep duration challenge the claim of increasingly sleep-deprived societies. Long sleep duration is more widespread than is short sleep duration. It has become more prevalent and thus should not be overlooked as a potential contributor to ill health.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.SMRV.2008.03.001
Abstract: 1. Observational studies have implicated habitual sleep duration as a risk factor for mortality and morbidity. Part of this association might be mediated by obesity, which has also been associated with habitual sleep duration. These studies generate wide media attention because of the public's health concerns surrounding increasing obesity and the temporal association with the other modern "epidemic" of sleep loss. Some commentators have recommended public health interventions to control obesity via habitual sleep duration modification. We conducted a critical review of the available literature describing the relationship between habitual sleep duration and obesity in community-based studies in both adults and children, with particular emphasis on longitudinal studies and on studies with objective measures of habitual sleep duration. 2. Existing data have variable consistency. Only one study objectively measured sleep duration for more than one 24-h period. Cross-sectional and longitudinal studies in adults often demonstrated an association of short sleep duration with BMI. However, some of these studies also showed that long sleep duration was also associated with obesity. In contrast, other studies showed that neither long nor short sleep was associated with obesity. In paediatric populations there appeared to be a clear pattern where shorter sleep durations were associated with obesity. We did not locate any interventional studies where sleep duration had been manipulated in order to prevent or treat obesity. 3. We contend that the evidence base is not yet strong enough to give public health advice to the general population or specific groups about sleep duration being a modifiable risk factor for obesity. We need to experimentally clarify whether sleep duration variability is a risk factor for obesity, in what manner, and in which populations. If a reliable aetiological model could be found, we would ideally then need community-based randomised controlled trials that show that sleep duration can be changed and that sleep duration manipulation produces actual weight loss and/or prevents the development of obesity without undue side-effects.
Publisher: European Respiratory Society (ERS)
Date: 31-10-2015
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/PY12021
Abstract: This paper reports a qualitative pilot study exploring primary care health practitioners’ perspectives on the management of insomnia following the extensive media coverage on the adverse effects of zolpidem in 2007–08. General practitioners and community pharmacists were recruited throughout metropolitan Sydney, New South Wales using a convenience s ling and snowballing technique. Demographic information was collected from each participant followed by a semistructured interview. In total 22 participants were interviewed, including eight general practitioners and 14 community pharmacists. Interview transcripts were analysed using ‘framework analysis’. Participants’ responses illuminated some of the key issues facing primary care practitioners in the management of insomnia. Practitioners perceived there to be an overreliance on pharmacotherapy among insomnia patients and inadequate support for directing patients to alternative treatment pathways if they require or prefer non-pharmacological management. Current prescribing trends appear to favour older benzodiazepines in new cases of insomnia whereas some successful sporadic users of zolpidem have continued to use zolpidem after the media coverage in 2007–08. The findings of this pilot study suggest the need to address the limitations in the management of insomnia within the current health care system, to revise and disseminate updated insomnia guidelines and to provide educational opportunities and resources to primary care practitioners concerning management options.
Publisher: American Thoracic Society
Date: 15-06-2022
Publisher: Oxford University Press (OUP)
Date: 04-2013
DOI: 10.5665/SLEEP.2562
Publisher: BMJ
Date: 28-11-2013
DOI: 10.1136/THORAXJNL-2013-203796
Abstract: Patients with mild to moderate obstructive sleep apnoea (OSA) commonly suffer excessive daytime sleepiness. Continuous positive airway pressure (CPAP) has limited effectiveness in reducing sleepiness in milder OSA. Modafinil is a wake-promoting drug licensed to treat residual sleepiness in CPAP-treated OSA. We hypothesised that modafinil may effectively treat sleepiness in untreated mild to moderate OSA. Untreated sleepy men with mild to moderate OSA (age 18-70, apnoea-hypopnoea index (AHI) 5-30/h, Epworth Sleepiness Scale (ESS) ≥10) were randomised to receive 200 mg modafinil or matching placebo daily for 2 weeks before crossing over to the alternative treatment after a minimum 2-week washout. Mixed model analysis of variance was used to compare the changes on modafinil to placebo while classifying all randomised patients as random factors. 32 patients were randomised (mean (SD) AHI 13 (6.4)/h, age 47 (10.7) years, ESS 13.6 (3.3), body mass index 28.2 (3.6) kg/m(2)), 29 of whom (91%) completed the trial. The primary outcome (ESS) improved more on modafinil than placebo (3.6 points, 95% CI 1.3 to 5.8, p=0.003) and the secondary outcome (40-min driving simulator performance) also improved more on modafinil than placebo (steering deviation 4.7 cm, 95% CI 0.8 to 8.5, p=0.018). Psychomotor Vigilance Task reciprocal reaction time improved significantly over placebo (0.15 (1/ms), 95% CI 0.03 to 0.27, p=0.016). Improvements on the Functional Outcomes of Sleep Questionnaire were not significant (5.3 points over placebo, 95% CI -1 to 11.6, p=0.093). Modafinil significantly improved subjective sleepiness in patients with untreated mild to moderate OSA. The size of this effect is clinically relevant at 3-4 ESS points of improvement compared with only 1-2 points in CPAP clinical trials. Driving simulator performance and reaction time also improved on modafinil. ACTRN#12608000128392.
Publisher: Elsevier BV
Date: 05-2013
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.SLEEP.2011.01.007
Abstract: Slow wave sleep (SWS) has been theorized as reflecting a homeostatic sleep process and is considered a state of recuperation. SWS is reduced in obstructive sleep apnea (OSA) patients, but SWS has not been specifically studied in respiratory failure patients. The aim of this study is to investigate SWS in predominantly hypercapnic respiratory failure patients. We analyzed sleep and arterial blood gas records of all 97 respiratory failure patients who underwent polysomnography and bilevel non-invasive ventilation (NIV) treatment in our laboratory from 2008 to July 2009. We also analyzed 32 initial diagnostic study data from these 97 patients. The 97 patients had an average age of 58±15 (SD) years. Total sleep time was 320.3±82.8 (SD) min of which 32.9%±15.4 (%) was spent in SWS. This high percentage SWS correlated positively with awake arterial CO(2) pressure (PCO(2)) in both the 97 treatment studies (r=0.35, p=0.001) and the 32 initial diagnostic studies (r=0.40, p=0.025). The relationship was particularly apparent in patients with obesity hypoventilation syndrome or overlap syndrome. Statistical modelling identified three significant predictor variables for SWS across both diagnostic and NIV nights: PCO(2), arousal index and female gender. Patients with respiratory failure have a high percentage of EEG assessed SWS which is in part determined by disease specific variables such as hypercapnia as well as by traditional SWS determinants such as sleep fragmentation and gender.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.SMRV.2019.101218
Abstract: Magnesium supplementation is often suggested for restless legs syndrome (RLS) or period limb movement disorder (PLMD) based on anecdotal evidence that it relieves symptoms and because it is also commonly recommended for leg cr s. We aimed to review all articles reporting the effects of magnesium supplementation on changes in RLS and/or PLMD. We conducted a systematic search looking for all relevant articles and then two reviewers read all article titles and abstracts to identify relevant studies. Eligible studies were scored for their quality as interventional trials. We found 855 abstracts and 16 of these could not be definitively excluded for not addressing all aspects of our research question. Seven full-text articles were unlocatable and one was ineligible which left eight studies with relevant data. One was a randomised placebo-controlled trial, three were case series and four were case studies. The RCT did not find a significant treatment effect of magnesium but may have been underpowered. After quality appraisal and synthesis of the evidence we were unable to make a conclusion as to the effectiveness of magnesium for RLS/PLMD. It is not clear whether magnesium helps relieve RLS or PLMD or in which patient groups any benefit might be seen.
Publisher: Elsevier BV
Date: 02-2005
DOI: 10.1111/J.1467-842X.2005.TB00742.X
Abstract: To assess the role of sleep-related factors, ethnicity and socioeconomic deprivation in self-reported motor vehicle accidents while driving, after controlling for gender, age and driving exposure. Mail survey to a random electoral roll s le of 10,000 people aged 30-60 years, stratified by age decades and ethnicity (71% response rate). The analytical s le included 5,534 current drivers (21.6% Maori men, 21.2% Maori women, 30% non-Maori men, 27.2% non-Maori women). Multiple logistic regression analyses revealed the following independent risk factors for accident involvement while driving (last three years): being younger higher average weekly driving hours never/rarely getting enough sleep (OR=1.26, 95% CI 1.06-1.49) reporting any chance of dozing in a car while stopped in traffic (Epworth Sleepiness Scale question 8, OR=1.52, 95% CI 1.15-2.02) and among women, being non-Maori. Total Epworth score was not significantly related to reported accident involvement. Chronic sleep restriction, and any likelihood of dozing off at the wheel of a motor vehicle, were significant independent predictors of self-reported involvement in all types of motor vehicle accidents, not only those identified as fatigue-related. The Epworth Sleepiness Scale alone is not a reliable clinical tool for identifying in iduals at higher risk of crashes. Factors relating to chronic sleepiness were as important as established demographic risk factors for self-reported motor vehicle accident involvement among 30-60 year-old drivers. The findings reinforce the need for multi-faceted c aigns to reduce sleepy driving.
Publisher: Springer Science and Business Media LLC
Date: 29-03-2019
DOI: 10.1007/S11325-019-01826-2
Abstract: Craniofacial structure is an important risk factor in the development of obstructive sleep apnoea. Most craniofacial imaging methods are not feasible for large-scale studies or the clinic. Craniofacial photography is a high-throughput technique for facial phenotyping however, derived measurements are a composite of skeletal and soft tissue craniofacial information. Weight change is a paradigm to help determine which facial measurements most relate to regional soft tissue (i.e. change with weight) versus skeletal structure (i.e. stable with weight changes). We aimed to assess the association between weight change and changes in key facial measurements from facial photography. Calibrated frontal and profile photographs were taken of participants in weight loss studies (N = 106). Univariate linear regression was used to assess whether weight change explained changes in facial dimensions. Patients lost 11.7 ± 10.8 kg body weight and 2.0 ± 2.0 cm of neck circumference. Weight changes influenced face width (r = 0.3, p < 0.001), mandibular width (r = 0.4, p < 0.001) and cervicomental angle (r = 0.3, p = 0.001). Facial angles, facial heights and mandibular length were not influenced by weight change. A weight loss paradigm suggests that face and mandibular width and cervicomental angle most strongly reflect regional adiposity. Facial angles and heights are insensitive to weight change and could be more representative of craniofacial skeletal structure. This study informs the interpretation of facial phenotype assessed by this craniofacial photographic method which can be applied to future studies of craniofacial phenotype in OSA.
Publisher: Informa UK Limited
Date: 10-2011
DOI: 10.3109/19401736.2011.632896
Abstract: The monogeneric family Fergusoninidae consists of gall-forming flies that, together with Fergusobia (Tylenchida: Neotylenchidae) nematodes, form the only known mutualistic association between insects and nematodes. In this study, the entire 16,000 bp mitochondrial genome of Fergusonina taylori Nelson and Yeates was sequenced. The circular genome contains one encoding region including 27 genes and one non-coding A+T-rich region. The arrangement of the protein-coding, ribosomal RNA (rRNA) and transfer RNA (tRNA) genes was the same as that found in the ancestral insect. Nucleotide composition is highly A+T biased. All of the protein initiation codons are ATN, except for nad1 which begins with TTT. All 22 tRNA anticodons of F. taylori match those observed in Drosophila yakuba, and all form the typical cloverleaf structure except for tRNA-Ser((AGN)) which lacks a dihydrouridine (DHU) arm. Secondary structural features of the rRNA genes of Fergusonina are similar to those proposed for other insects, with minor modifications. The mitochondrial genome of Fergusonina presented here may prove valuable for resolving the sister group to the Fergusoninidae, and expands the available mtDNA data sources for acalyptrates overall.
