Establishing the acute physiological and sleep disruption characteristics of wind farm versus road traffic noise disturbances in sleep: a randomized controlled trial protocol.

Study Objectives: Despite the global expansion of wind farms, effects of wind farm noise (WFN) on sleep remain poorly understood. This protocol details a randomized controlled trial designed to compare the sleep disruption characteristics of WFN versus road traffic noise (RTN). Methods: This study was a prospective, seven night within-subjects randomized controlled in-laboratory polysomnography-based trial. Four groups of adults were recruited from; <10 km away from a wind farm, including those with, and another group without, noise-related complaints; an urban RTN exposed group; and a group from a quiet rural area. Following an acclimation night, participants were exposed, in random order, to two separate nights with 20-s or 3-min duration WFN and RTN noise samples reproduced at multiple sound pressure levels during established sleep. Four other nights tested for continuous WFN exposure during wake and/or sleep on sleep outcomes. Results: The primary analyses will assess changes in electroencephalography (EEG) assessed as micro-arousals (EEG shifts to faster frequencies lasting 3-15 s) and awakenings (>15 s events) from sleep by each noise type with acute (20-s) and more sustained (3-min) noise exposures. Secondary analyses will compare dose-response effects of sound pressure level and noise type on EEG K-complex probabilities and quantitative EEG measures, and cardiovascular activation responses. Group effects, self-reported noise sensitivity, and wake versus sleep noise exposure effects will also be examined. Conclusions: This study will help to clarify if wind farm noise has different sleep disruption characteristics compared to road traffic noise.

The predictive validity of the family risk survey and child risk survey for identifying persistent firesetting risk.

Young firesetter behavior poses significant risks to individuals and communities. Intervention is important to mitigate youth firesetting, and treatment needs vary depending on underlying motives. Effective screening of persistent firesetter risk to inform intervention approach is critical to ensure appropriate matching of risk and needs. This study aimed to evaluate the utility of the child risk survey (CRS) and family risk survey (FRS) for predicting persistent firesetting risk, and subsequent triaging of cases toward the appropriate treatment. A total of 61 families engaged with the Firelighting Consequences Awareness Program, Melbourne, Australia, completed the CRS and FRS preintervention, and reported their firesetting behavior 1-year postintervention. The CRS was not effective for correctly predicting persistent and nonpersistent firesetters. The FRS was successful at predicting persistent firesetters 85% of the time, but had a high rate of false positives, overclassifying nonpersistent firesetters as high risk. Finally, the actual rate of firesetters that would be deemed suitable for each of the three recommended interventions based on the CRS and FRS scoring protocols was substantially different to the expected rates described in the accompanying manual. Implications for service provision are discussed.

Sleep difficulties among South Sudanese former refugees settled in Australia.

This quantitative study investigated self-reported sleep, mental health and trauma related nocturnal behaviours among South Sudanese Australians (SSA), examined sex differences in their responses, and sought to determine risk factors for insomnia in this population. Comparisons were also made to a general Australian (AUS) sample of 1,512 respondents, obtained in a previously published study using the same questions regarding sleep difficulties. Self-reports of sleep difficulties, psychological distress (Kessler Psychological Distress Scale, K10), and nocturnal post-traumatic stress symptoms (Pittsburgh Sleep Questionnaire Inventory-Addendum, PSQI-A) were obtained from 117 former refugees (aged 16-60 years) who had been resettled for a decade on average. A key finding was that SSA men (n = 62) reported many more problems compared to both SSA women and AUS men. These problems included high rates of clinical insomnia (32%), clinical-level nocturnal post-trauma symptoms (57%), restless legs (31%), daytime sleepiness (40%), fatigue (43%), and waking unrefreshed (55%). Nearly one in five SSA men had "very high psychological distress," a rate 10 times higher than that of men in Victoria and twice as high as SSA women. Analyses suggest that for many SSA men memories and dreams of past traumas may be affecting sleep health, with some improvement over time. It was concluded that men within the South Sudanese Australian community report hitherto unrecognised significant problems with their sleep. The findings are consistent with the interpretation that unresolved pre-migration trauma stress may be affecting the sleep of about half of the South Sudanese men in Australia.

The economic cost of inadequate sleep.

