Economic evaluation of cognitive behavioural therapy for insomnia (CBT-I) for improving health outcomes in adult population: A systematic review protocol

INTRODUCTION:Insomnia is associated with a number of adverse consequences that place a substantial economic burden on individuals and society. Cognitive behavioural therapy for insomnia (CBT-I) is a promising intervention that can improve outcomes in people who suffer from insomnia. However, evidence of its cost-effectiveness remains unclear. In this study, we will systematically review studies that report on economic evaluations of CBT-I and investigate the potential economic benefit of CBT-I as a treatment for insomnia. METHODS AND ANALYSIS:The search will include studies that use full economic evaluation methods (ie, cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) and those that apply partial economic evaluation approaches (ie, cost description, cost-outcome description and cost analysis). We will conduct a preliminary search in MEDLINE, Google Scholar, MedNar and ProQuest dissertation and theses to build the searching terms. A full search strategy using all identified keywords and index terms will then be undertaken in several databases including MEDLINE, Psychinfo, Proquest, Cochrane, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science and EMBASE. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for protocol guidelines in this review. Only articles in the English language and those reporting on adult populations will be included. We will use standardised data extraction tools for economic evaluations to retrieve and synthesise information from selected studies into themes and summarised in a Joanna Briggs Institute dominance ranking matrix. ETHICS AND DISSEMINATION:No formal ethics approval will be required as we will not be collecting primary data. Review findings will be disseminated through a peer-reviewed publication, workshops, conference presentations and a media release. PROSPERO REGISTRATION NUMBER:CRD42019133554.Andrea Natalie Natsky, Andrew Vakulin, Ching Li Chai-Coetzer, Leon Lack, R. Doug McEvoy, Billingsley Kaambw

How the chance of missing the alarm during an on-call shift affects pre-bed anxiety, sleep and next day cognitive performance

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (September 2018) in accordance with the publisher’s archiving policy.This study investigated how the likelihood of missing an alarm affects pre-bed anxiety, sleep and next day cognitive performance during on-call shifts. Participants (n=24) completed one adaptation night, one control night and two on-call nights in a time-isolated sleep laboratory. On one of the on-call nights, participants were informed that they would be woken by a loud alarm that they would definitely not be able to sleep through (low likelihood of missing the alarm). On the other on-call night, participants were informed that they would be woken by a quiet alarm that they may sleep through (high likelihood of missing the alarm). The two on-call nights were counterbalanced. Pre-bed anxiety was measured using the State Trait Anxiety Inventory x-1, while sleep macro- and micro-architecture was examined via routine polysomnography and power spectral analyses respectively. Following each sleep, cognitive performance was assessed four times (0930, 1200, 1430, 1700) using the 10-min psychomotor vigilance task (PVT). Results indicated that while pre-bed anxiety was similarly increased during both high and low likelihood of missing the on-call alarm conditions compared with control, only in the high likelihood condition was total sleep time shorter and sleep efficiency lower compared with the control condition. However, more wake after sleep onset was found in the low likelihood condition compared with control. PVT data indicate that response times (mean reciprocal and mean fastest 10% of reaction time) were fastest in the low likelihood condition, indicating better performance when compared with both other conditions. However, there were significantly more lapses in the low likelihood condition compared with control. No significant EEG power spectral differences were observed. As such, it appears that there are detrimental effects of both on-call conditions on anxiety, sleep and performance, with sleep poorest when the likelihood of missing the alarm is high. The adverse impacts on sleep and performance outcomes while on-call may be mitigated by the implementation of workplace systems to reduce the likelihood of missing alarms (e.g., having two available options for contacting on-call workers).This study was funded by an Australian Research Council Discovery grant (DP 150104497). Funding for Madeline Sprajcer’s PhD scholarship was provided by this grant. Dr Grace Vincent is supported by an Early Career Fellowship at Central Queensland University

Cognition in schizophrenia improves with treatment of severe obstructive sleep apnoea: a pilot study

Previous studies have shown that people with schizophrenia have high rates of Obstructive Sleep Apnoea (OSA). Despite this, intervention studies to treat OSA in this population have not been undertaken. The ASSET (Assessing Sleep in Schizophrenia and Evaluating Treatment) pilot study investigated Continuous Positive Airway Pressure (CPAP) treatment of severe OSA in participants recruited from a clozapine clinic in Adelaide. Participants with severe untreated OSA (Apnoea-Hypopnoea Index (AHI) > 30), were provided with CPAP treatment, and assessed at baseline and six months across the following domains: physical health, quality of sleep, sleepiness, cognition, psychiatric symptoms and CPAP adherence. Six of the eight ASSET participants with severe OSA accepted CPAP. At baseline, half of the cohort had hypertension, all were obese with a mean BMI of 45, and they scored on average 1.47 standard deviations below the normal population in cognitive testing. The mean AHI was 76.8 and sleep architecture was markedly impaired with mean rapid eye movement (REM) sleep 4.1% and mean slow wave sleep (SWS) 4.8%. After six months of treatment there were improvements in cognition (BACS Z score improved by an average of 0.59) and weight loss (mean weight loss 7.3 ± 9 kg). Half of the participants no longer had hypertension and sleep architecture improved with mean REM sleep 31.4% of the night and mean SWS 24% of the night. Our data suggests CPAP may offer novel benefits to address cognitive impairment and sleep disturbance in people with schizophrenia.Hannah Myles, Nicholas Myles, Ching Li Chai Coetzer, Robert Adams, Madhu Chandratilleke, Dennis Liu, Jeremy Mercer, Andrew Vakulin, Andrew Vincent, Gary Wittert, Cherrie Galletl

