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Timothy Howarth,1,2 Claire Gibbs,3 Asanga Abeyaratne,4 Subash S Heraganahally1,3,5,6 1Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia; 2Department of Technical Physics, University of Eastern Finland, Kuopio, North Savo, Finland; 3Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia; 4Menzies School of Health Research, Darwin, Northern Territory, Australia; 5Flinders University, College of Medicine and Public Health, Darwin, NT, Australia; 6School of Medicine, Charles Darwin University, Darwin, NT, AustraliaCorrespondence: Subash S Heraganahally, Respiratory and Sleep Medicine, Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, 105, Rocklands Drive, Tiwi, Darwin, NT, Australia, Tel +61-8-89228888, Fax +61-8-89206309, Email hssubhashcmc@hotmail.comBackground: The prevalence of bronchiectasis is significantly higher among adult Aboriginal Australians (the Indigenous peoples of Australia) compared to non-Aboriginal Australians. Currently, there is no well-established tool to assess bronchiectasis severity specific to Indigenous peoples. Nor has the applicability and validity of the two well-established bronchiectasis severity assessment tools - The “Bronchiectasis Severity Index” (BSI) and “FACED” scale been vigorously tested in an Indigenous population. This retrospective study evaluated the validity of the BSI and FACED amongst an adult Aboriginal Australian cohort with bronchiectasis in the Top End Northern Territory (NT) of Australia.Methods: Patients with CT confirmed bronchiectasis identified between 2011 and 2020, residing in the Top End of the NT were eligible to be enrolled. The primary endpoint of 4-year mortality was assessed via hospital records, and sensitivity and specificity of the BSI and FACED assessed against this using area under the curve (AUC) receiver operating characteristics analysis. For patients with missing data, a relative BSI / FACED score was used which divided the score recorded for that patient by the total potential score based on their available clinical data.Results: A total of 456 adult Aboriginal Australian patients > 18 years of age were included (55.5% female, median age 49 years). According to the BSI score 43.4% of patients were assessed to have mild, 30.5% moderate and 26.1% severe bronchiectasis (median score 4 (IQR 2, 8)). According to the FACED 80.9% were assessed to have mild, 17.8% moderate and 1.3% severe (median score of 1 (IQR 0, 2)). Four-year mortality was 11.2% (median age of death 55.6 years). Sensitivity and specificity of the BSI combining moderate and severe were 86.3 and 47.2% respectively, and for severe alone 51% and 77%. Sensitivity and specificity of the FACED combining moderate and severe were 21.6% and 81.2%, respectively, and for severe alone 2% and 98.8%. The AUC for the continuous total BSI was 0.703, and the FACED 0.515. Utilising a relative score, based only on data available for patients with missing data (ie lung function or BMI) resulted in slightly improved AUCs for both the BSI (0.717) and FACED (0.571).Conclusion: Both BSI and FACED bronchiectasis assessment tools may not be ideal in an Indigenous/Aboriginal people’s context. However, it may be reasonable to utilise the relative BSI score in this population until Indigenous people’s specific bronchiectasis severity assessment tools are developed.Plain Language Summary: Adult Indigenous people globally have a higher prevalence of chronic respiratory disorders, and bronchiectasis is no exception. To assess the bronchiectasis severity and to predict future mortality, there are well-established assessment tools. However, the existing bronchiectasis assessment tools are developed predominately from data gathered from non-Indigenous population cohorts. To date, it is unclear if these existing bronchiectasis assessment tools are appropriate or applicable for Indigenous people. Therefore, this study assessed how existing bronchiectasis tools, namely the “Bronchiectasis Severity Index” (BSI) and “FACED” [Forced expiratory volume in 1 s, Age, Chronic colonization, Extension, and Dyspnea] fit for an adult Indigenous/ Aboriginal Australian cohort diagnosed to have bronchiectasis. The results of the study showed that both BSI and FACED assessment tools may not be ideal in the Australian Indigenous/Aboriginal population, due to population demographics and other social determinants, including geographical isolation. Hence, further research is warranted in developing Indigenous/Aboriginal specific bronchiectasis assessment tools.Keywords: assessment, hospital admissions, scale, severity, spirometry, tool

Timothy Howarth,1– 3 Helmi Ben Saad,4 Subash S Heraganahally1,5,6 1Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia; 2Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; 3College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia; 4Faculté de Médecine de Sousse, Hôpital Farhat HACHED de Sousse, Laboratoire de recherche “Insuffisance Cardiaque” (LR12SP09), Université de Sousse, Sousse, Tunisia; 5Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; 6College of Medicine and Public Health, Flinders University, Adelaide, South Australia, AustraliaCorrespondence: Subash S Heraganahally, Email hssubhashcmc@hotmail.com; Subash.heraganahally@nt.gov.auBackground: Sleep disorders such as obstructive sleep apnoea (OSA) are known to overlap significantly with airway diseases in various populations. This study assessed the relationship between lung function parameters against polysomnography (PSG) and continuous positive airway pressure (CPAP) adherence data amongst an Aboriginal Australian population.Methods: Patients who undertook both a diagnostic PSG and spirometry were included. Restrictive, obstructive, and mixed impairments were assessed via global lung function initiative (GLI-2012, ATS/ERS) criteria/guidelines. PSG and CPAP data were evaluated between patients with or without spirometry impairments.Results: Of the total 771 patients, 248 had PSG and spirometry data available (52% female, 44% remote residents, 78% obese). The majority (89%) had OSA (51% severe), 95 (38%) were observed to have a restrictive impairment, and 31 (13%) had an obstructive or mixed impairment on spirometry. Compared to patients with no spirometric impairment, those with restrictive or obstructive/mixed impairments demonstrated significantly lower sleep efficiency (median 84% vs 79% and 78%), higher apnoea-hypopnea index (AHI) during rapid eye movement (REM) sleep (median 32 vs 52 and 55 events/hour), reduced REM oxygen saturation (SpO2) (median 94.0% vs 92.0% and 92.5%) and reduced adherence to CPAP therapy (median 39% vs 22% and 17%). Differences in sleep efficiency, REM AHI, and NREM SpO2 held for patients with obstructive/mixed impairments in multivariate modelling.Conclusion: Aboriginal Australian patients with OSA have a higher concurrent lung function’ impairment. Spirometric impairment appears to negatively influence sleep efficiency, nocturnal SpO2 and CPAP adherence. This may have substantial implications for OSA management among Aboriginal Australians.Keywords: COPD, CPAP, first nations, OSA, sleep apnoea, spirometry

