West Australian Sleep Disorders Research Institute

Jack Jumper ant (JJA) venom immunotherapy (VIT) is highly efficacious but the lowest effective dose is unknown. Delta-inulin adjuvant (Advax) is known to enhance honeybee VIT immunogenicity. This phase 1/2 single-blind, randomised controlled trial aimed to compare the efficacy and safety of JJA VIT with different doses of venom ± Advax. Adults aged 18-65 with a history of immediate systemic reaction (SR) to JJA stings were randomised to receive JJA VIT at a maintenance dose of 25 mcg or 50 mcg ± Advax; participants were blinded to treatment allocation. Primary outcomes were the response to sting challenges after 12 months and venom-specific IgE and IgG4 responses to treatment. Forty-nine of 50 screened subjects met inclusion criteria and were randomised; 44 started treatment (25 mcg n = 12; 25 mcg + Advax n = 13; 50mcg n = 12, 50 mcg + Advax n = 12). Subsequently, two withdrew due to SRs to treatment, and two withdrew due to unrelated factors. The higher JJA venom maintenance dose was associated with reduced likelihood of SRs (OR 0.53 (95% CI, 0.28-0.98)), while Advax did not have an effect (OR 1.17 (95% CI, 0.59-2.32)). Forty proceeded to sting challenge, with six developing SRs. There was no difference between groups for sting challenge outcome (p = 0.98), and the ORs for 25 mcg vs. 50 mcg venom dose (0.89, 95% CI, 0.38-2.09) and Advax vs. no Advax (0.99, 95% CI 0.42-2.33) indicated no effect. There were no differences between groups for venom sIgE (p = 0.78), sIgG4 (p = 0.25), sIgE/IgG4 ratio (p = 0.42), intradermal (p = 0.77), and basophil activation test (BAT) (p = 0.69) responses to treatment. Subjects with high baseline BAT sensitivity, which reduced markedly in response to treatment, were less likely to have a positive sting challenge (p = 0.006). Challenge outcomes were similar for all groups, with no significant difference found between 25 and 50 mcg maintenance dose or between treatment with and without Advax. Further research of low dose JJA VIT is warranted to confirm its efficacy and tolerability. NCT03066986.

Abstract Background Sedation and sleep have distinct electroencephalogram (EEG) properties. The presence of EEG patterns suggestive of sedation during sleep may have negative health effects. It has been shown that sedated intensive care unit (ICU) patients can be differentiated from matched sleep study patients not on Central Nervous System (CNS)-active medications using the amplitude criteria derived from cumulative frequency curves (CFCs). Aim To determine whether CFCs can be used to distinguish EEG patterns resembling sedation in patients with and without CNS-active medications. Methods Sleep study EEG data was analysed from 163 adult patients. Patients were categorised based on CNS medication status. 92 patients had no CNS medications, while 71 had CNS medications. Medications were sorted into the 7 CNS drug classes. Studies with poor signal quality, AHI > 5, were excluded. An automated analysis was applied to the left frontal lobe EEG trace and patients were compared on peak amplitude. Results Females and patients (<30yrs) spent more time at higher amplitudes. Patients with one or more CNS medications spent slightly more time (mean 7.46; SD 0.93 hours) asleep, vs unmedicated patients (mean 7.36; SD 1.01 hours; not statistically significant). Discussion Contrary to our original hypothesis, there was no significant difference in time at higher EEG amplitudes between CNS-medicated and non-medicated patients. It appears that in this population sample, CNS medications do not significantly affect sleep architecture but do slightly (not significantly) increase sleep duration. This study had limitations – we aim to use adequate sample sizes for each class of drug in future.

Autistic adolescents are vulnerable to sleep difficulties, with up to 80% experiencing sleep problems, most commonly insomnia. Little is known about how autistic adolescents are involved in their own sleep treatment, and their depth of knowledge about their sleep difficulties. The aims of this study were to investigate autistic adolescent and parent perspectives of experiencing and managing insomnia, and what factors influence the development of these perspectives on insomnia and treatment. Semi-structured interviews were conducted with 11 autistic adolescents with insomnia (45% female, mean age 11.6 years) and 16 parents of an autistic adolescent with insomnia (94% female, mean age 45.1 years). A qualitative content analytic approach was used to identify categories in the data. Adolescents often perceived themselves to sleep well, despite reporting symptoms and functional outcomes of insomnia. Insomnia was managed through a range of intentional routine activities involving sounds, stimulus reduction, and regular bedtimes. Parents generally sought their own information about sleep, while adolescents obtained most of their knowledge from their parents. Findings from this study highlight a range of techniques that autistic adolescents and their parents use to address sleep difficulties. Findings suggest the need for increased professional awareness of sleep problems in autistic adolescents and further recommendations to parents for available sleep services.

