Continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea (OSA) treatment and can provide rapid symptomatic relief. However, long-term adherence is often suboptimal, and a device-focused model may overlook upstream lifestyle and metabolic drivers. Increasing evidence shows that OSA commonly coexists with, and is partly driven by, modifiable factors such as poor diet quality, physical inactivity, alcohol use, circadian disruption, and adiposity. Emerging anti-obesity pharmacotherapies further support the concept that modifying mechanical and metabolic control can markedly reduce OSA severity. Framing OSA within a lifestyle-metabolic paradigm may therefore improve both symptom control and long-term cardiometabolic outcomes. In this perspective with targeted evidence synthesis, we argue for integration of structured lifestyle and behavioural interventions into routine OSA care and outline a pragmatic multidisciplinary model for implementation. Randomised controlled trials consistently show that healthy dietary patterns, structured physical activity, alcohol reduction, and interdisciplinary lifestyle programmes can reduce OSA severity, daytime sleepiness, and cardiometabolic risk markers. Some benefits appear to occur without substantial weight loss, suggesting additional mechanisms such as improved ventilatory stability, reduced rostral fluid shift, enhanced upper-airway neuromuscular responsiveness, and lower systemic inflammation. We therefore propose expansion, rather than replacement, of the current disease model by pairing airway therapies with structured lifestyle and metabolic risk modification from the time of diagnosis. This integrated, whole-person approach has the potential to improve quality of life, enhance treatment durability, and reduce long-term cardiovascular and metabolic complications. Aligning funding models, implementation pathways, and research priorities with this framework could help shift OSA care from device dependent nocturnal symptom control toward sustained health gains across the life course.

ObjectiveEvidence-based insomnia guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment. However, many people with insomnia are prescribed sedative-hypnotic medications. To understand this gap between guidelines and practice, this study surveyed people seeking treatment for insomnia about their help-seeking experiences and treatment preferences.MethodsAustralian adults who had previously expressed interest in a clinical trial of insomnia treatments were invited to complete a detailed online survey assessing their sleep difficulties, help seeking behaviours, and treatment preferences.ResultsAmong 745 adults responding to the survey (Mean +/- SD = 54 +/- 13 years, 69% Female), 74.5% reported an Insomnia Severity Index (ISI) score >= 15 indicating clinical insomnia symptoms and only 3 people (0.4%) reported receiving CBTi which included behavioural components. Among respondents with clinical insomnia symptoms, 64% had discussed sleep with their general practitioner but only 16% saw a psychologist about their sleep. Lack of referral to a psychologist (44%) and concerns about costs associated with treatment (21%) were the main reasons for not seeing a psychologist.ConclusionsThese findings highlight opportunities to directly address barriers in the management of insomnia. To improve access and use of CBTi it is important to increase public awareness and availability so more people with insomnia can access effective treatment.

CONTEXT:A suboptimal diet is a leading factor in the current burden of chronic diseases. In Australia, dietary factors contribute to one-fifth of the chronic disease burden. Understanding the dietary patterns of Australian adults and summarizing their effects on chronic conditions are imperative for improving interventions targeting dietary behaviors. OBJECTIVE:This systematic review aims to summarize the dietary patterns of Australian adults derived using a posteriori and hybrid analysis methods and their associations with adverse health outcomes. DATA SOURCES:Six databases were first searched in December 2020 and updated in August 2023. DATA EXTRACTION:Cardiometabolic health, cardiovascular mortality, cancer, pregnancy-related metabolic conditions (gestational diabetes mellitus [GDM] or hypertensive disorders during pregnancy [HDP]), mental health, and cognitive function were the main health outcomes. DATA ANALYSIS:Dietary patterns from each study were classified as either healthy or unhealthy. A narrative synthesis was used to describe the association of dietary patterns with adverse health outcomes in longitudinal studies. Fifty-nine observational studies (31 cross-sectional, 3 case-control, 22 longitudinal, and 3 combining both cross-sectional and longitudinal designs) were included, involving a total of 362 263 participants aged 18 years and older. CONCLUSION:Higher adherence to a healthy dietary pattern (characterized by higher consumption of dark-yellow, green leafy, cruciferous vegetables and fruits, nuts, whole grains, tomatoes, fish, and low-fat dairy) is associated with improved cardiometabolic risk factors, reduced risk of GDM and HDP, better mental health, and improved pregnancy outcomes. On the other hand, an unhealthy dietary pattern (characterized by a higher intake of processed and red meat, takeaway foods, white bread, high-fat dairy, potatoes, discretionary fat, sweet snacks, soft drinks, fat spreads, jam, and Vegemite) is linked to increased cardiometabolic risks. Overall, while healthy dietary patterns are associated with a reduced risk of several physical and mental health outcomes, unhealthy dietary patterns are linked to an increased risk in Australian adults. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42023452960.

