ObjectivesWeight loss is often recommended for individuals with obesity and OSA, however, weight loss is particularly hard for this population. This study investigates how weight and weight change are associated with sleep health in people with OSA.MethodsSleep data were analyzed from participants (n = 28) newly diagnosed with OSA over 12-months during which time they underwent a 6-month weight-loss intervention in a step-wedge design. Sleep duration, sleep regularity, and sleep efficiency were calculated for each participant based on Fitbit data. Linear mixed-effects models were used to examine the relationships between each sleep variable and weight and weight change over the intervention period.ResultsParticipants were middle-aged (51 ± 10 years), living with obesity (32.6 ± 4.4 kg/m2), and severe OSA (AHI 30.5[26.6, 49.8] events/h). There was no association between changes in weight and sleep duration or sleep efficiency. The higher an individual's weight (kg), the more likely they were to have irregular sleep (estimate = 0.81, 95% CI [0.29, 1.32] min, and p = 0.002). Conversely, weight changes (kg) were not associated with changes in sleep regularity (estimate = −0.10, 95% CI [−1.51, 1.31] min, and p = 0.884).ConclusionsHigher weight was associated with worse sleep regularity. However, weight change was not associated with improvements in sleep regularity. Our findings demonstrate an association between weight and poor sleep in people with OSA, but the relationship is likely complex.

Abstract Background Sleep disorders are prevalent with wide-ranging consequences but often underdiagnosed. Previous research indicates low coverage of sleep topics in medical curricula and knowledge gaps in primary care physicians around the world. Methods The medical dean and one staff member from the 22 medical programs in Australia and New Zealand were surveyed about sleep content within the curriculum and barriers and facilitators to providing sleep education. Results Eleven programs responded (48% responding; 5 undergraduate-, 4 postgraduate-entry, 2 both) and reported a median of 4h of sleep education (IQR 1.0 – 5.9h). Most frequently covered topics were normal sleep (91% of respondents), sleep apnoea (91%), insomnia (55%), circadian disorders (51%), sleep and circadian rhythms as related to student wellbeing (45%), movement disorders (36%), hypersomnias (36%), and parasomnias (27%). More than half gave students the opportunity to meet a sleep specialist (55%), but fewer provided opportunities to attend a sleep clinic (36%), observe a sleep investigation (27%), or visit a sleep laboratory (18%). Most respondents (73%) believed sleep content could be increased; these institutions actually provided more sleep education than their counterparts (median 7.4h vs. 3.3h). Respondents suggested professional bodies can help by advising on educational frameworks, developing standard learning outcomes, and creating reference and teaching materials but noted the main barrier of limited space in the curriculum. Conclusions There is scope to improve sleep education in Australian and New Zealand medical programs, however, consensus on core topics and content integration with other disciplines are key, given limited curriculum space and time.

Abstract Introduction Despite having a similar prevalence, OSA in patients of Chinese descent is driven more by anatomical factors compared to Caucasians. However, there is a dearth of evidence investigating the effect of ethnicity on acceptance and usage of positive airway pressure (PAP). This study investigated the PAP acceptance rate and predictors in an ethnically diverse population referred for PAP acclimatisation in a tertiary referral hospital. Methods A retrospective analysis of consecutive PAP acclimatisation trials between 2014-2020 was performed. Patient demographics, polysomnographic variables, and PAP trial variables were compared between groups. Multivariate stepwise logistic regression analyses were performed to identify predictors of PAP acceptance in each group. Results 543 PAP acclimatisation trials were included (10.7% Chinese patients). There were no differences in age, gender or AHI between groups, however the Chinese group had a lower BMI (p<0.001), and higher ESS (p<0.05). There was no difference between groups for average PAP use, residual AHI or PAP acceptance rate (86% vs 92%). Logistic regression analysis revealed that PSG AHI, residual AHI and average PAP usage were predictors of PAP acceptance in Caucasians (adjusted ORs 1.03, 0.90 and 1.01 respectively), but only residual AHI and PAP usage were predictors in Chinese patients (adjusted ORs 0.86, 1.01). Conclusion PAP acceptance was similar in Chinese and Caucasian patients, however severity of disease did not predict acceptance in Chinese patients. Future research should focus on determining if Chinese versus Caucasian ethnicity is an important contributing factor to clinical outcomes and therapeutic responses in OSA.