Subash S Heraganahally,1– 3 Timothy P Howarth,3,4 Angus Lloyd,1 Elisha White,3 Antony Veale,5 Helmi Ben Saad6 1Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; 2College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; 3Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia; 4College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia; 5Department of Respiratory and Sleep Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia; 6Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, Research Laboratory “Heart Failure, LR12SP09”, University of Sousse, Sousse, TunisiaCorrespondence: Subash S Heraganahally, Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin Respiratory and Sleep Health, Darwin private Hospital, Darwin, Northern Territory, Australia, Tel +61-8-89228888 ; +61-8-89206306, Fax +61-8-89206309, Email hssubhashcmc@hotmail.com; Subash.heraganahally@nt.gov.auBackground: Among Indigenous Australians, studies examining the clinical significance of airway bronchodilator responsiveness (BDR) are limited. In this retrospective study, we examined the nature of underlying lung disease in adult Indigenous patients with BDR referred for lung function testing (LFT) in the Top End Health Service region of the Northern Territory of Australia.Methods: Presence or absence of BDR as per usual (FVC or FEV1 change pre to post ≥ 12% and ≥ 0.2L) and updated (2021 “> 10% predicted) ATS/ERS criteria among Indigenous and non-Indigenous Australians was determined. The radiological findings in the Indigenous study participants with and without BDR were next assessed for the presence of underlying chronic airway/lung disease.Results: We found that 123/742 (17%) Indigenous and 578/4579 (13%) non-Indigenous patients had a significant BDR. Indigenous patients with BDR were younger (mean difference 7 years), with a greater proportion of females (52 vs 32%), underweight (15 vs 4%) and current smokers (52 vs 25%). Indigenous patients with BDR displayed lower LFT values, and a higher proportion exhibited FVC BDR compared to non-Indigenous (34 vs 20%). Almost half (46%) of Indigenous patients with BDR had evidence of COPD and/or bronchiectasis on radiology. Adjusting for the presence of radiologic or spirometric evidence of COPD, the presence of BDR was similar between Indigenous and non-Indigenous patients (5– 8 vs 7– 11%), irrespective of which BDR criteria was used.Conclusion: BDR was higher overall among Indigenous in comparison to non-Indigenous patients; however, a significant proportion of Indigenous patients demonstrating BDR had evidence of underlying COPD/bronchiectasis. This study highlights that although presence of BDR among Indigenous people may indicate asthma, it may also be observed among patients with COPD/bronchiectasis or could represent asthma/COPD/bronchiectasis overlap. Hence, a combination of clinical history, LFT and radiology should be considered for precise diagnosis of lung disease in this population.Keywords: asthma, airway obstruction, first nations, radiology imaging, reversible airflow obstruction, spirometry

Dorothy FL Sze,1 Timothy P Howarth,2,3 Clair D Lake,4 Helmi Ben Saad,5,6 Subash S Heraganahally1,3,7 1Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia; 2College of Health and Human Sciences, Charles Darwin University, Darwin, NT, Australia; 3Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia; 4Pulmonary Function Laboratory, Royal Darwin Hospital, Darwin, NT, Australia; 5Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia; 6Research laboratory “Heart Failure, LR12SP09”, Farhat HACHED Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia; 7College of Medicine and Public Health, Flinders University, Adelaide, SA, AustraliaCorrespondence: Subash S Heraganahally, Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia, Tel +61-8-89228888, Fax +61-8-89206309, Email hssubhashcmc@hotmail.com; Subash.heraganahally@nt.gov.auBackground: Comparison of spirometry parameters between Indigenous and non-Indigenous patients with underlying chronic obstructive pulmonary disease (COPD) has been sparsely reported in the past. In this study, differences in the lung function parameters (LFPs), in particular spirometry values for forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC ratio between Indigenous and non-Indigenous patients with COPD were assessed.Methods: In this retrospective study, Indigenous and non-Indigenous patients with a diagnosis of COPD between 2012– 2020 according to spirometry criteria (ie; post-bronchodilator (BD) FEV1/FVC < 0.7) were included. A further analysis was undertaken to compare the differences in the spirometry parameters, including lower limit of normal (LLN) values matching for age, sex, height and smoking status between these two diverse ethnic populations.Results: A total of 240/742 (32%) Indigenous and 873/4579 (19%) non-Indigenous patients were identified to fit the criteria for COPD. Indigenous patients were significantly younger (mean difference 9.9 years), with a greater proportion of females (50% vs 33%), underweight (20% vs 8%) and current smokers (47% vs 32%). Prior to matching, Indigenous patients’ post-BD percent predicted values for FVC, FEV1, and FEV1/FVC ratio were 17, 17%, and − 2 points lower (Hedges G measure of effect size large (0.91), large (0.87), and small (0.25), respectively). Among the matched cohort (111 Indigenous and non-Indigenous), Indigenous patients LFPs remained significantly lower, with a mean difference of 16%, 16%, and − 4, respectively (Hedges G large (0.94), large (0.92) and small (0.41), respectively). The differences persisted despite no significant differences in LLN values for these parameters.Conclusion: Indigenous Australian patients with COPD display a significantly different demographic and clinical profile than non-Indigenous patients. LFPs were significantly lower, which may or may not equate to greater severity of disease in the absence of normative predictive lung function reference values specific to this population.Keywords: chronic obstructive pulmonary disease, Global Initiative for Chronic Obstructive Lung Disease, First Nations, Indigenous, lung function test, spirometry