Disclosure: E. Mignone: None. A. Vincent: None. S. Appleton: None. R. Adams: None. G.A. Wittert: None. Background: Obstructive sleep apnoea (OSA) is characterized by recurrent episodes of hypoxaemia due to upper airway obstruction during sleep. The reported prevalence of OSA in patients with type 2 diabetes (T2D) ranges from 23-86%. When co-existing, there is an association with poor glycaemic control and increased microvascular complications. Aim: To determine whether men with T2D should be routinely screened for OSA by polysomnography (PSG). Methods: Cross-sectional analysis of participants in the “sleep sub-study” (N=861) of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study, a prospective cohort study of community dwelling men in South Australia. The analysis set was 834 men aged 44-88 years. The severity of OSA, assessed by home PSG, was graded using the Apnea Hypopnea Index (AHI); mild 10-19, moderate 20-29 and severe ≥ 30. T2D was determined by medication use, fasting glucose or HbA1c. Associations with OSA and severe OSA were assessed by proportional odds (PPO) and logistic regressions adjusted for age and BMI. Mediation analysis used a linear outcome model for log AHI and a PPO mediation model for T2D. Results: There were 120, 195, and 519 men with T2D, pre- T2D and no T2D respectively. The mean BMI was 30.3, 28.9, and 28.2, for T2D, pre-T2D and no T2D groups respectively. The prevalence of moderate or severe OSA in men with T2D [95%CI] was 28.3% [20.5-37.3], compared to 29.7% [23.4-36.7] and 24.3% [20.6-28.2] with pre-T2D or no T2D respectively. Severe OSA prevalence was 17.5% [11.2-25.5], 15.9% [11.1-21.8] and 9.8% [7.4-12.7] in T2D, pre-T2D and no T2D respectively. Moderate or severe REM-OSA prevalence was 45.8% [36.7-55.2] with T2D, compared to 36.9% [30.1-44.1] with pre-T2D and 35.1% [31-39.3] with no diabetes. T2D was associated with OSA (p=0.004) and REM-OSA (p=0.02). Pre-T2D was not associated with OSA (p=0.08) nor REM-OSA (p=0.26). On multivariable analysis age (p=0.0002) and BMI (p<0.0001) but not T2D associated with OSA of any severity, and similar results for REM-OSA. T2D did not mediate the association between BMI and OSA (p=0.66). Conclusion: There is a higher risk of severe OSA and REM-OSA in men with T2D compared to those without T2D. This is not independently mediated by the presence of diabetes, and instead by age and BMI. Although not independently associated, OSA should be excluded by PSG in men with T2D given the high prevalence and implications for glycaemic control and complication risk. Presentation: Monday, July 14, 2025