Abstract Introduction Insomnia and obstructive sleep apnoea (OSA) often co-occur as co-morbid insomnia and obstructive sleep apnoea (COMISA). Despite having a comparable prevalence of OSA with Caucasians, Chinese patients have a distinct OSA phenotype that is less dependent on obesity. However, to date, no studies have investigated COMISA in this population. This study investigated the prevalence and predictors of COMISA in an ethnically diverse clinically referred population for investigation of sleep disordered breathing. Methods Data from 183 patients (27 Chinese, 156 Caucasian) undergoing in-laboratory diagnostic polysomnography were reviewed. COMISA was defined as an apnoea-hypopnea index (AHI) >5 events/hour and an Insomnia Severity Index (ISI) score ≥15. Multivariable logistic and linear regression analyses were carried out on demographic and polysomnographic variables to determine predictors of COMISA and their associations with ISI respectively. Results Despite a similar prevalence of OSA (Caucasian 84.0% vs Chinese 81.5%, p=n.s.), Chinese participants showed significantly higher rates of insomnia (77.8% vs 41.3%, p<0.001) and COMISA (59.3% vs 34.7%, p=0.028) than Caucasians. For Caucasians, Arousal Index (OR: 1.04, p=0.003) and Depression (OR: 1.15, p=0.019) were both significant predictors of COMISA. For Chinese participants, no predictors of COMISA were identified, however both Sleep Onset Latency (SOL) (B=-0.198, p=0.029) and AHI (B=-0.150, p=0.020) inversely predicted ISI. Conclusion In our clinical population, COMISA was more prevalent among Chinese patients, driven by a higher incidence of insomnia. Future research should focus on determining the relative contribution of ethnic physiological differences and immigratory stress to the potential existence of a distinct Chinese COMISA phenotype.

Hospitalised patients are at increased risk of poor sleep quality which can negatively impact on recovery and quality of life. This study aimed to assess sleep quality in hospitalised patients and explore the factors associated with poor sleep. Prospective data were collected from 84 respiratory ward inpatients at time of discharge using a Likert scale questionnaire on contributing factors to sleep quality. Differences between groups reporting good and poor quality sleep were recorded. Most participants (77

Background Obstructive sleep apnoea (OSA) and insomnia are the two most common sleep disorders and are frequent reasons for presentation in Australian general practice. Objective This article describes the development, content and suggested uses of the online sleep health primary care clinical resource, which provides general practitioners and other primary healthcare professionals with evidence -based information on the aetiology, assessment, management, referral and ongoing care for OSA and chronic insomnia. Discussion The Royal Australian College of General Practitioners accepted clinical resource for the management of OSA and chronic insomnia in primary care was developed by the Australian National Centre for Sleep Health Services Research. The resource is designed to be used during consultations (eg following the steps in assessment and management and the use of online questionnaires for the assessment of OSA [Epworth Sleepiness Scale/OSA50/ STOP -Bang] and insomnia [Sleep Condition Indicator/ and Insomnia Severity Index]) and as an education/ training tool (eg evidence on the role of continuous positive airway pressure/mandibular advancement splints for management of OSA and brief behavioural therapy for insomnia/cognitive behavioural therapy for insomnia for the management of insomnia). Aim One of the objectives of the Australian National Centre for Sleep Health Services Research (National Health and Medical Research Council of Australia Centres of Excellence based at Flinders University; www.ncshsr.com) was to develop a sleep health primary care clinical resource. The aim of this article is to provide an overview of the online resource, the development process, website design, intended use by primary care clinicians and future testing and development. professionals involved in the care of OSA and chronic insomnia with up-to-date evidence -based information on the assessment, diagnosis, treatment and referral of OSA and chronic insomnia. Other primary healthcare professionals involved in treating these conditions include primary healthcare nurses, allied health professionals, pharmacists, psychologists and dentists. The resource is designed to be used online, and there is no hard copy version. The website is hosted and maintained by the Australasian Sleep Association (ASA). The resource has been endorsed by the RACGP and ASA, and has already been incorporated into Health Pathways by the Gold Coast Primary Health Network. Work with other Health Pathways teams and Therapeutic Guidelines is planned.

