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Summary: Obstructive sleep apnea (OSA) has been linked to cancer in several clinical and community‐based cohorts. The effect in community‐based studies free of clinical referral bias needs to be replicated. In this observational prospective cohort study, we pooled data from three community‐based prospective cohorts (Uppsala Sleep and Health in Men cohort [UMEN]; Sleep and health in women [SHE]; Men Androgen Inflammation Lifestyle Environment and Stress Cohort [MAILES]; nTotal = 1467). All cohorts had objective data on obstructive sleep apnea and registry linkage data on cancer and cancer mortality. Analyses for different obstructive sleep apnea measures (apnea–hypopnea index [AHI], oxygen desaturation index [ODI], and minimal saturation) as risk factors for cancer incidence (all cancers) were performed using Cox proportional hazards models (follow‐up 5–16 years). We did not find an overall increased risk of cancer after adjustment for age, sex, and BMI (HRAHI [95% CI] = 1.00 [0.98; 1.01] and HRODI [95% CI] = 0.99 [0.97; 1.01]). Stratifying by daytime sleepiness did not influence the association. Cancer mortality was not significantly associated with obstructive sleep apnea. Taken together, we did not observe an overall increased risk of cancer or cancer mortality in relation to obstructive sleep apnea, however, our confidence limits remain wide for important diagnostic categories of sleep apnea severity. The relationship between obstructive sleep apnea and cancer needs further investigation in a comprehensive multi‐cohort approach with greater statistical precision. For future studies we may need to find and then combine every community‐based cohort study that can provide a definitive answer to the question on the risk of cancer from obstructive sleep apnea in the general population. [ABSTRACT FROM AUTHOR]

Summary: We assessed: (1) the independent and joint association of obstructive sleep apnea risk and healthy lifestyle with common consequences (excessive daytime sleepiness, depression, cardiovascular disease and stroke) of obstructive sleep apnea; and (2) the effect of healthy lifestyle on survival in people with increased obstructive sleep apnea risk. Data from 13,694 adults (median age 46 years; 50% men) were used for cross‐sectional and survival analyses (mortality over 15 years). A healthy lifestyle score with values from 0 (most unhealthy) to 5 (most healthy) was determined based on diet, alcohol intake, physical activity, smoking and body mass index. In the cross‐sectional analysis, obstructive sleep apnea risk was positively associated with all chronic conditions and excessive daytime sleepiness in a dose–response manner (p for trend < 0.001). The healthy lifestyle was inversely associated with all chronic conditions (p for trend < 0.001) but not with excessive daytime sleepiness (p for trend = 0.379). Higher healthy lifestyle score was also associated with reduced odds of depression and cardiovascular disease. We found an inverse relationship between healthy lifestyle score with depression (p for trend < 0.001), cardiovascular disease (p for trend = 0.003) and stroke (p for trend = 0.025) among those who had high obstructive sleep apnea risk. In the survival analysis, we found an inverse association between healthy lifestyle and all‐cause mortality for all categories of obstructive sleep apnea risk (moderate/high‐ and high‐risk groups [p for trend < 0.001]). This study emphasises the crucial role of a healthy lifestyle in mitigating the effects of obstructive sleep apnea risk in individuals with an elevated obstructive sleep apnea risk. [ABSTRACT FROM AUTHOR]

Summary: Previous 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 home‐based 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 Trail‐Making 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. [ABSTRACT FROM AUTHOR]

Summary: Quetiapine is an antipsychotic medication indicated for schizophrenia and bipolar disorder. However, quetiapine also has hypnotic properties and as such is increasingly being prescribed at low doses 'off‐label' in people with insomnia symptoms. Pharmacologically, in addition to its dopaminergic properties, quetiapine also modulates multiple other transmitter systems involved in sleep/wake modulation and potentially breathing. However, very little is known about the impact of quetiapine on obstructive sleep apnoea (OSA), OSA endotypes including chemosensitivity, and control of breathing. Given that many people with insomnia also have undiagnosed OSA, it is important to understand the effects of quetiapine on OSA and its mechanisms. Accordingly, this concise review covers the existing knowledge on the effects of quetiapine on sleep and breathing. Further, we highlight the pharmacodynamics of quetiapine and its potential to alter key OSA endotypes to provide potential mechanistic insight. Finally, an agenda for future research priorities is proposed to fill the current key knowledge gaps. [ABSTRACT FROM AUTHOR]

Objective: To investigate clinicians' perceptions regarding the use of mobile technology tools during prolonged exposure (PE) therapy to allow for monitoring and enhancing in‐vivo exposures (IVEs). Methods: Clinicians with training in PE therapy (N = 32; average of 9 years of practice) completed surveys asking about their perspectives on the utility of virtually attending IVEs with patients while simultaneously having access to real‐time subjective and physiological data (i.e., heart rate, galvanic skin conductance) to guide exposure exercises and assure optimal stimulus engagement. Results: Findings showed clinicians to have a favorable view of applying technology devices and systems to enhance IVEs of PE therapy. Most clinicians (93.8%) believed that real‐time monitoring of IVEs—particularly monitoring patients' subjective distress and completion of and duration of time in the IVE—would be useful and significantly enhance PE therapy. Conclusion: The positive perceptions toward integrating technology into IVEs in this study have important implications for the development and implementation of technology‐enhanced PE therapy. A mobile technology system that incorporates real‐time indicators of engagement (i.e., both subjective and physiological) during IVEs and allows clinicians to review recordings of, or virtually accompany, patients during IVEs has the potential to innovate and transform PE and other exposure‐based treatments. Clinicians also believed that technology‐enhanced IVEs may help reduce early termination from PE. [ABSTRACT FROM AUTHOR]

