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Background: Measurements of upper airway size and shape are important in investigating the pathophysiology of obstructive sleep apnea (OSA) and in devising, applying, and determining the effectiveness of treatment modalities. We describe an endoscopic optical technique (anatomic optical coherence tomography, aOCT) that provides quantitative real-time imaging of the internal anatomy of the human upper airway. Methods: Validation studies were performed by comparing aOCT- and computed tomography (CT)-derived measurements of cross-sectional area (CSA) in (1) conduits in a wax phantom and (2) the velo-, oro-, and hypopharynx during wakefulness in five volunteers. aOCT scanning was performed during sleep in one subject with OSA. Results: aOCT generated images of pharyngeal shape and measurements of CSA and internal dimensions that were comparable to radiographic CT images. The mean difference between aOCT- and CT-derived measurements of CSA in (1) the wax phantom was 2.1 mm(2) with limits of agreement (2 SD) from -13.2 to 17.4 mm(2) and intraclass correlation coefficient of 0.99 (p < 0.001) and (2) the pharyngeal airway was 14.1 mm(2) with limits of agreement from -43.7 to 57.8 mm(2) and intraclass correlation coefficient of 0.89 (p < 0.001). aOCT generated quantitative images of changes in upper airway size and shape before, during, and after an apneic event in an individual with OSA. Conclusions: aOCT generates quantitative, real-time measurements of upper airway size and shape with minimal invasiveness, allowing study over lengthy periods during both sleep and wakefulness. These features should make it useful for study of upper airway behavior to investigate OSA pathophysiology and aid clinical management. [ABSTRACT FROM AUTHOR]

Objectives: To investigate cardiorespiratory and dyspnea responses to incremental and self-paced exercise tests in patients with COPD. Design: A prospective within-subject design was used. Patients: Twenty stable subjects (15 men), with a mean (+/- SD) age of 64.0 +/- 7.5 years and moderate-to-severe COPD (ie, mean FEV(1), 0.8 +/- 0.3 L and 28.9 +/- 7.9% predicted) were studied. Methods: Each subject completed a 6-min walk test (6MWT), an incremental shuttle walking test (ISWT), and a cycle ergometer test (CET), within a 2-week period. The tests were performed at least 24 h apart. Standardized encouragement was utilized in each test with the aim of maximizing performance. Heart rate (HR) and dyspnea were measured each minute throughout the tests, and pulse oximetric saturation (Spo(2)) was measured before and immediately after each test. The distances walked in the 6MWT and ISWT were compared to peak oxygen uptake (Vo(2)) values from the CET. Results: HR increased linearly with increasing workload during the CET and ISWT, but increased alinearly with a disproportionate increase early in the 6MWT. In contrast, dyspnea scores increased linearly during the 6MWT, but increased alinearly with a disproportionate increase late during the CET and ISWT. Peak HR and dyspnea were not significantly different between tests. Spo(2) was significantly lower at the end of both walking tests compared to that at the end of the CET (p < 0.001). The distance walked in both the ISWT and 6MWT were related to peak Vo(2) values on the CET (for both tests, r = 0.73; p < 0.001). Conclusions: The patterns of response in HR and dyspnea seen during the 6MWT suggest that patients with COPD titrate exertion against dyspnea to achieve a peak tolerable intensity. This strategy is not possible in an externally paced ISWT or CET. However, it is a limited strategy, with performance converging at higher workloads. Similar peak exercise responses were achieved in the 6MWT, ISWT, and CET. Greater oxygen desaturation was observed during the field walking tests, suggesting that both the ISWT and 6MWT are more sensitive than the CET in detecting exercise-induced hypoxemia and in assessing ambulatory oxygen therapy needs. [ABSTRACT FROM AUTHOR]

Issues Addressed: We aimed to identify latent health behaviour profiles of young adults and examine their associations with physical and mental health outcomes. We also characterised the profiles by socio-demographic characteristics., Methods: Data were collected between 2012 and 2014. Participants (N = 476) were young adults (M age [SD] = 22.1 [.57] years) from Generation 2 of the Raine Study longitudinal cohort. Health behaviours were measured via ActiGraph GT3X waist monitors (physical activity, sedentary behaviour) and questionnaires (diet quality, alcohol, smoking and sleep). Physical and mental health were measured using clinical health assessments, blood biomarkers, and questionnaires. Latent Profile Analysis using Mplus (8.2) was employed to identify profiles., Results: Four latent profiles were identified: 'heavy drinkers with moderately unhealthy eating habits' (high takeaway foods; n = 135), 'unhealthy food abstainers' (low takeaway foods; n = 138), 'moderately sedentary alcohol abstainers' (n = 139) and 'physically active drinkers with unhealthy eating habits' (high takeaway foods and sugary drinks; n = 64). 'Physically active drinkers with unhealthy eating habits' had the poorest (physical and mental) health outcomes, yet the lowest insulin resistance. 'Unhealthy food abstainers' had the most favourable health outcomes (adiposity, health perceptions, blood pressure). Sex differed among the profiles., Conclusions: The profiles identified among young adults are different to profiles with general adult populations. A novel finding was that 'physically active drinkers with unhealthy eating habits' had low insulin resistance. The findings also suggest that future interventions may need to be sex specific., So What: Our findings suggest that health behaviour interventions for young adults should be targeted to distinct profile characteristics., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Purpose: Artery dysfunction is an early, integral stage in atherogenesis that predicts future cardiovascular events. Sedentary behavior, such as TV watching, is highly prevalent and associated with increased risk of developing cardiovascular diseases. This study investigated whether patterns of TV watching throughout childhood and adolescence were associated with artery function in adulthood., Methods: TV watching data were collected when participants of the Raine Study were aged 5, 8, 10, 14, 17, and 20 yr. Previous latent class analysis indicated three trajectory groups of TV watching: low TV (<14 h·wk -1 ), high TV (>14 h·wk -1 ), and increasing TV (change from low TV to high TV). At age 28 yr, participants were invited to undergo tests of brachial and femoral artery function by flow-mediated dilation (FMD). General linear models examined differences in artery function between TV trajectory groups for men and women., Results: Five hundred sixty participants (n = 261 women, n = 299 men) were included in the study. In women, the low TV group had significantly greater femoral artery FMD (10.8 ± 1.6%) than both High TV (9.0 ± 1.3%, P = 0.005) and Increasing TV groups (8.5 ± 1.3%, P < 0.001); these results were maintained following mediation analysis, including contemporaneous risk factors. There were no significant differences in femoral artery FMD between TV trajectory groups in men ( P = 0.955)., Conclusions: This study suggests that TV watching behaviors during childhood and adolescence may have legacy impacts on artery function at age 28 yr, particularly in women. This may increase the risk of atherosclerotic vascular pathologies in later life., (Copyright © 2023 by the American College of Sports Medicine.)