This cross-sectional study assessed the clinical and economic costs (Inpatient Activity Database) associated with hospitalisations due to bronchiectasis exacerbations among adult indigenous patients in the Top End, Northern Territory. Twenty case episodes from 15 indigenous patients with a mean age of 51.8 ± 12.7 years were recorded in a 3-month study window. The estimated cost was AUD 400 579.9, with cost per patient AUD 26 705 over 3 months and average cost per admission AUD 20 029. Extrapolating cost data across a 10-year period gave a conservative estimate of AUD 28 million., (© 2025 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Background: Globally, adult Indigenous people, including Aboriginal Australians, have a high burden of chronic respiratory disorders, and bronchiectasis is no exception. However, literature detailing bronchiectasis disease characteristics among adult Indigenous people is sparse. This study assessed the clinical profile of bronchiectasis among adult Aboriginal Australians and compared against previously published international bronchiectasis registry reports., Methods: Aboriginal Australians aged >18 years with chest CT confirmed bronchiectasis between 2011 and 2020 in the Top End Northern Territory of Australia were included. Demographics, chest CT findings, pulmonary function results, sputum microbiology, coexistent medical comorbidities, and pharmacotherapy use were assessed and compared against five published international bronchiectasis registry reports (Australian (ABR), European (European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC)-Europe), Indian (EMBARC-India), Korean (KMBARC) and the USA (USBRR))., Results: A total of 459 patients were assessed. In comparison with international and non-Aboriginal Australian national cohorts, Aboriginal Australians were younger (median 56 years (IQR (48, 65)); however, sex distribution (55% female) and body mass index (23 kg/m 2 (IQR 19.4-27)) were comparable . Smoking rates were higher at 85% compared with other registry cohorts (22-46%) as was the prevalence of comorbidities (97%): cardiovascular diseases (73%), diabetes mellitus (50%) and chronic obstructive pulmonary disease (83%) compared with other registry cohorts (4-32%; 6-14%; and 14-37%, respectively). Spirometry demonstrated forced expiratory volume in 1 s of 38% predicted in comparison with 61-77% in other cohorts. Sputum microbiology showed Haemophilus influenzae (57%) isolated at 3.4 to 6 times the rate of other registry cohorts and Pseudomonas aeruginosa in 31%. Chest CT demonstrated multilobar and lower lobes involvement in 73% and inhaled pharmacotherapy use was recorded in up to 62% and long-term antibiotics in 5%., Conclusion: The overall bronchiectasis disease burden is higher in Aboriginal Australian adults in comparison with global ethnically diverse non-Indigenous populations. Further efforts are required to address this disparity secondary to bronchiectasis among Indigenous people., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: This pilot study investigated a new simplified OSA screening tool that could be used in primary care/GP settings - the "GPSS" tool - "General Practice Sleep Scale" and compared against common existing OSA screening tools., Methods: A convenience sample of patients attending the respiratory and sleep clinic in the Northern Territory of Australia were included if they completed the GPSS prior to undergoing a diagnostic polysomnography. The GPSS contained 9 questions to provide information on: sex, age, body mass index, neck circumference, snoring, witnessed apnoeas, morning tiredness, daytime sleepiness and presence of hypertension/diabetes/heart disease/depression. Presence of OSA was defined as an apnoea-hypopnoea index of ≥15/hour. The GPSS scoring was developed via log odds of regression predictions for each GPSS question upon OSA., Results: 159 patients (65 % male, median age 45 years) were enrolled. A minimum score of 1 was assigned to GPSS questions, up to 5 for the strongest predictor (neck circumference). The median total GPSS score was 13 (IQR 9, 16) (maximum 22) and correlated strongly with OSA (AUC 0.812 (95 % CI 0.744, 0.881)). Categorised into low (0-7), moderate (8-13) or high risk (>13), a moderate or severe score had sensitivity 100, specificity 34.9 %. The GPSS significantly outperformed the Epworth Sleepiness Scale, Berlin questionnaire and OSA-50, and was comparable but slightly improved against the STOP-Bang., Conclusions: The proposed GPSS tool could be of use in general practice settings. Further prospective research is warranted to test the applicability and adaptability of the GPSS tool in wider population settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Hearing loss (HL) is a leading cause of disability worldwide, but its health-related costs have been incompletely studied. Our objective was to examine the association between HL and direct health care costs and identify subgroups in which costs associated with HL are especially high., Method: This was a retrospective population-based cohort study of adults treated in a universal health care system between April 2008 and March 2019. HL was identified using administrative health data. We estimate health care costs in 2023 Canadian dollars, including costs for hospitalization, provider claims, ambulatory care visits, prescription medications, and long-term care (LTC)., Results: Of 4,424,632 participants, 146,644 (3.3%) had HL. Participants with HL were older ( Mdn = 55 years [interquartile range: 43-68] vs. 35 years [24-50]) and had more comorbidities (1 [0-2] vs. 0 [0-1]) at baseline than participants without, whereas the likelihood of female sex, rural residence, and material deprivation were similar between groups with and without HL. Over median follow-up of 11.0 years, total age-sex adjusted annual health costs and each of its component costs were significantly higher in participants with HL compared to those without (annual total costs: $6,871, 95% confidence interval [CI] [$6,778, $6,962] vs. $4,716, 95% CI [$4,729, $4,763]). After full adjustment (a maximum of 29 comorbidities), annual costs remained significantly higher in participants with HL overall and for certain subcomponents (provider claims, ambulatory visits, and medications), whereas adjusted costs of hospitalization and LTC were lower among people with HL. The magnitude of the incremental costs among participants with HL was most pronounced for younger participants, men, or those with less comorbidity. Total projected annual direct health costs for Alberta residents with HL were $1.01 billion in 2023, of which $125 million (95% CI [$116, $135 million]) was attributable to HL specifically., Conclusions: Compared to those without HL, health costs were markedly higher among participants with HL, partially due to a higher burden of comorbidity. The relatively high population attributable costs of HL suggest that better prevention, recognition, and management of this condition could yield substantial economic benefits., Supplemental Material: https://doi.org/10.23641/asha.27353439.