Abstract Introduction Vigilance testing (MSLT and MWT) is time consuming and labour intensive, requiring close to a 24h admission for five-nap MSLTs. Combined with increased referrals for hypersomnia, waiting times for vigilance testing has increased. Modelled on High Intensity Theatre Lists (UK), we re-directed sleep laboratory resources to run an intensive Vigilance Testing Accelerated List (ViTAL) over 1-week. Methods Resource planning and redirection was co-designed with all laboratory staff. All processes ran concurrently for 5 days to maximise throughput. Four beds were allocated for vigilance tests (i.e. 20 vigilance tests), with the remaining two beds available for urgent studies. Urgent sleep study scoring continued; all other operations were suspended. Following approval from hospital executive, laboratory staffing was reconfigured to cover all shifts and other key staff were consulted (kitchen, cleaning). Results 18 of the 20 slots were filled (15 MSLTs, 3 MWTs). Average wait time for vigilance tests reduced from 98 to 42 days. There was no negative impact on wait-times for regular PSG bookings (52 vs 42 days) or PSG scoring turnaround times (8.7 vs 4.7 days) compared to 1 month prior to ViTAL week. To maintain staffing for all shifts, two of six staff worked over their weekly rostered hours. Conclusion This temporary re-direction of resources was effective in managing a ballooning waitlist. Patient response and staff acceptance was high in the setting of co-design. If performed intermittently, this could be a useful tool to reduce waitlist times, noting sustained increases in workload may leave staff susceptible to burnout.

Abstract Background Studies demonstrate sleep loss during hospitalisation is common, with patients averaging 5.7 hours of sleep per night. This is well short of the recommended 7 to 9 hours for optimal recovery. Preceding an intervention to improve sleep through modifying the physical environment and delivery of care, we first need to understand nurses’ perspectives on changing delivery of overnight care, to identify behaviour change techniques that will best support change in practice. Methods This exploratory, cross-sectional study will survey respiratory ward nurses (n=42) in a tertiary hospital. Nurses will be invited to complete a voluntary electronic survey, comprising participant characteristics (e.g., sex, age, years of experience) and 35 5-point Likert scale items informed by the Theoretical Domains Framework (TDF). Results, reported as descriptive statistics, will be mapped to domains of the TDF and the Behaviour Change Wheel to determine the behaviour change techniques that will enable implementation of the practice change. Progress to date The draft “Sleep in Hospital: A Survey of Nurses’ Perspectives” has been completed, incorporating nursing co-design and will undergo pilot-testing and finalisation during June. Following ethical approval, surveys will be distributed, data collected, and analysed prior to SDU 2024. Intended outcome and impact To our knowledge, this is the first Australian study to investigate enablers and barriers to implementing changes in nursing care to sleep in hospital. The results will inform our understanding of how to enable change in care delivery to improve patients’ sleep, with the potential to enhance patient experience and healthcare outcomes.