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-019255
Abstract: Originally developed as a paper questionnaire, the electronic Epworth Sleepiness Scale (ESS) is widely used in sleep clinics and sleep population research. Despite potential differences between computer-based and conventional questionnaire delivery, studies have not evaluated the agreement between electronic and paper versions of the ESS. Given the widespread use of the ESS, a bias between results would present considerable data concerns. Thus, the aim of this study was to examine agreement between electronic and paper ESS responses in obstructive sleep apnoea (OSA). We undertook a secondary analysis of baseline data from a randomised controlled trial (ANZCTR: ACTRN12611000847910). Data were collected in a tertiary sleep research laboratory located in Sydney, Australia. Data were analysed from 112 adult patients with OSA. Patients were given the English version of the ESS as part of a battery of sleep laboratory questionnaires. They completed electronic and subsequently paper ESS questionnaires on the same day. We found no significant difference between electronic and paper ESS questionnaires (mean=0.1, SD=2.1, 95% CI −0.3 to 0.5, P=0.57) or heteroscedasticity. There was no evidence of bias along the range of the measure. 95% limits of agreement at 4.3 and −4.1 were comparable with previous data. We found no evidence of bias between electronic and paper ESS questionnaires in this s le of patients with OSA, as the two formats displayed sufficient agreement to be clinically comparable. Regardless of severity, patients reported the same level of daytime sleepiness with the same level of accuracy across both measures. ACTRN12611000847910 Pre-results.
Publisher: Oxford University Press (OUP)
Date: 08-2015
DOI: 10.5665/SLEEP.4912
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.SMRV.2016.06.004
Abstract: Heart rate variability (HRV) is an objective marker that provides insight into autonomic nervous system dynamics. There is conflicting evidence regarding the presence of HRV impairment in insomnia patients. Web-based databases were used to systematically search the literature for all studies that compared the HRV of insomnia patients to controls or reported the HRV of insomnia patients before and after an intervention. 22 relevant papers were identified. Study characteristics were summarised, HRV measures were extracted and a risk of bias assessment for each study was performed. We were limited in our ability to synthesise outcome measures and perform meta-analyses due to considerable differences in patient (and control) selection, study protocols, measurement and processing techniques and outcome reporting. Risk of bias was deemed to be high in the majority of studies. As such, we cannot confirm that HRV is reliably impaired in insomnia patients nor determine the HRV response to interventions. Whilst HRV impairment in insomnia is a widely accepted concept, it is not supported by empirical evidence. Large longitudinal studies incorporating 24-hour recordings are required to elucidate the precise nature of HRV dynamics in insomnia patients.
Publisher: Frontiers Media SA
Date: 30-10-2014
Publisher: European Respiratory Society (ERS)
Date: 04-02-2016
DOI: 10.1183/13993003.01509-2015
Abstract: Modafinil is used internationally to treat residual sleepiness despite continuous positive airway pressure in obstructive sleep apnoea (res-OSA). In 2011, the European Medicines Agency removed the indication based on an unfavourable risk–benefit profile in two trials for efficacy and all accumulated safety data. We performed a meta-analysis of all randomised controlled trials of modafinil (or armodafinil) in res-OSA to quantify efficacy and safety. We systematically searched and assessed studies from major databases, conferences and trials registries to find randomised, placebo-controlled trials of modafinil/armodafinil for ≥2 weeks in adult res-OSA treating sleepiness. We analysed 10 of the 232 articles identified that met inclusion criteria (1466 patients). Modafinil/armodafinil improved the Epworth Sleepiness Scale score (2.2 points, 95% CI 1.5–2.9) and the Maintenance of Wakefulness Test over placebo (3 min, 95% CI 2.1–3.8 min). Modafinil/armodafinil tripled adverse events and doubled adverse events leading to withdrawal but did not increase serious adverse events (hospitalisations or death). Modafinil and armodafinil improve subjective and objective daytime sleepiness in res-OSA. We believe our analysis is a fairer analysis of the risk–benefit profile of this indication. Clinicians may want to use this data to balance the risks and benefits on a case-by-case basis with their patients.
Publisher: European Respiratory Society (ERS)
Date: 26-05-2011
DOI: 10.1183/09031936.00022111
Abstract: Sleep apnoea is associated with increased mortality in sleep clinic and community population groups. It is unclear whether a clinical report of sleep apnoea results in additional mortality risk in patients with severe obesity. The Swedish Obese Subjects (SOS) study is a nonrandomised controlled trial of bariatric surgery versus conventional treatment for the treatment of severe obesity and its complications (mean ± SD body mass index 41 ± 5 kg · m(-2)). The presence or absence of sleep apnoea (witnessed pauses in breathing) was determined by self-reporting at baseline in 3,953 patients who were observed for 54,236 person-yrs (mean 13.5 maximum 21.0 yrs). Sleep apnoea was reported by 934 (23.6%) patients at baseline and was a significant univariate predictor of mortality (hazard ratio (95% CI) 1.74 (1.40-2.18)). In a range of multivariate models of mortality risk, controlling for ≤ 16 other potential confounders and established mortality risk factors, sleep apnoea remained a significant prognostic factor (fully adjusted model 1.29 (1.01-1.65)). Self-reported sleep apnoea is an independent prognostic marker of all-cause mortality in obese patients.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 10-2011
Publisher: Wiley
Date: 29-04-2011
DOI: 10.1111/J.1440-1754.2011.02014.X
Abstract: To study the association between childhood snoring and cardiovascular risk factors. Cross-sectional analyses of a population-based birth cohort, who had been participants in a randomised controlled trial of interventions to prevent asthma and who were assessed at age 8 years. The presence and frequency of snoring were assessed by parent-completed questionnaire. We measured a wide range of cardiovascular function markers including non-fasting serum lipoproteins, blood pressure, high-sensitivity C-reactive protein, carotid artery intima media thickness (by ultrasound), brachial pulse wave velocity and augmentation index (by applanation tonometry). Of 409 children whose snoring status was assessed at age 8 years, 321 had lipid and 386 had arterial structure and function measurements. Snoring was not independently associated with blood pressure, carotid artery intima media thickness or measures of arterial stiffness (all P > 0.05). Increasing snoring frequency was independently associated with lower high-density lipoprotein cholesterol (-0.032 g/dL per step, 95% confidence interval -0.060 to -0.003), although the difference in high-density lipoprotein between snorers and non-snorers was not significant (P = 0.052). An association of snoring frequency with brachial pulse wave velocity differed according to body mass index (P = 0.03) and was the reverse of that expected. Parentally reported snoring was not independently associated with adverse measurements of metabolic markers, vascular structure or function in 8-year-old children. Parental reports of snoring may be below the treatment threshold without additional diagnosis via sleep studies.
Publisher: Oxford University Press (OUP)
Date: 02-2005
Abstract: To examine possible relationships between excessive sleepiness (Epworth Sleepiness Scale score >10), and age, sex, ethnicity, socioeconomic deprivation, usual sleep, and self-reported symptoms of obstructive sleep apnea. Mail-out survey to a stratified random s le of 10,000 people aged 30 to 60 years, selected from the electoral roll. Nationwide survey of adults in New Zealand (71% response rate). The s le design aimed for equal numbers of Măori and non-Măori participants, men and women, and participants in each age decade. N/A. Two-page questionnaire. Măori participants had higher mean Epworth Sleepiness Scale scores than non-Măori (7.5 versus 6.0) and were more likely to have an Epworth Sleepiness Scale score of more than 10. Logistic multiple regression modeling identified the following significant independent risk factors for having an Epworth Sleepiness Scale score >10: being Măori, male, older, reporting more or less than 7.5 to 8.0 hours usual sleep, never or rarely getting enough sleep, never or rarely waking refreshed, larger neck circumference, observed apneas, and not drinking alcohol (compared with moderate alcohol consumption). The relationships between an Epworth Sleepiness Scale score >10 and sleep habits and risk factors for obstructive sleep apnea are as expected. The relationships between an ESS score > 10 and being Măori, a man, older, or more socioeconomically deprived could be related to a higher prevalence of sleep disorders in these groups. However, more research is needed to understand possible differences not only in pathophysiologic processes, but also in the wider societal trends and pressures that may impact differentially on sleep and sleepiness.
Publisher: Wiley
Date: 13-12-2007
DOI: 10.1111/J.1440-1681.2007.04541.X
Abstract: 1. The aim of the present review is to outline: (i) the association between sleep and metabolism (ii) how sleep duration influences the development of disease and (iii) how sex differences, ageing and obesity may potentially influence the relationship between sleep, metabolic control and subsequent disease. 2. Sleep is associated with a number of endocrine changes, including a change in insulin action in healthy young in iduals. Sleep duration shows a prospective U-shaped relationship with all-cause mortality, cardiovascular disease and Type 2 diabetes. 3. Chronic sleep restriction is becoming more common. Experimental sleep restriction impedes daytime glucose control and increases appetite. 4. The sex hormones oestrogen and testosterone influence sleep duration and quality and may account for sex differences in the prevalence of sleep-related disorders. 5. Ageing is associated with a decreased sleep duration, decreased muscle mass and impaired insulin action. 6. Obesity impairs insulin action and is associated with the incidence and severity of obstructive sleep apnoea. 7. Sleep plays an integral role in metabolic control. Consequently, insufficient sleep may represent a modifiable risk factor for the development of Type 2 diabetes. The challenge ahead is to identify how sex differences, ageing and obesity could potentially influence the relationship between sleep and metabolism.