Aim: To determine whether a digital nudge soon after dinner reduces after‐dinner snacking events as measured objectively by continuous glucose monitoring (CGM) in patients with type 2 diabetes (T2D). Methods: This is a single‐site micro‐randomized trial (MRT). People with T2D, aged 18‐75 years, managed with diet or a stable dose of oral antidiabetic medications for at least 3 months, and who habitual snack after dinner at least 3 nights per week, will be recruited. Picto‐graphic nudges were designed by mixed research methods. After a 2‐week lead‐in phase to determine eligibility and snacking behaviours by a CGM detection algorithm developed by the investigators, participants will be micro‐randomized daily (1:1) to a second 2‐week period to either a picto‐graphic nudge delivered‐in‐time (Intui Research) or no nudge. During lead‐in and MRT phases, 24‐hour glucose will be measured by CGM, sleep will be tracked by an under‐mattress sleep sensor, and dinner timing will be captured daily by photographing the evening meal. Results: The primary outcome is the difference in the incremental area under the CGM curve between nudging and non‐nudging days during the period from 90 minutes after dinner until 04:00 AM. Secondary outcomes include the effect of baseline characteristics on treatment, and comparisons of glucose peaks and time‐in‐range between nudging and non‐nudging days. The feasibility of 'just‐in‐time' messaging and nudge acceptability will be evaluated, along with the analysis of sleep quality measures and their night‐to‐night variability. Conclusions: This study will provide preliminary evidence of the impact of appropriately timed digital nudges on 24 ‐hour intertitial glucose levels resulting from altered after‐dinner snacking in people with T2D. An exploratory sleep substudy will provide evidence of a bidirectional relationship between after‐dinner snacking behaviour, glycaemia and sleep. Ultimately, this study will allow for the design of a future confirmatory study of the potential for digital nudging to improve health related behaviours and health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between three clinically significant sleep disorders (chronic insomnia, obstructive sleep apnoea, restless legs syndrome) and workplace productivity losses among young Australian adults. Design, setting: Prospective, observational study; 22‐year follow‐up of participants in the longitudinal birth cohort Raine Study (Perth, Western Australia). Participants: Currently employed 22‐year‐old Raine Study participants who underwent in‐laboratory sleep disorder screening for moderate to severe obstructive sleep apnoea (apnoea–hypopnea index of more than fifteen events/hour or obstructive sleep apnoea syndrome) and were assessed for insomnia and restless legs syndrome using validated measures. Main outcome measures: Total workplace productivity loss over twelve months, assessed with the World Health Organization Health and Work Performance Questionnaire. Results: Of 1235 contactable 22‐year‐old Raine Study cohort members, 554 people (44.9%; 294 women [53%]) underwent overnight polysomnography, completed the baseline sleep questionnaire, and completed at least three quarterly workplace productivity assessments. One or more clinically significant sleep disorders were identified in 120 participants (21.7%); 90 participants had insomnia (17%), thirty clinically significant obstructive sleep apnoea (5.4%), and two restless legs syndrome (0.4%). Seventeen people (14% of those with sleep disorders) had previously been diagnosed with a sleep disturbance by a health professional, including fourteen with insomnia. Median total workplace productivity loss was greater for participants with sleep disorders (164 hours/year; interquartile range [IQR], 0–411 hours/year) than for those without sleep disorders (30 hours/year; IQR, 0–202 hours/year); total workplace productivity loss was 40% greater for participants with sleep disorders (adjusted incidence rate ratio, 1.40; bias‐corrected and accelerated 95% confidence interval, 1.10–1.76). The estimated population total productivity loss (weighted for disorder prevalence) was 28 644 hours per 1000 young workers per year, primarily attributable to insomnia (28 730 hours/1000 workers/year). Conclusion: Insomnia is a risk factor for workplace productivity loss in young workers. Tailored interventions are needed to identify and manage sleep disorders, particularly as most of the sleep disorders detected in the Raine Study had not previously been diagnosed. [ABSTRACT FROM AUTHOR]

Summary: Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale‐15 items (GSS‐15). Data were derived from a population‐based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut‐off scores and test associations with sleep, daytime functioning, health, and quality‐of‐life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS‐15 global scores and outcomes, including 'a good night′s sleep' (r = 0.7), 'feeling un‐refreshed' (r = −0.59), and 'experienced sleepiness' (r = −0.51), p < 0.001. Cut‐off scores were derived to categorise individuals likely to be a good sleeper (GSS‐15 score ≥40) and those very likely to be a good sleeper (GSS‐15 score ≥45). The GSS‐15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples. [ABSTRACT FROM AUTHOR]

Summary: Insomnia and obstructive sleep apnea commonly co‐occur (co‐morbid insomnia and sleep apnea), and their co‐occurrence has been associated with worse cardiometabolic and mental health. However, it remains unknown if people with co‐morbid insomnia and sleep apnea are at a heightened risk of incident cardiovascular events. This study used longitudinal data from the Sleep Heart Health Study (N = 5803) to investigate potential associations between co‐morbid insomnia and sleep apnea and cardiovascular disease prevalence at baseline and cardiovascular event incidence over ~11 years follow‐up. Insomnia was defined as self‐reported difficulties initiating and/or maintaining sleep AND daytime impairment. Obstructive sleep apnea was defined as an apnea–hypopnea index ≥ 15 events per hr sleep. Co‐morbid insomnia and sleep apnea was defined if both conditions were present. Data from 4160 participants were used for this analysis. The prevalence of no insomnia/obstructive sleep apnea, insomnia only, obstructive sleep apnea only and co‐morbid insomnia and sleep apnea was 53.2%, 3.1%, 39.9% and 1.9%, respectively. Co‐morbid insomnia and sleep apnea was associated with a 75% (odd ratios [95% confidence interval]; 1.75 [1.14, 2.67]) increase in likelihood of having cardiovascular disease at baseline after adjusting for pre‐specified confounders. In the unadjusted model, co‐morbid insomnia and sleep apnea was associated with a twofold increase (hazard ratio, 95% confidence interval: 2.00 [1.33, 2.99]) in risk of cardiovascular event incidence. However, after adjusting for pre‐specified covariates, co‐morbid insomnia and sleep apnea was not significantly associated with incident cardiovascular events (hazard ratio 1.38 [0.92, 2.07]). Comparable findings were obtained when an alternative definition of insomnia (difficulties initiating and/or maintaining sleep without daytime impairment) was used. [ABSTRACT FROM AUTHOR]