Background: Obstructive sleep apnoea (OSA) and perioperative respiratory adverse events are significant risks for anaesthesia in children undergoing adenotonsillectomy. Upper airway collapse is a crucial feature of OSA that contributes to respiratory adverse events. A measure of upper airway collapsibility to identify undiagnosed OSA can help guide perioperative management. We investigated the utility of pharyngeal closing pressure (P CLOSE ) for predicting OSA and respiratory adverse events., Methods: Children scheduled for elective adenotonsillectomy underwent in-laboratory polysomnography 2-12 weeks before surgery. P CLOSE measurements were obtained while the child was anaesthetised and breathing spontaneously just before surgery. Logistic regression was used to assess the predictive performance of P CLOSE for detecting OSA and perioperative respiratory adverse events after adjusting for potential covariates., Results: In 52 children (age, mean [standard deviation] 5.7 [1.8] yr; 20 [38%] females), airway collapse during P CLOSE was observed in 42 (81%). Of these, 19 of 42 (45%) patients did not have OSA, 15 (36%) had mild OSA, and eight (19%) had moderate-to-severe OSA. All 10 children with no evidence of airway collapse during the P CLOSE measurements did not have OSA. P CLOSE predicted moderate-to-severe OSA (odds ratio [OR] 1.71; 95% confidence interval [CI]: 1.2-2.8; P=0.011). All children with moderate-to-severe OSA could be identified at a P CLOSE threshold of -4.0 cm H 2 O (100% sensitivity), and most with no or mild OSA were ruled out (64.7% specificity; receiver operating characteristic/area under the curve=0.857). However, there was no significant association between respiratory adverse events and P CLOSE (OR 1.0; 95% CI: 0.8-1.1; P=0.641)., Conclusions: Measurement of P CLOSE after induction of anaesthesia can reliably identify moderate or severe OSA but not perioperative respiratory adverse events in children before adenotonsillectomy., Clinical Trial Registration: ANZCTR ACTRN 12617001503314., (Copyright © 2023 British Journal of Anaesthesia. All rights reserved.)

Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity. To improve sleep health across the globe, a focus on education and awareness, research, and targeted public health policies are needed. We recommend developing sleep health educational programmes and awareness campaigns; increasing, standardising, and centralising data on sleep quantity and quality in every country across the globe; and developing and implementing sleep health policies across sectors of society. Efforts are needed to ensure equity and inclusivity for all people, particularly those who are most socially and economically vulnerable, and historically excluded., Competing Interests: Declaration of interests DCL serves on the scientific advisory board for Apnimed. CMM has received research grants from Eisai, Idorsia, and Lallemand Health; and is a scientific advisory board member and consultant for Eisai and Idorsia. VKS is a consultant for Jazz, Apnimed, Bayer, Lilly, Zoll, and Huxley; and is a scientific advisory board member for Sleep Number. PCZ is a consultant for Eisai, Idorsia, Harmony Bioscience, Jazz, Sleep Number, and CVS Caremark; and serves as President of the World Sleep Society. PRE is a consultant for Invicta Medical. All other authors declare no competing interests., (Copyright © 2023 Copyright © Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: Early-life obstructive sleep apnoea (OSA) predictors are unavailable for young adults. This study identifies early-life factors predisposing young adults to OSA., Methods: This retrospective study included 923 young adults and their mothers from the Western Australian Pregnancy Raine Study Cohort. OSA at 22 years was determined from in-laboratory polysomnography. Logistic regression was used to identify maternal and neonatal factors associated with OSA in young adulthood., Results: OSA was observed in 20.8% (192) participants. Maternal predictors of OSA included gestational diabetes mellitus (odds ratio (OR) 9.54, 95% confidence interval (CI) 1.7, 58.5, P = 0.011), preterm delivery (OR 3.18, 95%CI 1.1,10.5, P = 0.043), preeclampsia (OR 2.95, 95%CI 1.1,8.0, P = 0.034), premature rupture of membranes (OR 2.46, 95%CI 1.2, 5.2, P = 0.015), age ≥35 years (OR 2.28, 95%CI 1.2,4.4, P = 0.011), overweight and obesity (pregnancy BMI≥25 kg/m 2 ) (OR 2.00, 95%CI 1.2,3.2, P = 0.004), pregnancy-induced hypertension (OR 1.89, 95%CI 1.1,3.2, P = 0.019), and Chinese ethnicity (OR 2.36,95%CI 1.01,5.5, P = 0.047). Neonatal predictors included male child (OR 2.10, 95%CI 1.5,3.0, P < 0.0001), presence of meconium-stained liquor during delivery (OR 1.60, 95%CI 1.0,2.5, P = 0.044) and admission to special care nursery (OR 1.51 95%CI 1.0,2.2, P = 0.040). Higher birth lengths reduced OSA odds by 7% for each centimetre (OR 0.93, 95%CI 0.87, 0.99, P = 0.033)., Conclusions: A range of maternal and neonatal factors predict OSA in young adults, including those related to poor maternal metabolic health, high-risk pregnancy and stressful perinatal events. This information could assist in the early identification and management of at-risk individuals and indicates that better maternal health may reduce the likelihood of young adults developing OSA., Competing Interests: Declaration of competing interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Study Objectives: There is currently no way to estimate the period of time a person has had obstructive sleep apnoea (OSA). Such information would allow identification of people who have had an extended exposure period and are therefore at greater risk of other medical disorders; and enable consideration of disease chronicity in the study of OSA pathogenesis/treatment., Method: The 'age of OSA Onset' algorithm was developed in the Wisconsin Sleep Cohort (WSC), in participants who had ≥2 sleep studies and not using continuous positive airway pressure (n = 696). The algorithm was tested in a participant subset from the WSC (n = 154) and the Sleep Heart Health Study (SHHS; n = 705), those with an initial sleep study showing no significant OSA (apnea-hypopnea index (AHI) < 15 events/hr) and later sleep study showing moderate to severe OSA (AHI≥15 events/hr)., Results: Regression analyses were performed to identify variables that predicted change in AHI over time (BMI, sex, and AHI; beta weights and intercept used in the algorithm). In the WSC and SHHS subsamples, the observed years with OSA was 3.6 ± 2.6 and 2.7 ± 0.6 years, the algorithm estimated years with OSA was 10.6 ± 8.2 and 9.0 ± 6.2 years., Conclusions: The OSA-Onset algorithm estimated years of exposure to OSA with an accuracy of between 6.6 and 7.8 years (mean absolute error). Future studies are needed to determine whether the years of exposure derived from the OSA-Onset algorithm is related to worse prognosis, poorer cognitive outcomes, and/or poorer response to treatment., Competing Interests: Declaration of competing interest None., (Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)