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-06-2011
DOI: 10.5664/JCSM.1066
Publisher: Elsevier BV
Date: 11-2021
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-04-2007
DOI: 10.5664/JCSM.26799
Publisher: Oxford University Press (OUP)
Date: 12-09-2021
DOI: 10.1093/NOP/NPAA057
Abstract: Emerging evidence supports the clinical impact of sleep disturbance (SD) on cancer patients. This study aimed to determine the prevalence and predictors of SD in people with malignant brain tumors and caregivers, and explore any relationship between the patient-caregiver dyad’s sleep. Eighty-one adults with primary malignant (91%) or metastatic (9%) brain tumors and their family caregivers (n = 44) completed a series of self-report questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the drowsiness item of The MD Anderson Symptom Inventory-Brain Tumor in an Australian ambulatory neuro-oncology setting. Participants were grouped by the PSQI cutoff (SD & 5), and binary logistic regression analyses were performed to identify risk factors. Of patients, 53% reported SD and 15% of those clinically significant insomnia, and 27% reported moderate to severe daytime drowsiness. Whereas anxiety, depression, fatigue, pain, neurocognitive symptoms, and antiemetic use were higher in patients with SD, fatigue and KPS were strong predictors of SD. In caregivers, 55% reported poor sleep and 13% clinical insomnia. Anxiety, caregiver burden, and comorbid illness were significantly associated with caregivers’ SD. The in idual’s SD did not affect the chance of the other member of the patient-caregiver dyad experiencing SD. More than half the s le had sleep disturbance, which was linked to many concomitant symptoms, such as fatigue in patients and anxiety in caregivers, potentially contributing to distress and functional impairment. Understanding underlying mechanisms of SD, the potential use of these clinical predictors in care settings, and options for management is warranted.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.SLEH.2015.02.007
Abstract: Self-reported habitual sleep duration has been used widely in epidemiologic research, yet this measure remains to be validated. We evaluated whether simple sleep duration questions concord with sleep diaries in an online s le. Australian adults aged 18+ years completed an internet survey examining measures of sleep, sociodemographic risk factors, and a 7-day sleep diary. We examined single-question (how many hours of sleep would you normally get?) and 2-question assessments (difference between sleep and wake times) to a 7-day sleep diary estimation of sleep duration. Using Bland-Altman plots and associated statistics, we tested systematic differences, precision, and systematic bias. We also evaluated whether the differences were consistent along the entire range of the measurement and whether they were associated with any sociodemographic risk factors (Spearman rho). Data were analyzed from 1662 participants (67.3% female). Bland-Altman plots displayed visual discrepancies between both 1-question and 2-question reports of sleep duration compared with sleep diaries. Both the single- (-17 minutes) and double-question (8 minutes) sleep duration estimates differed significantly (both P < .001). These simple estimates only agreed to within ±2.5-3 hours compared with diary estimates. The measure was also weakly systematically biased (rho = +0.204 and +0.309, P < .001) through the measurement range. There were significant differences and associations between differences in sleep duration estimation and determinants of health. Simple questions estimating habitual sleep duration are imprecise and systematically biased in a large online survey. The amount of difference is correlated with well-known sociodemographic risk factors.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.JSMC.2016.05.005
Abstract: Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), but it is also common in the general population. When sleepiness remains after continuous positive airway pressure (CPAP) treatment of OSA, comorbid conditions or permanent brain injury before CPAP therapy may be the cause of the residual sleepiness. There is currently no broad approach to treating residual EDS in patients with OSA. In idual assessment must be made of comorbid conditions and medications, and of lifestyle factors that may be contributing to the sleepiness. Modafinil and armodafinil are the only pharmacologic agents indicated for residual sleepiness in these patients.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.CLINPH.2013.02.022
Abstract: To explore the use of detrended fluctuation analysis (DFA) scaling exponent of the awake electroencephalogram (EEG) as a new alternative biomarker of neurobehavioural impairment and sleepiness in obstructive sleep apnea (OSA). Eight patients with moderate-severe OSA and nine non-OSA controls underwent a 40-h extended wakefulness challenge with resting awake EEG, neurobehavioural performance (driving simulator and psychomotor vigilance task) and subjective sleepiness recorded every 2-h. The DFA scaling exponent and power spectra of the EEG were calculated at each time point and their correlation with sleepiness and performance were quantified. DFA scaling exponent and power spectra biomarkers significantly correlated with simultaneously tested performance and self-rated sleepiness across the testing period in OSA patients and controls. Baseline (8am) DFA scaling exponent but not power spectra were markers of impaired simulated driving after 24-h extended wakefulness in OSA (r=0.738, p=0.037). OSA patients had a higher scaling exponent and delta power during wakefulness than controls. The DFA scaling exponent of the awake EEG performed as well as conventional power spectra as a marker of impaired performance and sleepiness resulting from sleep loss. DFA may potentially identify patients at risk of neurobehavioural impairment and assess treatment effectiveness.
Publisher: Wiley
Date: 30-06-2017
DOI: 10.1111/JSR.12572
Abstract: Very low energy diets (VLED) appear to be the most efficacious dietary-based obesity reduction treatments in obstructive sleep apnea (OSA) however, effective weight loss maintenance strategies remain untested in this condition. Our study aimed to assess the feasibility, tolerability and efficacy of two common maintenance diets during a 10-month follow-up period after rapid weight loss using a 2-month VLED. In this two-arm, single-centre, open-label pilot trial, obese adult OSA patients received a 2-month VLED before being allocated to either the Australian Guide to Healthy Eating diet (AGHE) or a low glycaemic index high-protein diet (LGHP). Outcomes were measured at 0, 2 and 12 months. We recruited 44 patients [113.1 ± 19.5 kg, body mass index (BMI): 37.2 ± 5.6 kg m
Publisher: Wiley
Date: 30-12-2022
DOI: 10.1111/JPI.12782
Abstract: Melatonin is commonly used for sleep and jetlag at low doses. However, there is less documentation on the safety of higher doses, which are being increasingly used for a wide variety of conditions, including more recently COVID‐19 prevention and treatment. The aim of this review was to investigate the safety of higher doses of melatonin in adults. Medline, Scopus, Embase and PsycINFO databases from inception until December 2019 with convenience searches until October 2020. Randomised controlled trials investigating high‐dose melatonin (≥10 mg) in human adults over 30 years of age were included. Two investigators independently abstracted articles using PRISMA guidelines. Risk of bias was assessed by a committee of three investigators. 79 studies were identified with a total of 3861 participants. Studies included a large range of medical conditions. The meta‐analysis was pooled data using a random effects model. The outcomes examined were the number of adverse events (AEs), serious adverse events (SAEs) and withdrawals due to AEs. A total of 29 studies (37%) made no mention of the presence or absence of AEs. Overall, only four studies met the pre‐specified low risk of bias criteria for meta‐analysis. In that small subset, melatonin did not cause a detectable increase in SAEs (Rate Ratio = 0.88 [0.52, 1.50], p = .64) or withdrawals due to AEs (0.93 [0.24, 3.56], p = .92), but did appear to increase the risk of AEs such as drowsiness, headache and dizziness (1.40 [1.15, 1.69], p .001). Overall, there has been limited AE reporting from high‐dose melatonin studies. Based on this limited evidence, melatonin appears to have a good safety profile. Better safety reporting in future long‐term trials is needed to confirm this as our confidence limits were very wide due to the paucity of suitable data.
Publisher: Wiley
Date: 31-07-2018
DOI: 10.1111/JSR.12738
Publisher: Informa UK Limited
Date: 03-08-2023
Publisher: Elsevier BV
Date: 2005
Publisher: Informa UK Limited
Date: 20-08-2021
DOI: 10.1080/15402002.2021.1967157
Abstract: This pilot trial aimed to provide evidence for whether the integration of a wearable device with digital behavioral therapy for insomnia (dBTi) improves treatment outcomes and engagement. One hundred and twenty-eight participants with insomnia symptoms were randomized to a 3-week dBTi program (SleepFix®) with a wearable device enabling sleep data synchronization (dBTi+wearable group n = 62) or dBTi alone (n = 66). Participants completed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI) parameters: wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST) at baseline and weeks 1, 2, 3, and primary endpoint of week 6 and follow-up at 12 weeks. Engagement was measured by the number of daily sleep diaries logged in the app. There was no difference in ISI change scores between the groups from pre- to post-treatment (Cohen's This pilot trial found that integration of wearable device with a digital insomnia therapy enhanced user engagement and led to improvements in sleep parameters compared to dBTi alone. These findings suggest that adjunctive wearable technologies may improve digital insomnia therapy effectiveness.
Publisher: Oxford University Press (OUP)
Date: 12-10-2020
Abstract: Obesity is a common and reversible risk factor for obstructive sleep apnea (OSA). However, there is substantial unexplained variability in the amount of OSA improvement for any given amount of weight loss. Facial photography is a simple, inexpensive, and radiation-free method for craniofacial assessment. Our aims were (1) to determine whether facial measurements can explain OSA changes, beyond weight loss magnitude and (2) whether facial morphology relates to how effective weight loss will be for OSA improvement. We combined data from three weight loss intervention trials in which participants had standardized pre-intervention facial photography (N = 91 70.3% male, mean ± SD weight loss 10.4 ± 9.6% with 20.5 ± 51.2% apnea–hypopnea index [AHI] reduction). Three skeletal-type craniofacial measurements (mandibular length, lower face height, and maxilla-mandible relationship angle) were assessed for relationship to AHI change following weight loss intervention. Weight and AHI changes were moderately correlated (rho = 0.3, p = 0.002). In linear regression, an increased maxilla-mandible relationship angle related to AHI improvement (β [95% CI] −1.7 [−2.9, −0.5], p = 0.004). Maxilla-mandible relationship angle explained 10% in the variance in AHI over the amount predicted by weight loss amount (20%). The relationship between weight change and AHI was unaffected by the maxilla–mandible relationship angle (interaction term p & 0.05). Regardless of facial morphology, weight loss is similarly moderately predictive of OSA improvement. Increased maxilla-mandible relationship angle, suggestive of retrognathia, was weakly predictive of OSA response to weight loss. Although this is unlikely to be clinically useful, exploration in other ethnic groups may be warranted.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.SMRV.2019.101232
Abstract: Sleep disturbances are commonly reported by patients with autoimmune disease, and are negatively related to both disease activity and quality of life. Despite the potential for sleep disturbance to exacerbate inflammatory pathways, acute management of sleep disturbance with pharmacological aids is not well understood in this patient group. The objective of this review was to determine the efficacy of pharmacological treatments for sleep disturbance to improve sleep outcomes in adult patients with diagnosed autoimmune disease. Four databases and grey literature were searched for randomized controlled trials which used a pharmacological treatment specifically to treat sleep disturbance in patients with diagnosed autoimmune disease, both in hospitalized and non-hospitalized settings. A sleep outcome was required to be the primary endpoint of the study. Of the 409 studies identified, a total of six were included in the systematic review. Risk of bias across the studies was largely unclear, making an assessment challenging meta-analysis was not undertaken due to clinical and methodological heterogeneity between studies. While there appeared to be perceived improvement in self-reported sleep quantity and quality in existing studies with pharmacological treatment, there was also evidence of placebo effect on some measures. Relatively small numbers of patients have undergone gold-standard polysomnographic (PSG) recording of sleep which limits our knowledge of objectively determined sleep quantity and quality in patients with autoimmune disease receiving pharmacological treatment for sleep disturbance. Presently there is insufficient evidence to determine whether pharmacological treatment of sleep disturbance is beneficial for improving sleep quantity and quality in this patient group beyond rheumatoid arthritis.
Publisher: Elsevier BV
Date: 06-2011
Abstract: Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea (OSA), but patient compliance is a major barrier to long-term effectiveness. Flexible pressure delivery of PAP reduces pressure during early exhalation with the aim of improving comfort and, therefore, compliance, leading to subsequent symptoms improvement. We undertook a systematic literature search of PubMed (January 1, 2000, to July 11, 2010) to identify all randomized trials comparing flexible and standard CPAP in adult patients with OSA with at least 1-week follow-up. Either we or the original trial investigators extracted means, SEs, and s le sizes for all relevant outcome measures. We then performed meta-analyses quantifying improvements in objective compliance and symptoms as measured by the Epworth Sleepiness Scale (ESS), the Maintenance of Wakefulness Test (MWT), and the Psychomotor Vigilance Task (PVT). We found 10 relevant trials (599 patients). Meta-analysis of the seven trials where we could extract compliance data (514 patients) indicated that flexible pressure did not improve compliance compared with CPAP in either the parallel (0.16 h 95% CI, -0.09-0.42 P = .21) or the crossover trials (0.20 h 95% CI, -0.26-0.66 P = .39). Flexible pressure caused no improvement over CPAP in any secondary outcome (ESS, MWT, PVT, and residual OSA, all P > .05). Flexible pressure modification neither significantly improves compliance with CPAP in patients with OSA nor significantly improves patient outcomes beyond the effects of CPAP. Unfortunately, we were unable to locate compliance data in the correct format for three out of the 10 suitable trials.