Aims: Contemporary long-term survival following a heart failure (HF) hospitalization is uncertain. We evaluated survival up to 10 years after a HF hospitalization using national data from Australia and New Zealand, identified predictors of survival, and estimated the attributable loss in life expectancy.Methods and Results: Patients hospitalized with a primary diagnosis of HF from 2008-2017 were identified and all-cause mortality assessed by linking with Death Registries. Flexible parametric survival models were used to estimate survival, predictors of survival and loss in life expectancy. A total of 283 048 patients with HF were included (mean age 78.2 ± 12.3 years, 50.8% male). Of these, 48.3% (48.1-48.5) were surviving by 3 years, 34.1% (33.9-34.3) by 5 years and 17.1% (16.8-17.4) by 10 years (median survival 2.8 years). Survival declined with age with 53.4% of patients aged 18-54 years and 6.2% aged ≥85 years alive by 10 years (adjusted hazard ratio [aHR] for mortality 4.84, 95% confidence interval [CI] 4.65-5.04 for ≥85 years vs. 18-54 years) and was worse in male patients (aHR 1.14, 95% CI 1.13-1.15). Prior HF (aHR 1.20, 95% CI 1.18-1.22), valvular and rheumatic heart disease (aHR 1.11, 95% CI 1.10-1.13) and vascular disease (aHR 1.07, 95% CI 1.04-1.09) were cardiovascular comorbidities most strongly associated with long-term death. Non-cardiovascular comorbidities and geriatric syndromes were common and associated with higher mortality. Compared with the general population, HF was associated with a loss of 7.3 years in life expectancy (or 56.6% of the expected life expectancy) and reached 20.5 years for those aged 18-54 years.Conclusion: Less than one in five patients hospitalized for HF were surviving by 10 years with patients experiencing almost 60% loss in life expectancy compared with the general population, highlighting the considerable persisting societal burden of HF. Concerted multidisciplinary efforts are needed to improve post-hospitalization outcomes of HF. [ABSTRACT FROM AUTHOR]

While polyploidy (whole‐genome multiplication) is generally considered rare in extant gymnosperms (with the exception of Ephedra, Ephedraceae), the occurrence of sporadic polyploid individuals belonging to various genera in the conifer family Cupressaceae has been reported in the literature. In addition, recent studies have revealed that polyploidy is not uncommon in the genus Juniperus (Cupressaceae), with tetraploid and hexaploid individuals reported in individuals collected from wild populations. Given these findings, we undertook a comprehensive screening of ploidy levels in 32 species belonging to the four genera that are phylogenetically closest to Juniperus (i.e., Callitropsis, Hesperocyparis, Xanthocyparis, and Cupressus), referred to as the CaHXCu complex. In addition, we also determined the ploidy level of two accessions in the poorly studied tetraploid, Fitzroya cupressoides. Using flow cytometry together with published chromosome counts to assign ploidy levels, we show that all species of the CaHXCu complex are diploid except Xanthocyparis vietnamensis, which is tetraploid, with a genome size of 44.60 pg/2 C. This study opens up new opportunities for studying the impact and consequences of polyploidy on the evolution and adaptation of species in Cupressaceae. [ABSTRACT FROM AUTHOR]

Summary: The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well‐being in Australian adults. A cross‐sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18–90 years. Composite scores of self‐reported healthy sleep were based on Ru‐SATED (R‐SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 (<1 hr). Mental well‐being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ‐5D‐5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well‐being with sleep dimensions, and total R‐SATED (range 0–11) and SATED scores (0–10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well‐being. A 1 unit increase in the total SATED score (mean [SD] 6.6 [2.1]) was associated with less problems on the EQ‐5D‐5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08–1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17–1.23). These estimates did not differ when the total R‐SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well‐being. [ABSTRACT FROM AUTHOR]

Summary: Evidence linking obstructive sleep apnea with cognitive dysfunction predominantly comes from clinical or select community samples. We investigated the independent cross‐sectional association of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function in unselected community‐dwelling middle‐aged and older men. Four hundred and seventy‐seven Florey Adelaide Male Ageing Study participants underwent successful home‐based polysomnography. They also completed cognitive testing, including the inspection time task, Fuld object memory evaluation, trail‐making test A and B, and mini‐mental state examination. Multivariable regression models examined independent cross‐sectional associations of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function. In univariable analyses, a higher apnea–hypopnea index and percentage of total sleep time with oxygen saturation <90% were associated with worse trail‐making test A performance (both p <.05). A higher apnea–hypopnea index was also associated with worse trail‐making test B performance and slower inspection time (both p <.05). In adjusted analyses, obstructive sleep apnea and sleep macroarchitecture parameters were not associated with cognitive function (all p >.05). In age‐stratified analysis in men ≥65 years, greater stage 1 sleep was independently associated with worse trail‐making test A performance, whereas greater stage 3 sleep was independently associated with better trail‐making test A performance (both p <.05). Our findings suggest that obstructive sleep apnea is not independently associated with cognitive function. In older, but not younger, men, light sleep was associated with worse attention, whereas deep sleep was associated with better attention. Longitudinal population‐based cohort studies are needed to determine if obstructive sleep apnea and disrupted sleep macroarchitecture independently predict prospective cognitive dysfunction and decline. [ABSTRACT FROM AUTHOR]