Aim: Investigate if childhood measures of sleep health are associated with epigenetic age acceleration in late adolescence., Methods: Parent-reported sleep trajectories from age 5 to 17, self-reported sleep problems at age 17, and six measures of epigenetic age acceleration at age 17 were studied in 1192 young Australians from the Raine Study Gen2., Results: There was no evidence for a relationship between the parent-reported sleep trajectories and epigenetic age acceleration (p ≥ 0.17). There was a positive cross-sectional relationship between self-reported sleep problem score and intrinsic epigenetic age acceleration at age 17 (b = 0.14, p = 0.04), which was attenuated after controlling for depressive symptom score at the same age (b = 0.08, p = 0.34). Follow-up analyses suggested this finding may represent greater overtiredness and intrinsic epigenetic age acceleration in adolescents with higher depressive symptoms., Conclusion: There was no evidence for a relationship between self- or parent-reported sleep health and epigenetic age acceleration in late adolescence after adjusting for depressive symptoms. Mental health should be considered as a potential confounding variable in future research on sleep and epigenetic age acceleration, particularly if subjective measures of sleep are used., (© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

To investigate: (1) whether TV watching habits throughout childhood and adolescence, a proxy of sedentary behaviour, impacted cardiorespiratory fitness (CRF) in adulthood, and (2) whether any potential impact of TV watching in childhood and adolescence on CRF in adulthood was changed by adult physical activity (PA) levels. A longitudinal study with questionnaire data available regarding TV watching collected at ages 5, 8, 10, 14, 17 and 20 yrs, allowed trajectories of TV watching to be developed. At age 28 yrs, participants completed a V̇O 2 peak test and the International Physical Activity Questionnaire. General linear models tested for differences in CRF (time to exhaustion TTE and V̇O 2 peak mL·kg -1 ·min -1 ) between TV watching trajectories. The secondary analysis tested the potential effect current PA levels has on the relationship between TV trajectory and fitness. In total, 449 participants [male n  = 255 (56.8%), 28.3 ± 0.5 yrs; female n  = 194 (43.2%), 28.2 ± 0.4 yrs] were included in the study. Three distinct trajectories of TV watching were identified: High TV, Increasing TV and Low TV. CRF was lowest in the High TV watching trajectory and increased progressively from High to Increasing TV and Increasing to Low TV (all P  < .05). Within each of the TV trajectories, those engaging in high levels of current PA had greater CRF than those engaging in low and moderate PA. TV watching in childhood and adolescence negatively impacts upon adult fitness at the age of 28 years. However, this negative impact of historical TV watching on CRF can largely be attenuated by engaging in higher levels of PA in adulthood.

Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs., Competing Interests: Declaration of competing interest HS reports consultancy and/or research support from Re-Time Pty Ltd, Compumedics Ltd, the American Academy of Sleep Medicine Foundation, and Flinders University, outside of the submitted work. AS reports research funding from ResMed, Philips, the NHMRC, Flinders University and The Hospital Research Foundation, and consultancy work for Australian Doctor and Re-Time Pty Ltd, outside of the submitted work. ACR reports research funding from MSD and Carers Australia through the Sleep Health Foundation, Flinders Foundation, Compumedics Ltd, Safework SA, Sydney Trains and Vanda Pharmaceuticals, outside of the submitted work. Dr. Lovato has received competitive research funding and equipment from Philips Respironics and ResMed as part of NHMRC Centre of Research Excellence (GNT 1134954) and Partnership Grant (GNT 2005779) unrelated to the submitted work. Dr Lovato is also named inventor on 3 patents that are outside of the scope of the submitted work. No other authors report conflicts of interest related to the submitted manuscript., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Study Objectives: We tested a telemedicine model of care to initiate continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA) living in remote Western Australia., Methods: A prospective study comparing telemedicine for CPAP initiation in a remote population versus standard face-to-face CPAP initiation in a metropolitan population. The primary outcome was average nightly CPAP use in the final week of a CPAP trial., Results: A total of 186 participants were allocated to either telemedicine (n = 56) or standard care (n = 130). The average distance from the study center for the telemedicine group was 979 km (±792 km) compared to 19 km (±14 km) for the standard care group. The CPAP trial duration in the standard care group was less than the telemedicine group (37.6 vs 69.9 days, p < .001). CPAP adherence in the telemedicine group was not inferior to standard care (Standard 4.7 ± 0.2 h, Telemedicine 4.7 ± 0.3 h, p = 0.86). No differences were found between groups in residual apnea-hypopnea index, symptom response, sleep specific quality of life at the end of the trial, and continued CPAP use (3-6 months). Participant satisfaction was high in both groups. Total health care costs of the telemedicine model were less than the standard model of care. An estimated A$4538 per participant in travel costs was saved within the telemedicine group by reducing the need to travel to the sleep center for in-person management., Conclusions: In remote dwelling adults starting CPAP for the treatment of OSA, outcomes using telemedicine were comparable to in-person management in a metropolitan setting., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Mental health conditions confer considerable global disease burden in young adults, who are also the highest demographic to work shifts, and of whom 20% meet criteria for a sleep disorder. We aimed to establish the relationship between the combined effect of shift work and sleep disorders, and mental health. The Raine Study is the only longitudinal, population-based birth cohort in the world with gold-standard, Level 1 measurement of sleep (polysomnography, PSG) collected in early adulthood. Participants (aged 22y) underwent in-laboratory PSG and completed detailed sleep questionnaires. Multivariable adjusted robust linear regression models were conducted to explore associations with anxiety (GAD7) and depression (PHQ9), adjusted for sex, health comorbidities, and work hours/week. Data were from 660 employed young adults (27.3% shift workers). At least one clinically significant sleep disorder was present in 18% of shift workers (day, evening and night shifts) and 21% of non-shift workers (p = 0.51); 80% were undiagnosed. Scores for anxiety and depression were not different between shift and non-shift workers (p = 0.29 and p = 0.82); but were higher in those with a sleep disorder than those without (Md(IQR) anxiety: 7.0(4.0-10.0) vs 4.0(1.0-6.0)), and depression: (9.0(5.0-13.0) vs 4.0(2.0-6.0)). Considering evening and night shift workers only (i.e. excluding day shift workers) revealed an interaction between shift work and sleep disorder status for anxiety (p = 0.021), but not depression (p = 0.96), with anxiety scores being highest in those shift workers with a sleep disorder (Md(IQR) 8.5(4.0-12.2). We have shown that clinical sleep disorders are common in young workers and are largely undiagnosed. Measures of mental health do not appear be different between shift and non-shift workers. These findings indicate that the identification and treatment of clinical sleep disorders should be prioritised for young workers as these sleep disorders, rather than shift work per se, are associated with poorer mental health. These negative mental health effects appear to be greatest in those who work evening and/or night shift and have a sleep disorder., (© 2022. The Author(s).)

Study Objectives: Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascular (CV) events in patients randomized to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). This study examined whether randomized study populations were representative of OSA patients attending a sleep clinic., Methods: Sleep clinic patients were 3,965 consecutive adults diagnosed with OSA by in-laboratory polysomnography from 2006 to 2010 at a tertiary hospital sleep clinic. Characteristics of these patients were compared with participants of five recent RCTs examining the effect of CPAP on adverse CV events in OSA. The percentage of patients with severe (apnea-hypopnea index, [AHI] ≥ 30 events/h) or any OSA (AHI ≥ 5 events/h) who met the eligibility criteria of each RCT was determined, and those criteria that excluded the most patients identified., Results: Compared to RCT participants, sleep clinic OSA patients were younger, sleepier, more likely to be female and less likely to have established CV disease. The percentage of patients with severe or any OSA who met the RCT eligibility criteria ranged from 1.2% to 20.9% and 0.8% to 21.9%, respectively. The eligibility criteria that excluded most patients were preexisting CV disease, symptoms of excessive sleepiness, nocturnal hypoxemia and co-morbidities., Conclusions: A minority of sleep clinic patients diagnosed with OSA meet the eligibility criteria of RCTs of CPAP on adverse CV events in OSA. OSA populations in these RCTs differ considerably from typical sleep clinic OSA patients. This suggests that the findings of such OSA treatment-related RCTs are not generalizable to sleep clinic OSA patients.Randomized Intervention with Continuous Positive Airway Pressure in CAD and OSA (RICCADSA) trial, https://clinicaltrials.gov/ct2/show/NCT00519597, ClinicalTrials.gov number, NCT00519597.Usefulness of Nasal Continuous Positive Airway Pressure (CPAP) Treatment in Patients with a First Ever Stroke and Sleep Apnea Syndrome, https://clinicaltrials.gov/ct2/show/NCT00202501, ClinicalTrials.gov number, NCT00202501.Effect of Continuous Positive Airway Pressure (CPAP) on Hypertension and Cardiovascular Morbidity-Mortality in Patients with Sleep Apnea and no Daytime Sleepiness, https://clinicaltrials.gov/ct2/show/NCT00127348, ClinicalTrials.gov number, NCT00127348.Continuous Positive Airway Pressure (CPAP) in Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea (OSA) (ISAACC), https://clinicaltrials.gov/ct2/show/NCT01335087, ClinicalTrials.gov number, NCT01335087., (© Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: Cross-sectional studies have variably reported that poor sleep quality may be associated with myopia in children. Longitudinal data, collected over the ages when myopia develops and progresses, could provide new insights into the sleep-myopia paradigm. This study tested the hypothesis that 12-year trajectories of sleep behaviour from childhood to adolescence is associated with myopia during young adulthood., Methods: At the 5-, 8-, 10-, 14- and 17-year follow-ups of the longitudinal Raine Study, which has been following a cohort since their birth in 1989-1992, participants' parents/guardians completed the Child Behaviour Checklist questionnaire (CBCL), which collected information on their child's sleep behaviour and quality. The CBCL includes six questions measuring sleep behaviour, which parents rated as 0 = not true, 1 = somewhat/sometimes true, or 2 = very/often true. Scores were summed at each follow-up to form a composite "sleep behaviour score". Latent Class Growth Analysis (LCGA) was used to classify participants according to their 12-year trajectory of sleep behaviour. At the 20-year follow-up, an eye examination was performed which included cycloplegic autorefraction and axial length measurement., Results: The LCGA identified three clusters of participants based on their trajectory of sleep behaviour: those with minimal' (43.6% of the total Raine Study sample), 'declining' (48.9%), or 'persistent' (7.5%) sleep problems. A total of 1194 participants had ophthalmic data and longitudinal sleep data available for analysis (47.2% female, 85.6% Caucasian). No significant differences were observed in regards to age, sex, ethnicity or ocular parameters between trajectory groups. Unadjusted and fully adjusted analyses demonstrated that sleep problem behaviour was not significantly associated with changes in refractive error, axial length or corneal radius., Conclusions: Our findings do not support the hypothesis that there is an association between sleep behaviour and myopia. Future longitudinal studies should explore sleep trajectory data pre- and post-myopia diagnosis to confirm our results., (© 2021 The Authors Ophthalmic and Physiological Optics © 2021 The College of Optometrists.)

