Jeremy Goldin - Academia.edu (original) (raw)

Papers by Jeremy Goldin

Research paper thumbnail of An Australian <scp>COVID‐19</scp> respiratory care unit experience

Internal Medicine Journal, May 30, 2023

Research paper thumbnail of O017 Utility of Inpatient Overnight Oximetry

Sleep advances, Oct 1, 2022

Advanced Trainees Oral Presentations objectively, via reaction time on the psychomotor vigilance ... more Advanced Trainees Oral Presentations objectively, via reaction time on the psychomotor vigilance task. Sleep is measured via sleep log and wrist-worn actigraphy. Stress via autonomic nervous system imbalance is measured by changes in heart rate variability (i.e. chest monitor). Linear regression analyses will be performed to test if sleep or schedule variables predict stress or cognitive function. Progress to date: A pilot study (N=4) was conducted during the 2021 fire season to inform methodology. As of July 2022, a representative sample of 50 firefighters (13 F) have been recruited across all regions of British Columbia (BC), Canada. Data collection for the current study is ongoing and will continue until September 2022. Intended outcome and impact: This investigation entails both theoretical and applied benefits. Its direct relevance to occupational health and safety could improve worker safety (1) by providing insight and recommendations towards improved fatigue management policy within the BC Wildfire Service and (2) by testing the practicality of mobile tools designed to monitor levels of sleep, stress, and cognitive function.

Research paper thumbnail of A prospective cohort study of thoracic ultrasound in acute respiratory failure: the <i>C<sub>3</sub>PO</i> protocol

JRSM open, May 1, 2017

Objectives: This study was performed to assess the clinical utility of a standardised thoracic ul... more Objectives: This study was performed to assess the clinical utility of a standardised thoracic ultrasound examination when added to standard care in patients with acute respiratory failure admitted to an intermediate care unit. This study aimed to assess the impact on clinical diagnosis, clinician confidence and management. Ultrasound has been shown to have utility in patients admitted to intensive care and emergency; however, utility in a ward setting is unknown. Design: Prospective cohort study. Setting: Tertiary hospital in Melbourne, Australia. Participants: 50 patients with acute respiratory failure requiring admission to an intermediate care unit. Main outcome measures: (1) Change in clinical diagnosis or additional clinical diagnosis following thoracic ultrasound. (2) Change in diagnostic confidence following thoracic ultrasound. (3) Change to management following thoracic ultrasound. Results: In 34% of patients, ultrasound detected unexpected findings that changed or added to the clinical diagnosis. Diagnostic confidence was increased in 44%, and the treating clinician altered the management plan in 30% as a result of the ultrasound. Ultrasound was particularly useful in clarifying the diagnosis in patients with multiple initial diagnoses, reducing to a single diagnosis in 69%. Conclusions: Thoracic ultrasound has clinical utility in nonintubated adults with acute respiratory failure managed outside intensive care settings. It changed aetiological diagnosis, increases diagnostic confidence and altered clinical management in one out of three patients scanned. Our results suggest extended utility of thoracic ultrasound in acute respiratory failure to a broader context outside the intensive care unit population.

Research paper thumbnail of Sleep during and following critical illness: A narrative review

World Journal of Critical Care Medicine

Research paper thumbnail of An Australian COVID‐19 respiratory care unit experience

Internal Medicine Journal

Research paper thumbnail of P138 Nocturnal oxygen desaturation and MET call criteria during in-laboratory sleep studies

SLEEP Advances, 2021

Introduction Patients undergoing sleep studies can experience frequent and profound oxygen desatu... more Introduction Patients undergoing sleep studies can experience frequent and profound oxygen desaturation. Most hospitals have standard MET (Medical Emergency Team) call criteria which obligate a response to severe oxygen desaturation. At our tertiary institution this is “Pulse oximetry/oxygen saturation: < 90 despite oxygen administration”. For most sleep studies provision of oxygen overnight would not be appropriate. We sought to examine the proportion of our sleep study patients who would meet MET call criteria. Method We retrospectively examined the data of all sleep studies which were performed in our laboratory between 01/01/2021 and 30/04/2021. Demographic and pulse oximetry data was collected. Results We collected data from 448 studies (95 CPAP, 342 diagnostic, 9 Split, 2 other). Patients were 40% female, 49±15 (mean±SD) years old and had a median AHI of 10 events per hour. 290 (65%) patients had a nadir SpO2 of <90%. The percentage of patients below with nadir SpO2 of 8...