Summary: EXpanding Treatment for Existing Neurological Disease (EXTEND) investigated whether hydroxycarbamide lowers transcranial Doppler (TCD) velocities in Jamaican children with sickle cell anaemia (SCA) and elevated TCD velocity with or without previous stroke. Forty‐three children (age 2–17 years) with baseline maximum time‐averaged mean velocity (TAMV) ≥ 170 cm/s were stratified into three risk categories based on treatment status and stroke history: Group 1 (no history of stroke, on hydroxycarbamide, n = 12); and Groups 2 (no stroke, no hydroxycarbamide, n = 21) and 3 (previous stroke, no hydroxycarbamide, n = 10). Open‐label hydroxycarbamide at 20 mg/kg/day was commenced, with escalation to maximum tolerated dose (MTD) based on mild marrow suppression (average dose 25·4 ± 4·5 mg/kg/day). TCD was performed every six months with brain magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) at baseline and after 18‐months of hydroxycarbamide. The maximum TAMV decreased significantly compared to baseline (24 ± 30 cm/s, P < 0·0001), with similar declines in all groups. Clinical stroke occurred in five children, one in Group 1, none in Group 2, and four in Group 3, P = 0·0032, comparing group incidence rates. Brain MRI/MRA was stable in children without clinical stroke. EXTEND documents the feasibility and benefits of hydroxycarbamide at MTD to lower TCD velocities and reduce stroke risk in children with SCA and no history of primary stroke in low‐resource settings without transfusion management. [ABSTRACT FROM AUTHOR]

Background: Occupational musculoskeletal injuries are prevalent in healthcare workers and are reported to be profession-specific. There is, however, a paucity of information around the injuries sustained from working as a podiatrist. This paper looks at the incidence of injury from working as a podiatrist, the aggravating factors to sustain these injuries and whether the changes in workload due to the COVID-19 pandemic altered the incidence. Methods: A modified work based musculoskeletal injury questionnaire was distributed in the UK via podiatry led social media platforms. Open and Closed questions explored the demographics of the sample, perceived injury 12 months prior to the COVID-19 pandemic and then 6 months into the lockdown. Pre and post COVID-19 data were analysed for differences and thematic analysis was included to categorise reported experiences. Results: 148 podiatrists representing 3 % of HCPC registered practitioners responded to the questionnaire. Employment status altered as a result of the COVID-19 pandemic with a 13 % reduction in those working full time. Environments also changed with domiciliary and telehealth significantly increasing (p > 0.00) and non-clinical roles being extended (p > 0.002). Pain frequency and intensity significantly (p > 0.04) increased as a result of the pandemic with shoulder pain being most frequent before lockdown altering to the neck during the lockdown. Two main themes were identified that were attributed to the causes of pain including physical demands and working in awkward spaces. Conclusions: Work-related musculoskeletal pain in podiatrists is common with the shoulder and neck being the most frequently affected. Changes in work practices due to the restrictions enforced from the COVID-19 pandemic increased the frequency and intensity of pain mostly associated with increased domiciliary and telehealth working environments. [ABSTRACT FROM AUTHOR]

Depression and insomnia commonly co-occur, resulting in greater morbidity for patients, and difficult diagnostic and treatment decisions for clinicians. When patients report symptoms of both depression and insomnia, it is common for medical practitioners to conceptualise the insomnia as a secondary symptom of depression. This implies that there is little purpose in treating insomnia directly, and that management of depression will improve both the depression and insomnia symptoms. In this review, we present an overview of research investigating the comorbidity and treatment approaches for patients presenting with depression and insomnia in primary care. Evidence shows that clinicians should avoid routinely conceptualising insomnia as a secondary symptom of depression. This is because insomnia symptoms: (i) often occur before mood decline and are independently associated with increased risk of future depression; (ii) commonly remain unchanged following depression treatment; and (iii) predict relapse of depression after treatment for depression only. Furthermore, compared with control, cognitive behaviour therapy for insomnia improves symptoms of both depression and insomnia. It is critical that primary care clinicians dedicate specific diagnostic and treatment attention to the management of both depression (eg, psychotherapy, antidepressants) and insomnia (eg, cognitive behaviour therapy for insomnia administered by trained therapists or psychologists through a mental health treatment plan referral, by online programs, or by a general practitioner or nurse) when they co-occur. These treatments may be offered concurrently or sequentially (eg, insomnia treatment followed by depression treatment, or vice versa), depending on presenting symptoms, history, lifestyle factors and other comorbidities. [ABSTRACT FROM AUTHOR]

Background and objective: Atomoxetine combined with oxybutynin (Ato‐Oxy) has recently been shown to reduce obstructive sleep apnoea (OSA) severity by >60%. However, Ato‐Oxy also modestly reduced the respiratory arousal threshold, which may decrease sleep quality/efficiency. We sought to investigate the additional effect of zolpidem with Ato‐Oxy on sleep efficiency (primary outcome), the arousal threshold, OSA severity, other standard polysomnography (PSG) parameters, next‐day sleepiness and alertness (secondary outcomes). Methods: Twelve participants with OSA received 10 mg zolpidem plus Ato‐Oxy (80‐5 mg, respectively) or Ato‐Oxy plus placebo prior to overnight in‐laboratory PSG according to a double‐blind, randomized, crossover design (1‐week washout). Participants were fitted with an epiglottic catheter, a nasal mask and pneumotachograph to quantify arousal threshold and airflow. Next‐day sleepiness and alertness were assessed via the Karolinska Sleepiness Scale and a driving simulation task. Results: The addition of zolpidem increased sleep efficiency by 9% ± 13% (80.9% ± 16.9% vs. 88.2% ± 8.2%, p = 0.037) and the respiratory arousal threshold by 17% ± 18% (−26.6 ± 14.5 vs. −33.8 ± 20.3 cm H2O, p = 0.004) versus Ato‐Oxy + placebo. Zolpidem did not systematically change OSA severity. Combination therapy was well tolerated, and zolpidem did not worsen next‐day sleepiness. However, median steering deviation during the driving simulator task increased following the zolpidem combination. Conclusion: Zolpidem improves sleep efficiency via an increase in the respiratory arousal threshold to counteract potential wake‐promoting properties of atomoxetine in OSA. These changes occur without altering the rate of respiratory events or overnight hypoxaemia. However, while the addition of zolpidem does not increase next‐day perceived sleepiness, caution is warranted given the potential impact on next‐morning objective alertness. Combined atomoxetine and oxybutynin (Ato‐Oxy) has been shown to decrease obstructive sleep apnoea severity, yet with a slight decrease of the arousal threshold. Here, we show that the addition of zolpidem counteracted the 'wake‐promoting' properties of Ato‐Oxy and increased sleep efficiency and the arousal threshold, but impaired next‐day driving simulator performance. See relatedEditorial [ABSTRACT FROM AUTHOR]