Abstract Introduction Chronic non-cancer pain (CNCP) is the leading cause of disability globally affecting 20% of adults in Australia. It is associated with poor sleep and increased substance use including prescription medications. This study aimed to determine its prevalence in patients attending a tertiary referral sleep laboratory and assess impact on sleep and the nature of substance use. Methods Participants (n=245, 112 females, 50.0 ± 15.3 years) completed in-lab overnight diagnostic polysomnography and validated pain and sleep questionnaires (including Brief Pain Inventory [BPI]). Pain questionnaires (BPI [Yes/No] and Pain Sleep Questionnaire [75+]) were used to indicate probable CNCP. Fifteen participants with CNCP completed an interview exploring pain and sleep. Results 59.6% indicated CNCP. Those with CNCP were more likely to be older (CNCP 51.6, Controls 47.6, p<0.05), female (p<0.001), had higher BMI (p=0.008) and to rate sleep as fairly or very bad (p<0.05). Participants with BPI interference 5+ (clinically significant) had a higher AHI (p=.028), increased REM latency (p<0.001) and %REM sleep (p<.001). Interviewees indicated poor sleep to be a consequence of pain. Nine described misusing medication including taking more than prescribed (2), medication prescribed to someone else (5), pain medication for sleep (3), and six misusing alcohol (6). Discussion CNCP prevalence in patients attending for a diagnostic sleep study is triple that of the general population. There is concern regarding misuse of prescription medication and alcohol in people with sleep disturbance and CNCP. Consideration should be given to an interdisciplinary approach to pain and sleep management.

Abstract Background & Aim Hospitalised patients are at increased risk of poor sleep which can negatively impact on recovery and quality of life. This study aimed to assess sleep quality in hospitalised patients and explore the factors associated with poorer sleep. Methods A hospital-wide questionnaire completed at discharge as asked patients to rate their sleep quality during their admission. Results were compared between respiratory and non-respiratory inpatients. A more detailed questionnaire rating sleep quality and factors disrupting sleep was completed by respiratory ward inpatients at discharge and combined with medical record review of co-morbidities that may impact on sleep. Results The hospital-wide questionnaire was completed by 619 patients.28% of respiratory ward inpatients reported poor or very poor quality sleep compared to 20% of patients in a general medicine or other subspecialty ward. 83 respiratory inpatients have completed the more detailed questionnaire to date with recruitment ongoing. Sixteen patients (19.3%) reported poor or very poor sleep. These patients were compared to those who reported fair, good, or very good sleep. Age, gender distribution and BMI were similar between both groups. Noise rating was a significantly different between the groups and may predict sleep quality. Conclusion A high proportion of hospitalised patients reported poor sleep quality at our tertiary centre particularly on the respiratory inpatient ward where noise was a significant factor. Further research is needed to determine whether strategies to reduce noise will improved sleep quality and clinical outcomes.

Abstract Study Objectives Obstructive sleep apnea (OSA) is linked to the emergence and progression of cardiovascular complications including hypertension, stroke, arrhythmias, coronary artery disease and heart failure. Epidemiological studies have reported that hypertension is associated with respiratory events during REM sleep. We examined the relationship between respiratory events during REM and morning and evening hypertension in a clinical sleep population. Methods This study included data from in-laboratory diagnostic polysomnographic studies (n=797) from adults attending for investigation of OSA. Hypertension was defined using blood pressure measurements taken in the evening before and morning after polysomnography, and use of anti-hypertensive medication. Regression modelling was undertaken to examine the probability of evening and morning hypertension according to REM apnea hypopnea index (AHI), NREM AHI, gender, age, body mass index (BMI), alcohol use, total sleep time (TST), sleep time SpO2 <90%, smoking and waist-to-hip ratio. Results The probability of morning hypertension was significantly independently associated with age (p<0.001), BMI (p<0.001) and REM AHI (p=0.012). No significant effect was found for male gender, NREM AHI, alcohol use, TST, sleep time SpO2 <90%, smoking or waist-to-hip ratio (p>0.05 for all). The probability of evening hypertension was only significantly associated with age (p<0.001), BMI (p<0.001) and TST (p=0.029). Conclusions Respiratory events during REM sleep are significantly associated with morning hypertension. Future research is needed to determine whether treatment of these events can prevent or reverse morning hypertension.