Background: Chronic respiratory disorders in the adult Aboriginal and Torres Strait Islander population are common, but there is a sparsity of literature detailing an approach to clinical management., Objective: This paper describes a clinical approach to chronic respiratory disorders for clinicians working with Aboriginal and Torres Strait Islander people, particularly in the remote Australian context., Discussion: There are significant differences in the way chronic respiratory diseases manifest in Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians. Chronic obstructive pulmonary disease (COPD), bronchiectasis and asthma often overlap in clinical features, and can be present concurrently. Restrictive impairment on spirometry is common. The presence of bronchodilator response might indicate asthma, but can also be observed in patients with asthma/COPD/bronchiectasis overlap. Because the management of each of these conditions differs, accurate diagnosis and disease severity classification are important, particularly in the prescribing of guideline-recommended inhaled pharmacotherapy.

Introduction: There is limited evidence in the literature illustrating chest computed tomography (CT) characteristics among adult Aboriginal Australians with bronchiectasis. This retrospective study evaluates the radiological characteristics of bronchiectasis in Aboriginal Australians residing in the Top End, Northern Territory of Australia., Methods: Patients aged >18 years with chest CT-confirmed bronchiectasis between 2011 and 2020 were included. Demographics and relevant clinical parameters were collected. Alongside confirming bronchiectasis, chest CT reports were assessed for (i) lobar location (ii) unilateral or bilateral involvement and (iii) bronchiectasis type when available., Results: A total of 459 patients were identified with chest CT-confirmed bronchiectasis, with a median age of 47 years, and 55% were females. Bronchiectasis was predominantly recorded in the left lower lobe (LLL) (73%), followed by the right lower lobe (RLL) (62%) and the left upper lobe (LUL) was least common (22%). Females recorded the right middle lobe (RML) affected significantly more often than males (50 vs. 34%, P = 0.012). Bilateral involvement was common (74%), with the strongest pairwise correlation associated between the right upper lobe (RUL) and LUL (P < 0.001). Cylindrical (50%) and cystic (28%) types were most common. The RML and LLL showed positive correlation with cylindrical and LUL with cystic bronchiectasis. Neither lobar location nor bronchiectasis type showed any significant association with lung function parameters other than RML, Lingula and LUL involvement being associated with better percent predicted values of diffusing capacity for carbon monoxide. There were no significant associations between sputum culture and type or lobar locations of bronchiectasis except for non-Aspergillus fungus culture prevalence was higher with cystic or cylindrical types., Conclusion: The results of this study may be an avenue to develop CT bronchiectasis severity scale in the future specific for Aboriginal Australians., (© 2024 The Authors. Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Radiologists.)

Background: The prevalence of bronchiectasis among adult Aboriginal Australians is higher than that of non-Aboriginal Australians. However, despite evidence to suggest higher prevalence of bronchiectasis among Aboriginal people in Australia, there is sparce evidence in the literature assessing clinical parameters that may predict survival or mortality in this population., Methods: Aboriginal Australians residing in the Top End Health Service region of the Northern Territory of Australia aged >18 years with chest computed tomography (CT) confirmed bronchiectasis between 2011 and 2020 were included. Demographics, body mass index (BMI), medical co-morbidities, lung function data, sputum microbiology, chest CT scan results, hospital admissions restricted to respiratory conditions and all-cause mortality were assessed., Results: A total of 459 patients were included, of whom 146 were recorded deceased (median age at death 59 years). Among the deceased cohort, patients were older (median age 52 vs. 45 years, p = 0.023), had a higher prevalence of chronic obstructive pulmonary disease (91 vs. 79%, p = 0.126), lower lung function parameters (median percentage predicted forced expiratory volume in 1 s 29 vs. 40%, p = 0.149), a significantly greater proportion cultured non- Aspergillus fungi (65 vs. 46%, p = 0.007) and pseudomonas (46 vs. 28%, p = 0.007) on sputum microbiology and demonstrated bilateral involvement on radiology. In multivariate models advancing age, prior pseudomonas culture and Intensive care unit (ICU) visits were associated with increased odds of mortality. Higher BMI, better lung function on spirometry, prior positive sputum microbiology for Haemophilus and use of inhaled long-acting beta antagonist/muscarinic agents may have a favourable effect., Conclusion: The results of this study may be of use to stratify high risk adult Aboriginal patients with bronchiectasis and to develop strategies to prevent future mortality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Heraganahally, Gibbs, Ravichandran, Erdenebayar, Abeyaratne and Howarth.)