Study Objectives: To estimate the economic cost (financial and nonfinancial) of inadequate sleep in Australia for the 2016-2017 financial year and relate this to likely costs in similar economies. Methods: Analysis was undertaken using prevalence, financial, and nonfinancial cost data derived from national surveys and databases. Costs considered included the following: (1) financial costs associated with health care, informal care provided outside healthcare sector, productivity losses, nonmedical work and vehicle accident costs, deadweight loss through inefficiencies relating to lost taxation revenue and welfare payments; and (2) nonfinancial costs of loss of well-being. They were expressed in US dollars ($). Results: The estimated overall cost of inadequate sleep in Australia in 2016-2017 (population: 24.8 million) was $45.21 billion. The financial cost component was $17.88 billion, comprised of as follows: direct health costs of $160 million for sleep disorders and $1.08 billion for associated conditions; productivity losses of $12.19 billion ($5.22 billion reduced employment, $0.61 billion premature death, $1.73 billion absenteeism, and $4.63 billion presenteeism); nonmedical accident costs of $2.48 billion; informal care costs of $0.41 billion; and deadweight loss of $1.56 billion. The nonfinancial cost of reduced well-being was $27.33 billion. Conclusions: The financial and nonfinancial costs associated with inadequate sleep are substantial. The estimated total financial cost of $17.88 billion represents 1.55 per cent of Australian gross domestic product. The estimated nonfinancial cost of $27.33 billion represents 4.6 per cent of the total Australian burden of disease for the year. These costs warrant substantial investment in preventive health measures to address the issue through education and regulation.

Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons.

BACKGROUND: Preliminary evidence suggests that the enteric microbiota may play a role in the expression of neurological symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Overlapping symptoms with the acute presentation of D-lactic acidosis has prompted the use of antibiotic treatment to target the overgrowth of species within the Streptococcus genus found in commensal enteric microbiota as a possible treatment for neurological symptoms in ME/CFS. METHODS: An open-label, repeated measures design was used to examine treatment efficacy and enable sex comparisons. Participants included 44 adult ME/CFS patients (27 females) from one specialist medical clinic with Streptococcus viable counts above 3.00 × 105 cfu/g (wet weight of faeces) and with a count greater than 5% of the total count of aerobic microorganisms. The 4-week treatment protocol included alternate weeks of Erythromycin (400 mg of erythromycin as ethyl succinate salt) twice daily and probiotic (D-lactate free multistrain probiotic, 5 × 1010 cfu twice daily). 2 × 2 repeated measures ANOVAs were used to assess sex-time interactions and effects across pre- and post-intervention for microbial, lactate and clinical outcomes. Ancillary non-parametric correlations were conducted to examine interactions between change in microbiota and clinical outcomes. RESULTS: Large treatment effects were observed for the intention-to-treat sample with a reduction in Streptococcus viable count and improvement on several clinical outcomes including total symptoms, some sleep (less awakenings, greater efficiency and quality) and cognitive symptoms (attention, processing speed, cognitive flexibility, story memory and verbal fluency). Mood, fatigue and urine D:L lactate ratio remained similar across time. Ancillary results infer that shifts in microbiota were associated with more of the variance in clinical changes for males compared with females. CONCLUSIONS: Results support the notion that specific microorganisms interact with some ME/CFS symptoms and offer promise for the therapeutic potential of targeting gut dysbiosis in this population. Streptococcus spp. are not the primary or sole producers of D-lactate. Further investigation of lactate concentrations are needed to elucidate any role of D-lactate in this population. Concurrent microbial shifts that may be associated with clinical improvement (i.e., increased Bacteroides and Bifidobacterium or decreased Clostridium in males) invite enquiry into alternative strategies for individualised treatment. Trial Registration Australian and New Zealand Clinical Trial Registry (ACTRN12614001077651) 9th October 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366933&isReview=true.

Correction to: Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons.

The original version of this article [1], published on 6 February 2018, contains a mistake in the 'Conclusions' section. The corrected version of the affected sentence is given below and the corrected part is marked in bold.

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review.

BACKGROUND: The pursuit for clarity in diagnostic and treatment pathways for the complex, chronic condition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) continues. This systematic review raises a novel question to explore possible overlapping aetiology in two distinct conditions. Similar neurocognitive symptoms and evidence of D-lactate producing bacteria in ME/CFS raise questions about shared mechanisms with the acute condition of D-lactic acidosis (D-la). METHODS: D-la case reports published between 1965 and March 2016 were reviewed for episodes describing both neurological symptoms and high D-lactate levels. Fifty-nine D-la episodes were included in the qualitative synthesis comparing D-la symptoms with ME/CFS diagnostic criteria. A narrative review of D-la mechanisms and relevance for ME/CFS was provided. RESULTS: The majority of neurological disturbances reported in D-la episodes overlapped with ME/CFS symptoms. Of these, the most frequently reported D-la symptoms were motor disturbances that appear more prominent during severe presentations of ME/CFS. Both patient groups shared a history of gastrointestinal abnormalities and evidence of bacterial dysbiosis, although only preliminary evidence supported the role of lactate-producing bacteria in ME/CFS. LIMITATIONS: Interpretation of results are constrained by both the breadth of symptoms included in ME/CFS diagnostic criteria and the conservative methodology used for D-la symptom classification. Several pathophysiological mechanisms in ME/CFS were not examined. CONCLUSIONS: Shared symptomatology and underlying microbiota-gut-brain interactions raise the possibility of a continuum of acute (D-la) versus chronic (ME/CFS) presentations related to D-lactate absorption. Measurement of D-lactate in ME/CFS is needed to effectively evaluate whether subclinical D-lactate levels affect neurological symptoms in this clinical population.