Research paper thumbnail of 005 Impact of Continuous Positive Airway Pressure on the Atrial Substrate in Patients With Obstructive Sleep Apnoea and Atrial Fibrillation: The SLEEP-AF Substrate Sub-Study

Heart, Lung and Circulation, 2020

rejection. The safety of the two approaches was assessed at 52 weeks with respect to the endpoint... more rejection. The safety of the two approaches was assessed at 52 weeks with respect to the endpoints of rejection, infection, hospitalisation, death, total immunosuppression dose, renal function and biopsy-related complications. Results: A total of 238 CMRs and 11 EMBx were performed in the CMR group; 235 EMBx were performed in the EMBx group. Significant rejection occurred in similar numbers of patients in each group (CMR 7; EMBx 8); more hospitalisations ((HR 2.74; CI 1.71-4.41) p,0.001) and infections ((HR 2.39; CI 1.31-4.38), p=0.005) were observed in the EMBx group. Immunosuppression requirements were similar between groups. There was no difference in mortality with one patient dying in each group; likewise, renal function did not differ significantly between groups. There were 3 biopsy-related complications in the EMBx group. Conclusion: CMR-based surveillance for cardiac allograft rejection in the first year after cardiac transplantation is safe compared to traditional EMBx-based surveillance and effectively reduced the number of invasive EMBx procedures by ninety five percent over this period.

Research paper thumbnail of Prevalence of Obstructive Sleep Aponea in Atrial Fibrillation Ablation Patients: Relationship with the Atrial Fibrillation Phenotype

Heart, Lung and Circulation, 2018

Research paper thumbnail of High-Density Mapping of the Substrate for Atrial Fibrillation in Obstructive Sleep Apnoea: Relationship with Atrial Fibrillation Phenotype

Heart, Lung and Circulation, 2018

Background: Congestive heart failure (CHF) is a risk factor for pulmonary embolism (PE). PE is al... more Background: Congestive heart failure (CHF) is a risk factor for pulmonary embolism (PE). PE is also an independent predictor of death or re-hospitalisation among patients with CHF. We assessed the incidence and identified novel predictors of subsequent CHF admission in patients with acute PE using population-linkage analysis. Methods: Patients were identified from a comprehensive single-centre PE database and CHF admissions after their PE were tracked from a statewide Admitted Patient Data Collection registry. Patients were divided into two groups: group 1 included patients without a history of CHF and left ventricular ejection fraction ≥50%; group 2 included patients with a history of CHF and/or left ventricular ejection fraction < 50%. Cox regression was used to identify independent predictors for post-PE CHF admission. Results: The study cohort comprised 515 patients (group 1: n = 338 [65.6%]; group 2: n = 177 [34.4%]). The incidence of CHF hospitalisation after discharge for acute PE over a period of 4.3 ± 3.6 years for the total cohort was 142 (27.6%), with the rate significantly higher in group 2 than group 1 (61.5 per 100 patient-years vs 25.4 per 100 patient-years). Independent predictors for CHF admission after acute PE in group 1 were age, being on warfarin during the index PE admission, and chronic pulmonary disease. For group 2, predictors were a history of CHF, chronic pulmonary disease, day 1 serum sodium level, and the use of diuretics during the index PE admission (all p < 0.05). Conclusion: We report a high incidence of CHF requiring hospital admission after acute PE, particularly in patients who are elderly, have prior heart failure, chronic pulmonary disease, and hyponatraemia during acute PE.

Research paper thumbnail of Delayed habitual sleep times in patients undergoing multiple sleep latency testing significantly contributes to test failure

