Sleep
Diagnosis of Obstructive Sleep Apnea in Primary Care
(Professor Ron Grunstein / Dr Keith Wong)
We have commenced the NHMRC project grant-funded “Diagnosis of obstructive sleep apnea in primary care” study. This study will evaluate simplified methods to diagnose OSA in general practice, using a combination of questionnaires, analysis of facial photographs and a portable apnea monitor. The first group of GPs were trained in September 2008, and to date 50 patients of the target 570 have been recruited.
Pharmacy-based Screening for Sleep Disorders
(Professor Ron Grunstein / Dr Keith Wong / Dr Bandana Saini)
Commencement of a study undertaken in collaboration with investigators from the University of Sydney School of Pharmacy to evaluate the feasibility of a pharmacy-based screening programme for sleep disorders is also underway. Training of 20 community pharmacists was completed in November, and the project will commence patient recruitment in January 2009. Funding for this project was provided by Commonwealth Department of Health and Ageing and Fourth Community Pharmacy Agreement
Sleep Apnea Mortality Risks
(Professor Ron Grunstein / Dr Nathaniel Marshall)
The major research achievement for the year has been publishing the world’s first community-based estimate of the mortality associated with sleep apnea in the journal SLEEP based on Australian data from Busselton. Work has also been published describing two randomised controlled trials of Mirtazapine showing that it should not be used for sleep apnea despite earlier findings. We are also in the exploratory phase for setting up a nationwide multicentre clinical trials team for sleep surgery. Over the long-term this collaboration, if successful, may vastly improve the evidence base surrounding surgery for sleep apnea.
Obesity and Sleep Disordered Breathing – Novel Treatments
(Professor Ron Grunstein / Associate Professor Peter Liu / Dr Roo Killick)
The NHMRC funded randomised controlled trial project assessing the therapeutic effects of testosterone in obese men as adjuvant therapy for a weight loss program, exploring novel pathways for the treatment of obesity. Assessments of ventilatory responses are also being conducted in a subset of patients to help us further understand airway response mechanisms in these patients.
Circadian Rhythm
(Professor Ron Grunstein / Associate Professor Peter Liu / Dr Roo Killick)
Protocol development of research investigating sleep-wake mechanisms is underway. We will examine the effects of sleep loss on metabolism and it is hoped that NHMRC funding will be successfully sought in the next round of project grants. This work will be undertaken in our new laboratory which boasts state of the art circadian rhythm testing facilities.
Interdisciplinary Clinics (IDCs) for Metabolic Syndrome (MS) and Obstructive Sleep Apnea (OSA)
(Professor Ron Grunstein / Associate Professor Peter Liu / Dr Peter Buchanan / Dr Brendon Yee / Dr Amanda Piper)
OSA occurs in 25% of men and is strongly associated with metabolic syndrome and its individual components. We have identified a 30% prevalence of undiagnosed or under-treated MS in OSA clinic patients. Males are under-represented in clinical weight-loss intervention trials. An interdisciplinary clinic (IDC) focusing on optimal care of MS and OSA should streamline healthcare delivery, foster clinical research in men with central obesity and increase therapeutic impact. IDCs involving contemporaneous assessment by an exercise physiotherapist, dietitian, sleep-trained registered nurse, sleep medicine and endocrine-metabolic physicians have been established to test the practicality of applying sleep-breathing and metabolic care, exercise promotion and dietary advice, to MS-OSA patients identified from general sleep medicine clinics. In the future we aim to test the effectiveness of this approach in weight loss and metabolic health in patients with OSA through a randomised, controlled, health-intervention trial.
In addition we have been awarded NHMRC project funding which will allow us to focus on the use novel treatments to reduce abdominal and upper airway fat in patients with sleep apnea. Sponsored clinical trials with weight loss agents are also planned.
Diagnosis and Management of Sleep Disorders
(Professor Ron Grunstein / Professor Guy Marks)
The diagnosis of OSA is usually made with an in-laboratory polysomnogram (PSG), in the context of a consultation with a sleep specialist. This remains the primary diagnostic methodology for OSA recommended by professional organisations. There are practical limitations to this diagnostic strategy in terms of cost and availability of testing facilities.
We have successfully completed a project comparing multiple night recordings of nasal airflow with multiple nights of oximetry to determine which method is a better predictor of polysomnographic determined apnea/hypopnea index. Funding has been secured from the NHMRC to investigate the best models of diagnosis of OSA in primary care.
Some of this work utilises novel Australian technology, through a Sydney based biotech, Diagnose IT which is partnering the Woolcock Institute in field trials of co-developed web based clinical systems for interacting screening of sleep apnea with primary care.
Improving Adherence to Sleep Apnea Therapy
(Dr Delwyn Bartlett)
We have established that specific cognitive behavioural therapy will markedly increase adherence to CPAP therapy. We have obtained NHMRC funds to assess the generalisability of our initial work and establish the most effective way of delivering CBT with the best cost-utility. Later we expect to extend this work to mandibular advancement splints.
Shiftwork Health
We are involved in a number of research translation projects including examining the evidence base for various strategies for reducing sleepiness and fatigue in the workplace. The CCRE has organised annual seminar on sleep and workplace safety and in August, 2007 organised a seminar on safety in the hospital workplace and fatigue with a keynote address from Professor Charles Czeisler from Harvard University. The CCRE was actively involved in organising several sessions on these and related areas at the World Sleep Research Congress in Cairns in September 2007.
With the ASTN we will be formulating new multi-centre studies of the impact of shiftwork on sleep, performance and general health.
SAVE (Sleep Apnea Cardio-Vascular Endpoints Study) in China
(Dr Keith Wong)
© 2009