Publisher: Wiley
Date: 11-04-2011
DOI: 10.1111/J.1365-2869.2011.00919.X
Abstract: A prominent media publicity cluster during 2007-2008 in Australia linked the common hypnotic zolpidem to adverse drug reaction reports of parasomnias, amnesia, hallucinations and suicidality. The collection of adverse drug reaction data through spontaneous reporting systems is a mainstay of drug safety monitoring, but a stimulated reporting event such as this often renders such data uninterpretable. As such, we aimed to investigate whether these associations were present before the media cluster and then to quantify the effect of stimulated reporting on those four specific outcomes. Using disproportionality analyses we compared zolpidem to all other drugs in the database, and then separately to each of all hypnotics, then all benzodiazepines, and then temazepam alone, and did so in every year from 2001 to 2008. Year-by-year analyses of Reporting odds ratios for zolpidem exposure and adverse events of interest, adjusted for a number of covariates, revealed an association between zolpidem exposure and parasomnias, amnesia and hallucination both before and after the cluster of media publicity beginning in early 2007. The odds ratios increased significantly after the media publicity for only parasomnias and amnesia. Suicidality was increased in some analyses, but limited data make this outcome difficult to interpret. We conclude that zolpidem adverse drug reaction reports have higher odds for parasomnia, amnesia, hallucination and perhaps suicidality compared to either all other drugs or hypnotics, even before the media publicity cluster. However, the extant literature and the limitations of these spontaneously reported adverse drug reaction data do not allow us to conclude that these events are related causally to zolpidem.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 26-05-2004
Publisher: Oxford University Press (OUP)
Date: 21-05-2018
Publisher: Oxford University Press (OUP)
Date: 26-05-2020
Abstract: Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep psychoeducation in improving postpartum maternal sleep, and depression. A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress. Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness. Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms. ACTRN12611000859987
Publisher: Wiley
Date: 12-2022
DOI: 10.5694/MJA2.51797
Publisher: Wiley
Date: 19-08-2019
DOI: 10.1111/CEO.13363
Abstract: Idiopathic Macular Telangiectasia Type 2 (MacTel) is an uncommon, progressive retinal disease usually affecting both eyes. Currently there is no know treatment however with similar comorbidities to Obstructive Sleep Apnoea (OSA) there is plausibility of an association which may accelerate disease progression. To identify an association between MacTel and OSA and whether OSA may result in increased disease progression. Matched case-control study and retrospective cohort analysis. Fifty-seven patients with MacTel and 165 matched controls from the Busselton Health Study. MacTel participants were matched based on age, gender and body mass index (BMI) (and where possible hypertension and diabetes) on a 3:1 ratio with controls from the Busselton Health Study. Participants undertook a sleep questionnaire using a previously validated questionnaire. In a subset sleep apnoea severity was objectively measured via overnight ambulatory polygraphy (30 cases and 83 matched controls ApneaLink device ResMed, Sydney, Australia). In a retrospective analysis of the suspected MacTel cases we assessed whether major markers of OSA severity and MacTel progression were associated. Apnoea Hypopnea Index along with key markers of MacTel progression. MacTel patients did not have a higher risk of sleep apnoea when compared to age, sex and BMI -matched controls (mean ± SD Apnoea hypopnea index [AHI] cases 9.6 ± 14.7 vs. controls 9.7 ± 10.8, P = 0.95). No markers of disease progression in the cases were associated with any marker of OSA severity. Sleep apnoea does not increase the risk or accelerate the progression of MacTel.
Publisher: Wiley
Date: 31-03-2020
DOI: 10.1111/JSR.13015
Abstract: Impact factors and ranking lists of research journals are very often used to judge our career achievements and progression by employers and granting bodies. However, a comprehensive list for the interdisciplinary field of sleep research does not currently exist because our journals tend to be placed into discipline‐specific lists that do not cope well with our historic interdisciplinarity, which embraces many core disciplines. We aimed to build a ranking list specifically for sleep research journals based on the journal impact factor and the google scholar H 5 indices. We then searched for all sleep journals given an impact factor by Thomson Reuters from 2005 to 2018 and all journals given a current H 5 index by Google Scholar. We provide a ranking list specifically for sleep journals that might be useful for researchers to cite when providing context in their applications for employment, promotion and funding.
Publisher: American Thoracic Society
Date: 15-06-2023
Publisher: Oxford University Press (OUP)
Date: 09-2012
DOI: 10.5665/SLEEP.2076
Publisher: Springer Science and Business Media LLC
Date: 09-08-2020
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJOPEN-2019-034421
Abstract: Insomnia is a highly prevalent and costly condition that is associated with increased health risks and healthcare utilisation. Anecdotally, cannabis use is frequently reported by consumers to promote sleep. However, there is limited research on the effects of cannabis on sleep and daytime function in people with insomnia disorder using objective measures. This proof-of-concept study will evaluate the effects of a single dose of an oral cannabis-based medicine on sleep and daytime function in participants with chronic insomnia disorder. A randomised, crossover, placebo-controlled, single-dose study design will be used to test the safety and efficacy of an oral oil solution (‘ETC120’) containing 10 mg Δ 9 -tetrahydrocannabinol (THC) and 200 mg cannabidiol (CBD) in 20 participants diagnosed with chronic insomnia disorder. Participants aged 35–60 years will be recruited over an 18-month period commencing August 2019. Each participant will receive both the active drug and matched placebo, in a counterbalanced order, during two overnight study assessment visits, with at least a 1-week washout period between each visit. The primary outcomes are total sleep time and wake after sleep onset assessed via polysomnography. In addition, 256-channel high-density electroencephalography and source modelling using structural brain MRI will be used to comprehensively examine brain activation during sleep and wake periods on ETC120 versus placebo. Next-day cognitive function, alertness and simulated driving performance will also be investigated. Ethics approval was received from Bellberry Human Research Ethics Committee (2018-04-284). The findings will be disseminated in a peer-reviewed open-access journal and at academic conferences. ANZCTRN12619000714189.
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-12-2007
DOI: 10.5664/JCSM.27025
Publisher: Springer Science and Business Media LLC
Date: 31-05-2008
DOI: 10.1007/S11325-008-0189-3
Abstract: Obstructive sleep apnea (OSA) is often treated with continuous positive airway pressure (CPAP) but the effectiveness of treatment is probably limited by poor compliance. CPAP manufacturers are thus attempting to devise more comfortable PAP devices in an effort to improve compliance. An ex le of such a novel device is Flexible expiratory-modulated PAP (C-Flex mode Respironics REMstar Pro, Murraysville, PA, USA). We aimed to compare compliance between C-Flex and standard CPAP in patients with severe OSA in a randomised controlled trial. Nineteen patients with severe OSA (mean +/- SD Apnea Hypopnea Index = 78 +/- 33/h, Epworth 14 +/- 4, PAP 8-17 cm H2O, BMI = 39 +/- 10 kg/m2) and aged 20-63 years were randomly assigned to 4 weeks of either C-Flex (setting II, n = 9) or CPAP (n = 10). Patients treated with C-Flex exhibited a trend toward higher compliance with their PAP devices compared to patients treated with standard CPAP (4.7 +/- 2.9 vs. 3.0 +/- 2.1 h/night, p = 0.15, effect size = 0.68). Paradoxically, improvements in subjective sleepiness (Epworth Sleepiness Scale) were greater in those who received CPAP than C-Flex (8.1 + 4.9 vs. 2.1 + 4.0 points, p = 0.014, effect size = 1.46). Improvements in objective wakefulness (Modified Maintenance of Wakefulness Test) and simple reaction times (Psychomotor Vigilance Task) were not significantly different between treatments. This randomised trial provides some evidence that C-Flex might increase initial treatment compliance, compared to CPAP, in patients with severe OSA. However, this trend toward greater compliance was not associated with better short-term treatment outcomes for patients. These findings need to be confirmed in a larger, longer-term trial.
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-02-2009
DOI: 10.5664/JCSM.27387
Publisher: Oxford University Press
Date: 23-09-2010
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/IS08032
Abstract: The Gondwanan relict oribatid mite family Crotoniidae contains the genera Austronothrus Hammer, 1966, Crotonia Thorell, 1876 and Holonothrus Wallwork, 1963. This family is of considerable interest biogeographically and also because the members of the family may have re-evolved sexuality from thelytokous parthenogenetic ancestors. Crotonia and Holonothrus are speciose and widely distributed whereas Austronothrus is obscure, hitherto monospecific and known only from New Zealand. We revise Austronothrus and compare it with its better-known congeners. Two new species of Austronothrus are described from New Zealand, namely A. clarki, sp. nov., and A. flagellatus, sp. nov. The only previously known species, Austronothrus curviseta Hammer, 1966, is redescribed and the genus is redefined. The presence of male specimens of all species confirmed Austronothrus as a sexual genus, like its congeners. Secondary sexual characteristics within Austronothrus and Crotonia include significant differences in body size and proportion, as well as the lengths and shapes of various setae, predominantly those of the notogastral region. Because these characters are frequently used by taxonomists to separate and define species within the Crotoniidae, it is important that the sex of adult specimens be determined to avoid describing conspecific males and females as separate species. A phylogenetic analysis based on morphological characters shows the crotoniid genera nested within the Camisiidae, with Camisia von Heyden, 1826 basal to the crotoniid clade of Austronothrus, Holonothrus and Crotonia, and with a clade of Platynothrus Berlese, 1913, Heminothrus Berlese, 1913 and Paracamisia Olszanowski & Norton, 2002 (Camisiidae) forming the sister clade of Camisia + Crotoniidae. Thus, Camisiidae is paraphyletic with respect to Crotoniidae. The family Crotoniidae is revised in light of the cladistic analysis, and relegated to subfamily rank. Three subfamilies are defined within the Camisiidae : Crotoniinae (containing Crotonia, Austronothrus and Holonothrus), Camisiinae (containing Camisia) and Heminothridae, subfam. nov. (containing Heminothrus, Platynothrus and Neonothrus Forsslund, 1955). Nothrus maximus Trägårdh, 1901 belongs to the genus Platynothrus and is recombined.
Publisher: Springer Science and Business Media LLC
Date: 07-01-2021
DOI: 10.1007/S00415-020-10353-0
Abstract: Rapid Eye Movement sleep behavior disorder (RBD) is a parasomnia causing sufferers to physically act out their dreams. These behaviors can disrupt sleep and sometimes lead to injuries in patients and their bed-partners. Clonazepam and melatonin are the first-line pharmacological treatment options for RBD based on direct uncontrolled clinical observations and very limited double-blind placebo-controlled trials. Given the risk for adverse outcomes, especially in older adults, it is of great importance to assess the existing level of evidence for the use of these treatments. In this update, we therefore critically review the clinical and scientific evidence on the pharmacological management of RBD in people aged over 50. We focus on the first-line treatments, and provide an overview of all other alternative pharmacological agents trialed for RBD we could locate as supplementary materials. By amalgamating all clinical observations, our update shows that 66.7% of 1,026 RBD patients reported improvements from clonazepam and 32.9% of 137 RBD patients reported improvements from melatonin treatment on various outcome measures in published accounts. Recently, however, three relatively small randomized placebo-controlled trials did not find these agents to be superior to placebo. Given clonazepam and melatonin are clinically assumed to majorly modify or eliminate RBD in nearly all patients—there is an urgent need to test whether this magnitude of treatment effect remains intact in larger placebo-controlled trials.
Publisher: Informa UK Limited
Date: 10-2019
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-06-2011
DOI: 10.5664/JCSM.1088
Publisher: Springer Science and Business Media LLC
Date: 08-05-2017
DOI: 10.1007/S11065-017-9344-6
Abstract: Previous systematic reviews and meta-analyses have identified cognitive deficits in adults with obstructive sleep apnoea (OSA). However, quantitative analysis of the association between OSA and neuropsychological performance has not been conducted specifically in older adults, for whom there is a greater risk of cognitive decline. We searched Medline, Embase and PsycINFO through August 2016 for studies describing associations between OSA and neuropsychological outcomes in people aged>50 years. Meta-analyses were performed on these studies for overall cognition and within cognitive domains. Subgroup analyses were performed taking into account risk of bias and moderating differences in study design. 13 studies met eligibility criteria for analysis. A small negative association was found between OSA and all neuropsychological outcomes combined, g=0.18(95% CI 0.04-0.32), and in memory and processing speed domains. Small case-control studies from sleep clinic populations observed the greatest associations, while larger cohort studies from community s les illustrated no association. Analysis accounting for publication bias resulted in a null overall association, g=0.02 (95%CI -0.12 to 0.16). Associations between OSA and cognition in later life are highly variable and the findings differ based on the type and setting of study. It appears some older adults may be at risk of cognitive impairments attributable to OSA however, the risk of bias renders the evidence inconclusive. High quality research is warranted in clinically diagnosed OSA patients as well as those already experiencing neuropsychological impairment and who may be regarded at higher risk of further cognitive decline.