Support for the microgenderome invites enquiry into sex differences.

The microgenderome defines the interaction between microbiota, sex hormones and the immune system. Our recent research inferred support for the microgenderome by showing sex differences in microbiota-symptom associations in a clinical sample of patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS). This addendum expands upon the sex-specific pattern of associations that were observed. Interpretations are hypothesized in relation to genera versus species-level analyses and D-lactate theory. Evidence of sex-differences invites future research to consider sex comparisons in microbial function even when microbial abundance is statistically similar. Pairing assessment of clinical symptoms with microbial culture, DNA sequencing and metabolomics methods will help advance our current understandings of the role of the microbiome in health and disease.

Support for the Microgenderome: Associations in a Human Clinical Population.

The 'microgenderome' provides a paradigm shift that highlights the role of sex differences in the host-microbiota interaction relevant for autoimmune and neuro-immune conditions. Analysis of cross-sectional self-report and faecal microbial data from 274 patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) suggests that commensal gut microorganisms may play both protective and deleterious roles in symptom expression. Results revealed significant sex-specific interactions between Firmicutes (Clostridium, Streptococcus, Lactobacillus and Enterococcus) and ME/CFS symptoms (including neurological, immune and mood symptoms), regardless of compositional similarity in microbial levels across the sexes. Extending animal studies, we provide support for the microgenderome in a human clinical population. Applied and mechanistic research needs to consider sex-interactions when examining the composition and function of human microbiota.

Congruent Validity of the Strengths and Difficulties Questionnaire to Screen for Comorbidities in Children With ADHD.

OBJECTIVE: This study aimed to determine whether the Strengths and Difficulties Questionnaire (SDQ) is an effective screening tool for identifying comorbid mental health difficulties in children with ADHD. METHOD: Parents of children with ADHD (5-13 years) completed the SDQ and the Anxiety Disorders Interview Schedule for DSM-IV-Parent Version (ADIS-C/P-IV). Data from both the measures were compared to determine congruent validity. RESULTS: Analyses revealed that significant relationships exist between the SDQ total score and the total number of comorbidities on the ADIS-C/P-IV. The SDQ emotional problem and conduct problem scales were significantly related to internalizing and externalizing comorbidities on the ADIS-C/P-IV, respectively. CONCLUSION: While significant relationships were found between the SDQ and ADIS-C/P-IV across various domains, this relationship was stronger for externalizing comorbidities. Additional screening questions are required to effectively screen for less common internalizing comorbidities in children with ADHD, for example, major depression and panic disorder.

Chronic sleep difficulties in non-depressed young women: a longitudinal population-based investigation.

OBJECTIVES/BACKGROUND: Young women are at a risk of poor sleep, but the extent to which their sleep difficulties remain chronic is not known. Little is also known about the frequency of seeking health care for sleep and satisfaction with that health care. This longitudinal study investigated these issues over nine years in women who reported sleep difficulties over the preceding 12 months. PATIENTS/METHODS: Data from the Australian Longitudinal Study on Women's Health were analysed (N = 9683). Information on self-reported sleep difficulties, help seeking, and health-care satisfaction was obtained from four surveys collected from 2000 (aged 22-27 years) to 2009. Generalized estimating equations were conducted to calculate odds ratios (OR) for the likelihood of women who reported sleep difficulties in 2000 to report sleep difficulties at subsequent surveys. RESULTS: The prevalence of self-reported sleep difficulties 'often' was consistent at 9.1-10.8%. Women who reported sleep difficulties 'often' in 2000 had a markedly increased risk of continued sleep difficulties 'often' over the subsequent 9 years [2003: OR (95% confidence interval, CI) = 11.07 (8.03-15.27); 2006: 12.19 (8.08-16.88); 2009: 10.70 (7.57-15.12)]. Of women who reported sleep difficulties 'often' in 2000 (N = 981), 45.1% had persistent sleep problems and 21.1% experienced relapse of symptoms. About one-third of women who reported sleep problems 'often' sought help. CONCLUSION: Self-reported frequent sleep difficulties in non-depressed young women strongly predicted a continuation of this level of sleep difficulty over a decade, even if help is sought. Current health practice may not be breaking the ongoing chronicity of sleep difficulties in young women.

Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study.

Chronic Fatigue Syndrome (CFS) is a multisystem illness, which may be associated with imbalances in gut microbiota. This study builds on recent evidence that sleep may be influenced by gut microbiota, by assessing whether changes to microbiota in a clinical population known to have both poor sleep and high rates of colonization with gram-positive faecal Streptococcus, can improve sleep. Twenty-one CFS participants completed a 22- day open label trial. Faecal microbiota analysis was performed at baseline and at the end of the trial. Participants were administered erythromycin 400 mg b.d. for 6 days. Actigraphy and questionnaires were used to monitor sleep, symptoms and mood. Changes in patients who showed a clinically significant change in faecal Streptococcus after treatment (responders; defined as post-therapy distribution<6%) were compared to participants who did not respond to treatment. In the seven responders, there was a significant increase in actigraphic total sleep time (p=0.028) from baseline to follow up, compared with non-responders. Improved vigour scores were associated with a lower Streptococcus count (ρ=-0.90, p=0.037). For both the responders and the whole group, poorer mood was associated with higher Lactobacillus. Short term antibiotic treatment appears to be insufficient to effect sustainable changes in the gut ecosystem in most CFS participants. Some improvement in objective sleep parameters and mood were found in participants with reduced levels of gram-positive gut microbiota after antibiotic treatment, which is encouraging. Further study of possible links between gut microorganisms and sleep and mood disturbances is warranted.

Beliefs about the 'shape' and continuity of healthy sleep as a function of age.

OBJECTIVE: Treating insomnia includes challenging unrealistic beliefs that may contribute to anxieties and wakefulness. This study explored beliefs about the shape and continuity of healthy adult sleep at different adult ages. METHODS: Younger (n=113, M=21.4 (2.4)) and older adults (n=110, M=72.3 (7.7)) depicted their concept of the normal sleep of both a healthy 18 and 65 year olds. Plots were drawn to show sleep depth and awakenings across the night. RESULTS: Seventy percent conceptualized healthy sleep as an unbroken U shape and 18 year olds were depicted with deeper sleep than 65 year olds. About 95% of younger adults and three quarters of older adults showed both healthy 18 and 65 year olds sleep without awakenings. CONCLUSION: Unrealistic sleep beliefs are widespread, with healthy sleep usually being mistakenly conceptualized as unbroken, even in older adults. Education that awakenings are part of normal sleep may have preventative health implications and reduce sleep anxieties.

Sleep difficulties and the development of depression and anxiety: a longitudinal study of young Australian women.

Previous longitudinal studies have demonstrated that poor sleep may precede depression and anxiety. The current study examined the association between self-reported sleeping difficulties and new onset depression and anxiety in young women. A nationally representative sample of 9,683 young women from the Australian Longitudinal Study of Women's Health was analyzed. Women were surveyed in 2000 (aged 22 to 25 years), 2003, 2006, and 2009. Generalized estimating equations were used to examine the association between sleeping difficulties in 2000 and new-onset depression (excluding postnatal depression) and anxiety at each subsequent survey. Significant increased risk of new onset depression (odds ratio (OR)=2.6 in 2003; OR=4.4 in 2006; OR=4.4 in 2009) and anxiety (OR=2.4 in 2006; OR=2.9 in 2009) was found at each follow-up survey in women who reported sleeping difficulties "often" in 2000. Further research is needed to uncover the mechanisms underlying the link between sleep problems and mental health.

Sleep abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a review.

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a chronic, disabling illness that affects approximately 0.2% of the population. Non-restorative sleep despite sufficient or extended total sleep time is one of the major clinical diagnostic criteria; however, the underlying cause of this symptom is unknown. This review aims to provide a comprehensive overview of the literature examining sleep in CFS/ME and the issues surrounding the current research findings. Polysomnographic and other objective measures of sleep have observed few differences in sleep parameters between CFS/ME patients and healthy controls, although some discrepancies do exist. This lack of significant objective differences contrasts with the common subjective complaints of disturbed and unrefreshed sleep by CFS/ME patients. The emergence of new, more sensitive techniques that examine the microstructure of sleep are showing promise for detecting differences in sleep between patients and healthy individuals. There is preliminary evidence that alterations in sleep stage transitions and sleep instability, and other physiological mechanisms, such as heart rate variability and altered cortisol profiles, may be evident. Future research investigating the etiology of non-restorative sleep in CFS/ME may also help us to undercover the causes of non-restorative sleep and fatigue in other medical conditions.