Study Objectives: This randomized, double-blind, placebo-controlled, crossover study was conducted to evaluate the safety and efficacy of 2 weeks of nightly sublingual cannabinoid extract (ZTL-101) in treating chronic insomnia (symptoms ≥3 months)., Methods: Co-primary study endpoints were safety of the medication based on adverse event reporting and global insomnia symptoms (Insomnia Severity Index [ISI]). Secondary endpoints included: self-reported (sleep diary), actigraphy-derived, and polysomnography measurements of sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE); and self-reported assessments of sleep quality (sSQ) and feeling rested upon waking. Adjusted mean differences between placebo and ZTL-101 were calculated., Results: Twenty-three of 24 randomized participants (n = 20 female, mean age 53 ± 9 years) completed the protocol. No serious adverse events were reported. Forty mild, nonserious, adverse events were reported (36 during ZTL-101) with all but one resolving overnight or soon after waking. Compared to placebo, ZTL-101 decreased ISI (-5.07 units [95% CI: -7.28 to -2.86]; p = 0.0001) and self-reported SOL (-8.45 min [95% CI: -16.33 to -0.57]; p = 0.04) and increased self-reported TST (64.6 min [95% CI: 41.70 to 87.46]; p < 0.0001), sSQ (0.74 units [95% CI: 0.51 to 0.97]; p < 0.0001), and feeling of being rested on waking (0.51 units [95% CI: 0.24 to 0.78]; p = 0.0007). ZTL-101 also decreased actigraphy-derived WASO (-10.2 min [95% CI: -16.2 to -4.2]; p = 0.002), and increased actigraphy-derived TST (33.4 min [95% CI: 23.07 to 43.76]; p < 0.001) and SE (2.9% [95% CI: 2.0 to 3.8]; p = 0.005)., Conclusions: Two weeks of nightly sublingual administration of a cannabinoid extract (ZTL-101) is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms., Clinical Trial: ANZCTR; anzctr.org.au; ACTRN12618000078257., (© Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society.)

There is a scarcity of research examining the effects of long-distance transmeridian travel (LDTT) on the sleep and match performance of team sport players. To address this, 37 elite male rugby union players from a Super Rugby team undertaking LDTT were recruited. The participants completed validated sleep questionnaires and wore a wrist-worn activity monitor (Readiband™) during a Super Rugby season (including during periods of LDTT crossing 5, 6, and 13 time-zones) to ascertain objective measures of sleep. Sleep measures were compared using mixed model analysis to ascertain the effects of competition and LDTT on sleep. Total sleep time (TST) increased in the days prior to matches, and decreased following matches (accompanied by a later time at sleep onset), particularly when next-day early-morning flights were required. TST was decreased when sleep was attempted during LDTT, except for in the last travel bout where players napped in addition to achieving night-time sleep. TST was also reduced for the night immediately following LDTT, except for in Condition 3 where players delayed wake time and also achieved naps. This study exemplifies the challenges that team-sport athletes face in obtaining regular sleep when LDTT is required.

Head posture influences the collapsibility of the passive upper airway during anaesthesia. However, little is known about the impact of head posture during sleep. The objective of this study was to develop and validate an instrument to measure head posture during supine sleep and to apply this instrument to investigate the influence of head posture on obstructive sleep apnea (OSA) severity. A customized instrument to quantify head flexion and rotation during supine sleep was developed and validated in a benchtop experiment. Twenty-eight participants with suspected OSA were successfully studied using diagnostic polysomnography with the addition of the customized instrument. Head posture in supine sleep was discretized into four categories by two variables: head flexed or not (flexion >15°); and head rotated or not (rotation >45°). Sleep time in each posture and the posture-specific apnea-hypopnea index (AHI) were quantified. Linear mixed-effect modelling was applied to determine the influence of flexion and rotation on supine OSA severity. Twenty-four participants had ≥15 min of supine sleep in at least one head-posture category. Only one participant had ≥15 min of supine sleep time with the head extended. Head flexion was associated with a 12.9 events/h increase in the AHI (95% CI: 3.7-22.1, p = .007). Head rotation was associated with an 11.0 events/h decrease in the AHI (95% CI: 0.3-21.6, p = .04). Despite substantial interparticipant variability, head flexion worsened OSA severity, and head rotation improved OSA severity. Interventions to promote rotation and restrict flexion may have therapeutic benefit in selected patients., (© 2021 European Sleep Research Society.)