SUMMARY OF KEY POINTSCOVID‐19 and sleep The COVID‐19 pandemic is associated with an increase in insomnia and impaired sleep quality Health care workers are particularly susceptible and improved with cognitive behavioural therapy for insomnia (CBT‐I) Long COVID has significant effects on sleep OSA impacts on the severity of acute COVID‐19 illness Obstructive sleep apnoea Large trials of clinically representative patients confirm the cardiovascular benefits of CPAP treatment in OSA CPAP may improve long‐term cognitive outcomes in OSA, but further research is needed Racial disparities in OSA prevalence and mortality risk are becoming evident Periodic evaluation of OSA risk in pregnancy is important as timing may be key for intervention to prevent or treat cardiovascular risk factors Insomnia Comorbid insomnia and obstructive sleep apnoea (COMISA) can frequently co‐exist and the combined negative effects of both may be deleterious, particularly to cardiovascular health There is evidence for effectiveness with novel orexin receptor antagonists

Abstract Introduction Late night eating is associated with obstructive sleep apnoea (OSA) and may increase obesity risk. Time Restricted Eating (TRE) involves shifting the eating window to 8-12 continuous hours per day, prompting energy intake to earlier in the day without any complex dietary prescription, and has metabolic benefits. We aimed to investigate timing of food intake in patients with OSA and assess their openness to trial TRE. Methods Adults undergoing in-laboratory diagnostic polysomnography (PSG, n=138, 67 male) completed a dietary questionnaire outlining typical eating habits, including timing of meals, frequency of getting up overnight, and frequency of eating/drinking overnight. Questionnaire responses were reviewed with demographics and PSG variables. Proportions of responses were compared across categories of OSA severity using z-tests. Results Patients with moderate/severe OSA (AHI>15events/h, n=77) were more likely to report getting up at night “often” or “always” compared to patients with no/mild OSA (n=61) (63.6% v 47.5%, p=0.08), more likely to report getting up multiple times (66.2% v 47.5%, p=0.04), and more likely to report eating/drinking overnight (42.9% v 18.0%, p=0.003). 71.0% of all patients indicated they would consider trying a TRE diet, and 71.7% could incorporate a TRE diet into their lifestyle. Conclusion Moderate/severe OSA is associated with an increased likelihood of getting up multiple times overnight, and getting up to eat and drink. Patients in this clinical cohort reported a willingness to trial TRE. Future research should investigate the efficacy of implementing TRE in OSA and evaluating its effect on weight loss and sleep quality.