Overfishing, bycatch, and habitat loss and alteration during the late 19th century to the end of the 20th century caused significant declines in Atlantic Sturgeon Acipenser oxyrinchus stock abundances along the Atlantic coast. To prevent further stock reductions, a coastwide harvest moratorium was implemented in 1998. With fishery‐dependent data unavailable to inform stock management, fishery‐independent surveys contribute vital information for monitoring population trends by providing data for evaluating the effectiveness of the moratorium and for informing recovery planning. In 2004, a standardized monitoring survey was developed to assess trends in the relative abundance of juvenile Atlantic Sturgeon in the Hudson River, New York. The multimesh anchored gill‐net survey randomly sampled locations in soft, deep depositional areas of Haverstraw Bay from late February through early May. Predicted length‐at‐age relationships were used to infer annual age structure and to examine the relationships between age and annual catch rates. Generalized additive regression modeling was used to describe the relationships between the environmental variables and catch rates and to standardize the abundance index to account for variability in environmental conditions over time. Atlantic Sturgeon catch rates generally increased with increasing water temperature and salinity, and the standardized abundance index (accounting for environmental variability) was highly correlated with the nominal abundance index. In the 16 years of annual monitoring, there has been a significant increase in the relative abundance of juvenile Atlantic Sturgeon. The average catch rate in recent years (2012–2019) is more than twice that observed during the first 8 years (2004–2011) of the survey, as the effects of the moratorium are expected to be delayed due to the long maturation period of Atlantic Sturgeon. These trends suggest that juvenile Atlantic Sturgeon in the Hudson River may be recovering in response to the moratorium and demonstrate the need for long‐term fisheries‐independent monitoring to document abundance trends in slow‐maturing, long‐lived species. [ABSTRACT FROM AUTHOR]

Objective: To assess long term survival and patient characteristics associated with survival following acute myocardial infarction (AMI) in Australia and New Zealand.Design: Cohort study.Setting, Participants: All patients admitted with AMI (ICD-10-AM codes I21.0-I21.4) to all public and most private hospitals in Australia and New Zealand during 2009-2015.Main Outcome Measure: All-cause mortality up to seven years after an AMI.Results: 239 402 initial admissions with AMI were identified; the mean age of the patients was 69.3 years (SD, 14.3 years), 154 287 were men (64.5%), and 64 335 had ST-elevation myocardial infarction (STEMI; 26.9%). 7-year survival after AMI was 62.3% (STEMI, 70.8%; non-ST-elevation myocardial infarction [NSTEMI], 59.2%); survival exceeded 85% for people under 65 years of age, but was 17.4% for those aged 85 years or more. 120 155 patients (50.2%) underwent revascularisation (STEMI, 72.2%; NSTEMI, 42.1%); 7-year survival exceeded 80% for patients in each group who underwent revascularisation, and was lower than 45% for those who did not. Being older (85 years or older v 18-54 years: adjusted hazard ratio [aHR], 10.6; 95% CI, 10.1-11.1) or a woman (aHR, 1.15; 95% CI, 1.13-1.17) were each associated with greater long term mortality during the study period, as was prior heart failure (aHR, 1.79; 95% CI, 1.76-1.83). Several non-cardiac conditions and geriatric syndromes common in these patients were independently associated with lower long term survival, including major and metastatic cancer, cirrhosis and end-stage liver disease, and dementia.Conclusion: AMI care in Australia and New Zealand is associated with high rates of long term survival; 7-year rates exceed 80% for patients under 65 years of age and for those who undergo revascularisation. Efforts to further improve survival should target patients with NSTEMI, who are often older and have several comorbid conditions, for whom revascularisation rates are low and survival after AMI poor. [ABSTRACT FROM AUTHOR]

Objectives: To systematically assess the efficacy of different non‐surgical treatment methods to manage peri‐implantitis reported to date in the literature, together with its correlation with time following therapy. Materials and Methods: A systematic literature review was undertaken to identify randomised control trials of the non‐surgical management of peri‐implantitis published up to November 2019. The search was limited to English language human studies containing follow‐up periods of ≥3 months and for sample size of 10 or more patients. A meta‐analysis was implemented for the following clinical parameters: Peri‐implant pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), radiographic bone loss (RBL) and mucosal recession (MR). Results: Twelve articles met the inclusion criteria. Two principal treatment modalities were identified; mechanical debridement and laser therapy, with two adjunctive therapies antimicrobial and antiseptic agents. Non‐surgical interventions (ultrasonic scalers, Er:YAG laser and powdered air‐abrasive devices) showed significant clinical improvement in the short term (<3 months). Clinical benefit was demonstrated with the adjunctive use of antimicrobial agents in the short term but diminished with time. Antiseptic agents alone have no significant effect. Non‐surgical therapies applied in these studies failed to arrest mucosal recession, peri‐implant bone loss or reduce the counts of viable pathogens in the long term. Conclusion: The evidence demonstrate that the clinical parameters of peri‐implantitis, i.e. BOP, PPD and CAL may all be improved by simple mechanical debridement, using either ultrasonic instrumentation or Er:YAG laser therapy; adjunctive antimicrobial and antiseptic therapy. Further randomised control trials in this area are, however, required. [ABSTRACT FROM AUTHOR]