Background: Excessive daytime sleepiness (EDS) is a cause of low quality of life among obstructive sleep apnoea (OSA) patients. Current methods of assessing and predicting EDS are limited due to time constraints or differences in subjective experience and scoring. Electroencephalogram (EEG) power spectral densities (PSDs) have shown differences between OSA and non-OSA patients, and fatigued and non-fatigued patients. Therefore, polysomnographic EEG PSDs may be useful to assess the extent of EDS among patients with OSA., Methods: Patients presenting to Israel Loewenstein hospital reporting daytime sleepiness who recorded mild OSA on polysomnography and undertook a multiple sleep latency test. Alpha, beta, and delta relative powers were assessed between patients categorized as non-sleepy (mean sleep latency (MSL) ≥10 min) and sleepy (MSL <10 min)., Results: 139 patients (74% male) were included for analysis. 73 (53%) were categorized as sleepy (median MSL 6.5 min). There were no significant differences in demographics or polysomnographic parameters between sleepy and non-sleepy groups. In multivariate analysis, increasing relative delta frequency power was associated with increased odds of sleepiness (OR 1.025 (95% CI 1.024-1.026)), while relative alpha and beta powers were associated with decreased odds. The effect size of delta PSD on sleepiness was significantly greater than that of either alpha or beta frequencies., Conclusion: Delta PSD during polysomnography is significantly associated with a greater degree of objective daytime sleepiness among patients with mild OSA. Further research is needed to corroborate our findings and identify the direction of potential causal correlation between delta PSD and EDS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Howarth, Tashakori, Karhu, Rusanen, Pitkänen, Oksenberg and Nikkonen.)

Background: This study assessed hospitalisation frequency and related clinical outcomes among adult Aboriginal Australians with bronchiectasis over a ten-year study period., Method: This retrospective study included patients aged ≥ 18 years diagnosed with bronchiectasis between 2011 and 2020 in the Top End, Northern Territory of Australia. Hospital admissions restricted to respiratory conditions (International Classification of Diseases (ICD) code J) and relevant clinical parameters were assessed and compared between those with and without hospital admissions., Results: Of the 459 patients diagnosed to have bronchiectasis, 398 (87%) recorded at least one respiratory related (ICD-J code) hospitalisation during the 10-year window. In comparison to patients with a recorded hospitalisation against those without-hospitalised patients were older (median 57 vs 53 years), predominantly females (54 vs 46%), had lower body mass index (23 vs 26 kg/m 2 ) and had greater concurrent presence of chronic obstructive pulmonary disease (COPD) (88 vs 47%), including demonstrating lower spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ) (median FVC 49 vs 63% & FEV 1 36 vs 55% respectively)). The total hospitalisations accounted for 3,123 admissions (median 4 per patient (IQR 2, 10)), at a median rate of 1 /year (IQR 0.5, 2.2) with a median length of 3 days (IQR 1, 6). Bronchiectasis along with COPD with lower respiratory tract infection (ICD code-J44) was the most common primary diagnosis code, accounting for 56% of presentations and 46% of days in hospital, which was also higher for patients using inhaled corticosteroids (81 vs 52%, p = 0.007). A total of 114 (29%) patients were recorded to have had an ICU admission, with a higher rate, including longer hospital stay among those patients with bronchiectasis and respiratory failure related presentations (32/35, 91%). In multivariate regression model, concurrent presence of COPD or asthma alongside bronchiectasis was associated with shorter times between subsequent hospitalisations (-423 days, p = 0.007 & -119 days, p = 0.02 respectively)., Conclusion: Hospitalisation rates among adult Aboriginal Australians with bronchiectasis are high. Future interventions are required to explore avenues to reduce the overall morbidity associated with bronchiectasis among Aboriginal Australians., (© 2024. The Author(s).)