Objectives: To investigate whether participation in sport during the developmental stages of life is associated with cardiorespiratory fitness (CRF) in adulthood., Design: Observational longitudinal study., Methods: Participants were Generation 2 of the Raine Study. Questionnaires related to participation in sport were administered at ages 5, 8, 10, 14 and 17 years. These data were used to develop sex-specific trajectories of sports participation: (for males) Consistent Participators, Drop-Outs and Joiners; and (females) Consistent Participators, Non-Participators and Drop-Outs. At age 28.3 ± 0.6 years, participants completed a graded maximal exercise test (i.e. V̇O 2 peak test). A General Linear Model assessed differences in CRF between trajectories., Results: 402 participants n = 231 (57.5%) male, n = 171 (42.5%) female were included in the study. In males, Consistent Participators (all p < 0.001) and Joiners (p < 0.050) had greater fitness than Drop-Outs. In females, Consistent Participators had greater fitness than Non-Participators (p < 0.050), but there were no significant differences in fitness between Consistent Participators and Drop-Outs (p > 0.050) or Non-Participators and Drop-Outs (p > 0.050)., Conclusion: Participation in sport during childhood and adolescence is associated with greater fitness in adulthood, compared to individuals who never participate or those that cease participation in adolescence. A simple dichotomous question regarding sports participation over the childhood and adolescent period can be implemented to predict better fitness outcomes in young adulthood. Childhood and adolescence could be an opportune stage in life for parents, schools and governments to facilitate participation in sport and prevent drop out, as it may have an impact on long term risk reduction, with associated health and economic benefits., Competing Interests: Declaration of interest The authors have no conflicts of interest to declare., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Study Objectives: To determine cognitive profiles in individuals with short sleep duration insomnia (SSDI) and normal sleep duration insomnia (NSDI; also, paradoxical insomnia), compared to healthy sleepers. Method: Polysomnographic (PSG) and neuropsychological data were analysed from 902 community-based Raine Study participants aged 22 ± 0.6 years of whom 124 met criteria for insomnia (53 with NSDI and 71 with or SSDI) and 246 were classified as healthy with normal sleep (i.e., without insomnia or other sleep disorders). Measurements of self- report (attention and memory) and laboratory-assessed (attention, episodic memory, working memory, learning, and psychomotor function) cognition and mood, and PSG-based sleep stages (% total sleep time; %TST) were compared between these 3 groups. Results: In comparison to the healthy sleeper group, both insomnia groups had poorer self-reported attention, memory, mood, and sleep, and poorer laboratory-assessed attention (inconsistency). The NSDI group had less consistent working memory reaction time than healthy-sleepers or those with SSDI. The SSDI group had more inconsistency in executive function (shifting), and showed greater %TST in stage N1 and N3, and less REM sleep than either healthy-sleepers or those with NSDI. Conclusions: Individuals with NSDI demonstrated greater working memory inconsistency, despite no laboratory assessed sleep problems, implicating early signs of pathophysiology other than disturbed sleep. Those with SSDI demonstrated different sleep architecture, poorer attention (inconsistency), and greater executive function (inconsistency) compared to healthy-sleepers and those with NSDI, implicating sleep disturbance in the disease process of this phenotype., 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 © 2021 Olaithe, Ree, McArdle, Donaldson, Pushpanathan, Eastwood and Bucks.)

Purpose: The endurance shuttle walk test (ESWT) was used to evaluate ground-based walking training in chronic obstructive pulmonary disease. During pre-training testing, those who walked 5-10 min on the first ESWT with minimal symptoms performed additional ESWTs at increasing speeds until they were at least moderately symptomatic and terminated the test between 5 and 10 min. This report compares participant characteristics and test responsiveness with participants grouped according to whether or not faster walking speeds were selected for the ESWT during pre-training testing., Methods: We conducted a retrospective analysis of data collected in the intervention group during a randomized controlled trial. The intervention was supervised ground-based walking training, performed two to three times/wk, for 8-10 wk. Prior to and immediately following completion of training, participants completed the 6-min walk test (6MWT), incremental shuttle walk test (ISWT), and ESWT., Results: Data were available on 77 participants (70 ± 9 yr, forced expiratory volume in the first second of expiration [FEV1] 43 ± 15 % predicted). For those whom a faster speed was selected during the pre-training ESWTs were characterized by milder dyspnea and leg fatigue on completion of the baseline 6MWT and ISWT (P < .05 for all). On training completion, the change in ESWT was greater in those for whom a faster speed was selected (376 ± 344 sec vs 176 ± 274 sec; P = .017)., Conclusions: Participants who report modest symptoms on completion of the pre-training 6MWT or ISWT may achieve a long pre-training ESWT time. In this situation, repeating the pre-training ESWT at a faster walking speed to achieve an exercise time between 5 and 10 min with moderate symptoms may be advantageous., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Atypical facial morphology, particularly increased facial asymmetry, has been identified in some individuals with Autism Spectrum Conditions (ASC). Many cognitive, behavioural and biological features associated with ASC also occur on a continuum in the general population. The aim of the present study was to examine subthreshold levels of autistic traits and facial morphology in non-autistic individuals. Facial asymmetry was measured using three-dimensional facial photogrammetry, and the Autism-spectrum Quotient was used to measure autistic-like traits in a community-ascertained sample of young adults (n = 289). After accounting for covariates, there were no significant associations observed between autistic-like traits and facial asymmetry, suggesting that any potential facial morphology differences linked to ASC may be limited to the clinical condition.

Abstract: Jones, MJ, Dawson, B, Eastwood, PR, Halson, SL, Miller, J, Murray, K, Dunican, IC, Landers, GJ, and Peeling, P. Influence of electronic devices on sleep and cognitive performance during athlete training camps. J Strength Cond Res 35(6): 1620-1627, 2021-This study investigated the effects of removing athletes' electronic devices in the evening on sleep and performance during training camps. Water polo athletes (n = 26) attending a 7-night training camp (study 1) and triathletes (n = 23) attending a 4-night training camp (study 2) were randomly allocated to a no-device group (no electronic devices could be used after dinner or overnight; ND) or control group (unrestricted electronic device use; CON). Sleep was monitored through wrist actigraphy. The ND group completed a questionnaire measuring anxiety related to being unable to use electronic devices ("nomophobia"). Triathletes also completed a psychomotor vigilance test (PVT) at the start and end of camp. Water polo ND athletes went to bed earlier and spent longer time in bed than CON on the first night, but not on other nights. In triathletes, sleep quantity was not different between groups on any night. No statistically significant differences were observed for changes in nomophobia from the first to the last night of camp. No differences in PVT performance were observed between ND and CON triathletes. In conclusion, removal of evening electronic devices does not improve sleep quantity or cognitive performance in athletes during short-duration (4-7 nights) training camps., (Copyright © 2019 National Strength and Conditioning Association.)