Aims: National 30‐day mortality and readmission rates after heart failure (HF) hospitalisations are a focus of US policy intervention and yet have rarely been assessed in other comparable countries. We examined the frequency, trends and institutional variation in 30‐day mortality and unplanned readmission rates after HF hospitalisations in Australia and New Zealand. Methods and results: We included patients >18 years hospitalised with HF at all public and most private hospitals from 2010–15. The primary outcomes were the frequencies of 30‐day mortality and unplanned readmissions, and the institutional risk‐standardised mortality rate (RSMR) and readmission rate (RSRR) evaluated using separate cohorts. The mortality cohort included 153 592 patients (mean age 78.9 ± 11.8 years, 51.5% male) with 16 442 (10.7%) deaths within 30 days. The readmission cohort included 148 704 patients (mean age 78.6 ± 11.9 years, 51.7% male) with 33 158 (22.3%) unplanned readmission within 30 days. In 392 hospitals with at least 25 HF hospitalisations, the median RSMR was 10.7% (range 6.1–17.3%) with 59 hospitals significantly different from the national average. Similarly, in 391 hospitals with at least 25 HF hospitalisations, the median RSRR was 22.3% (range 17.7–27.1%) with 24 hospitals significantly different from the average. From 2010–15, the adjusted 30‐day mortality [odds ratio (OR) 0.991/month, 95% confidence interval (CI) 0.990–0.992, P < 0.01] and unplanned readmission (OR 0.998/month, 95% CI 0.998–0.999, P < 0.01) rates declined. Conclusion: Within 30 days of a HF hospitalisation, one in 10 patients died and almost a quarter of those surviving experienced an unplanned readmission. The risk of these outcomes varied widely among hospitals suggesting disparities in HF care quality. Nevertheless, a substantial decline in 30‐day mortality and a modest decline in readmissions occurred over the study period. [ABSTRACT FROM AUTHOR]

Objective: To examine the predictive validity of the FRAIL scale for mortality, and diagnostic test accuracy (DTA) against the frailty phenotype (FP). Measurement: Frailty was measured in 846 community‐dwelling adults (mean age 74.3 [SD 6.3] years, 54.8% female) using a modified FRAIL scale and modified FP. Mortality was matched to death records. Results: The FRAIL scale demonstrated significant predictive validity for mortality up to 10 years (Frail adjHR: 2.60, P <.001). DTA findings were acceptable for specificity (86.8%) and Youden index (0.50), but not sensitivity (63.6%), or area under the receiver operator curve (auROC) (0.75). DTA estimates were more acceptable when a cut‐point of ≥2 characteristics was used rather than ≥3 in the primary DTA analysis. Conclusion: The FRAIL scale is a valid predictor of mortality. DTA estimates depend on FRAIL scale cut‐point used. This instrument is a potentially useful frailty screening tool. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Frailty places individuals at greater risk of adverse health outcomes. However, it is a dynamic condition and may not always lead to decline. Our objective was to determine the relationship between frailty status (at baseline and follow‐up) and mortality using both the frailty phenotype (FP) and frailty index (FI). DESIGN: Population‐based cohort. SETTING: Community‐dwelling older adults. PARTICIPANTS: A total of 909 individuals aged 65 years or older (55% female), mean age 74.4 (SD 6.2) years, had frailty measurement at baseline. Overall, 549 participants had frailty measurement at two time points. MEASUREMENTS: Frailty was measured using the FP and FI, with a mean 4.5 years between baseline and follow‐up. Mortality was matched to official death records with a minimum of 10 years of follow‐up. RESULTS: For both measures, baseline frailty was a significant predictor of mortality up to 10 years, with initially good predictive ability (area under the curve [AUC] =.8‐.9) decreasing over time. Repeated measurement at follow‐up resulted in good prediction compared with lower (AUC =.6‐.7) discrimination of equivalent baseline frailty status. In a multivariable model, frailty measurement at follow‐up was a stronger predictor of mortality compared with baseline. Frailty change for the Continuous FI was a significant predictor of decreased or increased mortality risk based on corresponding improvement or worsening of score (hazard ratio = 1.04; 95% confidence interval = 1.02‐1.07; P = .001). CONCLUSIONS: Frailty measurement is a good predictor of mortality up to 10 years; however, recency of frailty measurement is important for improved prediction. A regular review of frailty status is required in older adults. J Am Geriatr Soc 67:2311–2317, 2019 [ABSTRACT FROM AUTHOR]

Research related to the paramedic workforce is increasing, particularly given the associations with physical and mental health outcomes. However, it is clear that the evidence base to support future paramedic workforce initiatives lacks longitudinal data in cohorts of paramedics. We identify gaps in the epidemiological evidence base for this workforce, and provide insight into the role that prospective cohorts can, and should, play in future research in the paramedic workforce in order to identify health and safety changes over time, and the associations with job requirements, particularly shift work. [ABSTRACT FROM AUTHOR]

Sleep and circadian rhythm disturbances are prevalent in older populations. Numerous factors can affect sleep, including medications, living environment and physical, mental and psychosocial factors (e.g. loneliness and stress). Sleep architecture changes with aging, with less deep sleep (slow wave sleep) and an increased frequency of awakenings after sleep onset. Benzodiazepines, Z‐drugs and low doses of the tricyclic antidepressant doxepin have modest positive benefits for sleep complaints, but side effects are a concern in older people because they include an increased risk of falls, fractures and cognitive impairment. Somnolence can be prolonged in older adults. Melatonin has very modest effects on sleep initiation in older adults, although appears safe. Overall, the effects of pharmacological treatments are modest and there are concerns about the efficacy and safety of their ongoing use. There is strong evidence for non‐pharmacological interventions, including cognitive and behavioural strategies, to improve sleep. These have at least comparable efficacy to pharmacological interventions, fewer adverse effects and are more likely to have longer‐term, sustained benefits. Sleep complaints in older adults need to be approached on a patient‐by‐patient basis, and medication should be reviewed frequently, with preference to limit pharmacological intervention as far as practicable. [ABSTRACT FROM AUTHOR]

