$4.9 million for sleep health in quadriplegia research

The Institute for Breathing and Sleep at Austin Health will lead one of four teams of neurotrauma experts that have received almost $19 million for research in brain and spinal cord injury as part of the fourth round of the Victorian Neurotrauma Initiatives (VNI) research funding.

The VNI is a $63 million health research fund that supports research into Traumatic Brain Injury and Spinal Cord Injury conducted by Victorian scientists in collaboration with national and international colleagues. It was established in 2005 with funding from the Transport Accident Commission and the Department of Innovation, Industry and Regional Development.

Sleep Health in Quadriplegia (SHiQ)

Optimising Sleep in Quadriplegia: Mechanisms and Management

Most patients with quadriplegia have poor sleep quality which impacts on their daily functioning, quality of life and recovery from injury. This program will address how the sleep of people with quadriplegia can be assessed, managed and improved.

We will use our unique national and international collaborations between sleep and spinal clinical researchers to systematically investigate the mechanisms and management of the major causes, develop novel treatments and translate that research into improved outcomes for the sleep problems in quadriplegia. The program will work with consumers, scientists and clinicians to ensure that this knowledge is translated into improved care. Both immediately after injury and in chronic quadriplegia the research program will investigate the utility of pharmaceutical and physical treatments.

The anatomical determinants of sleep apnoea in quadriplegia will be explored using cutting edge imaging technology and detailed studies of upper airway and pulmonary mechanics.

Good sleep is an essential element of a good life. Humans are asleep for almost one third of their lives, yet sleep in quadriplegia has received very little attention in research circles outside of Victoria. Our research group has previously characterised the sleep problems of those living with quadriplegia across the spectrum from acute injury to the community and demonstrated that sleep disorders impair daytime functioning and compromise quality of life.

In Victoria we are now uniquely positioned to meet these challenges by creating new knowledge and developing innovative treatments which will yield dramatic benefits in functional and rehabilitation outcomes.

Lead Chief Investigator:

Professor Robert Pierce, Institute for Breathing and Sleep, Austin Health, VIC

Chief Investigators:

• Dr David Berlowitz
  Institute for Breathing and Sleep, Austin Health, VIC
• Associate Professor Doug Brown
  Austin Health, VIC
• Professor Peter Cistulli
  Centre for Sleep Health & Research, Royal North Shore Hospital, NSW
• Professor Graeme Jackson
  Brain Research Institute, Austin Health, VIC
• Dr Fergal O'Donoghue
  Institute for Breathing and Sleep, Austin Health, VIC
• Professor Paul Kennedy
  National Spinal Injuries Centre & University of Oxford, United Kingdom
• Associate Professor Gerald Kennedy
  Victoria University, VIC
• Professor Meg Morris
  University of Melbourne, VIC
• Professor Don Campbell
  Monash University, VIC
• Professor Simon Gandevia
  Prince of Wales Medical Research Institute, NSW

Administering Organisation:

Institute for Breathing and Sleep, Bowen Centre, Austin Hospital

VNI Funding: $4,999,978

For further information about the Victorian Neurotrauma Initiatives, visit www.vni.com.au

Trial initiated by ASTN Shiftwork Steering Group is funded by NHMRC

A randomised controlled trial of a light-based intervention for alertness in shift workers, initiated by the ASTN Shiftwork Steering Group and endorsed by the ASTN, received NHMRC funding in the 2009 Project Grant round. Chief Investigators Shantha Rajaratnam, Naomi Rogers, Sally Ferguson, Steven Lockley and David Kennaway and Associate Investigators Lyle palmer and Wei Xuan plan to complete the LAPS (Light for Alertness and Performance in Shiftworkers) trial by 2011.

As a non-pharmacological, non-invasive, relatively low-cost and safe intervention, a light intervention which could enhance alertness during the night shift would have widespread utility in many occupational settings. There is already evidence from healthy volunteers in highly controlled lab studies that short wavelength light improves alertness during the night but this type of intervention has not yet been evaluated in a large randomised controlled trial in real shiftworker populations in a work-like setting. The LAPS trial will now assess efficacy of light enriched in the short wavelength range on alertness and neurobehavioural function in night shiftworkers, compared to standard light.

Dr Rajaratnam acknowledged the contribution of the ASTN to development of the study. "The ASTN provided the focus for development of this study and an open process to build the investigator team. We also obtained valuable feedback and suggestions from the ASTN Research Committee and consultancies which strengthened our proposal and made the grant application more competitive. The ASTN also facilitated investigator meetings to develop the application." he said.

For more information about the LAPS study, contact Dr Rajaratnam at Monash University

PSG Concordance Project

Measures of sleep and breathing from polysomnography (PSG) are used in diagnosing sleep disorders, but Australian researchers Rob Pierce and Peter Rochford in Melbourne and Andrew Thornton in Adelaide have reported large inter-scorer variation for many of these measures. The chart at right shows the ranges of apnea-hypopnea index values when a set of 10 sleep studies was scored by different technologists. For example, AHI values for the first sleep study ranged from 26 to 66 events per hour.

This level of variation would be a major problem for ASTN multicentre trials relying on PSG, so the Network sponsored a project led by Rob, Peter and Andrew. Fifteen participating laboratories, each with two scorers, were randomised to one of three groups. One group received no intervention, another group received feedback about their performance, and the third group received feedback and participated in active sessions aimed at improving scoring agreement. The project was conducted between October 2006 and July 2007 with results presented at Worldsleep07, the Australasian Sleep Association and Australasian Sleep Technologists Association 2008 Annual Scientific Meeting and in upcoming journal articles.

Sleep Apnoea CardioVascular Endpoints study (SAVE)

Planning is now being stepped up for the Sleep Apnea cardioVascular Endpoints (SAVE) trial, an international trial with Network representation which is providing valuable experience for the Network in the organisation of large-scale trials.

SAVE is designed to definitively address one of the most important questions remaining in the field of sleep medicine - namely, whether OSA causes cardiovascular events, and, if so, what level of risk reduction is achieved by OSA treatment. The Principal Investigator, ASTN CI Doug McEvoy is joined by an international investigator group to develop and implement SAVE.

Some industry sponsors are already in place, including Platinum sponsorship from Respironics Inc, and additional industry and government partnerships are currently being sought to enlarge this important trial.

View the SAVE website

Study development groups in 2009

ASTN steering groups, in the fields of insomnia, shiftwork, non-invasive ventilation and paediatric sleep health, are keen to hear from investigators interested in developing or joining multicentre clinical trials. Contact people for the groups are:

• Insomnia group, Simon Smith
• Shiftwork group, Shantha Rajaratnam
• Non-invasive ventilation group, Amanda Piper
• Paediatrics group, Gillian Nixon

Get in touch with a steering group via the ASTN National Research Manager.