Publisher: BMJ
Date: 16-01-2015
DOI: 10.1136/THORAXJNL-2014-206354
Abstract: Performing rigorously designed clinical trials in device-based treatments is challenging. Continuous positive airway pressure (CPAP) is the most effective device-based treatment for obstructive sleep apnoea. We performed a randomised crossover trial of CPAP versus placebo therapy and did not disclose the presence of placebo. We assessed rates of staff unblinding, the likelihood of patient unblinding and obtained patient perceptions on lack of full disclosure. All patients (n=30) underwent a semi-structured exit interview. Prior to full disclosure patients were asked questions to ascertain whether they suspected one therapy was ineffective. The use of placebo was then disclosed and additional questions were administered to indicate the likelihood of unblinding had full disclosure occurred during consent. Staff unblinding was determined by means of a questionnaire that was completed after each patient encounter. While the lack of full disclosure prevented patient unblinding during the trial, patients revealed a clear preference for active CPAP. After disclosing the presence of placebo, 73% (n=22) felt they would have been unblinded had they known at the start of the trial. Only one patient described unease about the lack of full disclosure. Staff thought they were unblinded in 6% (n=16/282) of encounters. They correctly identified the treatment device in 69% of cases (n=11/16, p<0.001). Successful patient blinding was achieved, however this was probably reliant on the lack of full disclosure. Staff unblinding occurred and highlights the difficulty with investigator blinding in device-based trials. Ethical challenges in this type of study are likely to compromise research feasibility. This clinical trial is registered with the Australian and New Zealand Clinical Trials Registry at www.anzctr.org.au (ACTRN 12605000066684).
Publisher: Springer Science and Business Media LLC
Date: 03-07-2014
DOI: 10.1111/SBR.12074
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.SLEEP.2007.09.002
Abstract: To describe the prevalence and risk factors for primary care consultations for insomnia and/or snoring/sleep apnea. Retrospective cross-sectional, population-based postal survey of 10,000 people randomly selected from the New South Wales electoral roll 3300 responded (35.6%). Direct contact with a random subset from the non-responders (n=100) was also undertaken with a response rate of 49%. The population weighted prevalence for having insomnia was 33.0%, with 11.1% visiting a doctor. The weighted prevalence for reporting a visit to the doctor for snoring/sleep apnea was 6.2%, while 2.9% reported having visited a doctor for both disorders. The percentages of males and females consulting their doctor for either sleep disorder were similar. Independent risk factors for insomnia visits were: being older, daytime sleepiness, short sleep durations, and reduced enthusiasm. Self-medication for insomnia symptoms was common. Independent risk factors for snoring/sleep apnea visits were: being older, daytime sleepiness, short sleep durations, and reduced enthusiasm. The risk factors for seeking medical help for self-suspected insomnia or snoring/sleep apnea were similar. The reported excess proportion of men being diagnosed in sleep apnea clinics appears to be related to a differential referral by clinicians. We recommend that clinicians discuss both insomnia and snoring/sleep apnea because these disorders are commonly found in patients presented with either condition.
Publisher: American Thoracic Society
Date: 08-2011
Publisher: Informa UK Limited
Date: 31-01-2012
DOI: 10.3109/19401736.2011.644042
Abstract: Approximately 2500 fly species comprise the Sarcophagidae family worldwide. The complete mitochondrial genome of the carrion-breeding, forensically important Sarcophaga impatiens Walker (Diptera: Sarcophagidae) from Australia was sequenced. The 15,169 bp circular genome contains the 37 genes found in a typical Metazoan genome: 13 protein-coding genes, 2 ribosomal RNA genes and 22 transfer RNA genes. It also contains one non-coding A þ T-rich region. The arrangement of the genes was the same as that found in the ancestral insect. All the protein initiation codons are ATN, except for cox1 that begins with TCG (encoding S). The 22 tRNA anticodons of S. impatiens are consistent with those observed in Drosophila yakuba, and all form the typical cloverleaf structure, except for tRNA-Ser((AGN)) that lacks the DHU arm. The mitochondrial genome of Sarcophaga presented will be valuable for resolving phylogenetic relationships within the family Sarcophagidae and the order Diptera, and could be used to identify favourable genetic markers for species identifications for forensic purposes.
Publisher: BMJ
Date: 03-12-2009
DOI: 10.1136/BMJ.B4363
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 02-06-2007
DOI: 10.1111/J.1445-5994.2007.01395.X
Abstract: The aim of this study was to provide the first population-based descriptions of typical sleep duration and the prevalence of chronic sleep restriction and chronic sleepiness in community-dwelling Australian adults. Ten thousand subjects randomly selected from the New South Wales electoral roll, half aged 18-24 years and the other half aged 25-64 years were posted a questionnaire asking about sleep behaviour, sleepiness and sleep disorders. Responses were received from 3300 subjects (35.6% response rate). The mean +/- standard deviation of sleep duration was 7.25 +/- 1.48 h/night during the week and 7.53 +/- 2.01 h/night in the weekends. Of the working age group, 18.4% reported sleeping less than 6.5 h/night. Chronic daytime sleepiness was present in 11.7%. Logistic modelling indicated that the independent risk factors for excessive daytime sleepiness were being older, sleeping less than 6.5 h per night during the week, getting qualitatively insufficient sleep, having at least one symptom of insomnia and lacking enthusiasm (marker of depression). In New South Wales almost one-fifth of the people are chronically sleep restricted and 11.7% are chronically sleepy. Chronic sleepiness was most commonly associated with voluntarily short sleep durations and symptoms of insomnia and depression. If the experimentally observed health effects of sleep restriction also operate at a population level, this prevalence of chronic sleep restriction is likely to have a significant influence on public health in Australia.
Publisher: Wiley
Date: 15-01-2015
DOI: 10.1111/JSR.12277
Publisher: Elsevier BV
Date: 08-2008
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 08-2023
Publisher: Wiley
Date: 03-2019
DOI: 10.1111/JSR.12838
Abstract: Electroencephalography is collected routinely during clinical polysomnography, but is often utilised to simply determine sleep time to calculate apnea-hypopnea indices. Quantitative analysis of these data (quantitative electroencephalogram) may provide trait-like information to predict patient vulnerability to sleepiness. Measurements of trait-like characteristics need to have high test-retest reliability. We aimed to investigate the intra-in idual stability of slow-wave (delta power) and spindle frequency (sigma power) activity during non-rapid eye movement sleep in patients with obstructive sleep apnea. We recorded sleep electroencephalograms during two overnight polysomnographic recordings in 61 patients with obstructive sleep apnea (median days between studies 47, inter-quartile range 53). Electroencephalograms recorded at C3-M2 derivation were quantitatively analysed using power spectral analysis following artefact removal. Relative delta (0.5-4.5 Hz) and sigma (12-15 Hz) power during non-rapid eye movement sleep were calculated. Intra-class correlation coefficients and Bland-Altman plots were used to assess agreement between nights. Intra-class correlation coefficients demonstrated good-to-excellent agreement in the delta and sigma frequencies between nights (intra-class correlation coefficients: 0.84, 0.89, respectively). Bland-Altman analysis of delta power showed a mean difference close to zero (-0.4, 95% limits of agreement -9.4, 8.7) and no heteroscedasticity with increasing power. Sigma power demonstrated heteroscedasticity, with reduced stability as sigma power increased. The mean difference of sigma power between nights was close to zero (0.1, 95% limits -1.6, 1.8). We have demonstrated the stability of slow-wave and spindle frequency electroencephalograms during non-rapid eye movement sleep within patients with obstructive sleep apnea. The electroencephalogram profile during non-rapid eye movement sleep may be a useful biomarker for predicting vulnerability to daytime impairment in obstructive sleep apnea and responsiveness to treatment.
Publisher: Canadian Science Publishing
Date: 10-2008
DOI: 10.1139/G08-066
Abstract: We sequenced the entire mitochondrial genome of Abispa ephippium (Hymenoptera: Vespoidea: Vespidae: Eumeninae) and most of the mitochondrial genome of Polistes humilis synoecus (Hymenoptera: Vespoidea: Vespidae: Polistinae). The arrangement of genes differed between the two genomes and also differed slightly from that inferred to be ancestral for the Hymenoptera. The genome organization for both vespids is different from that of all other mitochondrial genomes previously reported. A number of tRNA gene rearrangements were identified that represent potential synapomorphies for a subset of the Vespidae. Analysis of all available hymenopteran mitochondrial genome sequences recovered an uncontroversial phylogeny, one consistent with analyses of other types of data.
Publisher: Springer Science and Business Media LLC
Date: 2010
Publisher: BMJ
Date: 08-2023
DOI: 10.1136/BMJOPEN-2022-071148
Abstract: Insomnia is the most prevalent sleep disorder, with few effective pharmacotherapies. Anecdotal reports and recent preclinical research suggest that cannabinol (CBN), a constituent of Cannabis sativa derived from delta-9-tetrahydrocannabinol, could be an effective treatment. Despite this, the isolated effects of CBN on sleep have yet to be systematically studied in humans. The present protocol paper describes a randomised, double-blind, placebo-controlled, single-dose, three-arm, cross-over, proof-of-concept study which investigates the effects of CBN on sleep and next-day function in 20 participants with clinician-diagnosed insomnia disorder and an Insomnia Severity Index Score ≥15. Participants receive a single fixed oral liquid dose of 30 mg CBN, 300 mg CBN and matched placebo, in random order on three treatment nights each separated by a 2-week wash-out period. Participants undergo overnight sleep assessment using in-laboratory polysomnography and next-day neurobehavioural function tests. The primary outcome is wake after sleep onset minutes. Secondary outcomes include changes to traditional sleep staging, sleep-onset latency and absolute spectral power during non-rapid eye movement (NREM) sleep. Tertiary outcomes include changes to sleep spindles during NREM sleep, arousal indices, absolute spectral power during REM sleep and subjective sleep quality. Safety-related and exploratory outcomes include changes to next-day simulated driving performance, subjective mood and drug effects, postural sway, alertness and reaction time, overnight memory consolidation, pre and post-sleep subjective and objective sleepiness and plasma, urinary, and salivary cannabinoid concentrations. The study will provide novel preliminary data on CBN efficacy and safety in insomnia disorder, which will inform larger clinical trials. Human Research Ethics Committee approval has been granted by Bellberry (2021-08-907). Study findings will be disseminated in a peer-reviewed journal and at academic conferences. NCT05344170 .
Publisher: Wiley
Date: 18-12-2022
DOI: 10.1111/JSR.13802
Abstract: Our objective was to assess the agreement and linear relationships amongst multiple measures of sleep duration in a s le of patients with insomnia disorder and good sleeper controls. We retrospectively analysed data from 123 patients with insomnia disorder and 123 age‐ and gender‐matched good sleeper controls who completed a simple subjective habitual sleep duration question (Pittsburgh Sleep Quality Index), a sleep diary (5–14 days), 2 nights of polysomnography, and two corresponding morning subjective estimates of sleep duration. Descriptive statistics, linear regression analyses and Bland–Altman plots were used to describe the relationship and (dis)agreement between sleep duration measures. Relationships between polysomnography and the simple question as well as between polysomnography and sleep diary were weak to non‐existent. Subjective measures and polysomnography did not agree. Sleep duration measured with the Pittsburgh Sleep Quality Index or sleep diary was about 2 hr above or up to 4 hr below polysomnography‐measured sleep duration. Patients with insomnia disorder, on average, reported shorter sleep duration compared with polysomnography, while good sleeper controls, on average, reported longer sleep duration compared with polysomnography. The results suggest that subjective and objective measures apparently capture different aspects of sleep, even when nominally addressing the same value (sleep duration). They disagree in both patients with insomnia disorder and good sleeper controls, but in different directions. Studies assessing sleep duration should take into account both the investigated population and the assessment method when interpreting results. Future studies should continue to investigate possible psychological and physiological correlates of sleep (mis)perception.