Sleep Medicine, 2017

H test, Spearman's correlation coefficients and logistic regression analysis. A p value of less t... more H test, Spearman's correlation coefficients and logistic regression analysis. A p value of less than 0.05 was considered as statistically significant. Results: The mean age of the patients was 36.93 ± 10.50 years (range¼ 19-75), and the median disease duration was 60 years (range¼ 1-300). Ninety patients (88.2%) had relapsing remitting MS. The mean global PSQI score was 5.98 ± 3.94, and 52.0% of the participants had poor sleep quality. Approximately 20.0% of the patients had anemia. The global PSQI scores were higher in patients who never smoked or who quit smoking (z ¼ À2.24; p ¼ 0.025), those who had a comorbidity (z ¼ À2.34; p ¼ 0.019), those who had poor self-rated health (z ¼ À2.54; p ¼ 0.011) and patients with low levels of physical activity (z ¼ À2.49; p ¼ 0.013). There were a positive correlation between the global PSQI score and the VAS-F fatigue subscale score (r ¼ 0.39; p < 0.001). The global PSQI score was negatively correlated with the VAS-F energy subscale score (r ¼ À0.32; p ¼ 0.001) and the total IPAQ-S score (r ¼ À0.32; p ¼ 0.001). The multivariate logistic regression analysis showed that the only factor associated with poor sleep quality was a higher VAS-F fatigue score (adjusted Odds Ratio, 1.283; 95% confidence interval, 1.031-1.596), after controlling for potential risk factors. Conclusions: The results of the study indicated that poor sleep quality was common in patients with MS. Poor sleep quality was also associated with fatigue among patients with MS. A better understanding of risk factors related to sleep quality may facilitate appropriate interventions that improve health outcomes in this population. Acknowledgements: The authors thank the patients who participated in this study.

Research paper thumbnail of Ultra High Density Mapping Reveals Regional Conduction Slowing in Obstructive Sleep Apnoea

Heart, Lung and Circulation, 2017

Research paper thumbnail of Obstructive Sleep Apnoea in Patients Having Atrial Fibrillation Ablation: Prevalence, Severity and Association with Arrhythmia Phenotype

Heart, Lung and Circulation, 2017

Research paper thumbnail of Feasibility and efficacy of ‘Can-Sleep’: effects of a stepped-care approach to cognitive-behavioral therapy for insomnia in cancer

Journal of Cancer Survivorship

Purpose This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepp... more Purpose This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepped-care intervention for people with cancer-related sleep disturbance. Methods A total of 147 individuals with cancer were screened. Participants who reported sleep disturbances and were at low-moderate risk for intrinsic sleep abnormalities were given self-managed cognitive behavioral therapy for insomnia (SMCBT-I). Those reporting sleep disturbance and scoring at high risk of intrinsic sleep abnormalities (i.e., restless leg syndrome and obstructive sleep apnoea) were referred to a specialist sleep clinic. In both groups, participants received a stepped-up group CBT-I intervention (GCBT-I) if they continued to report sleep disturbance following SMCBT-I or the specialist sleep clinic. Results Overall, 87 participants reported sleep disturbance or screened at risk for intrinsic sleep abnormality. Thirty-four were referred to a specialist sleep clinic, and of the 17 who declined this refe...

Research paper thumbnail of Impact of CPAP on the Atrial Fibrillation Substrate in Obstructive Sleep Apnea

JACC: Clinical Electrophysiology

Research paper thumbnail of AYA ‘Can-Sleep’ programme: protocol for a stepped-care, cognitive behavioural therapy-based approach to the management of sleep difficulties in adolescents and young adults with cancer

Pilot and Feasibility Studies

Background Sleep problems are reported in up to 50% of adolescents and young adults (AYA) with ca... more Background Sleep problems are reported in up to 50% of adolescents and young adults (AYA) with cancer. Cognitive behavioural therapy for insomnia (CBTi) is considered the gold-standard treatment. In the AYA population, CBTi is associated with improvements in insomnia, daytime sleepiness, fatigue and quality of life. In adults, stepped-care interventions can improve accessibility to CBTi. This study aims to evaluate the acceptability and feasibility of a stepped-care CBTi programme in AYA with cancer. Methods and analysis AYA (target N = 80) aged 16–25 with a diagnosis of cancer will be screened using the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS). When sleep difficulties are identified by the ISI and/or ESS, they will be screened for obstructive sleep apnoea and restless leg syndrome and referred to a sleep service if indicated. The remainder with sleep difficulties will be offered a stepped-care sleep programme including CBT self-management and coaching (first...