This study examined the nature and characteristics of sleep-disordered breathing, including obstructive sleep apnea and central sleep apnea, in patients with post-stroke dysphagia, to determine the demographic, anthropometric and clinical variables that were associated with sleep-disordered breathing. Thirty-nine patients diagnosed with acute stroke (28 males and 11 females with a mean age of 72.3 ± 10.0 years) underwent overnight polysomnography (within 3.9 ± 1.6 days after admission). Sleep-disordered breathing was described by the apnea-hypopnea index and its obstructive and central components by the obstructive apnea-hypopnea index and central apnea-hypopnea index, respectively. Severity of dysphagia was assessed using the Mann Assessment of Swallowing Ability score. Severity of stroke and functional dependence were assessed by the National Institute of Health Stroke Scale and the modified Barthel index, respectively. Most of the cohort (87%) had moderate-to-severe dysphagia (Mann Assessment of Swallowing Ability of 143.2 ± 19.9). Sleep-disordered breathing (apnea-hypopnea index ≥ 5 events/hr) was present in 38 participants (97%) with a mean apnea-hypopnea index of 37.5 ± 24.4 events/hr. Sleep-disordered breathing was predominantly obstructive in nature, with a mean obstructive apnea-hypopnea index and central apnea-hypopnea index of 19.6 ± 15.7 and 11.4 ± 17.6 events/hr, respectively. Multivariate linear regression analyses showed that the apnea-hypopnea index was associated with sex (p = .0001), body mass index (p = .029) and the modified Barthel index (p = .006); the obstructive apnea-hypopnea index was associated with the Mann Assessment of Swallowing Ability (p = .006), sex (p = .004) and body mass index (p = .015) and had a nonlinear relationship with the modified Barthel index (p = .019); and the central apnea-hypopnea index was associated with sex (p = .027) and the modified Barthel index (p = .019). The present study showed that dysphagia severity was associated with obstructive sleep apnea severity and this association was independent of sex, modified Barthel index and body mass index. However, stroke-induced dysphagia was not associated with central sleep apnea or overall sleep-disordered breathing., (© 2020 European Sleep Research Society.)

Objective: To investigate the association between energy drink (ED) use and sleep-related disturbances in a population-based sample of young adults from the Raine Study., Design: Analysis of cross-sectional data obtained from self-administered questionnaires to assess ED use and sleep disturbance (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire (FOSQ-10) and the Pittsburgh Sleep Symptoms Questionnaire-Insomnia (PSSQ-I)). Regression modelling was used to estimate the effect of ED use on sleep disturbances. All models adjusted for various potential confounders., Setting: Western Australia., Participants: Males and females, aged 22 years, from Raine Study Gen2-22 year follow-up., Results: Of the 1115 participants, 66 % were never/rare users (i.e. once/month to

Reports linking prenatal testosterone exposure to autistic traits and to a masculinized face structure have motivated research investigating whether autism is associated with facial masculinization. This association has been reported with greater consistency for females than for males, in studies comparing groups with high and low levels of autistic traits. In the present study, we conducted two experiments to examine facial masculinity/femininity in 151 neurotypical adults selected for either low, mid-range, or high levels of autistic traits. In the first experiment, their three-dimensional facial photographs were subjectively rated by 41 raters for masculinity/femininity and were objectively analysed. In the second experiment, we generated 6-face composite images, which were rated by another 36 raters. Across both experiments, findings were consistent for ratings of photographs and composite images. For females, a linear relationship was observed where femininity ratings decreased as a function of higher levels of autistic traits. For males, we found a U-shaped function where males with mid-range levels of traits were rated lowest on masculinity. Objective facial analyses revealed that higher levels of autistic traits were associated with less feminine facial structures in females and less masculine structures in males. These results suggest sex-specific relationships between autistic traits and facial masculinity/femininity., (© 2019 The British Psychological Society.)

Sleep disorders in adults are associated with adverse health effects including reduced quality of life and increased mortality. However, there is little information on sleep disorders in young adults. A cross-sectional observational study was undertaken in 1,227 young adults participating in the Western Australian Pregnancy (Raine) Study (2012-2014) to describe the prevalence of common sleep disorders. In-laboratory polysomnography (PSG) and validated survey methods were used, including the Epworth Sleepiness Scale, Pittsburgh Sleep Symptom Questionnaire-Insomnia, and International Restless Legs Syndrome Study Group criteria. A total of 1,146 participants completed a core questionnaire, 1,051 completed a sleep-focused questionnaire and 935 had analyzable PSG data. Participants had a mean age of 22.2 years and female to male ratio of 1.1 to 1. The respective sleep disorder prevalences in females and males were: obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI]: ≥5 events/hour) 14.9% (95% CI: 11.8-18.5) and 26.9% (95% CI: 22.9-31.2); chronic insomnia, 19.3% (95% CI: 16.7-23.9) and 10.6% (95% CI: 8.3-13.9); restless legs syndrome, 3.8% (95% CI: 2.4-5.6) and 1.9% (95% CI: 0.9-3.4); and abnormal periodic leg movements during sleep (>5 movements/hour), 8.6% (95% CI: 6.3-11.5) and 9.6% (95% CI: 7.1-12.7). There were statistically significant differences in prevalence between sexes for OSA and insomnia, which persisted after adjustment for body mass index and education. In those with complete data on all sleep-related assessments (n = 836), at least one sleep disorder was present in 41.0% of females and 42.3% of males. Sleep disorders are very common in young adults. Health practitioners should be aware of these high prevalences, as early identification and treatment can improve quality of life and may reduce later morbidity and mortality., (© Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Study Objectives: Although cognitive dysfunction is a recognized consequence of untreated obstructive sleep apnea (OSA), the deficit pattern is heterogeneous. Understanding this heterogeneity may identify those at risk of cognitive deficits and guide intervention strategies. To facilitate understanding, we examined whether distinct profiles of neuropsychological performance were present in OSA and, if so, how they are related to other OSA features., Methods: We studied sleep clinic (n = 121) and community (n = 398) samples with moderate-severe OSA (apnea-hypopnea index ≥ 15 events/h). Attention and memory were assessed using the Cognitive Drug Research system. Sleep was assessed using polysomnography in the clinic sample and dual channel (flow, oximetry) portable monitoring in the community sample. Latent profile analysis was used to determine structure of cognitive clusters. Discriminant function analysis was used to examine associations between nocturnal and diurnal features of OSA and profile membership., Results: Both samples were best characterized by a 3-profile solution: (1) strong thinkers (performed well across most domains and showed greater cognitive reserve); (2) inattentive fast thinkers (strong processing speed but poor ability to maintain attention); and (3) accurate slow thinkers (strengths in maintaining attention but poor processing speed). Profile membership was associated with mean overnight oxygen saturation and cognitive reserve in the clinic sample and the presence of cardiovascular disease and/or diabetes in the community sample., Conclusions: These findings help explain the diversity of outcomes in previous studies of cognitive dysfunction in OSA by demonstrating that individual differences in cognitive reserve, nocturnal oxygen saturation, and comorbidities affect how cognition is impacted by OSA., (© 2020 American Academy of Sleep Medicine.)