Objectives: To assess the prevalence of bronchiectasis among Aboriginal and Torres Strait Islander (Indigenous) adults in the Top End of the Northern Territory, and mortality among Indigenous adults with bronchiectasis., Study Design: Retrospective cohort study., Setting, Participants: Aboriginal and Torres Strait Islander adults (18 years or older) living in the Top End Health Service region of the NT in whom bronchiectasis was confirmed by chest computed tomography (CT) during 1 January 2011 - 31 December 2020., Main Outcome Measures: Prevalence of bronchiectasis, and all-cause mortality among Indigenous adults with CT-confirmed bronchiectasis - overall, by sex, and by health district - based on 2011 population numbers (census data)., Results: A total of 23 722 Indigenous adults lived in the Top End Health Service region in 2011; during 2011-2020, 459 people received chest CT-confirmed diagnoses of bronchiectasis. Their median age was 47.5 years (interquartile range [IQR], 39.9-56.8 years), 254 were women (55.3%), and 425 lived in areas classified as remote (93.0%). The estimated prevalence of bronchiectasis was 19.4 per 1000 residents (20.6 per 1000 women; 18.0 per 1000 men). The age-adjusted prevalence of bronchiectasis was 5.0 (95% CI, 1.4-8.5) cases per 1000 people in the Darwin Urban health area, and 18-36 cases per 1000 people in the three non-urban health areas. By 30 April 2023, 195 people with bronchiectasis had died (42.5%), at a median age of 60.3 years (IQR, 50.3-68.9 years)., Conclusion: The prevalence of bronchiectasis burden among Indigenous adults in the Top End of the NT is high, but differed by health district, as is all-cause mortality among adults with bronchiectasis. The socio-demographic and other factors that contribute to the high prevalence of bronchiectasis among Indigenous Australians should be investigated so that interventions for reducing its burden can be developed., (© 2024 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Introduction: Indigenous Australians have a high prevalence of chronic lung diseases. However, no previous studies have reported on cystic lung disease in an Indigenous patient cohort., Methods: This report describes 20 adult Indigenous patients noted to have incidental lung cysts on chest computed tomography (CT) while being referred to undergo lung function tests in the Northern Territory of Australia., Results: Of the total 20 Indigenous patients demonstrating presence of pulmonary cysts on chest CT scan, 13/20 (65%) were males with a mean age of 49.9 years (range 24-74 years), with no significant difference in age between males and females. The majority reported a smoking history and spirometry demonstrated moderate reduction in lung function parameters. While there was no pattern in the size or location of cysts, most demonstrated multiple cysts (55% had ≥5 cysts) with bilateral involvement (65%), alongside a range of concurrent pulmonary radiological abnormalities. The aetiology for lung cysts was largely unknown., Conclusion: This is the first report to illustrate cystic lung disease within an Indigenous population. Further radiology studies are required to investigate the causes and prognostications of cystic lung disease in Indigenous patients., (© 2023 The Authors. Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Radiologists.)

Background: The majority of Indigenous Australians reside in non-urban locations, with reduced access to chest radiology such as computed tomography (CT). Spirometry and chest X-ray (CXR) may be used in the absence of CT; however, the correlation of spirometry indices to CT-defined chronic airway diseases (i.e. chronic obstructive pulmonary disease (COPD) and bronchiectasis) compared with CXR among Indigenous people is sparsely reported., Aim: To evaluate spirometry indices against CXR and CT findings among adult Indigenous Australians., Methods: Indigenous patients who had undergone a spirometry test between 2012 and 2020 and had a CXR or chest CT scan assessed for the presence ( + )/absence ( - ) of airway diseases were included in this study., Results: Of 643 patients (57% female, 31% remote/very remote), 364 (57%) had CT and CXR available. Patients who were 'CT - and CXR - ' for airway diseases (48%) recorded a mean FVC, FEV 1 and FEV 1 /FVC of 61%, 59% and 0.76 compared to 57%, 49% and 0.66 in the 'CT + and CXR - ' group and 53%, 39% and 0.58 in the 'CT + and CXR + ' group. CXR showed sensitivity (44%) and specificity (88%), while spirometry showed 62% and 77% compared to CT. Spirometry demonstrated predominately restrictive impairment among 'CT - and CXR - ' and mixed/obstructive impairment among 'CT + and CXR - ' and 'CT + and CXR + ' groups., Conclusion: Indigenous Australians tend to demonstrate restrictive impairment in the absence of radiological evidence of airway disease. However, in the presence of airway disease, combinations of mixed and obstructive impairments were common. Obstructive impairment shows greater sensitivity for identifying COPD than that shown by CXR; however, CXR shows greater specificity. Hence, spirometry in conjunction with chest radiology should be utilised to aid in the assessment of airway diseases in this population., (© 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Background: Hearing loss (HL) is a leading cause of disability worldwide, but its clinical consequences and population burden have been incompletely studied., Methods: We did a retrospective population-based cohort study of 4,724,646 adults residing in Alberta between April 1, 2004 and March 31, 2019, of whom 152,766 (3.2%) had HL identified using administrative health data. We used administrative data to identify comorbidity and clinical outcomes, including death, myocardial infarction, stroke/transient ischemic attack, depression, dementia, placement in long-term care (LTC), hospitalization, emergency visits, pressure ulcers, adverse drug events and falls. We used Weibull survival models (binary outcomes) and negative binomial models (rate outcomes) to compare the likelihood of outcomes in those with vs without HL. We calculated population-attributable fractions to estimate the number of binary outcomes associated with HL., Findings: The age-sex-standardized prevalence of all 31 comorbidities at baseline was higher among participants with HL than those without. Over median follow-up of 14.4 y and after adjustment for potential confounders at baseline, participants with HL had higher rates of days in hospital (rate ratio 1.65, 95% CI 1.39, 1.97), falls (RR 1.72, 95% CI 1.59, 1.86), adverse drug events (RR 1.40, 95% CI 1.35, 1.45), and emergency visits (RR 1.21, 95% CI 1.14, 1.28) compared to those without, and higher adjusted hazards of death, myocardial infarction, stroke/transient ischemic attack, depression, heart failure, dementia, pressure ulcers and LTC placement. The estimated number of people with HL who required new LTC placement annually in Canada was 15,631, of which 1023 were attributable to HL. Corresponding estimates for new dementia among people with HL were 14,959 and 4350, and for stroke/TIA the estimates were 11,582 and 2242., Interpretation: HL is common, is often accompanied by substantial comorbidity, and is associated with significant increases in risk for a broad range of adverse clinical outcomes, some of which are potentially preventable. This high population health burden suggests that increased and coordinated investment is needed to improve the care of people with HL., Funding: Canadian Institutes of Health Research; David Freeze chair in health services research., Competing Interests: TH is a (non-paid) board director for the Canadian Academy of Audiology. SWK is a director of the Real World Evidence Consortium, and the Alberta Drug and Therapeutic Evaluation Consortium (Universities of Alberta, Calgary, and Institute of Health Economics); these entities receive funding from decision makers and industry to conduct research. All research funding is made to the academic institution; investigator retains full rights of academic freedom and right to publish. This relationship is not related to the current work. Otherwise there were no potential conflicts of interest to declare., (© 2023 The Author(s).)