Research paper thumbnail of Additional Material

Research paper thumbnail of Potential immune‐boosting power of sleep to improve COVID ‐19 vaccine efficacy

Internal Medicine Journal, 2021

Health care costs and resource utilization among commercially insured adult patients with hemophi... more Health care costs and resource utilization among commercially insured adult patients with hemophilia A managed with FVIII prophylaxis in the United States 450

Research paper thumbnail of Author response to Dr. Sethi

This study aims to reveal the characteristics of and factors influencing uplift forces acting on ... more This study aims to reveal the characteristics of and factors influencing uplift forces acting on bridge bearings during earthquakes. Firstly, three different analysis models were compared through seismic response analyses in order to select a suitable model for parametric analysis. Secondly, factors influencing the uplift force were investigated by examining the seismic response analyses of six different bridge models of normal Japanese steel railway bridges. Finally, a nonlinear hysteresis model of a bridge bearing was proposed and the influence of using this model was investigated. As a result, it was confirmed that the response displacement does not exceed the limit displacement even during large-scale earthquakes.

Research paper thumbnail of P159 Successful treatment of sleep disordered breathing improves comorbidities in patients with nocturia

SLEEP Advances, 2021

Introduction Sleep disordered breathing (SDB) has been shown to increase nocturia (waking with th... more Introduction Sleep disordered breathing (SDB) has been shown to increase nocturia (waking with the need to void urine) frequency. Nocturia negatively affects sleep, autonomic dysfunction, mental health and mortality. Nocturia and these co-morbidities share central control areas in the brainstem. We hypothesised that treatment of SDB would decrease nocturia frequency and impact these co-morbidities. Methods A prospective repeated measures study with participants ≥40 years, naïve to treatment, with an AHI ≥30/hr and experiencing ≥1 episodes of nocturia was conducted. Participants undertook two months of CPAP with before and after measures of lower urinary tract symptoms (Overactive Bladder Symptom Score (OABSS) and urine volume), sleep quality (PSQI and actigraphy), autonomic dysfunction (blood pressure and orthostatic change) and wellbeing (Nocturia quality of life score (NQoL) and the Hospital anxiety and depression scores (HADS)). Results 490 diagnostic studies screened, 36 patient...

Research paper thumbnail of Obstructive sleep apnoea induced atrial fibrillation

Internal Medicine Journal, 2006

A 69-year-old man presented with palpitations and rapid atrial fibrillation (AF) on a background ... more A 69-year-old man presented with palpitations and rapid atrial fibrillation (AF) on a background history of ischaemic heart disease, diabetes, smoking,mild cerebrovascular accident (with no residual deficits) and hypertension. A history of loud habitual snoring was obtained from his wife. All biochemical investigations were within normal limits. Transthoracic echocardiogram showed a mildly dilated left atrium (50 mm diameter) and ventricle. Examination showed body mass index of 36 kg/m, neck circumference of 47 cm and Mallampati score of 2. Cardiorespiratory examination was unremarkable. Initial treatment with digoxin and sotalol resulted in reversion to sinus rhythm (SR), and the patient was discharged home anticoagulated and on sotalol. A polysomnograph at 6 weeks (Fig. 1) identified SR and intermittent AF associated with severe obstructive sleep apnoea (OSA) with 95 events/h and significant arterial oxygen desaturation (45% of sleep time SpO2 < 90%). He began nasal continuous positive airway pressure (CPAP) 2 weeks later, when OSA severity was reduced (21 events/h, 1% sleep time SpO2 < 90%), and he remained in SR with five brief (<5 min) episodes of AF. Six months later, a CPAP review polysomnograph showed SR, resolution of his OSA and no episodes of AF. A concurrent 24-h Holter monitor identified two brief episodes of AF (8 and 28 s) occurring during wakefulness. Approximately 25% of patients with moderately severe OSAwill have supraventricular arrhythmias, which relate to degree of nocturnal hypoxaemia, and approximately 50% of patients with AF have symptoms of OSA, compared with approximately 3% of a general population. Treatment of OSA can halve the reoccurrence rate of AF postcardioversion. Possible OSA factors that might contribute to AF include: (i) sympathetic hyperactivity related to hypoxaemia, hypercapnia and arousals, (ii) impaired and reset parasympathetic and baroreceptor activity secondary to large negative intrathoracic pressure swings, (iii) myocardial ischaemia related to hypoxaemia and increased myocardialwork related to surges in systemic bloodpressureon a background of coronary artery disease and (iv) atrial chamber dilatation related to large negative intrathoracic pressure swings. Atrial fibrillation carries significantmortality, morbidity and economic costs. The age-adjusted prevalence of AF has tripled from the 1960s to the 1980s.Obesity, amajor risk factor for OSA, has reached endemic proportions. Coupled with these facts, and based on current scientific knowledge, questioning for OSA should be considered in all patients with AF.