From the results of well-performed population health studies, we now have excellent data demonstrating that deficits in adult lung function may be present early in life, possibly as a result of developmental disorders, incurring a lifelong risk of obstructive airway diseases such as asthma and chronic obstructive pulmonary disease. Suboptimal fetal development results in intrauterine growth restriction and low birth weight at term (an outcome distinct from preterm complications), which are associated with subsequent obstructive disease. Numerous prenatal exposures and disorders compromise fetal development and these are summarized herein. Various physiological, structural, and mechanical abnormalities may result from prenatal disruption, including changes to airway smooth muscle structure-function, goblet cell biology, airway stiffness, geometry of the bronchial tree, lung parenchymal structure and mechanics, respiratory skeletal muscle contraction, and pulmonary inflammation. The literature therefore supports the need for early life intervention to prevent or correct growth defects, which may include simple nutritional or antioxidant therapy. © 2024 American Physiological Society. Compr Physiol 14:5729-5762, 2024.

This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation). All these changes negatively impact health status and are counterproductive to recovery from illness and operation. Hospitalization challenges sleep in a variety of ways. These challenges include environmental factors such as noise, bright light, and overnight awakenings for observations, interventions, and transfers; physiological factors such as pain, dyspnea, bowel or urinary dysfunction, or discomfort from therapeutic devices; psychological factors such as stress and anxiety; care-related factors including medications or medication withdrawal; and preexisting sleep disorders that may not be recognized or adequately managed. Many of these challenges appear readily addressable. The key to doing so is to give sleep greater priority, with attention directed at ensuring that patients' sleep needs are recognized and met, both within the hospital and beyond. Requirements include staff education, creation of protocols to enhance the prospect of sleep needs being addressed, and improvement in hospital design to mitigate environmental disturbances. Hospitals and health care providers have a duty to provide, to the greatest extent possible, appropriate preconditions for healing. Accumulating evidence suggests that these preconditions include adequate patient sleep duration and quality. The Society of Anesthesia and Sleep Medicine calls for systematic changes in the approach of hospital leadership and staff to this issue. Measures required include incorporation of optimization of patient sleep into the objectives of perioperative and general patient care guidelines. These steps should be complemented by further research into the impact of hospitalization on sleep, the effects of poor sleep on health outcomes after hospitalization, and assessment of interventions to improve it.

Oropharyngeal dysphagia and gastroesophageal reflux are risk factors for respiratory disease in cerebral palsy (CP). Some children require gastrostomy to ensure adequate nutrition and growth and for administration of medication. The European prevalence of gastrostomy is 3-22%. The aim was to determine the prevalence of gastrostomy feeding, gastrojejunal (GJ) tubes and fundoplication in WA children with CP aged 0-12 years. All children aged 0-12 years on the WA CP Register with Gross Motor Functional Classification Scale (GMFCS) III to V currently receiving care at Perth Children's Hospital were included. Data collected included age, gender, GMFCS level and the presence of gastrostomy, fundoplication and/or GJ tube and the year and mode of insertion. Ethical approval was obtained. 221 children were included, mean age of 6.5 years (SD =3.4) and 119 (54%) males. 89 (40%) children had a gastrostomy. Age at insertion varied from 0-9 years with a mean of 2.8 years. The presence of gastrostomy was 12%, 24% and 72% for GMFCS III, IV and V respectively. GJ prevalence was 2%, 4% and 20% for GMFCS III, IV and V, respectively. Only 8 children had a fundoplication. As GMFCS III-V comprises 33.5% of the WA CP population, the prevalence of gastrostomy feeding is 14%, GJ is 3% and fundoplication is 1%. The rates of gastrostomy, fundoplication and GJ tube feeding increase with GMFCS level.