Aim: Frailty is a state of decreased physiological reserve and vulnerability to stressors. Understanding the characteristics of those most at risk of worsening, or likely to improve their frailty status, are key elements in addressing this condition. The present study measured frailty state transitions and factors associated with improvement or worsening frailty status in the North West Adelaide Health Study. Methods: Frailty was measured using the frailty phenotype (FP) and a 34‐item frailty index (FI) for 696 community‐dwelling participants aged ≥65 years, with repeated measures at 4.5‐year follow up. Results: Improvement in frailty state was common for both tools (FP 15.5%; FI 7.9%). The majority remained stable (FP 44.4%; FI 52.6%), and many transitioned to a worse level of frailty (FP 40.1%; FI 39.5%). For both measures, multimorbidity was associated with worsening frailty among non‐frail participants. Among pre‐frail participants, normal waist circumference was associated with improvement, whereas older age was associated with worsening of frailty status. Among frail individuals, younger age was associated with improvement, and male sex and older age were associated with worsening frailty status. Conclusions: Frailty is a dynamic process where improvement is possible. Multimorbidity, obesity, age and sex were associated with frailty transitions for both tools. Geriatr Gerontol Int 2018; 18: 1549–1555. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of frailty and associated factors in the North West Adelaide Health Study (2004-2006) using the Frailty Phenotype (FP) and Frailty Index (FI). Methods: Frailty was measured in 909 communitydwelling participants aged ≥65 years using the FP and FI. Results: The FP classified 18% of participants as frail and the FI 48%. The measures were strongly correlated (r = 0.76, P < 0.001) and had a kappa agreement of 0.38 for frailty classification, with 37% of participants classified as non-frail by the FP being classified as frail by the FI. Being older, a current smoker, and having multimorbidity and polypharmacy were associated with higher frailty levels by both tools. Female, low income, obesity and living alone were associated with the FI. Conclusion: Frailty prevalence was higher when assessed using the FI. Socioeconomic factors and other health determinants contribute to higher frailty levels. [ABSTRACT FROM AUTHOR]

Objective: To examine frailty prevalence in Australian older adults. Methods: Frailty was measured using a modified Fried Frailty Phenotype (FFP) in a combined cohort of 8804 Australian adults aged ≥65 years (female 86%, median age 80 (79-82) years) from the Dynamic Analyses to Optimise Ageing Project and the North West Adelaide Health Study. Results: Using the FFP, 21% of participants were frail while a further 48% were prefrail. Chi-squared testing of frailty among four age groups (65-69, 70-74, 75-79 and 80-84 years) for sex, and marital status revealed that frailty was significantly higher for women (approximately double that of men), increased significantly with advancing age for both sexes, and was significantly higher for women who were widowed, divorced or never married. Conclusion: If frailty could be prevented or reversed, it would have an impact on a larger number of older people. [ABSTRACT FROM AUTHOR]

Summary: This study investigated the association of nutritional and haematological variables with maximum time‐averaged mean velocity (TAMV) measured by transcranial Doppler (TCD) velocity and the agreement of classification between two protocols. TCD categories included: normal (<170 cm/s), conditional (170–199 cm/s) and abnormal (≥200 cm/s) based on TAMV in distal internal carotid artery (dICA), middle cerebral artery (MCA), internal carotid bifurcation, anterior and posterior cerebral arteries. Of 358 children with sickle cell anaemia (SCA) examined, the mean age (±standard deviation) was 7·4 ± 2·7 years; 13·1% and 6·7% had conditional and abnormal velocities, respectively. Children with abnormal TCD velocities had higher prevalence of prior stroke (P = 0·006). Increased TAMV was associated with younger age (P = 0·001), lower weight (P = 0·001), height (P = 0·007) and oxygen saturation (P = 0·005). There was no association of TAMV with height‐age or body mass index (BMI) z‐scores. Adjusting for gender, BMI z‐score, age, previous stroke and oxygen saturation, mean corpuscular volume (P = 0·005) and reticulocyte count (P = 0·013) were positively associated with TAMV, while haemoglobin concentration (P = 0·009) was negatively associated. There was good agreement [99%; weighted Kappa 0·98 (95% confidence interval 0·89–1), P = 0·0001] in TCD classification using data from five vessels versus two vessels (dICA and MCA). Haematological variables, rather than nutritional status, may be useful markers that identify high‐risk children with SCA. [ABSTRACT FROM AUTHOR]

Objective: To determine the suitability of using the International Prostate Symptom Score (IPSS), a condition‐specific instrument, within economic evaluation of lower urinary tract symptom (LUTS) interventions. Methods: Data were obtained from a cohort of 2236 community‐dwelling Australian men. Using correlations and a modified Bland–Altman plot, we investigated the convergent validity of the IPSS with two generic quality of life (GQol) instruments: the Assessment of Quality of Life 4 Dimensions (AQoL‐4D) and the Short‐Form 36 (SF‐36). Discriminant validity was investigated using Wilcoxon–Mann–Whitney and Kruskal–Wallis tests, comparing instrument scores and utilities between subgroups varying in age, marital status, history of illness, smoking status and self‐assessed general health. Results: Discriminant validity was confirmed for all instruments by finding statistically significant differences in summary scores and utilities between nearly all subgroups. Convergent validity between the summary scores/utilities of the IPSS and the GQoL instruments was weak (absolute correlation value range, 0.11–0.23) but differed considerably between dimensions of the instruments (absolute correlation value range, 0.01–0.24). Weak to moderate correlation between the GQoL instruments was seen (absolute correlation value range, 0.01–0.49). Conclusion: Our findings suggest that the IPSS has comparable discriminant validity to the GQoL instruments and therefore useful for assessing subgroup differences related to urinary symptoms. The weak convergence between the IPSS and the GQoL instruments however suggests that, within economic evaluation, the IPSS should be viewed as a complement rather than a substitute to the GQoL instruments because it captures different quality of life constructs. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective Obstructive sleep apnoea ( OSA) and insomnia coexist in clinical populations but prevalence in the community and risk factors remain largely unknown. We examined the prevalence and profile of previously undiagnosed co-morbid OSA and insomnia symptoms ( COMISA) in community-dwelling men. Methods Men ( n = 700, aged 58.5 ± 11.0 (mean ± SD) years) without a prior diagnosis of OSA completed full at-home unattended polysomnography, the Pittsburgh Sleep Quality Index and 36-item short form ( SF-36) survey (2007-2012). Insomnia symptoms included difficulty initiating/maintaining sleep in the presence of daytime fatigue ( DIMS-F). Depressive symptoms were assessed using the Beck Depression Inventory- 1A, Centre for Epidemiological Studies Depression Scale and Patient Health Questionnaire-9 ( PHQ-9) (2007-2010). Univariate ( χ2 and analysis of variance ( ANOVA)) and multiple linear regressions were used to compare data from four groups of individuals: neither disorder; previously undiagnosed OSA (apnoea-hypopnoea index ≥ 10) or DIMS-F alone; and COMISA. Results COMISA prevalence was 6.7%. Depression prevalence ( COMISA, 42.6%; DIMS-F, 21.6%; OSA, 8.4%, χ2 = 71.6, P < 0.00) and symptom scale scores (e.g. PHQ-9 mean ± SD: 16.1 ± 5.5 c.f. DIMS-F: 14.0 ± 4.9, P < 0.01 and OSA: 11.4 ± 3.0, P = 0.01) were highest in men with COMISA. In COMISA, respiratory and arousal indices were similar to those observed in OSA whilst reductions in subjective sleep and day dysfunction scores were similar to DIMS-F. After adjustment, predicted mean depression scores were all higher in DIMS-F and COMISA using linear regression (e.g. PHQ-9 β (95% CI): DIMS-F: 2.3 (1.2, 3.5); COMISA: 4.1 (3.0, 5.1)). Conclusion Men with COMISA have a greater prevalence, and severity, of depression than men with only one disorder. [ABSTRACT FROM AUTHOR]