Research paper thumbnail of An Australian <scp>COVID‐19</scp> respiratory care unit experience

Internal Medicine Journal, May 30, 2023

Research paper thumbnail of O017 Utility of Inpatient Overnight Oximetry

Sleep advances, Oct 1, 2022

Advanced Trainees Oral Presentations objectively, via reaction time on the psychomotor vigilance ... more Advanced Trainees Oral Presentations objectively, via reaction time on the psychomotor vigilance task. Sleep is measured via sleep log and wrist-worn actigraphy. Stress via autonomic nervous system imbalance is measured by changes in heart rate variability (i.e. chest monitor). Linear regression analyses will be performed to test if sleep or schedule variables predict stress or cognitive function. Progress to date: A pilot study (N=4) was conducted during the 2021 fire season to inform methodology. As of July 2022, a representative sample of 50 firefighters (13 F) have been recruited across all regions of British Columbia (BC), Canada. Data collection for the current study is ongoing and will continue until September 2022. Intended outcome and impact: This investigation entails both theoretical and applied benefits. Its direct relevance to occupational health and safety could improve worker safety (1) by providing insight and recommendations towards improved fatigue management policy within the BC Wildfire Service and (2) by testing the practicality of mobile tools designed to monitor levels of sleep, stress, and cognitive function.

Research paper thumbnail of A prospective cohort study of thoracic ultrasound in acute respiratory failure: the <i>C<sub>3</sub>PO</i> protocol

JRSM open, May 1, 2017

Objectives: This study was performed to assess the clinical utility of a standardised thoracic ul... more Objectives: This study was performed to assess the clinical utility of a standardised thoracic ultrasound examination when added to standard care in patients with acute respiratory failure admitted to an intermediate care unit. This study aimed to assess the impact on clinical diagnosis, clinician confidence and management. Ultrasound has been shown to have utility in patients admitted to intensive care and emergency; however, utility in a ward setting is unknown. Design: Prospective cohort study. Setting: Tertiary hospital in Melbourne, Australia. Participants: 50 patients with acute respiratory failure requiring admission to an intermediate care unit. Main outcome measures: (1) Change in clinical diagnosis or additional clinical diagnosis following thoracic ultrasound. (2) Change in diagnostic confidence following thoracic ultrasound. (3) Change to management following thoracic ultrasound. Results: In 34% of patients, ultrasound detected unexpected findings that changed or added to the clinical diagnosis. Diagnostic confidence was increased in 44%, and the treating clinician altered the management plan in 30% as a result of the ultrasound. Ultrasound was particularly useful in clarifying the diagnosis in patients with multiple initial diagnoses, reducing to a single diagnosis in 69%. Conclusions: Thoracic ultrasound has clinical utility in nonintubated adults with acute respiratory failure managed outside intensive care settings. It changed aetiological diagnosis, increases diagnostic confidence and altered clinical management in one out of three patients scanned. Our results suggest extended utility of thoracic ultrasound in acute respiratory failure to a broader context outside the intensive care unit population.

Research paper thumbnail of Sleep during and following critical illness: A narrative review

World Journal of Critical Care Medicine

Research paper thumbnail of An Australian COVID‐19 respiratory care unit experience

Internal Medicine Journal

Research paper thumbnail of P138 Nocturnal oxygen desaturation and MET call criteria during in-laboratory sleep studies

SLEEP Advances, 2021

Introduction Patients undergoing sleep studies can experience frequent and profound oxygen desatu... more Introduction Patients undergoing sleep studies can experience frequent and profound oxygen desaturation. Most hospitals have standard MET (Medical Emergency Team) call criteria which obligate a response to severe oxygen desaturation. At our tertiary institution this is “Pulse oximetry/oxygen saturation: < 90 despite oxygen administration”. For most sleep studies provision of oxygen overnight would not be appropriate. We sought to examine the proportion of our sleep study patients who would meet MET call criteria. Method We retrospectively examined the data of all sleep studies which were performed in our laboratory between 01/01/2021 and 30/04/2021. Demographic and pulse oximetry data was collected. Results We collected data from 448 studies (95 CPAP, 342 diagnostic, 9 Split, 2 other). Patients were 40% female, 49±15 (mean±SD) years old and had a median AHI of 10 events per hour. 290 (65%) patients had a nadir SpO2 of <90%. The percentage of patients below with nadir SpO2 of 8...