Publisher: Springer Science and Business Media LLC
Date: 06-08-2021
DOI: 10.1007/S11325-021-02455-4
Abstract: Consistent predictors of weight loss outcomes with very low-energy diets (VLEDs) in obstructive sleep apnea (OSA) have not been identified. This study aimed to identify variables predictive of weight loss success in obese patients with OSA undertaking an intensive weight loss programme. We analysed biological, psychological, and behavioural variables as potential predictors of weight loss in obese patients with OSA after a 2-month VLED followed by one of two 10-month weight loss maintenance diets. Actigraphy, in-lab polysomnography, urinary catecholamines, and various psychological and behavioural variables were measured at baseline, 2, and 12 months. Spearman's correlations analysed baseline variables with 2-month weight loss, and 2-month variables with 2-12 month-weight change. Forty-two patients completed the VLED and thirty-eight completed the maintenance diets. Actigraphy data revealed that late bedtime (r Results from this small patient s le reveal correlations between actigraphy characteristics and weight loss in obese patients with OSA. We suggest the IWQOL may also be a useful clinical tool to identify OSA patients at risk of weight regain after initial weight loss. This clinical trial was prospectively registered on 18/02/2013 with the Australia and New Zealand Clinical Trials Registry (ACTRN12613000191796). Sleep, Lifestyle, Energy, Eating, Exercise Program for the management of sleep apnea patients indicated for weight loss treatment: A randomised, controlled pilot study. URL: www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363680.
Publisher: Wiley
Date: 22-11-2010
Publisher: American Thoracic Society
Date: 10-2018
Publisher: AMPCo
Date: 12-2011
DOI: 10.5694/MJA11.10302
Abstract: To determine whether sleep duration of Australian adults has declined over recent years. Analysis of nationally representative data from repeated cross-sectional time-use surveys conducted in 1992, 1997 and 2006. Private households in Australia. Respondents aged 15 years and over (N = 21 195) who completed time-use diaries over two consecutive days. Change in sleep duration by sociodemographic group. Mean sleep duration was 8 h 20 min in 1992, 8 h 33 min in 1997, and 8 h 30 min in 2006 (SEM for all years, 1 min). After adjustment for s ling during weekends and different seasons, there was no significant change in sleep duration from 1992 to 2006 (adjusted difference, 2 min 95% CI, -2 to 5 min P = 0.33). The only significant decreases in sleep duration were observed in people aged 65 years and over (adjusted difference, 12 min 95% CI, 4-19 min P < 0.001), people with no income (adjusted difference, 17 min 95% CI, 7-27 min P = 0.001) and male carers (adjusted difference, 31 min 95% CI, 9-53 min P = 0.002), although people in these groups reported over 8 h sleep on average. Most Australian adults were not sleeping less in 2006 than they did in 1992. Public health concerns over declining sleep duration do not appear to be warranted. Investigation of possible changes in quality of sleep is required.
Publisher: Wiley
Date: 02-03-2012
Publisher: Wiley
Date: 31-10-2019
DOI: 10.1002/MDS.27886
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.SLEH.2018.03.001
Abstract: Sleep research has been dominated by high income countries (HIC). Sleep may be different in low and middle income countries (LMIC) due to cultural, demographic, geographical and health factors. We systematically reviewed the epidemiological literature reporting sleep parameters in the adult population in LMIC and meta-analyzed the prevalence of subjective poor sleep quality and sleep duration. We identified 45 publications over 50% of which came from China and Brazil. Of the 45 identified studies, 32 contained data on sleep quality and 17 on self-reported sleep duration. Only one study utilized polysomnography and only one study utilized actigraphy. This review provides evidence that sleep parameters in LMIC appear to be similar to those in HIC but the variability and bias found suggests any attempt to extract a universal prevalence estimate or average sleep duration from the current data is very likely flawed and should be taken with caution. In our meta-analysis we found an enormous variability that was not explicable by regional, rurality, gender, age group or sleep assessment method. Further, there was a suggestion of significant small study effect, with smaller studies reporting worse sleep. There is surprisingly little consistent high-quality data that could be used for policy, planning, or scientific purposes at a global level in low and middle-income countries about what humans spend a third of their lives doing. High-quality epidemiological research about basic sleep health parameters is needed that focuses on the whole-population in LMIC, and that uses standardized, well-validated and culturally applicable measures.
Publisher: Wiley
Date: 03-2010
DOI: 10.1016/J.OTOHNS.2009.06.011
Abstract: Objective: To describe the provision, through the Australian state‐funded Medicare system, of uvulopalatopharyngoplasty (UPPP) and its laser‐assisted variation (LAUP) to the population of Australia between 1995 and 2007. Study Design: Case series using a comprehensive national administrative database. Setting: The Commonwealth of Australia. Subjects and Methods: Subjects comprised the population of Australia. The raw numbers of procedures, reimbursement amounts in Australian dollars, and per capita adjustment nationwide and in each state/territory for UPPP and LAUP for each calendar year from 1995 to 2007 were downloaded from a publicly accessible database run by Medicare. Results: The Australian federal government paid AUD 8.2 million for 19,534 UPPP procedures and AUD 1.1 million for 3270 LAUP procedures in the calendar years 1995 to 2007, inclusive. There is substantive variability between states in provision. Over time, provision of UPPP has declined slightly compared with population growth and overall Medicare provision. LAUP provision has declined markedly. Conclusion: Provision of UPPP under Medicare in Australia has declined slowly relative to population growth and overall growth in Medicare per capita provision. Laser‐assisted UPPP (LAUP) has steadily declined and is now rarely used compared with the peak in its provision in the mid 1990s.
Publisher: Wiley
Date: 19-01-2013
DOI: 10.1111/JSR.12024
Publisher: American Thoracic Society
Date: 15-04-2010
Publisher: Wiley
Date: 21-08-2201
DOI: 10.1111/J.1365-2869.2008.00665.X
Abstract: We hypothesized that in iduals with untreated obstructive sleep apnea (OSA) would exhibit greater vulnerability to sleep deprivation than healthy controls, due to the additional neurobiological 'load' of chronic sleep fragmentation. After baseline sleep with 8 h time in bed, participants remained awake for 40 h. Psychomotor Vigilance Task (PVT, mean slowest 10% 1/RT), AusEd Driving Simulator task (steering and speed deviation), and subjective sleepiness (Karolinska Sleepiness Scale, KSS) were assessed every 2 h. Nonlinear mixed-effects models were used to characterize in idual differences in baseline/average performance, the linear effect of increasing hours awake, circadian litude and phase. Eight participants with untreated OSA with mean (SD) age 44.6 (8.4), apnea-hypopnea index (AHI) 49.8 (24.7), Epworth Sleepiness Scale (ESS) 11.9 (4.8) and nine healthy controls age 27.8 (3.7), AHI 4.5 (2.7), ESS 7.3 (2.1) completed the protocol. Baseline KSS was significantly higher (1.4 units, P = 0.03) in the OSA group and there was a trend toward lower baseline speed deviation on the AusEd (P = 0.05). After adjusting for the significant effects of accumulated time awake, circadian litude and phase (all P 0.5). Random-effects modeling confirmed the presence of significant inter-in idual variability in vulnerability to sleep deprivation. Patients with OSA did not respond differently to sleep deprivation than healthy controls. As expected, total sleep deprivation led to significant worsening in performance and subjective sleepiness in both groups.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.GENE.2012.09.103
Abstract: Members of the Calliphoridae (blowflies) are significant for medical and veterinary management, due to the ability of some species to consume living flesh as larvae, and for forensic investigations due to the ability of others to develop in corpses. Due to the difficulty of accurately identifying larval blowflies to species there is a need for DNA-based diagnostics for this family, however the widely used DNA-barcoding marker, cox1, has been shown to fail for several groups within this family. Additionally, many phylogenetic relationships within the Calliphoridae are still unresolved, particularly deeper level relationships. Sequencing whole mt genomes has been demonstrated both as an effective method for identifying the most informative diagnostic markers and for resolving phylogenetic relationships. Twenty-seven complete, or nearly so, mt genomes were sequenced representing 13 species, seven genera and four calliphorid subfamilies and a member of the related family Tachinidae. PCR and sequencing primers developed for sequencing one calliphorid species could be reused to sequence related species within the same superfamily with success rates ranging from 61% to 100%, demonstrating the speed and efficiency with which an mt genome dataset can be assembled. Comparison of molecular ergences for each of the 13 protein-coding genes and 2 ribosomal RNA genes, at a range of taxonomic scales identified novel targets for developing as diagnostic markers which were 117-200% more variable than the markers which have been used previously in calliphorids. Phylogenetic analysis of whole mt genome sequences resulted in much stronger support for family and subfamily-level relationships. The Calliphoridae are polyphyletic, with the Polleninae more closely related to the Tachinidae, and the Sarcophagidae are the sister group of the remaining calliphorids. Within the Calliphoridae, there was strong support for the monophyly of the Chrysomyinae and Luciliinae and for the sister-grouping of Luciliinae with Calliphorinae. Relationships within Chrysomya were not well resolved. Whole mt genome data, supported the previously demonstrated paraphyly of Lucilia cuprina with respect to L. sericata and allowed us to conclude that it is due to hybrid introgression prior to the last common ancestor of modern sericata populations, rather than due to recent hybridisation, nuclear pseudogenes or incomplete lineage sorting.
Publisher: Wiley
Date: 26-04-2011
Abstract: Surgical approaches for alleviating snoring and/or obstructive sleep apnea (OSA) have been questioned because of a lack of evidence from high‐quality randomized controlled trials (RCTs). An ethical requirement for RCTs is that they must test questions where community equipoise (ie, uncertainty) exists as to the correct treatment. We aimed to measure perceived importance, community equipoise, and willingness to enroll patients in 5 potential trial targets among members of the Australian Society for Otolaryngology Head and Neck Surgery (ASOHNS). All ASOHNS members were surveyed using a multistage mail, email, Internet, and phone‐based questionnaire. Equipoise was measured for each of the scenarios using a bidirectional linear scale comparing 2 treatments. Responses were categorized into 1 of 3 groups: (A) preferred treatment 1, (B) completely undecided, and (C) preferred treatment 2. The resulting proportions are called equipoise ratios: A:B:C. Using tick boxes, the authors queried the general clinical importance and willingness to enroll patients for all scenarios. A total of 167 of 313 surgeons responded (53.4%). Three of the 5 trial scenarios exhibited evidence of community equipoise, but 2 scenarios, radiofrequency ablation plus uvulopalatopharyngoplasty (UPPP) versus UPPP alone and upper‐airway reconstruction versus mandibular advancement splint (MAS), did not have strong support for enrolling patients. Informal feedback indicates one of these may be feasible in a smaller number of specifically trained surgeons. We suggest 2 potential RCT targets: septoplasty and turbinate reduction versus conservative measures for snoring and airway reconstruction versus MAS for OSA, where importance, clinical equipoise, and willingness all exist.