Структурно-функциональные модификации лимфоидных органов при вибрационных воздействиях и их коррекция с использованием эссенциальных фосфолипидов

The research of lymphoid organs of male rats of Vistar line wich were subjected to vibration with freguency of 32 Hz during 30 days has been conducted. Cytological shifts of the basic structural components of the investigated organs during the vibration period, postcontact rehabilitation period (30, 60 days) and under essencial phospholipides correction were estimated by the methods of light and electron microscopy and morphometry. The analysis of the obtained data demonstrated that the important infringement of lymphoid organs structures takes place. The dynamic study of morphofunctional and ultrastructural changes, cytoarchitectony of parenchymatous stromal compartment gives evidence of the development of degenerate-distrophic processes with mainly involutional character. Pharmacological correction resulted in positive dynamic of cytological shifs and helped to rehabilitation the natural cell phenotype.Проведено экспериментальное исследование лимфоидных органов (тимус) у крыс-самцов линии Вистар, подвергавшихся воздействию вибрации частотой 32 Гц в течение 30 дней. Методами световой и электронной микроскопии, морфометрии оценивались цитологические сдвиги основных структурных компонентов изучаемых органов в период вибрационной нагрузки, восстановительный постконтактный период (30, 60 сут) и на фоне коррекции эссенциальными фосфолипидами. Анализ полученных данных показал, что в процессе вибрационного влияния происходит существенное нарушение структуры лимфоидных органов. Изучение динамики морфофункциональных и ультраструктурных изменений, цитоархитектоники паренхиматозно-стромального компонента свидетельствует о развитии дегенеративно-дистрофических процессов преимущественно инволютивного характера. Фармакологическая коррекция способствует восстановлению естественного фенотипа клеток

Multi-night measurement for diagnosis and simplified monitoring of obstructive sleep apnoea

Substantial night-to-night variability in obstructive sleep apnoea (OSA) severity has raised misdiagnosis and misdirected treatment concerns with the current prevailing single-night diagnostic approach. In-home, multinight sleep monitoring technology may provide a feasible complimentary diagnostic pathway to improve both the speed and accuracy of OSA diagnosis and monitor treatment efficacy. This review describes the latest evidence on night-to-night variability in OSA severity, and its impact on OSA diagnostic misclassification. Emerging evidence for the potential impact of night-to-night variability in OSA severity to influence important health risk outcomes associated with OSA is considered. This review also characterises emerging diagnostic applications of wearable and non-wearable technologies that may provide an alternative, or complimentary, approach to traditional OSA diagnostic pathways. The required evidence to translate these devices into clinical care is also discussed. Appropriately sized randomised controlled trials are needed to determine the most appropriate and effective technologies for OSA diagnosis, as well as the optimal number of nights needed for accurate diagnosis and management. Potential risks versus benefits, patient perspectives, and cost-effectiveness of these novel approaches should be carefully considered in future trials.Bastien Lechat, Hannah Scott, Jack Manners, Robert Adams, Simon Proctor, Sutapa Mukherjee, Peter Catcheside, Danny J. Eckert, Andrew Vakulin, Amy C. Reynold

Associations of baseline obstructive sleep apnea and sleep macroarchitecture with cognitive function after 8 years in middle‐aged and older men from a community‐based cohort study