Objective: To explore how chronic stress, reactivity to acute stress, and obesogenic eating are linked in adolescent females predisposed to obesity., Methods: Participants included 21 adolescent females (m age  = 14.57 years) and their biological mothers with obesity (body mass index [BMI] ≥ 30 kg/m 2 ). The pilot and feasibility study involved adolescent self-report of chronic stress, an acute stress-induction paradigm (Trier Social Stress Task, TSST), salivary cortisol collection to assess stress reactivity, and both subjective (self-report) and objective (snack buffet) measures of obesogenic eating., Results: Adolescent females reporting high chronic stress were significantly more likely to engage in self-reported emotional and external eating and to have higher food cravings (p's < .05) compared to adolescents with low chronic stress. Effect size estimates suggested a blunting effect of cortisol in the high chronic stress group. Blunted cortisol reactivity significantly predicted higher self-reported food cravings for the high chronic stress group (p = .04). Associations among chronic stress, cortisol, and self-reported and objective obesogenic eating reflected medium to large effect sizes., Conclusions: This study built on limited extant research on stress and eating to demonstrate that chronic stress was associated with self-reported obesogenic eating patterns in adolescent females predisposed to obesity. Different patterns of cortisol reactivity and eating emerged depending on chronic stress group (low versus high). Understanding these eating patterns in the context of chronic stress can inform interventions to reduce obesity risks in adolescence., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver disease in youth, yet little is known about the adolescent patient's experience with NAFLD, which is key for treatment engagement. We examined adolescents' experiences with NAFLD diagnosis, thoughts on how NAFLD affects their daily life, understanding and perceptions of diagnosis and treatment, and impressions of how to improve care., Methods: Utilizing a mixed-method design, adolescents with NAFLD (N = 16; Mean age = 15.8 years; Mean BMI = 37 kg/m 2 ) participated in focus groups. To supplement qualitative data, adolescents and their caregiver completed measures assessing illness perceptions, adolescent quality of life, and eating/activity behaviors., Results: Focus group themes suggested reactions to diagnosis varied from unconcerned to anxious. NAFLD diagnosis occurred within the context of other psychological/medical concerns and was not perceived to affect most adolescents' daily lives. Although adolescents understood general contributors to NAFLD, comprehension of their diagnosis varied. Adolescents were more likely to make lifestyle changes when families were supportive, and they preferred tailored recommendations for health behavior change from the healthcare team. Notably, 62.5% of adolescents were more concerned about their weight than NAFLD. Almost half (43.8%) identified as food insecure., Conclusions: Adolescents with NAFLD may benefit from personalized treatment. Care could be enhanced by ensuring comprehension of diagnosis, problem-solving personal, and family barriers and increasing family support. Harnessing adolescents' desire for weight loss may be a more salient driver for change in disease status. Interventions should also address systemic barriers such as food insecurity to ensure equitable care., Competing Interests: Sources of Funding: S.L.L. and K.M.K. were supported, in part, by an NIH post-doctoral training grant (T32 DK063929). The aforementioned funding source played no role in study design, data collection, analysis and interpretation of data, report writing, or in the decision to submit the article for publication. The remaining authors report no conflicts of interest., (Copyright © 2022 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Objectives: Correlational models suggest increased cardiometabolic risk when sleep replaces moderate-to-vigorous (but not sedentary or light) physical activity. This study tested which activity ranges are impacted by experimentally altering adolescents' bedtime., Method: Adolescents completed a 3-week within-subjects crossover experiment with 5 nights of late bedtimes and 5 nights early bedtimes (6.5- and 9.5-hours sleep opportunity, respectively). Experimental condition order was randomized. Waketimes were held constant throughout to mimic school start times. Sleep and physical activity occurred in the natural environments, with lab appointments following each 5-day condition. Waist-worn accelerometers measured physical activity and sedentary behavior. Wrist-worn actigraphs confirmed sleep condition adherence. Wilcoxon tests and linear mixed effects models compared waking activity levels between conditions and across time., Results: Ninety healthy adolescents (14-17 years) completed the study. When in the early (vs. late) bedtime condition, adolescents fell asleep 1.96 hours earlier (SD = 1.08, d = 1.82, p < .0001) and slept 1.49 hours more (SD = 1.01, d = 1.74, p < .0001). They spent 1.68 and 0.32 fewer hours in sedentary behavior (SD = 1.67, d = 1.0, p < .0001) and light physical activity (SD = 0.87, d = 0.37, p = .0005), respectively. This pattern was reflected in increased proportion of waking hours spent in sedentary and light activity. Absolute and proportion of moderate-to-vigorous physical activity did not differ between conditions (d = 0.02, p = .89; d = 0.14, p = .05, respectively)., Conclusions: Inducing earlier bedtimes (allowing for healthy sleep opportunity) did not affect moderate-to-vigorous physical activity. Alternatively, later bedtimes (allowing for ≤ 6.5 hours of sleep opportunity, mimicking common adolescent school night sleep) increased sedentary behavior. Results are