Respiratory disease

n/a

and the extended voting group

Shedding light on common but under-recognised individual and community problemsBy the time the average person reaches his or her average life expectancy of around 80 years, they will have invested 28 years of their lives in sleep. It is remarkable that an activity of this scale is so taken for granted. Ironically, it is the defining characteristic of sleep — perceptual disengagement from the environment — that ...

Darren R Mansfield MB BS, FRACP · David R Hillman MB BS, FANZCA, FRCPE · Nicholas A Antic MB BS, FRACP, PhD · R Doug McEvoy MB BS, FRACP · Shantha M W Rajaratnam PhD

Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%–35%). These difficulties ...

David R Hillman MB BS, FANZCA, FRCPE · Leon C Lack PhD

About 1.5 million Australians are shift workers. Shift work is associated with adverse health, safety and performance outcomes. Circadian rhythm misalignment, inadequate and poor-quality sleep, and sleep disorders such as sleep apnoea, insomnia and shift work disorder (excessive sleepiness and/or insomnia temporally associated with the work schedule) contribute to these associations. Falling asleep at work at least once a week occurs in 32%–36% of shift ...

Shantha M W Rajaratnam PhD · Mark E Howard MB BS, FRACP, PhD · Ronald R Grunstein FRACP, MD, PhD

Delayed sleep phase disorder (DSPD) — a circadian rhythm sleep disorder — is most commonly seen in adolescents. The differential diagnosis between DSPD and conventional psychophysiological insomnia is important for correct therapeutic intervention. Adolescent DSPD sleep duration is commonly 9 hours or more. Depression may be comorbid with DSPD. DSPD has a negative impact on adolescent academic performance. DSPD treatments include ...

Delwyn J Bartlett PhD, MAPS · Sarah N Biggs PhD · Stuart M Armstrong BSc, PhD, MAPS

Obstructive sleep apnoea (OSA) determined by polysomnography is highly prevalent, affecting about 25% of men and 10% of women in the United States, although most have few or no symptoms. Symptomatic moderate to severe OSA has major health implications related to daytime sleepiness, such as increased accidents, altered mood and loss of productivity in the workplace. Severe OSA may increase the risk of cardiovascular ...

Darren R Mansfield MB BS, FRACP · Nicholas A Antic MB BS, FRACP, PhD · R Doug McEvoy MB BS, FRACP

Obstructive sleep apnoea (OSA) is a potential cause of systemic hypertension in young and middle-aged people, and treatment helps reduce blood pressure in some patients. Severe OSA (apnoea–hypopnoea index [AHI] > 30/h) is strongly associated with increased mortality, stroke and cardiovascular disease in middle-aged populations. The cardiovascular risk from moderate OSA (AHI, 15–30/h) is uncertain, particularly if the oxygen desaturation index is low, although ...

Garun S Hamilton MB BS, PhD, FRACP · Matthew T Naughton MB BS, MD, FRACP

Sleep disorders are very common in childhood and are often amenable to simple advice and parental education. Questions about sleep should be an integral part of every paediatric consultation. Children with underlying syndromes or complex medical conditions often have multiple sleep issues. Excessive sleepiness in children requires careful history-taking and consideration of specialised investigation. Obstructive sleep apnoea (OSA) is a common ...

Karen A Waters MB BS, FRACP, PhD · Sadasivam Suresh MB BS, MRCPCH, FRACP · Gillian M Nixon MB ChB, MD, FRACP

Insomnia is common and can have serious consequences, such as increased risk of depression and hypertension. Acute and chronic insomnia require different management approaches. Chronic insomnia is unlikely to spontaneously remit, and over time will be characterised by cycles of relapse and remission or persistent symptoms. Chronic insomnia is best managed using non-drug strategies such as cognitive behaviour therapy. For patients ...

David Cunnington MB BS, MMedSc, FRACP · Moira F Junge BA, BAppSc(Hons), DPsych (Health) · Antonio T Fernando MD, FRANZCP

A cross-sectional study finds that symptoms and spirometric evidence of chronic obstructive pulmonary disease are common among people aged 40 years or older in Australia, and increase with age.

Brett G Toelle PhD · Wei Xuan PhD · Tessa E Bird RN · Michael J Abramson MB BS, PhD, FAFPHM · David N Atkinson MB BS, MPH · Deborah L Burton PhD · Alan L James MD, FRACP · Christine R Jenkins MB BS, MD, FRACP · David P Johns PhD · Graeme P Maguire MB BS, FRACP, PhD · A W (Bill) Musk MB BS, MD, FRACP · E Haydn Walters MA, DM, FRACP · Richard Wood-Baker DM, FRCP, FRACP · Michael L Hunter PhD · Bruce J Graham BSc, MEd, PhD · Phillipa J Southwell BMedSc(Hons) · William M Vollmer PhD · A Sonia Buist MD · Guy B Marks MB BS, PhD, FRACP

A retrospective audit of patients referred for venous thromboembolism-related imaging reveals that the availability of new screening and diagnostic tests may have led to overdiagnosis of clinically insignificant pulmonary embolism.

Tatiana Segard MD · William B G Macdonald MB BS, MPH, FRACP

Objective: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD).Design, setting and participants: Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009.Intervention: Participants from intervention group practices were visited at their home by a ...

Nicholas A Zwar MPH, PhD, FRACGP · Oshana Hermiz MB BS · Elizabeth Comino BVSc, PhD · Sandy Middleton PhD · Sanjyot Vagholkar MB BS, MPH · Wei Xuan PhD · Stephen F Wilson PhD, FRACGP, FAFRM · Guy B Marks MB BS, PhD, FRACP

Objective: To determine whether sleep duration of Australian adults has declined over recent years.Design: Analysis of nationally representative data from repeated cross-sectional time-use surveys conducted in 1992, 1997 and 2006.Setting: Private households in Australia.Participants: Respondents aged 15 years and over (N = 21 195) who completed time-use diaries over two consecutive days.Main outcome measure: Change in sleep duration by sociodemographic group.Results: Mean sleep duration was 8 h 20 min in 1992, 8 h 33 min in 1997, and 8 h 30 min in 2006 (SEM for all years, 1 min). After adjustment for sampling during weekends and different seasons, there was no significant change in sleep duration from 1992 to 2006 (adjusted difference, 2 min; 95% CI, − 2 to 5 min; P = 0.33). The only significant decreases in sleep duration were observed in people aged 65 years and over (adjusted difference, 12 min; 95% CI, 4–19 min; P < 0.001), people with no income (adjusted difference, 17 min; 95% CI, 7–27 min; P = 0.001) and male carers (adjusted difference, 31 min; 95% CI, 9–53 min; P = 0.002), although people in these groups reported over 8 h sleep on average.Conclusions: Most Australian adults were not sleeping less in 2006 than they did in 1992. Public health concerns over declining sleep duration do not appear to be warranted. Investigation of possible changes in quality of sleep is required.

Yu Sun Bin BSc(Hons) · Nathaniel S Marshall PhD · Nicholas S Glozier MB BS, MRCPsych, PhD