Research paper thumbnail of 005 Impact of Continuous Positive Airway Pressure on the Atrial Substrate in Patients With Obstructive Sleep Apnoea and Atrial Fibrillation: The SLEEP-AF Substrate Sub-Study

Heart, Lung and Circulation, 2020

rejection. The safety of the two approaches was assessed at 52 weeks with respect to the endpoint... more rejection. The safety of the two approaches was assessed at 52 weeks with respect to the endpoints of rejection, infection, hospitalisation, death, total immunosuppression dose, renal function and biopsy-related complications. Results: A total of 238 CMRs and 11 EMBx were performed in the CMR group; 235 EMBx were performed in the EMBx group. Significant rejection occurred in similar numbers of patients in each group (CMR 7; EMBx 8); more hospitalisations ((HR 2.74; CI 1.71-4.41) p,0.001) and infections ((HR 2.39; CI 1.31-4.38), p=0.005) were observed in the EMBx group. Immunosuppression requirements were similar between groups. There was no difference in mortality with one patient dying in each group; likewise, renal function did not differ significantly between groups. There were 3 biopsy-related complications in the EMBx group. Conclusion: CMR-based surveillance for cardiac allograft rejection in the first year after cardiac transplantation is safe compared to traditional EMBx-based surveillance and effectively reduced the number of invasive EMBx procedures by ninety five percent over this period.

Research paper thumbnail of Prevalence of Obstructive Sleep Aponea in Atrial Fibrillation Ablation Patients: Relationship with the Atrial Fibrillation Phenotype

Heart, Lung and Circulation, 2018

Research paper thumbnail of High-Density Mapping of the Substrate for Atrial Fibrillation in Obstructive Sleep Apnoea: Relationship with Atrial Fibrillation Phenotype

Heart, Lung and Circulation, 2018

Background: Congestive heart failure (CHF) is a risk factor for pulmonary embolism (PE). PE is al... more Background: Congestive heart failure (CHF) is a risk factor for pulmonary embolism (PE). PE is also an independent predictor of death or re-hospitalisation among patients with CHF. We assessed the incidence and identified novel predictors of subsequent CHF admission in patients with acute PE using population-linkage analysis. Methods: Patients were identified from a comprehensive single-centre PE database and CHF admissions after their PE were tracked from a statewide Admitted Patient Data Collection registry. Patients were divided into two groups: group 1 included patients without a history of CHF and left ventricular ejection fraction ≥50%; group 2 included patients with a history of CHF and/or left ventricular ejection fraction < 50%. Cox regression was used to identify independent predictors for post-PE CHF admission. Results: The study cohort comprised 515 patients (group 1: n = 338 [65.6%]; group 2: n = 177 [34.4%]). The incidence of CHF hospitalisation after discharge for acute PE over a period of 4.3 ± 3.6 years for the total cohort was 142 (27.6%), with the rate significantly higher in group 2 than group 1 (61.5 per 100 patient-years vs 25.4 per 100 patient-years). Independent predictors for CHF admission after acute PE in group 1 were age, being on warfarin during the index PE admission, and chronic pulmonary disease. For group 2, predictors were a history of CHF, chronic pulmonary disease, day 1 serum sodium level, and the use of diuretics during the index PE admission (all p < 0.05). Conclusion: We report a high incidence of CHF requiring hospital admission after acute PE, particularly in patients who are elderly, have prior heart failure, chronic pulmonary disease, and hyponatraemia during acute PE.

Research paper thumbnail of Delayed habitual sleep times in patients undergoing multiple sleep latency testing significantly contributes to test failure