Abstract Objectives Altered sleep microarchitecture including sleep spindles and decline in cognitive function occurs with advancing age. However, the longitudinal relationship between changes in sleep neurophysiology and cognition in middle-to-late life is currently unclear. This study examined sleep micro-architecture measured by electroencephalography (EEG) and cognitive performance in middle-aged and older men over a 10-year period. Methods 156 participants from the Florey Adelaide Male Ageing Study who reported no previous obstructive sleep apnoea diagnosis underwent home-based polysomnography and cognitive testing including mini mental state examination (MMSE) and trail-making tests A (visual attention) and B (executive function) at baseline (2010-2011) and follow up (2019-2020). Power spectral analysis of single-channel EEG (F4-M1) recordings at follow up (n=142) was performed. Baseline and follow-up sleep parameters including spindle metrics, and cognition were compared using paired t-tests, and associations examined with Pearson’s correlations. Results NREM (267.6 vs 299.2 minutes) and REM (57.0 vs 77.7 minutes) sleep was higher during follow up compared to baseline (p <0.001). NREM sleep spindle events (257.5 vs 351.7) and spindle density (0.95 to 1.17 events/minute) was higher at follow-up (p <0.001). Performance on the TMT was worse (TMT-A: 15.4 vs. 38.7 seconds, TMT-B: 74.9 vs. 93.7 seconds, p <.001), indicating cognitive decline in these domains. There was no change in MMSE. The change in sleep spindles and cognition were not correlated. Conclusions In this community-dwelling cohort of men, no longitudinal relationship between sleep spindles and cognitive function was observed. The unexpected increase in spindle activity across the 10-year follow-up warrants further exploration.

Snoring may be a risk factor for cardiovascular disease independent of other co-morbidities. However, most prior studies have relied on subjective, self-report, snoring evaluation. This study assessed snoring prevalence objectively over multiple months using in-home monitoring technology, and its association with hypertension prevalence. In this study, 12,287 participants were monitored nightly for approximately six months using under-the-mattress sensor technology to estimate the average percentage of sleep time spent snoring per night and the estimated apnea-hypopnea index (eAHI). Blood pressure cuff measurements from multiple daytime assessments were averaged to define uncontrolled hypertension based on mean systolic blood pressure≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between snoring and uncontrolled hypertension were examined using logistic regressions controlled for age, body mass index, sex, and eAHI. Participants were middle-aged (mean ± SD; 50 ± 12 y) and most were male (88%). There were 2467 cases (20%) with uncontrolled hypertension. Approximately 29, 14 and 7% of the study population snored for an average of >10, 20, and 30% per night, respectively. A higher proportion of time spent snoring (75th vs. 5th; 12% vs. 0.04%) was associated with a ~1.9-fold increase (OR [95%CI]; 1.87 [1.63, 2.15]) in uncontrolled hypertension independent of sleep apnea. Multi-night objective snoring assessments and repeat daytime blood pressure recordings in a large global consumer sample, indicate that snoring is common and positively associated with hypertension. These findings highlight the potential clinical utility of simple, objective, and noninvasive methods to detect snoring and its potential adverse health consequences.

Obstructive sleep apnea (OSA) has been associated with incident type 2 diabetes mellitus (T2DM); however, few prospective epidemiological studies have accounted for important T2DM predictors including pre-diabetes status and testosterone. Participants in the longitudinal Men Androgens Inflammation Lifestyles Environment and Stress (MAILES) study, who underwent eight-channel home-based polysomnography (PSG) in 2010-2011 (n = 824) and were free of diabetes at baseline were included in the analysis (n = 682). From 2015 to 2021, 78.6% (n = 536) completed at least one follow-up assessment. Incident T2DM was determined by self-reported doctor diagnosis, diabetes medications, plasma glucose (fasting >= 7.0 mmol/L or random >= 11.0 mmol/L) or glycated haemoglobin >= 6.5%. Conservative hierarchical Poisson regression models adjusted associations of PSG metrics (categorical and continuous) for age, waist circumference, baseline fasting glucose and testosterone concentrations. In all, 52 men (9.7%) developed T2DM over a mean (range) of 8.3 (3.5-10.5) years. Significant age- and waist circumference-adjusted association of incident T2DM with rapid eye movement (REM) sleep apnea-hypopnea index (AHI) >= 20 events/h (incidence rate ratio [IRR] 1.5, 95% confidence interval [CI] 0.8-2.8; p = 0.23] and highest quartile of delta index (IRR 2.1, 95% CI 0.95-4.6; p = 0.066) were attenuated after adjustment for baseline glucose and testosterone, and the association with the lowest quartile of mean oxygen saturation persisted (IRR 4.2, 95% CI 1.7-10.3; p = 0.029). Categorical measures of AHI severity, oxygen desaturation index, and hypoxia burden index (HBI) were not independently associated with incident T2DM. Associations with T2DM were similar when continuous PSG variables were used; however, HBI was significant (IRR 1.015, 95% CI 1.006-1.024; p = 0.007). In a sub-sample with OSA treatment data (n = 479), these significant associations persisted after excluding adequately treated OSA (n = 32). Understanding underlying OSA endotypes generating hypoxaemia may identify opportunities for diabetes prevention.