Introduction: Evidence demonstrates that health care professionals are more prone to burnout than other professionals due to the emotionally taxing interactions they have with their patients on a daily basis. The aims of this study were to measure occupational burnout levels among sonographers, radiographers and radiologists and to examine predictors of burnout according to demographic characteristics.Methods: A cross-sectional online survey was administered in 2010 to radiographers, sonographers and radiologists who were members of the following professional bodies: Australian Institute of Radiography, Australian Sonographers Association and The Royal Australian and New Zealand College of Radiologists. The Maslach Burnout Inventory was used to measure burnout levels for each profession. Data were analysed using SPSS Ver 20 (IBM, Chicago, IL, USA) statistical software.Results: A total of 613 radiographers, 121 sonographers and 35 radiologists participated in the survey. Radiographers, sonographers and radiologists had a high mean (±SD) burnout score for emotional exhaustion (39.9 ± 8.5, 42.2 ± 8.5 and 44.9 ± 7.1 respectively) and depersonalization (18.9 ± 5.5, 20.3 ± 5.8 and 20.6 ± 5.6) compared to MBI norms. Radiographers also had low personal achievement (30.8 ± 5.5) compared to MBI norms. Radiographers and sonographers who were male, worked >10 hours overtime and spent <10% of their time training students per week had significantly higher depersonalization scores (p < 0.05).Conclusion: Burnout levels among radiographers, sonographers and radiologists are high and likely to vary according to some demographic and work-related factors. Further research is needed to examine ways to alleviate burnout in these professions so that loss of experienced staff due to burnout can be minimized and quality of patient care can be maintained. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of musculoskeletal pain with objectively determined obstructive sleep apnea (OSA) and subjective sleep measures in a population-based sample.Methods: Participants were community-dwelling men (n = 360) age ≥35 years from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study. Shoulder, back, hip, knee, hand, and foot pain were assessed by computer-assisted telephone interview or self-completed questionnaire. OSA was determined with full in-home unattended polysomnography (Embletta X100) scored by 2007 American Academy of Sleep Medicine alternative criteria. The Epworth Sleepiness Scale assessed daytime sleepiness and the Pittsburgh Sleep Quality Index assessed sleep quality.Results: OSA was not associated with the presence of any joint pain (adjusted odds ratio [OR] 1.03 [95% confidence interval (95% CI) 0.61-1.76]). There was no association between OSA and pain in any specific joint (shoulder, back, hip, knee, hand, or foot), nor was the number of joints in pain associated with OSA. There was, similarly, no association between pain variables and excessive daytime sleepiness, except for hand pain (OR 3.10 [95% CI 1.50-6.39]). However, pain was associated with poor sleep quality: any pain (OR 2.19 [95% CI 1.25-3.82]), shoulder pain (OR 2.16 [95% CI 1.25-3.75]), back pain (OR 2.24 [95% CI 1.41-3.55]), and foot pain (OR 2.47 [95% CI 1.43-4.26]). The number of painful joints was also associated with poor sleep quality (5-6 joints versus no joints OR 7.34 [95% CI 2.30-23.42]).Conclusion: No association between OSA and pain or between daytime sleepiness and pain was found. Consistent with previous reports, poor sleep quality was associated with musculoskeletal pain in this population sample. The etiologic differences between OSA-related sleep disruption and poor subjective sleep quality require further investigation. [ABSTRACT FROM AUTHOR]

Obesity is a risk factor for cancer. However, it is not known if general adiposity, as measured by body mass index (BMI) or central adiposity [ e.g., waist circumference (WC)] have stronger associations with cancer, or which anthropometric measure best predicts cancer risk. We included 79,458 men and women from the Australian and New Zealand Diabetes and Cancer Collaboration with complete data on anthropometry [BMI, WC, Hip Circumference (HC), WHR, waist to height ratio (WtHR), A Body Shape Index (ABSI)], linked to the Australian Cancer Database. Cox proportional hazards models assessed the association between each anthropometric marker, per standard deviation and the risk of overall, colorectal, post-menopausal (PM) breast, prostate and obesity-related cancers. We assessed the discriminative ability of models using Harrell's c-statistic. All anthropometric markers were associated with overall, colorectal and obesity-related cancers. BMI, WC and HC were associated with PM breast cancer and no significant associations were seen for prostate cancer. Strongest associations were observed for WC across all outcomes, excluding PM breast cancer for which HC was strongest. WC had greater discrimination compared to BMI for overall and colorectal cancer in men and women with c-statistics ranging from 0.70 to 0.71. We show all anthropometric measures are associated with the overall, colorectal, PM breast and obesity-related cancer in men and women, but not prostate cancer. WC discriminated marginally better than BMI. However, all anthropometric measures were similarly moderately predictive of cancer risk. We do not recommend one anthropometric marker over another for assessing an individuals' risk of cancer. [ABSTRACT FROM AUTHOR]