Sleep Medicine, 2017

H test, Spearman's correlation coefficients and logistic regression analysis. A p value of less t... more H test, Spearman's correlation coefficients and logistic regression analysis. A p value of less than 0.05 was considered as statistically significant. Results: The mean age of the patients was 36.93 ± 10.50 years (range¼ 19-75), and the median disease duration was 60 years (range¼ 1-300). Ninety patients (88.2%) had relapsing remitting MS. The mean global PSQI score was 5.98 ± 3.94, and 52.0% of the participants had poor sleep quality. Approximately 20.0% of the patients had anemia. The global PSQI scores were higher in patients who never smoked or who quit smoking (z ¼ À2.24; p ¼ 0.025), those who had a comorbidity (z ¼ À2.34; p ¼ 0.019), those who had poor self-rated health (z ¼ À2.54; p ¼ 0.011) and patients with low levels of physical activity (z ¼ À2.49; p ¼ 0.013). There were a positive correlation between the global PSQI score and the VAS-F fatigue subscale score (r ¼ 0.39; p < 0.001). The global PSQI score was negatively correlated with the VAS-F energy subscale score (r ¼ À0.32; p ¼ 0.001) and the total IPAQ-S score (r ¼ À0.32; p ¼ 0.001). The multivariate logistic regression analysis showed that the only factor associated with poor sleep quality was a higher VAS-F fatigue score (adjusted Odds Ratio, 1.283; 95% confidence interval, 1.031-1.596), after controlling for potential risk factors. Conclusions: The results of the study indicated that poor sleep quality was common in patients with MS. Poor sleep quality was also associated with fatigue among patients with MS. A better understanding of risk factors related to sleep quality may facilitate appropriate interventions that improve health outcomes in this population. Acknowledgements: The authors thank the patients who participated in this study.

Research paper thumbnail of Ultra High Density Mapping Reveals Regional Conduction Slowing in Obstructive Sleep Apnoea

Heart, Lung and Circulation, 2017

Research paper thumbnail of Obstructive Sleep Apnoea in Patients Having Atrial Fibrillation Ablation: Prevalence, Severity and Association with Arrhythmia Phenotype

Heart, Lung and Circulation, 2017

Research paper thumbnail of Feasibility and efficacy of ‘Can-Sleep’: effects of a stepped-care approach to cognitive-behavioral therapy for insomnia in cancer

Journal of Cancer Survivorship

Purpose This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepp... more Purpose This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepped-care intervention for people with cancer-related sleep disturbance. Methods A total of 147 individuals with cancer were screened. Participants who reported sleep disturbances and were at low-moderate risk for intrinsic sleep abnormalities were given self-managed cognitive behavioral therapy for insomnia (SMCBT-I). Those reporting sleep disturbance and scoring at high risk of intrinsic sleep abnormalities (i.e., restless leg syndrome and obstructive sleep apnoea) were referred to a specialist sleep clinic. In both groups, participants received a stepped-up group CBT-I intervention (GCBT-I) if they continued to report sleep disturbance following SMCBT-I or the specialist sleep clinic. Results Overall, 87 participants reported sleep disturbance or screened at risk for intrinsic sleep abnormality. Thirty-four were referred to a specialist sleep clinic, and of the 17 who declined this refe...

Research paper thumbnail of Impact of CPAP on the Atrial Fibrillation Substrate in Obstructive Sleep Apnea

JACC: Clinical Electrophysiology

Research paper thumbnail of AYA ‘Can-Sleep’ programme: protocol for a stepped-care, cognitive behavioural therapy-based approach to the management of sleep difficulties in adolescents and young adults with cancer

Pilot and Feasibility Studies

Background Sleep problems are reported in up to 50% of adolescents and young adults (AYA) with ca... more Background Sleep problems are reported in up to 50% of adolescents and young adults (AYA) with cancer. Cognitive behavioural therapy for insomnia (CBTi) is considered the gold-standard treatment. In the AYA population, CBTi is associated with improvements in insomnia, daytime sleepiness, fatigue and quality of life. In adults, stepped-care interventions can improve accessibility to CBTi. This study aims to evaluate the acceptability and feasibility of a stepped-care CBTi programme in AYA with cancer. Methods and analysis AYA (target N = 80) aged 16–25 with a diagnosis of cancer will be screened using the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS). When sleep difficulties are identified by the ISI and/or ESS, they will be screened for obstructive sleep apnoea and restless leg syndrome and referred to a sleep service if indicated. The remainder with sleep difficulties will be offered a stepped-care sleep programme including CBT self-management and coaching (first...