Background: Insomnia is more prevalent in females, however studies examining sex differences in response to insomnia treatment are scarce. This study assessed sex-specific differences in cognitive behavioural therapy for insomnia (CBT-I)-related changes in insomnia symptoms in a large clinical cohort. Methods: A chart review was conducted of a clinical cohort (females n = 305, males n = 150) referred to a sleep clinic. Participants had a registered psychologist confirm diagnosis of chronic insomnia according to DSM-IV/V criteria and a Level 1 or 2 sleep study. Daily sleep diaries and questionnaires including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), the Daytime Feelings and Functioning Scale (DFFS), and the Depression, Anxiety and Stress Scale-21 items (DASS), were administered at baseline, post-treatment, and three-month follow-up. Linear mixed models determined interactions between sex and timepoint on symptoms. Results: Mean (SD) age was 51.7 yrs (15.7, range = 18-90 yrs), and mean BMI was 26.3 kg/m2 (4.9), neither of which differed by sex. At pre-treatment, females demonstrated higher objective total sleep time (min) [343.5 (97.6) vs 323.8 min (92.1), p = 0.044], ISI [19.7 (4.2) vs 18.6 (4.4), p = 0.033], and FFS scores [19.2 (6.0) vs 16.9 (7.2), p = 0.003]. Compared to males, females experienced a greater reduction in FFS and DFFS scores and DASS depressive symptoms (p for interaction: 0.017, 0.043, 0.016 respectively) from baseline to follow-up. The greater reduction in depressive symptoms did not persist after controlling for age, BMI, and sleep apnea severity. Subjective total sleep time similarly increased across treatment for both males [baseline: 335.7 (15.1), post: 357.9 (15.5)] and females [baseline: 318.3 (10.4), post: 354.4 (10.7)], p for interaction: 0.22. Conclusion: Females and males experience similar, substantial benefits from CBT-I after accounting for comorbidities, suggesting the same treatment can resolve insomnia in both sexes.

Objective Examine how sleep affects objective measures of sleep. Design Prospective observation. Setting Tertiary care sleep unit. Participants Athletes diagnosed with a concussion. Interventions (or Assessment of Risk Factors) Overnight polysomnographic measures of sleep, including electroencephalography, oculography, chin electromyography, heart rate, and oxygen saturation. Outcome Measures Changes in sleep measures from acute post-concussion (within 7 days) to sub-acute post-concussion (8 weeks). Sleep measures included; Sleep stage, being stage 1, stage 2, deep sleep, and rapid eye movement, sleep efficiency, sleep stage onset latency, and total sleep time. Main Results Ten participants participated (median age 24, range 20–52 years, mean BMI 23.7±2.3kg.m-2, 7/10 previous concussions). The paired-sample t-tests showed that compared to the acute phase of concussion, the sub-acute phase of concussion experienced significantly improved sleep efficiency (88.9% vs 93.2%, t9 = 4.1, p = 0.003), reduced wake after sleep onset (45.6 mins vs 25.1 mins, t9 = 2.8, p = 0.02), and reduced latencies for both stage N3 sleep (86.8 mins vs 43.7 mins, t9 = 3.1, p = 0.014) and stage REM sleep (170.0 mins vs 89.2 mins, t9 = 3.5, p = 0.006). No other differences existed between the other sleep metrics. Conclusions The results of this study indicated sleep efficiency increased from acute to sub-acute concussion, whilst onset to deep sleep and REM sleep reduced. Future research should examine greater numbers, as well as endeavour to undertake baseline testing.