OnlinePublPrevious prospective studies examining associations of obstructive sleep apnea and sleep macroarchitecture with future cognitive function recruited older participants, many demonstrating baseline cognitive impairment. This study examined obstructive sleep apnea and sleep macroarchitecture predictors of visual attention, processing speed, and executive function after 8 years among younger community-dwelling men. Florey Adelaide Male Ageing Study participants (n = 477) underwent homebased polysomnography, with 157 completing Trail-Making Tests A and B and the Mini-Mental State Examination. Associations of obstructive sleep apnea (apnea– hypopnea index, oxygen desaturation index, and hypoxic burden index) and sleep macroarchitecture (sleep stage percentages and total sleep time) parameters with future cognitive function were examined using regression models adjusted for baseline demographic, biomedical, and behavioural factors, and cognitive task performance. The mean (standard deviation) age of the men at baseline was 58.9 (8.9) years, with severe obstructive sleep apnea (apnea–hypopnea index ≥30 events/h) in 9.6%. The median (interquartile range) follow-up was 8.3 (7.9–8.6) years. A minority of men (14.6%) were cognitively impaired at baseline (Mini-Mental State Examination score <28/30). A higher percentage of light sleep was associated with better TrailMaking Test A performance (B = 0.04, 95% confidence interval [CI] 0.06, 0.01; p = 0.003), whereas higher mean oxygen saturation was associated with worse performance (B = 0.11, 95% CI 0.02, 0.19; p = 0.012). While obstructive sleep apnea and sleep macroarchitecture might predict cognitive decline, future studies should consider arousal events and non-routine hypoxaemia measures, which may show associations with cognitive decline.Jesse L. Parker, Andrew Vakulin, Ganesh Naik, Yohannes Adama Melaku, David Stevens, Gary A. Wittert, Sean A. Martin, Peter G. Catcheside, Barbara Toson, Sarah L. Appleton, Robert J. Adam

Associations of Baseline Sleep Microarchitecture with Cognitive Function After 8 Years in Middle-Aged and Older Men from a Community-Based Cohort Study

Published: 24 May 2023. Corrected by: Corrigendum to: Associations of Baseline Sleep Microarchitecture with Cognitive Function After 8 Years in Middle-Aged and Older Men from a Community-Based Cohort Study (Nat Sci Sleep. 2023, 15, 389–406.) In vol. 15 (2023), pp. 433-434. The authors advise that the funding section on page 404 is incorrect.Purpose: Prospective studies examining associations between baseline sleep microarchitecture and future cognitive function recruited from small samples with predominantly short follow-up. This study examined sleep microarchitecture predictors of cognitive function (visual attention, processing speed, and executive function) after 8 years in community-dwelling men. Patients and Methods: Florey Adelaide Male Ageing Study participants (n=477) underwent home-based polysomnography (2010– 2011), with 157 completing baseline (2007– 2010) and follow-up (2018– 2019) cognitive assessments (trail-making tests A [TMT-A] and B [TMT-B] and the standardized mini-mental state examination [SMMSE]). Whole-night F4-M1 sleep EEG recordings were processed following artifact exclusion, and quantitative EEG characteristics were obtained using validated algorithms. Associations between baseline sleep microarchitecture and future cognitive function (visual attention, processing speed, and executive function) were examined using linear regression models adjusted for baseline obstructive sleep apnoea, other risk factors, and cognition. Results: The final sample included men aged (mean [SD]) 58.9 (8.9) years at baseline, overweight (BMI 28.5 [4.2] kg/m2), and well educated (75.2% ≥Bachelor, Certificate, or Trade), with majorly normal baseline cognition. Median (IQR) follow-up was 8.3 (7.9, 8.6) years. In adjusted analyses, NREM and REM sleep EEG spectral power was not associated with TMT-A, TMT-B, or SMMSE performance (all p> 0.05). A significant association of higher N3 sleep fast spindle density with worse TMT-B performance (B=1.06, 95% CI [0.13, 2.00], p=0.026) did not persist following adjustment for baseline TMT-B performance. Conclusion: In this sample of community-dwelling men, sleep microarchitecture was not independently associated with visual attention, processing speed, or executive function after 8 years.Jesse L Parker, Andrew Vakulin, Yohannes Adama Melaku, Gary A Wittert, Sean A Martin, Angela L D, Rozario, Peter G Catcheside, Bastien Lechat, Barbara Toson, Alison J Teare, Sarah L Appleton, Robert J Adam

Establishing the acute physiological and sleep disruption characteristics of wind farm versus road traffic noise disturbances in sleep: a randomized controlled trial protocol

Advance access publication 6 September 2023Study Objectives: Despite the global expansion of wind farms, effects of wind farm noise (WFN) on sleep remain poorly understood. This protocol details a randomized controlled trial designed to compare the sleep disruption characteristics of WFN versus road traffic noise (RTN). Methods: This study was a prospective, seven night within-subjects randomized controlled in-laboratory polysomnography-based trial. Four groups of adults were recruited from; 15 s events) from sleep by each noise type with acute (20-s) and more sustained (3-min) noise exposures. Secondary analyses will compare dose–response effects of sound pressure level and noise type on EEG K-complex probabilities and quantitative EEG measures, and cardiovascular activation responses. Group effects, self-reported noise sensitivity, and wake versus sleep noise exposure effects will also be examined. Conclusions: This study will help to clarify if wind farm noise has different sleep disruption characteristics compared to road traffic noise.Gorica Micic, Branko Zajamsek, Bastien Lechat, Kristy Hansen, Hannah Scott, Barbara Toson, Tessa Liebich, Claire Dunbar, Duc Phuc Nguyen, Felix Decup, Andrew Vakulin, Nicole Lovato, Leon Lack, Colin Hansen, Dorothy Bruck, Ching Li Chai-Coetzer, Jeremy Mercer, Con Doolan and Peter Catchesid