Medical Journal of AustraliaVolume 219, Issue 3 p. 104-105 Editorials Insomnia and lost productivity among young adults: there is still much work to do Alan Young, Corresponding Author Alan Young [email protected] [email protected] Eastern Health Clinical School, Monash University, Melbourne, VIC Box Hill Hospital, Melbourne, VIC[email protected]; [email protected]Search for more papers by this authorDenise O'Driscoll, Denise O'Driscoll Eastern Health Clinical School, Monash University, Melbourne, VIC Box Hill Hospital, Melbourne, VICSearch for more papers by this author Alan Young, Corresponding Author Alan Young [email protected] [email protected] Eastern Health Clinical School, Monash University, Melbourne, VIC Box Hill Hospital, Melbourne, VIC[email protected]; [email protected]Search for more papers by this authorDenise O'Driscoll, Denise O'Driscoll Eastern Health Clinical School, Monash University, Melbourne, VIC Box Hill Hospital, Melbourne, VICSearch for more papers by this author First published: 03 July 2023 https://doi.org/10.5694/mja2.52025Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1McArdle N, Reynolds AC, Hillman D, et al. Prevalence of common sleep disorders in a middle-aged community sample. J Clin Sleep Med 2022; 18: 1503-1514. 2 Deloitte Economics. Rise and try to shine: the social and economic cost of sleep disorders in Australia. May 2021. https://www2.deloitte.com/au/en/pages/economics/articles/rise-try-to-shine.html (viewed June 2023). 3Reynolds AC, Coenen P, Lechat B, et al. Insomnia and workplace productivity loss among young working adults: a prospective observational study of clinical sleep disorders in a community cohort. Med J Aust 2023; 219: 107-112. 4Jennum P, Coaquira Castro JP, Mettam S, et al. Socioeconomic and humanistic burden of illness of excessive daytime sleepiness severity associated with obstructive sleep apnoea in the European Union 5. Sleep Med 2021; 84: 46-55. 5Kivimäki M, Head J, Ferrie JE, et al. Working while ill as a risk factor for serious coronary events: the Whitehall II study. Am J Public Health 2005; 95: 98-102. 6Collins JJ, Baase CM, Sharda CE, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med 2005; 47: 547-557. 7Kessler RC, Berglund PA, Coulouvrat C, et al. Insomnia and the performance of US workers: results from the America insomnia survey. Sleep 2011; 34: 1161-1171. 8Buysse DJ, Angst J, Gamma A, et al. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep 2008; 31: 473-480. 9 The Lancet. Waking up to the importance of sleep. Lancet 2022; 400: 973. 10Haycock J, Grivell N, Redman A, et al. Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners. BMC Fam Pract 2021; 22: 158. 11 House of Representatives Standing Committee on Health, Aged Care and Sport. Bedtime reading. Inquiry into sleep health awareness in Australia. 4 Apr 2019. https://apo.org.au/node/228986 (viewed June 2023). Volume219, Issue3August 2023Pages 104-105 ReferencesRelatedInformation

Background: In 2016, Melbourne was struck by the world's largest and most devastating epidemic thunderstorm asthma (ETSA) episode. While affected individuals displayed worsened short-term asthma control, little is known about their longer-term natural history, nor about interventions that restore control. Objective: We assessed the asthma symptomatology and related behaviours of ETSA-affected individuals through a single-centre prospective 5-year longitudinal study. We embedded an open-label observational trial investigating the role of grass pollen sublingual tablet (Oralair) allergen immunotherapy in improving asthma and allergic rhinitis symptoms. Methods: Allergic rhinitis symptom severity, frequency of asthma symptoms and inhaled corticosteroid usage were assessed via questionnaire yearly. In 2018, a subgroup of participants was enrolled in an observational study of Oralair treatment compared to control. The active group received Oralair from 2019 to 2021; both groups were followed-up for 5 years. Subgroup analyses were performed for participants with complete datasets, and who completed the trial per-protocol. Results: Year-on-year data across 5 years was available for 30 participants. The rate of persistent asthma symptoms declined from 37% to 7% in 2016 to 2021. Only 10%-27% of participants reported being completely asymptomatic in any given year. The inhaled preventer prescription rate was 67%, with only 35% being adherent. Twenty-seven participants with available data completed the Oralair trial per-protocol. No significant difference was noted between control and active groups for allergic rhinitis symptoms or asthma control, although the Oralair group saw a significant improvement in asthma control comparing 2019 with 2021. Conclusion: This is the longest documented follow-up of ETSA- affected individuals. Five years following sentinel event, there was progressive reduction but some persistence in asthma symptoms. Oralair allergen immunotherapy did not further improve allergic rhinitis or asthma symptoms compared to control, but there were no further ETSA events to test a protective effect during the study period.