Introduction: Pathophysiology changes associated with pleural effusion, its drainage and factors governing symptom response are poorly understood. Our objective was to determine: 1) the effect of pleural effusion (and its drainage) on cardiorespiratory, functional and diaphragmatic parameters; and 2) the proportion as well as characteristics of patients with breathlessness relief post-drainage., Methods: Prospectively enrolled patients with symptomatic pleural effusions were assessed at both pre-therapeutic drainage and at 24-36 h post-therapeutic drainage., Results: 145 participants completed pre-drainage and post-drainage tests; 93% had effusions ≥25% of hemithorax. The median volume drained was 1.68 L. Breathlessness scores improved post-drainage (mean visual analogue scale (VAS) score by 28.0±24 mm; dyspnoea-12 (D12) score by 10.5±8.8; resting Borg score before 6-min walk test (6-MWT) by 0.6±1.7; all p<0.0001). The 6-min walk distance (6-MWD) increased by 29.7±73.5 m, p<0.0001. Improvements in vital signs and spirometry were modest (forced expiratory volume in 1 s (FEV 1 ) by 0.22 L, 95% CI 0.18-0.27; forced vital capacity (FVC) by 0.30 L, 95% CI 0.24-0.37). The ipsilateral hemi-diaphragm was flattened/everted in 50% of participants pre-drainage and 48% of participants exhibited paradoxical or no diaphragmatic movement. Post-drainage, hemi-diaphragm shape and movement were normal in 94% and 73% of participants, respectively. Drainage provided meaningful breathlessness relief (VAS score improved ≥14 mm) in 73% of participants irrespective of whether the lung expanded (mean difference 0.14, 95% CI 10.02-0.29; p=0.13). Multivariate analyses found that breathlessness relief was associated with significant breathlessness pre-drainage (odds ratio (OR) 5.83 per standard deviation (sd) decrease), baseline abnormal/paralyzed/paradoxical diaphragm movement (OR 4.37), benign aetiology (OR 3.39), higher pleural pH (OR per sd increase 1.92) and higher serum albumin level (OR per sd increase 1.73)., Conclusions: Breathlessness and exercise tolerance improved in most patients with only a small mean improvement in spirometry and no change in oxygenation. Breathlessness improvement was similar in participants with and without trapped lung. Abnormal hemi-diaphragm shape and movement were independently associated with relief of breathlessness post-drainage., Competing Interests: Conflict of interest: S. Muruganandan has nothing to disclose. Conflict of interest: M. Azzopardi has nothing to disclose. Conflict of interest: R. Thomas has nothing to disclose. Conflict of interest: D.B Fitzgerald has nothing to disclose. Conflict of interest: Y.J. Kuok has nothing to disclose. Conflict of interest: H.M. Cheah has nothing to disclose. Conflict of interest: C.A. Read has nothing to disclose. Conflict of interest: C.A. Budgeon has nothing to disclose. Conflict of interest: P.R. Eastwood has nothing to disclose. Conflict of interest: S. Jenkins has nothing to disclose. Conflict of interest: B. Singh has nothing to disclose. Conflict of interest: K. Murray has nothing to disclose. Conflict of interest: Y.C.G. Lee has served on the advisory board of CareFusion/BD Ltd and has previously led clinical trials for which Rocket Medical plc (UK) provided the drainage kits for study participants without charge, as well as providing an unrestricted educational grant to assist the running of the trial., (Copyright ©ERS 2020.)

Background: The propensities for the upper airway to collapse during anesthesia and sleep are related, although much of our understanding of this relationship has been inferred from clinical observation and indirect measures such as the apnea-hypopnea index. The aim of this study was to use an identical, rigorous, direct measure of upper airway collapsibility (critical closing pressure of the upper airway) under both conditions to allow the magnitude of upper airway collapsibility in each state to be precisely compared., Methods: Ten subjects (8 men and 2 women; mean ± SD: age, 40.4 ± 12.1 years; body mass index, 28.5 ± 4.0 kg/m) were studied. Critical closing pressure of the upper airway was measured in each subject on separate days during (1) propofol anesthesia and (2) sleep., Results: Critical closing pressure of the upper airway measurements were obtained in all 10 subjects during nonrapid eye movement sleep and, in 4 of these 10 subjects, also during rapid eye movement sleep. Critical closing pressure of the upper airway during anesthesia was linearly related to critical closing pressure of the upper airway during nonrapid eye movement sleep (r = 0.64 [95% CI, 0.02-0.91]; n = 10; P = .046) with a similar tendency in rapid eye movement sleep (r = 0.80 [95% CI, -0.70 to 0.99]; n = 4; P = .200). However, critical closing pressure of the upper airway during anesthesia was systematically greater (indicating increased collapsibility) than during nonrapid eye movement sleep (2.1 ± 2.2 vs -2.0 ± 3.2 cm H2O, respectively, n = 10; within-subject mean difference, 4.1 cm H2O [95% CI, 2.32-5.87]; P < .001) with a similar tendency during rapid eye movement sleep (1.6 ± 2.4 vs -1.9 ± 4.3 cm H2O, respectively, n = 4; unadjusted difference, 3.5 cm H2O [95% CI, -0.95 to 7.96]; P = .087)., Conclusions: These results demonstrate that the magnitude of upper airway collapsibility during anesthesia and sleep is directly related. However, the upper airway is systematically more collapsible during anesthesia than sleep, suggesting greater vulnerability to upper airway obstruction in the anesthetized state.