Correlation between driving-related skill and alcohol use in young-adults from six European countries: the TEN-D by Night Project

<p>Abstract</p> <p>Background</p> <p>Only few studies with small experimental samples investigated the impact of psychoactive substances on driving performance. We conducted a multicenter international cross-sectional study to evaluate the correlation between alcohol use and driving-related skill as measured by brake reaction time (RT).</p> <p>Methods</p> <p>Before and after the entrance into randomly selected recreational sites from six European countries, all subjects aged 16-35 years, owning a driver license, were asked to compile a structured socio-demographic questionnaire and measure RT (SimuNomad3 driving simulator), breath alcohol concentration (BAC; Drager Alcoltest), and drug use (Oratect III saliva test, only at the exit). Mixed regression modeling was used to evaluate the independent association between RT and alcohol concentration or drug use.</p> <p>Results</p> <p>Before the entrance into the recreational site, 4534 subjects completed all assessments and composed the final sample. Their mean age was 23.1 ± 4.2y; 68.3% were males; 54.7% had BAC > 0 g/L (assumed alcoholics); 7.5% declared illegal drug assumption (mostly cannabis). After the exit, 3019 also completed the second assessment: 71.7% showed BAC > 0 g/L. Controlling for age, gender, educational level, occupation, driver license years, and drug use, BAC was positively associated with RT, achieving significance, however, only when BAC was higher than 0.49 g/L. Significant interaction terms were found between BAC and female gender or drug use, with highest RTs (> 1 sec.) recorded among drug users with BAC > = 1 g/L.</p> <p>Conclusions</p> <p>This field study confirms previous experimental data on the negative impact of alcohol use on driving-related skill, supporting regulations and educational campaigns aimed at discouraging driving after consumption of psychoactive substances.</p

Current of Humid Air via the Cylindrical Channel. Results

Статья представляет собой вторую часть экспериментального исследования, посвященного изучению течения влажного воздуха через дроссельные каналы. Приведены некоторые результаты экспериментальных исследований течения однофазной и двухфазной среды через цилиндрические дроссельные каналы (штуцеры) с различными геометрическими характеристиками. Получены расходные и расходно-перепадные характеристики при ламинарном и турбулентном режимах течения газа через штуцер. Обсуждается влияние на коэффициент расхода значений внутреннего диаметра и относительной длины штуцера в широком диапазоне чисел Рейнольдса. Приводится сравнение экспериментальных значений коэффициента расхода с теоретическими, рассчитанными по методике Л. А. Залманзона. Проведена аппроксимация экспериментальных зависимостей набором линейной и квадратичной функций. Показано, что эту зависимость можно использовать при создании расходомера переменного перепада, предназначенного для измерения расхода газа. Для двухфазной среды, протекающей через штуцер, получены зависимости массового расхода от перепада давления на штуцере. Установлено наличие высокой чувствительности массового расхода от газосодержания при значениях отношения давлений после и до штуцера, меньших критического. Показано, что штуцер может быть использован в качестве элемента многофазного расходомера, предназначенного для измерений расхода потока среды дисперсной структуры. Проведено качественное сравнение полученных результатов с результатами Фортунати и др. Получены численные характеристики критического течения воздуховодяной смеси в штуцере.This article presents the second part of the research on a humid air current via cylindrical channels. The authors provide the results of experimental studies of a stream of the singlephase and two-phase medium via cylindrical channels with various geometrical characteristics. Consumable and flow-differential characteristics are obtained for the laminar and turbulent modes of gas flow through the nozzle. The influence on coefficient of internal diameter and influence on coefficient of relative length of the cylindrical channels in the wide range of numbers of Reynolds is discussed. The experimental values of the coefficient of an expense are compared with theoretical values, calculated by L. A. Zalmanzon’s method. The experimental dependences are approximated by a set of linear and square functions in the wide range of Reynolds’ numbers. The results show that this dependence can be used at creation of a flowmeter of the variable difference intended for measurement of a of gas streams. For a two-phase medium flowing through the nozzle, the dependences of the mass flow rate on the pressure drop across the nozzle are obtained. The presence of high sensitivity of mass flow from gas content is established at the values of pressure ratios after and before the choke, which is less than critical. The authors show that the nozzle can be used as an element of a multiphase flow meter intended for measuring the flow rate of a dispersed structure. The results compared with the data of Fortunatti and others. Numerical characteristics of the critical flow of the air-water mixture in the choke were obtained