Background/Objectives Continuous positive airway pressure (CPAP) concomitant with weight loss is a recommended treatment approach for adults with moderate-severe obstructive sleep apnoea (OSA) and obesity. This requires multiple synchronous behaviour changes. The aim of this study was to examine the effectiveness of a 6-month lifestyle intervention and to determine whether the timing of starting a weight loss attempt affects weight change and trajectory after 12 months in adults newly diagnosed with moderate-severe OSA and treated at home with overnight CPAP. Methods Using a stepped-wedge design, participants were randomised to commence a six-month lifestyle intervention between one and six-months post-enrolment, with a 12-month overall follow-up. Adults ( n = 60, 75% males, mean age 49.4 SD 10.74 years) newly diagnosed with moderate-severe OSA and above a healthy weight (mean BMI 34.1 SD 4.8) were recruited. Results After 12 months, exposure to the intervention (CPAP and lifestyle) resulted in a 3.7 (95% CI: 2.6 to 4.8, p < 0.001) kg loss of weight compared to the control condition (CPAP alone). Timing of the weight loss attempt made no difference to outcomes at 12 months. When exposed to CPAP only (control period) there was no change in body weight (Coef, [95% CI] 0.03, [−0.3 to 0.36], p = 0.86). Conclusions The lifestyle intervention resulted in a modest reduction in body weight, while timing of commencement did not impact the degree of weight loss at 12 months. These findings support the recommendation of adjunctive weight-loss interventions within six-months of starting CPAP.

Abstract Background/Aim Sleep is a restorative process that is vital for maintaining health. Hospital inpatients are at risk of poor sleep, with noise frequently reported as a major disruptor of sleep. This study sought to identify specific sources of noise disrupting sleep in respiratory inpatients. Methods Cross-sectional data were collected from respiratory ward inpatients at time of discharge through medical record review and completion of a questionnaire exploring sleep quality and factors disrupting sleep. Results Data includes 24 participants to date – recruitment continues. The median age was 63 years, thirteen participants (54%) were male and 12 (50%) slept in a shared room. The median number of comorbidities was seven and the most frequent admission diagnosis was COPD (29%). Sixteen patients (67%) rated sleep quality as fair to very poor, and 16 patients (67%) reported poorer sleep compared to home. Noise (10 patients – 42%) and acute medical issues (10 patients – 42%) were most frequently reported as more than a little disruptive to sleep. Seven patients in shared rooms (58%) reported noise as more than a little disruptive to sleep, compared with four patients in single rooms (25%). Environmental noise (e.g. doors banging, overhead speakers) was the most frequently reported source of noise disrupting sleep (7 patients – 29%), followed by other patients (4 patients – 17%). Conclusion Most patients described their sleep in hospital as worse than at home. Noise and acute medical issues disrupted sleep most frequently, with environmental noise and other patients the most frequent noise sources.

Shift work has detrimental effects on healthcare workers, which may be further compounded by frontline work during the COVID-19 pandemic. We postulated that sleep would worsen and distress would increase during COVID-ward service. Doctors (n = 18) were recruited from a tertiary centre during the second wave of the COVID-19 pandemic in Melbourne, Australia. Participants had been rostered ON to consecutive 7 day or night shifts and a week OFF over a fortnight. 9 worked on COVID wards managing positive/suspected COVID patients, and 9 were allocated to general MEDICAL wards. Participants wore wrist actigraphy, and completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Kessler Psychological Distress Scale (K10) at baseline and the end of each week. Both the COVID and MEDICAL groups spent less time in bed and had reduced total sleep time during their week ON shift compared to week OFF shift. The COVID group had worse sleep quality (PSQI Δ + 1.0, 6.8 vs 5.8, p = 0.036), daytime sleepiness (ESS Δ + 2.6, 8 vs 5.4, p = 0.014) and greater distress (K10 Δ + 1.7, 17 vs 15.3, p = 0.002) during their week ON compared to BASELINE. During the COVID-19 pandemic shift workers had poorer sleep during their week ON. Those working on COVID wards had greater distress during their week ON than those working on general MEDICAL wards. It is important to recognise the potential for sleep deficits and greater distress in medical workers during the pandemic.