reassuring for the benefits of earlier bedtimes., (Copyright © 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Machado-Joseph Disease (MJD), or Spinocerebellar Ataxia Type 3 (SCA3), is a genetic disorder that causes progressive muscle weakness, loss of motor control, ataxia and permanent physical disability. Sleep disturbances are associated with MJD but remain poorly understood., Objective: To investigate frequency and characteristics of sleep disorders and their association with health-related quality of life and psychosocial wellbeing for Aboriginal Australians living with MJD., Methods: A convenience sample of MJD participants n = 24 participated in a semi-attended, ambulatory diagnostic sleep study to capture polysomnography, actigraphy and sleep diary data. Self-report measures collected were the Pittsburgh Sleep Quality Index (PSQI), STOP-BANG Questionnaire for Obstructive Sleep Apnoea (OSA), International Restless Legs Syndrome Study Group rating scale (IRLS), Kessler-5 (K5) and EuroQoL-5 Dimension (EQ5D). Caregivers (n = 22) reported EQ-5D, K5 and bed partners' sleep behaviour (Mayo Sleep Questionnaire-Informant). Environmental factors were measured., Results: We observed Nocturia, Sleep Related Leg Cramps, OSA, REM Behaviour Disorder, and RLS, respectively in 100%, 71%, 47%, 43%, and 33% of participants with a significant positive correlation between Body mass index (BMI) and Apnoea hypopnea index (AHI). The majority of sleep was spent in non-rapid eye movement sleep (NREM)-N2 stage (77.8% (67.7, 81.6)). Overcrowding (92%) and overnight care needs (42%) interrupted sleep. MJD participants and caregivers reported high psychological distress (K5 median 12.5 IQR 7, 16.5 & 8 IQR 6, 12 respectively)., Conclusion: Poor sleep quality and sleep disturbances are prevalent among this cohort. Disease manifestations and environmental factors are driving factors. Larger sample sizes are required to predict risk factors and confirm observed associations., Competing Interests: DLG, LM, GL, BD, JGW were, or are employed by the MJD Foundation., (© 2022 MJD Foundation. Published by Elsevier Inc.)

Background: Clinical characteristics of women with different obstructive sleep apnoea (OSA) severity and adherence to continuous positive airway pressure (CPAP) therapy have not been previously explored., Aims: To assess OSA prevalence, predictors, clinical and polysomnographic (PSG) characteristics and adherence to CPAP therapy among adult Australian women in a retrospective study., Methods: All female patients who underwent a diagnostic PSG between 2014 and 2015 were included. CPAP adherence was assessed during the study period between 2018 and 2019 using multiple regression models., Results: Among a total of 591 women included in this study (Aboriginal, n = 86), OSA was diagnosed in 458/591 (78%) patients; mild, moderate and severe OSA was present in 44%, 27% and 29% respectively. Older age, higher BMI and hypertension predicted the presence and severity of OSA. The Epworth Sleepiness Scale (ESS) score was not significantly different with (8 (5, 12)) or without (10 (5, 13)) OSA. PSG showed the rapid eye movement (REM) sleep-associated apnoea-hypopnea index (AHI) was higher with all severity of OSA. Adherence to CPAP therapy was noted in 171 (57%) patients; 47% mild, 57% moderate and 63% with severe OSA respectively. Three multiple regression models (clinical, PSG parameters, OSA severity, combined (clinical and PSG)) showed the combined model had the strongest predictive value and demonstrated that higher ESS and more severe oxygen desaturation were associated with CPAP adherence irrespective of OSA severity., Conclusions: Older age, higher BMI and the presence of hypertension predicted the presence of OSA. The REM sleep-related AHI was higher. Adherence to CPAP was associated with symptomatic OSA and severe oxygen desaturation., (© 2020 Royal Australasian College of Physicians.)

Background: Obesity has played a central role in heightened coronavirus disease 2019 (COVID-19) risk and vaccine response. COVID-19 vaccine intention among those with a history of severe obesity, specifically those who have undergone bariatric surgery, has not been described. This study aims to examine early COVID-19 vaccine intention among mothers with a history of severe obesity who underwent bariatric surgery., Methods: Sixty-four mothers (M age  = 39.3 years) who underwent bariatric surgery (M time since surgery  = 19.6 months) completed surveys online (November 2020-February 2021). Information obtained included their COVID-19 vaccine intention (vaccine ready, undecided, vaccine opposed). Analyses examined group differences in demographics, body mass index (BMI = kg/m 2 ), knowledge of obesity-related COVID-19 risk, flu vaccination history, general beliefs about vaccine safety/effectiveness, and factors increasing confidence/motivation to obtain a COVID-19 vaccine., Results: Thirty-six (56.3%) mothers had severe obesity (≥ Class II [BMI =  ≥ 35 kg/m 2 ]). The majority were vaccine hesitant (undecided [n = 28; 43.8%]; vaccine opposed [n = 15; 23.4%]). Compared to the vaccine-ready group, vaccine-hesitant groups were younger (p < .05). For the vaccine opposed, recent flu vaccination rates (p = .012) and general belief that vaccines are safe (p = .028) were lower than expected. Among hesitant participants, no reported side effects and the health of self and others were endorsed as top factors increasing vaccine confidence and motivation respectively., Conclusions: While preliminary, the prominence of early vaccine hesitancy in this sample of mothers who have undergone bariatric surgery, with most persisting with severe obesity, indicates a subgroup at high risk. Factors to address through targeted messaging and intervention were identified., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)