Publisher: Wiley
Date: 19-11-2018
DOI: 10.1111/JSR.12788
Abstract: Therapeutic-continuous positive airway pressure seems to increase weight compared with placebo-continuous positive airway pressure. It is not known whether weight gain with therapeutic-continuous positive airway pressure dose is dependent or whether it causes metabolic dysfunction. Data synthesis of three randomised placebo-continuous positive airway pressure-controlled trials (2-3 months) was performed to test whether there is a dose-dependent effect of continuous positive airway pressure on weight. Fasting glucose, insulin, insulin resistance (homeostatic model assessment), lipids and visceral abdominal fat were also tested to determine any effect on metabolic function. Mixed-model analysis of variance was used to quantify these effects. One-hundred and twenty-eight patients were analysed. Overall there was a small increase in weight with therapeutic-continuous positive airway pressure use compared with placebo-continuous positive airway pressure (difference: 1.17 kg 0.37-1.97, p = 0.005), which was greater with high-use therapeutic-continuous positive airway pressure compared with high-use placebo-continuous positive airway pressure (1.45 kg 0.10-2.80, p = 0.04). Continuous positive airway pressure use as a continuous variable was also significantly associated with weight change in continuous positive airway pressure users (0.30 kg hr
Publisher: Wiley
Date: 14-06-2011
DOI: 10.1111/J.1365-2869.2011.00931.X
Abstract: Centrally active agents have a variable impact in patients with obstructive sleep apnoea (OSA) that is unexplained. How to phenotype the in idual OSA response is clinically important, as it may help to identify who will be at risk of respiratory depression and who will benefit from a centrally active agent. Based on loop gain theory, we hypothesized that OSA patients with higher central chemosensitivity have higher breathing instability following the use of a hypnosedative, temazepam. In 20 men with OSA in a double-blind, placebo-controlled cross-over trial we tested the polysomnographically (PSG) measured effects of temazepam 10 mg versus placebo on sleep apnoea. Treatment nights were at least 1 week apart. Ventilatory chemoreflexes were also measured during wakefulness in each subject. The patients (mean ± standard deviation 44 ± 12 years) had predominantly mild-to-moderate OSA [baseline apnoea-hypopnoea index (AHI) = 16.8 ± 14.1]. Patients' baseline awake central chemosensitivity correlated significantly with both the change of SpO₂ nadir between temazepam and placebo (r = -0.468, P = 0.038) and oxygen desaturation index (ODI r = 0.485, P = 0.03), but not with the change of AHI (r = 0.18, P = 0.44). Peripheral chemosensitivity and ventilatory recruitment threshold were not correlated with the change of SpO₂ nadir, ODI or AHI (all P > 0.05). Mild-moderate OSA patients with higher awake central chemosensitivity had greater respiratory impairment during sleep with temazepam. Relatively simple daytime tests of respiratory control may provide a method of determining the effect of sedative-hypnotic medication on breathing during sleep in OSA patients.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1111/J.1753-6405.2012.00845.X
Abstract: To determine the extent to which insomnia poses an independent burden on in idual function and healthcare use in Australia. Cross-sectional data from 8,841 respondents and representative of the Australian population aged 16 to 85 in the 2007 National Mental Health and Wellbeing Survey were analysed. Insomnia was defined as 'sleeping only in short bursts and being awake most of the night' during the past week. This measure was validated against common epidemiological indicators of insomnia. Associations between insomnia, disability and healthcare consumption were explored using multivariate logistic regression. Insomnia was reported by 5.6% of adults and was associated with older age, female gender, pain and psychological distress. Controlling for these and other a priori confounders, insomnia was associated with greater odds of (Adjusted Odds Ratio 95% CI): disability days (1.62 1.20-2.18), difficulties in daily activities (1.60 1.10-2.31), life dissatisfaction (2.34 1.11-4.93), use of sleep medication (1.78 1.12-2.82) and a higher number of visits to general practitioners (1.57 1.06-2.33). Insomnia was not significantly associated with the use of medications for mental health (1.17 0.82-1.67), hospital admissions (1.31 0.82-1.67), the use of complementary and alternative medicine (1.10 0.73-1.67) or unmet need for healthcare (1.22 0.84-1.77). One in twenty adult Australians experience a level of insomnia that is independently associated with impairments in functioning and increased use of healthcare. Increasing public and clinician awareness of the impact of insomnia, and promotion of available insomnia treatments may be warranted.
Publisher: MDPI AG
Date: 10-02-2021
Abstract: Sleep and functioning are associated with a risk of early workforce exit. However, patterns of change in sleep and functioning through time have not been investigated using person-oriented approaches to show what features of sleep and functioning are associated with an early exit. We examined the pattern of interactions between sleep and health functioning characterizing homogenous subgroups of employees and their associations with premature work exit. An additional aim was to provide a tutorial providing detailed description on how to apply these models, compared to traditional variable based risk factors. We analyzed data from 5148 midlife employees of the City of Helsinki, Finland, surveyed over three phases (2000–02, 2007, and 2012). Using repeated measures latent class analyses (RMLCA) we classified people into groups based on their trajectories in sleep and functioning. We identified four longitudinal groups: (1) Stable good sleep and functioning (reference), (2) Persistent sleep problems and good or moderate functioning, (3) Poor functioning with good sleep, and (4) Problematic sleep and health functioning. Compared to group 1, elevated risk was found in all classes with group 4 being the worst. In conclusion, focusing on person-orientated patterns of interactions between sleep and functioning helped produce qualitatively different and quantitatively stronger predictions than using conventional risk factor methodology. Thus, longitudinal person-oriented approaches may be a more powerful method for quantifying the role of sleep and health functioning as risks for premature exit from work.
Publisher: MDPI AG
Date: 09-08-2022
DOI: 10.3390/CLOCKSSLEEP4030030
Abstract: Light therapy is used to treat sleep and circadian rhythm disorders, yet there are limited studies on whether light therapy impacts electroencephalographic (EEG) activity during sleep. Therefore, we aimed to provide an overview of research studies that examined the effects of light therapy on sleep macro- and micro-architecture in populations with sleep and circadian rhythm disorders. We searched for randomized controlled trials that used light therapy and included EEG sleep measures using MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials databases. Five articles met the inclusion criteria of patients with either insomnia or delayed sleep–wake phase disorder (DSWPD). These trials reported sleep macro-architecture outcomes using EEG or polysomnography. Three insomnia trials showed no effect of the timing or intensity of light therapy on total sleep time, wake after sleep onset, sleep efficiency and sleep stage duration compared to controls. Only one insomnia trial reported significantly higher sleep efficiency after evening light therapy ( lx between 21:00–23:00 h) compared with afternoon light therapy ( lx between 15:00–17:00 h). In the only DSWPD trial, six multiple sleep latency tests were conducted across the day (09:00 and 19:00 h) and bright light (2500 lx) significantly lengthened sleep latency in the morning (09:00 and 11:00 h) compared to control light (300 lx). None of the five trials reported any sleep micro-architecture measures. Overall, there was limited research about the effect of light therapy on EEG sleep measures, and studies were confined to patients with insomnia and DSWPD only. More research is needed to better understand whether lighting interventions in clinical populations affect sleep macro- and micro-architecture and objective sleep timing and quality.
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-04-2014
DOI: 10.5664/JCSM.3600
Publisher: Oxford University Press (OUP)
Date: 18-05-2023
Publisher: Springer Science and Business Media LLC
Date: 08-10-2015
Publisher: Springer Science and Business Media LLC
Date: 27-04-2018
DOI: 10.1038/S41598-018-25033-3
Abstract: In this retrospective cohort study, we describe acceptability, tolerability and potential efficacy of cognitive behavioural therapy (CBT) in Insomnia Disorder subtypes, derived from polysomnography (PSG): insomnia with normal-sleep duration (I-NSD) and insomnia with short-sleep duration (I-SSD). All research volunteers were offered access to digital CBT, single component sleep restriction therapy and face-to-face group CBT. Follow-up occurred at three months post-treatment using the insomnia severity index (ISI). 96 participants (61 females, mean age of 41 years) were grouped into either normal-sleep (n = 53) or short-sleep (n = 43). CBT was acceptable to 63% of participants (normal-sleep = 31, short-sleep = 29), with 28 completing therapy (tolerability: normal-sleep = 11, short-sleep = 17). For potential efficacy, 39 (normal-sleep = 20, short-sleep = 19) out of 96 participants (41%) completed a follow-up ISI assessment. In this reduced s le, mean (SD) ISI scores decreased across both groups (normal-sleep: 18.0 (4.0) to 10.7 (4.6) short-sleep: 16.5 (5.5) to 11.0 (6.3) both P 0.01). Those with normal-sleep were more likely to respond (≥6-point ISI reduction) to CBT compared to short-sleep (70%, n = 14/20 vs. 37%, n = 7/19 respectively, P = 0.038). In this cohort, 60 (63%) of participants attempted CBT and of those 28 (47%) completed therapy. Results may be comparable to clinical participants with implications for the successful translation of CBT for insomnia.
Publisher: Public Library of Science (PLoS)
Date: 08-01-2014
Publisher: Oxford University Press (OUP)
Date: 24-03-2021
DOI: 10.1093/BJS/ZNAB101
Abstract: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351 best case 196, worst case 816) or non-cancer surgery (733 best case 407, worst case 1664). Both exceeded the NNV in the general population (1840 best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
Publisher: BMJ
Date: 26-05-2012
DOI: 10.1136/THORAXJNL-2012-201622
Abstract: Placebo responses are complex psychobiological phenomena and often involve patient expectation of benefit. With continuous positive airway pressure (CPAP) treatment of obstructive sleep apnoea, greater hours of CPAP use are associated with reduced sleepiness. However, these open-label studies have not controlled for patient expectation of benefit derived from their knowledge of hours of device use. To investigate the relative effectiveness of the use of real or placebo CPAP on daytime sleepiness. Patient-level meta-analysis combining data on sleepiness measured by the Epworth Sleepiness Scale from three randomised placebo-controlled crossover trials. Mixed model analysis of variance was used to quantify the effects of real versus placebo device treatment, usage, their interaction and regression to the mean. Duration of real and placebo CPAP use was correlated within patients (r=0.53, p<0.001). High use of real CPAP reduced sleepiness more than high use of placebo (difference 3.0 points 95% CI 1.7 to 4.3, p<0.001) and more than low use of real CPAP (difference 3.3 95% CI 1.9 to 4.7, p<0.0001). High use of placebo was superior to low use of placebo (difference 1.5 95% CI 0.1 to 2.8, p=0.03). Twenty-nine per cent of the effect of high usage of CPAP (4.2 points 95% CI 3.3 to 5.1) was explained by the expectation of benefit effect associated with high use of placebo (1.2 points 95% CI 0.2 to 2.3). A clinically significant proportion of the effectiveness of high CPAP use in reducing sleepiness is probably caused by patient expectation of benefit.
Publisher: Environmental Health Perspectives
Date: 03-2023
DOI: 10.1289/EHP10757
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-08-2016
DOI: 10.5664/JCSM.6060
Publisher: Springer Science and Business Media LLC
Date: 03-2008
DOI: 10.1007/S11325-008-0175-9
Abstract: Daytime symptoms resulting from obstructive sleep apnea (OSA) include impaired neurobehavioural performance and increased sleepiness. Continuous positive airway pressure (CPAP) reduces these symptoms. However, even compliant users may temporarily withdraw from CPAP treatment resulting in an immediate return of OSA. It has been hypothesised that these treatment "holidays" may be associated with neurobehavioural decline. Acute administration of a wakefulness promoter during such treatment "holidays" may help maintain neurobehavioural functioning. We examined the effects of 200 mg modafinil on neurobehavioural performance in a placebo-controlled crossover trial including N = 12 OSA patients acutely removed from CPAP. Sleep-wake activity was assessed for four consecutive days on CPAP and one night off CPAP using actigraphy. During the night off, CPAP patients wore a single channel nasal airflow diagnostic device. On the morning after CPAP withdrawal, patients reported to the laboratory and were administered either modafinil (200 mg) or placebo. At 2 h post-administration, patients completed a single simulated drive of approximately 30 min with simultaneous administration of a ided attention task (STISIMtrade mark), critical flicker fusion (CFF) test and subjective sleepiness scales. After a 14-day washout, participants repeated the protocol. CPAP withdrawal was associated with a worsening of sleep efficiency and the movement and fragmentation index (MFI), compared to the on-CPAP nights (all p < or = 0.02). Modafinil did not result in a superior driving simulator performance or CFF responses the morning after CPAP withdrawal but did result in better subjective sleepiness (both p < or = 0.04) compared to placebo. These data do not support the use of modafinil for the maintenance of daytime functioning in patients with OSA who are acutely withdrawn from CPAP.