Abstract Background There is increasing evidence of ongoing inequity in the provision of sleep healthcare for Indigenous Australians. This cross-sectional review aims to capture the prevalence self-reported symptoms of poor sleep and correlating factors influencing this from an Indigenous perspective. Methods This survey data was collected as part of the Indigenous Human Papilloma and Oropharyngeal Squamous Cell Carcinoma study with demographic data and sleep indices collected at the 24 month follow up time point. Participants were >18 years of age, identified as Aboriginal and/or Torres Strait Islanders, and were recruited from Aboriginal Community Controlled Health Organisations in South Australia from February 2018 to January 2019. Progress to date 729 responses were collected from participants aged 18 to 79, with 227 (31.1%) males and 502 (68.9%) females . Most participants lived in rural locations (62.9% [457/727]). 21.9% (75/343) participants reported witnessed loud snoring three or more times/week, with 16.1% (55/342) reporting witnessed apnoea once or more per week. Top End Sleepiness Score of ≥8 which has been associated with moderate to severe obstructive sleep apnoea was reported in 6.6% (48) of participants. Further data analysis is underway. Intended outcome and impact This survey of Indigenous Australians included demographic details, OSA-50 scores, TESS scores, subjective assessment of factors determining sleep quality, as well as social determinants of sleep health. Correlating this data will provide a fuller understanding of the current self-perception of sleep and factors affecting it in this population.

Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence-based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are: Weight loss, and reduced alcohol consumption should be recommended, where appropriate If clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advised Positional therapy should be considered in supine dominant snorers In dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physician Continuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to try Surgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non-surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association.