Research paper thumbnail of Additional Material

Research paper thumbnail of Potential immune‐boosting power of sleep to improve COVID ‐19 vaccine efficacy

Internal Medicine Journal, 2021

Health care costs and resource utilization among commercially insured adult patients with hemophi... more Health care costs and resource utilization among commercially insured adult patients with hemophilia A managed with FVIII prophylaxis in the United States 450

Research paper thumbnail of Author response to Dr. Sethi

This study aims to reveal the characteristics of and factors influencing uplift forces acting on ... more This study aims to reveal the characteristics of and factors influencing uplift forces acting on bridge bearings during earthquakes. Firstly, three different analysis models were compared through seismic response analyses in order to select a suitable model for parametric analysis. Secondly, factors influencing the uplift force were investigated by examining the seismic response analyses of six different bridge models of normal Japanese steel railway bridges. Finally, a nonlinear hysteresis model of a bridge bearing was proposed and the influence of using this model was investigated. As a result, it was confirmed that the response displacement does not exceed the limit displacement even during large-scale earthquakes.

Research paper thumbnail of P159 Successful treatment of sleep disordered breathing improves comorbidities in patients with nocturia

SLEEP Advances, 2021

Introduction Sleep disordered breathing (SDB) has been shown to increase nocturia (waking with th... more Introduction Sleep disordered breathing (SDB) has been shown to increase nocturia (waking with the need to void urine) frequency. Nocturia negatively affects sleep, autonomic dysfunction, mental health and mortality. Nocturia and these co-morbidities share central control areas in the brainstem. We hypothesised that treatment of SDB would decrease nocturia frequency and impact these co-morbidities. Methods A prospective repeated measures study with participants ≥40 years, naïve to treatment, with an AHI ≥30/hr and experiencing ≥1 episodes of nocturia was conducted. Participants undertook two months of CPAP with before and after measures of lower urinary tract symptoms (Overactive Bladder Symptom Score (OABSS) and urine volume), sleep quality (PSQI and actigraphy), autonomic dysfunction (blood pressure and orthostatic change) and wellbeing (Nocturia quality of life score (NQoL) and the Hospital anxiety and depression scores (HADS)). Results 490 diagnostic studies screened, 36 patient...

Research paper thumbnail of Obstructive sleep apnoea induced atrial fibrillation

Internal Medicine Journal, 2006

A 69-year-old man presented with palpitations and rapid atrial fibrillation (AF) on a background ... more A 69-year-old man presented with palpitations and rapid atrial fibrillation (AF) on a background history of ischaemic heart disease, diabetes, smoking,mild cerebrovascular accident (with no residual deficits) and hypertension. A history of loud habitual snoring was obtained from his wife. All biochemical investigations were within normal limits. Transthoracic echocardiogram showed a mildly dilated left atrium (50 mm diameter) and ventricle. Examination showed body mass index of 36 kg/m, neck circumference of 47 cm and Mallampati score of 2. Cardiorespiratory examination was unremarkable. Initial treatment with digoxin and sotalol resulted in reversion to sinus rhythm (SR), and the patient was discharged home anticoagulated and on sotalol. A polysomnograph at 6 weeks (Fig. 1) identified SR and intermittent AF associated with severe obstructive sleep apnoea (OSA) with 95 events/h and significant arterial oxygen desaturation (45% of sleep time SpO2 < 90%). He began nasal continuous positive airway pressure (CPAP) 2 weeks later, when OSA severity was reduced (21 events/h, 1% sleep time SpO2 < 90%), and he remained in SR with five brief (<5 min) episodes of AF. Six months later, a CPAP review polysomnograph showed SR, resolution of his OSA and no episodes of AF. A concurrent 24-h Holter monitor identified two brief episodes of AF (8 and 28 s) occurring during wakefulness. Approximately 25% of patients with moderately severe OSAwill have supraventricular arrhythmias, which relate to degree of nocturnal hypoxaemia, and approximately 50% of patients with AF have symptoms of OSA, compared with approximately 3% of a general population. Treatment of OSA can halve the reoccurrence rate of AF postcardioversion. Possible OSA factors that might contribute to AF include: (i) sympathetic hyperactivity related to hypoxaemia, hypercapnia and arousals, (ii) impaired and reset parasympathetic and baroreceptor activity secondary to large negative intrathoracic pressure swings, (iii) myocardial ischaemia related to hypoxaemia and increased myocardialwork related to surges in systemic bloodpressureon a background of coronary artery disease and (iv) atrial chamber dilatation related to large negative intrathoracic pressure swings. Atrial fibrillation carries significantmortality, morbidity and economic costs. The age-adjusted prevalence of AF has tripled from the 1960s to the 1980s.Obesity, amajor risk factor for OSA, has reached endemic proportions. Coupled with these facts, and based on current scientific knowledge, questioning for OSA should be considered in all patients with AF.