Publisher: Massachusetts Medical Society
Date: 27-07-2023
DOI: 10.1056/NEJME2305779
Publisher: Public Library of Science (PLoS)
Date: 12-11-2014
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 2006
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.YMPEV.2013.04.030
Abstract: Phylogenetic relationships within the Tabanidae are largely unknown, despite their considerable medical and ecological importance. The first robust phylogenetic hypothesis for the horse fly tribe Scionini is provided, completing the systematic placement of all tribes in the subfamily Pangoniinae. The Scionini consists of seven mostly southern hemisphere genera distributed in Australia, New Guinea, New Zealand and South America. A 5757 bp alignment of 6 genes, including mitochondrial (COI and COII), ribosomal (28S) and nuclear (AATS and CAD regions 1, 3 and 4) genes, was analysed for 176 taxa using both Bayesian and maximum likelihood approaches. Results indicate the Scionini are strongly monophyletic, with the exclusion of the only northern hemisphere genus Goniops. The South American genera Fidena, Pityocera and Scione were strongly monophyletic, corresponding to current morphology-based classification schemes. The most widespread genus Scaptia was paraphyletic and formed nine strongly supported monophyletic clades, each corresponding to either the current subgenera or several previously synonymised genera that should be formally resurrected. Molecular results also reveal a newly recognised genus endemic to New Zealand, formerly placed within Scaptia. Divergence time estimation was employed to assess the global biogeographical patterns in the Pangoniinae. These analyses demonstrated that the Scionini are a typical Gondwanan group whose ersification was influenced by the fragmentation of that ancient land mass. Furthermore, results indicate that the Scionini most likely originated in Australia and subsequently radiated to New Zealand and South American by both long distance dispersal and vicariance. The phylogenetic framework of the Scionini provided herein will be valuable for taxonomic revisions of the Tabanidae.
Publisher: American Thoracic Society
Date: 05-2016
Publisher: Wiley
Date: 2007
DOI: 10.1002/PPUL.20606
Abstract: Snoring is often found in allergic diseases and may be an early manifestation of more serious sleep-disordered breathing. We aimed to investigate whether the risk factors for snoring among pre-school children with rhinitis are similar to those for allergic diseases in a birth cohort. The study cohort was drawn from participants in the Childhood Asthma Prevention Study (CAPS). This is a randomized controlled trial of dietary intervention and house dust mite avoidance during the first 5 years of life, aimed at reducing the risk of acquiring asthma and other allergic conditions in children at high-risk for allergic diseases. Parents of children with symptoms of rhinitis at age 5 years (n = 219 out of 516 cohort members) were asked if their child snored: 127 (60%) reported some snoring and 56 (26%) snored more than three times per week. Multiple logistic regression analyses indicated that children who were first-born (adjusted odds ratio, 2.50, 95% CI 1.20-5.21), were exposed to maternal tobacco smoke during the first year of life (2.40, 1.1-5.25), or who had asthma (2.51, 1.14-5.55) and/or eczema (2.29, 1.02-5.13) at age 5 years were more likely to snore. Birth-weight, body mass index at age 4.5, spirometry, and breastfeeding were not related to snoring. Risk factors for snoring are similar to risk factors for allergic disorders. Snoring may be part of the allergic spectrum of diseases. Our data may contribute to clinician's ability to effectively screen for snoring in preschool children.
Publisher: Wiley
Date: 2012
Publisher: AME Publishing Company
Date: 11-2022
DOI: 10.21037/AJO-21-23
Publisher: European Respiratory Society (ERS)
Date: 10-11-2011
DOI: 10.1183/09031936.00093811
Abstract: Obstructive sleep apnoea (OSA) is often treated with autotitrating continuous positive airway pressure (autoCPAP) devices. Clinical and bench tests of these devices have suggested performance limitations. These studies do not indicate whether this is a failure to detect or a failure to respond to airway obstruction. In this randomised, crossover trial, 34 patients with moderate-to-severe OSA underwent polysomnography on two laboratory visits. The autoCPAP device was randomly set to a fixed subtherapeutic pressure (detection assessment) or autotitrating mode (response assessment). Airflow was measured both from the autoCPAP (autoCPAP flow) and directly from the nasal mask, and recorded on polysomnography. Apnoea/hypopnoea indices (AHIs) measured at the two sites and from the autoCPAP download report were compared. Regarding detection, the AHI measured from the nasal mask showed good agreement with the autoCPAP flow AHI, but agreement was lower with the autoCPAP report AHI. In autotitrating mode, there was significant misclassification of those with and without OSA (AHI ≥ 10 events · h(-1)) on the autoCPAP report. Regarding response, residual OSA (AHI ≥ 10 events · h(-1)) was still evident in 24% of patients during autotitration. In some patients, autoCPAP fails to detect and/or respond to sleep apnoea. Clinicians should consider limitations of each device and use caution when using autoCPAP report statistics to verify effective treatment.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2017
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.SMRV.2011.07.003
Abstract: Little evidence exists to support the common assertion that adult sleep duration has declined. We investigated secular trends in sleep duration over the past 40 years through a systematic review. Systematic search of 5 electronic databases was conducted to identify repeat cross-sectional studies of sleep duration in community-dwelling adults using comparable s ling frames and measures over time. We also attempted to access unpublished or semi-published data sources in the form of government reports, theses and conference proceedings. No studies were excluded based on language or publication date. The search identified 278 potential reports, from which twelve relevant studies were identified for review. The 12 studies described data from 15 countries from the 1960s until the 2000s. Self-reported average sleep duration of adults had increased in 7 countries: Bulgaria, Poland, Canada, France, Britain, Korea and the Netherlands (range: 0.1-1.7 min per night each year) and had decreased in 6 countries: Japan, Russia, Finland, Germany, Belgium and Austria (range: 0.1-0.6 min per night each year). Inconsistent results were found for the United States and Sweden. There has not been a consistent decrease in the self-reported sleep duration of adults from the 1960s to 2000s. However, it is unclear whether the proportions of very short and very long sleepers have increased over the same period, which may be of greater relevance for public health.
Publisher: Cambridge University Press (CUP)
Date: 12-2013
DOI: 10.1017/S0022215113003009
Abstract: Adult patients with obstructive sleep apnoea can be a therapeutic surgical challenge if other treatments fail or are rejected. We report the outcomes of a series of 17 patients for whom standard device-based treatments failed or could not be used. These patients were considered unsuitable for a lesser operation and therefore underwent multilevel upper airway reconstruction. Data from 17 consecutive patients were collected prospectively. This included pre- and post-surgery findings for clinical assessments, body mass index, sleep questionnaires, and laboratory polysomnograms. Patients underwent a combination of modified uvulopalatopharyngoplasty, transpalatal advancement and various tongue reduction procedures. Analyses revealed statistically and clinically significant reductions in: mean apnoea-hypopnoea index scores (from 36.3 pre-operatively to 14.5 post-operatively, p 0.001), mean Epworth sleepiness scale scores (from 11.3 to 5.3, p 0.001) and mean snoring severity scores (from 6.9 to 1.3, p 0.001). Body mass index remained unchanged. Multilevel upper airway reconstructive surgery was associated with large reductions in both objective and patient-centred subjective measures of obstructive sleep apnoea severity.
Publisher: Wiley
Date: 24-08-2023
DOI: 10.1111/JSR.13699
Abstract: Sleep restriction therapy (SRT) is an effective stand‐alone behavioural intervention for insomnia disorder. However, its daytime side effects, particularly sleepiness, may be troubling for patients and/or may be a necessary part of the patient's treatment journey. This pilot trial aims to explore the potential benefit of armodafinil, a wakefulness promoter. Patients were treated with SRT with open label adjunctive armodafinil (150 mg/day). Thirty‐three patients from previous studies that have undergone exactly the same SRT intervention acted as controls. The primary outcome measure was the insomnia severity index (ISI), and secondary outcomes were the Epworth sleepiness scale, sleep restriction adherence scale (SRAS), and safety from baseline through to 12 weeks. We recruited 25 patients into the trial. Data for the primary end point (ISI at 12 weeks) was available for 20 of the participants. The baseline insomnia severity index was 20.2 (SD 3.3) and decreased to 9.1 (SE 1.1), with no change, to 10.2 and 11.2 at weeks 6 and 12 respectively (all p 0.05 compared with baseline). The insomnia severity index values for armodafinil patients were statistically inferior to historical controls at the primary time point of 12 weeks (11.2 vs. 6.7, p 0.01). Sleep restriction therapy plus armodafinil treatment was associated with frequent minor side effects but was generally safe and acceptable to patients. Sleep restriction therapy was associated with a robust clinical response in the insomnia severity index values for insomnia patients. Based upon historical control data, armodafinil does not appear to have beneficial adjunctive effects in addition to sleep restriction therapy alone.
Publisher: Oxford University Press (OUP)
Date: 11-2016
DOI: 10.5665/SLEEP.6230
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-02-2017
DOI: 10.5664/JCSM.6452
Publisher: BMJ
Date: 05-2005
Publisher: Wiley
Date: 09-03-2021
DOI: 10.1111/ANAE.15458
Abstract: Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-041500
Abstract: Melatonin has multiple proposed therapeutic benefits including antioxidant properties, synchronisation of the circadian system and lowering of blood pressure. In this protocol, we outline a randomised controlled trial to assess the feasibility, acceptability and tolerability of higher dose (25 mg) melatonin to target brain oxidative stress and sleep disturbance in older adults with mild cognitive impairment (MCI). The study design is a randomised double-blind, placebo-controlled, parallel group trial. Forty in iduals with MCI will be recruited from the Healthy Brain Ageing Clinic, University of Sydney and from the community, and randomised to receive either 25 mg oral melatonin or placebo nightly for 12 weeks. The primary outcomes are feasibility of recruitment, acceptability of intervention and adherence to trial medication at 12 weeks. Secondary outcomes will include the effect of melatonin on brain oxidative stress as measured by magnetic resonance spectroscopy, blood pressure, blood biomarkers, mood, cognition and sleep. Outcomes will be collected at 6 and 12 weeks. The results of this feasibility trial will inform a future conclusive randomised controlled trial to specifically test the efficacy of melatonin on modifiable risk factors of dementia, as well as cognition and brain function. This will be the first trial to investigate the effect of melatonin in the population with MCI in this way, with the future aim of using this approach to reduce progression to dementia. This protocol has been approved by the Sydney Local Health District Ethics Committee (X18-0077). This randomised controlled trial will be conducted in compliance with the protocol published in the registry, the International Conference for Harmonisation on Good Clinical Practice and all other applicable regulatory requirements. The findings of the trial will be disseminated via conferences, publications and media, as applicable. Participants will be informed of results of the study at the conclusion of the trial. Eligible authors will include investigators who are involved in the conception and design of the study, the conduct of the trial, the analysis of the results, and reporting and presentation of study findings. Australian and New Zealand Clinical Trials Registry (ANZCTRN 12619000876190). V.8 15 October 2020.
Publisher: BMJ
Date: 05-2006
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-06-2017
DOI: 10.5664/JCSM.6616
Start Date: 2016
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2016
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2013
End Date: 2018
Funder: National Health and Medical Research Council
View Funded Activity