Background Snoring may be a risk factor for cardiovascular disease and stroke. However, most prior studies have relied on subjective snoring evaluation from self-reports, or relatively short time-scale objective measures in small samples. This study assessed the prevalence of objectively quantified snoring measured over multiple months, and its association with blood pressure and hypertension. Methods 12,287 participants were monitored nightly in-home for approximately six months using an under-the-mattress sleep sensor to estimate the average percentage of sleep time spent snoring per night and the apnea-hypopnea index (AHI). Blood pressure cuff measurements from multiple daytime assessments were averaged to define uncontrolled hypertension based on mean systolic blood pressure ≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between snoring and uncontrolled hypertension were examined using logistic regressions controlled for age, body mass index (BMI), sex, and AHI. Findings Participants were predominantly middle-aged (mean±SD; 50±12 y) and male (88%). There were 2,467 cases (20%) with uncontrolled hypertension. Approximately 29, 14 and 7% of the study population snored for an average of >10, 20, and 30% per night, respectively. A higher proportion of time spent snoring (75th vs. 5th; 12% vs. 0·04%) was associated with an ∼1·9-fold increase (OR [95%CI]; 1·87 [1·63, 2·15]) in uncontrolled hypertension independent of sleep apnea. The effect size of the association between snoring and uncontrolled hypertension was higher in younger adults and those who were not obese (BMI <30 kg/m2). Interpretations Multi-night recordings in a large consumer sample indicate that snoring is common, and that snoring duration is positively associated with hypertension. These findings highlight the potential clinical utility of simple, objective, and non-invasive methods to detect snoring. Funding Source This was an unfunded, investigator-initiated study led by the Adelaide Institute for Sleep Health sleep research team. DJE is supported by a National Health and Medical Research Council (NHMRC) of Australia Leadership Fellowship (1196261). Evidence before this study We searched PubMed, Google, and Google Scholar for research articles published in English up to June 1, 2022, using common search terms including “wearable”, “nearable”, “sleep apnea”, and “snoring”. Articles were also retrieved through searching the citations of known literature. Snoring is a major feature of sleep disordered breathing, including hypopnea events which reflect partial airway obstruction typically with snoring. A meta-regression of 63 studies reported a highly variable snoring prevalence of between 2-83% in men and between 1-71% in women. These studies relied on self-reported snoring assessments, which may not be sufficiently reliable to evaluate prevalence and potential snoring impacts on cardiovascular health outcomes. A few small scale clinical and epidemiological studies with objective snoring assessments on a single night suggest associations between snoring and adverse cardiovascular health outcomes. However, a recent meta-analysis indicates that assessment of sleep apnea severity is highly variable night to night. Like sleep apnea severity, single time-point estimation of snoring parameters may not reliably reflect potentially problematic features of snoring and cumulative exposure risks over time. Added value of this study We investigated the prevalence of snoring and its association with uncontrolled hypertension on the largest dataset to date (>12,000 participants), including multi-night assessment of snoring over ∼6 months (∼2 million nights in total). Approximately 15% of the study population snored for an average of 20% per night, and a higher proportion of time spent snoring was associated with an 87% increase in uncontrolled hypertension independent of sleep apnea severity. Implications of all the available evidence These findings provide important insight into the consequences of snoring on hypertension risk and highlight the potential need to consider snoring as part of clinical care and management of sleep problems. These findings demonstrate the potential clinical utility of simple, objective, and non-invasive methods to detect and evaluate snoring. ### Competing Interest Statement Outside the submitted work, DJE has had research grants from Bayer, Apnimed, Takeda, Invicta Medical and Eli Lilly and a Cooperative Research Centre Grant (a collaboration between the Australian Government, Academia and Industry- industry partner Oventus Medical). DJE currently serves as a scientific advisor/consultant for Apnimed, Invicta Medical, Bayer and Mosanna. PE serves as a consultant for Withings. Withings provided sleep analysers for a validation trial. None of the other authors have any potential conflicts to declare. ### Funding Statement This was an unfunded, investigator-initiated study led by the Adelaide Institute for Sleep Health sleep research team. DJE is supported by a National Health and Medical Research Council (NHMRC) of Australia Leadership Fellowship (1196261). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The current study was approved by the Flinders University Human Research Ethics Committee (Project number: 4291). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Deidentified data that support the findings of this study, including individual data, are available from the corresponding author upon request subject to ethical and data custodian (Withings) approval.

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.

Purpose: Little is known about sleep after a concussion, a form of mild traumatic brain injury. Given the importance of sleep for both maintaining brain health and recovery from injury, we sought to examine sleep acutely and subacutely after concussion.Methods: Athletes who experienced a sports-related concussion were invited to participate. Participants underwent overnight sleep studies within 7 days of the concussion (acute phase), and again eight-weeks after the concussion (subacute phase). Changes in sleep from both the acute and subacute phases were compared to population normative values. Additionally, changes in sleep from acute to subacute phase were analysed.Results: When compared to normative data, the acute and subacute phases of concussion showed longer total sleep time (p < 0.005) and fewer arousals (p < 0.005). The acute phase showed longer rapid eye movement sleep latency (p = 0.014). The subacute phase showed greater total sleep spent in Stage N3% (p = 0.046), increased sleep efficiency (p < 0.001), shorter sleep onset latency (p = 0.013), and reduced wake after sleep onset (p = 0.013). Compared to the acute phase, the subacute phase experienced improved sleep efficiency (p = 0.003), reduced wake after sleep onset (p = 0.02), and reduced latencies for both stage N3 sleep (p = 0.014) and rapid eye movement sleep (p = 0.006).Conclusion: This study indicated sleep during both the acute and subacute phases of SRC was characterised by longer and less disrupted sleep, along with improvements in sleep from the acute to subacute phases of SRC.