Population study on the predictors of sleeping difficulties in young Australian women.

Gender disparity in sleep difficulties in young adults may be driven by higher rates of affective disorders in women. This article investigated a range of factors as potential predictors of "difficulty sleeping" in 9,061 women aged 24 to 30 years, using survey data. Regression analyses and odds ratios showed that depression and anxiety symptoms were indeed the greatest predictors of difficulty sleeping. However, 4 variables (binge-drinking, lower qualifications, dissatisfaction with excessive weight, and a history of abuse) also made significant contributions to sleep difficulty when a range of other variables (including depression and anxiety symptoms) were statistically controlled. Affective problems often predict sleep difficulties in young women, but other predictors are also significant and not necessarily intertwined with anxiety and depression.

Fire fatality and alcohol intake: analysis of key risk factors.

OBJECTIVE: After a brief review of the literature on the role of alcohol in residential fire deaths, a comparison of different risk factors for residential fire fatality was undertaken by closely analyzing the circumstances of fire victims as a function of alcohol intake. METHOD: Analyses were based on Australian coroners' fire fatality records for the state of Victoria (1998-2006) and considered demographic, behavioral, and environmental factors for the 95 adult fire victims who were tested for alcohol (64 male, 31 female). RESULTS: Most (58%) had a positive blood alcohol concentration (BAC) test, with 31% of the total sample having a BAC of more than 0.20 gm per 100 ml. Odds ratio analyses showed that four variables were significantly more associated with victims who had consumed alcohol compared with sober victims. In descending odds ratio order, these variables were as follows: (a) being aged 18-60 years, (b) involving smoking materials (e.g. cigarettes, pipes), (c) having no conditions preventing escape, and (d) being male. An important new finding is that fire fatalities with positive BAC levels were more than three times less likely to have their clothing alight or exits blocked than sober fire victims. CONCLUSIONS: The risk of dying in a fire for alcohol-affected people who are capable of being alerted and escaping may be reduced if they can be alerted more quickly and effectively. Suitable measures for improving smoke alarms via interlinking and the use of an alarm signal demonstrated to be more effective at waking sleepers, including those who are alcohol affected, are discussed.

Forced sex: a critical factor in the sleep difficulties of young Australian women.

The prevalence of forced sex and its contribution to sleep difficulties among young Australian women aged 24-30 years (n=9,061) was examined using data from the 2003 Australian Longitudinal Study of Women's Health. The lifetime prevalence of reported forced sex was 8.7%. Significantly higher levels of recurrent sleep difficulties, prescription sleep medication, clinical depression, anxiety disorder, self-harm, and substance use, as well as lower socioeconomic status (SES) indicators, were reported by the forced sex group compared to the no forced sex group. Hierarchical logistic regression revealed the high odds (OR=1.95, CI=1.66-2.26) of recurrent sleep difficulty in such women becomes partially attenuated, but remains statistically significant, after adjusting for key psychological, SES, and behavioral variables. Clinical implications for primary care providers and sleep specialists are discussed. Sleep difficulties are highly prevalent and affect more than 30% of those seeking primary health care (Kushida et al., 2005). They negatively impact on the way a person feels and functions (Dinges et al., 1997) and make a significant contribution to accidents, health care costs, and problems at work (Roth, 2005).

How does the pitch and pattern of a signal affect auditory arousal thresholds?

How arousal thresholds vary with different sounds is a critical issue for emergency awakenings, especially as sleepers are dying in fires despite having a working smoke alarm. Previous research shows that the current high-pitched (3000+ Hz) smoke alarm signal is significantly less effective than an alternative signal, the 520 Hz square wave, in all populations tested. However, as the number of sounds tested has been small further research is needed. Here we measured auditory arousal thresholds (AATs) across signals with a range of characteristics to determine the most effective waking signal. Thirty-nine young adults participated over three nights. In Part A, nine signals were presented in stage 4 sleep with ascending decibel levels. Signals were short beeps in the low- to mid-frequency range with different spectral complexities: square waves, pure tones, whoops and white noise. Part B manipulated temporal patterns, inserting silences of 0, 10 and 21 s after each 12 s of beeps. It was found that the low-frequency (400 and 520 Hz) square waves yielded significantly lower AATs than the alternatives. A trend was found across the three temporal manipulations, with a 10 s intervening silence showing some advantage. These findings support earlier research indicating that the best sound for awakening from deep sleep is a low-frequency square wave. It is argued that the signal with the lowest response threshold when awake may be the same as the most arousing signal when asleep, especially where the sleeper processes the signal as meaningful.