Sarah L Appleton

Flinders University · Adelaide Institute of Sleep Health; College of Medicine and Public Health

Obstructive sleep apnea (OSA) has been associated with incident type 2 diabetes mellitus (T2DM); however, few prospective epidemiological studies have accounted for important T2DM predictors including pre‐diabetes status and testosterone. Participants in the longitudinal Men Androgens Inflammation Lifestyles Environment and Stress (MAILES) study, w...

Snoring may be a risk factor for cardiovascular disease independent of other co-morbidities. However, most prior studies have relied on subjective, self-report, snoring evaluation. This study assessed snoring prevalence objectively over multiple months using in-home monitoring technology, and its association with hypertension prevalence. In this st...

Objective Examine how sleep affects objective measures of sleep. Design Prospective observation. Setting Tertiary care sleep unit. Participants Athletes diagnosed with a concussion. Interventions (or Assessment of Risk Factors) Overnight polysomnographic measures of sleep, including electroencephalography, oculography, chin electromyography, he...

Obstructive sleep apnea (OSA) has been linked to cancer in several clinical and community‐based cohorts. The effect in community‐based studies free of clinical referral bias needs to be replicated. In this observational prospective cohort study, we pooled data from three community‐based prospective cohorts (Uppsala Sleep and Health in Men cohort [U...

Background There is increasing evidence of ongoing inequity in the provision of sleep healthcare for Indigenous Australians. This cross-sectional review aims to capture the prevalence self-reported symptoms of poor sleep and correlating factors influencing this from an Indigenous perspective. Methods This survey data was collected as part of the I...

Background We evaluated 1) the independent and combined influence of obstructive sleep apnea (OSA) risk and a healthy lifestyle on typical OSA outcomes [excessive daytime sleepiness (EDS), depression, cardiovascular disease (CVD), and stroke]; and 2) the impact of a healthy lifestyle on survival in individuals presenting a heightened risk of OSA....

We assessed: (1) the independent and joint association of obstructive sleep apnea risk and healthy lifestyle with common consequences (excessive daytime sleepiness, depression, cardiovascular disease and stroke) of obstructive sleep apnea; and (2) the effect of healthy lifestyle on survival in people with increased obstructive sleep apnea risk. Dat...

Previous prospective studies examining associations of obstructive sleep apnea and sleep macroarchitecture with future cognitive function recruited older participants, many demonstrating baseline cognitive impairment. This study examined obstructive sleep apnea and sleep macroarchitecture predictors of visual attention, processing speed, and execut...

Background Insomnia is a common issue among individuals with mental health conditions, yet the frequency of insomnia treatment remains unclear. The purpose of this study was to investigate the prevalence of probable insomnia, discussions regarding sleep with health professionals, and the utilisation of commonly delivered insomnia treatments in Aust...

Parker JL, Vakulin A, Melaku YA, et al. Nat Sci Sleep. 2023;15:389–406. The authors advise that the funding section on page 404 is incorrect. The funding statement should read as follows: Funding This study was funded by a National Health and Medical Research Council of Australia Project Grant (627227) 2010-12, The Hospital Research Foundation, and...

Purpose Prospective studies examining associations between baseline sleep microarchitecture and future cognitive function recruited from small samples with predominantly short follow-up. This study examined sleep microarchitecture predictors of cognitive function (visual attention, processing speed, and executive function) after 8 years in communit...

Purpose Little is known about sleep after a concussion, a form of mild traumatic brain injury. Given the importance of sleep for both maintaining brain health and recovery from injury, we sought to examine sleep acutely and subacutely after concussion. Methods Athletes who experienced a sports-related concussion were invited to participate. Partic...

Objectives: Previous studies examining associations between sleep spindles and cognitive function attempted to account for obstructive sleep apnea (OSA) without consideration for potential moderating effects. To elucidate associations between sleep spindles, cognitive function, and OSA, this study of community-dwelling men examined cross-sectional...

Background: Irregularities in sleep duration and sleep timing have emerged as potential risk factors for hypertension. This study examined associations between irregularity in sleep duration and timing with hypertension in a large, global sample over multiple months. Methods: Data from 12 287 adults, who used an under-mattress device to monitor...

Background Snoring may be a risk factor for cardiovascular disease and stroke. However, most prior studies have relied on subjective snoring evaluation from self-reports, or relatively short time-scale objective measures in small samples. This study assessed the prevalence of objectively quantified snoring measured over multiple months, and its ass...

Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence‐based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sl...

Introduction Co-morbid insomnia and sleep apnoea (COMISA) is associated with poor health and reduced adherence to continuous positive airway pressure (CPAP) therapy in sleep clinic samples. However, health and treatment correlates of COMISA in community-based samples of obstructive sleep apnoea (OSA) are poorly described. Methods Australian adults...

Study objectives Prospective studies examining associations of obstructive sleep apnea (OSA) and sleep macroarchitecture with future cognitive function remain limited to older participants, many with baseline cognitive impairment, which may be a confounder. This study examined OSA and sleep macroarchitecture predictors of cognitive function (visual...

Introduction Research and guidance materials addressing on-call work typically focus on a narrow set of industries (e.g., emergency services, healthcare). However, modern working arrangements are changing. The casualisation of many industries, combined with the rise in online and app-based working arrangements, means that many workers who can be ca...

Introduction Co-morbid insomnia and sleep apnoea (COMISA) is a highly prevalent condition associated with negative health outcomes. This population-based study aimed to investigate the association between COMISA and all-cause mortality. Methods Sleep data in 6,877 participants (Age median [IQR]=45 [33,57], 50.1% male) were drawn from the National...

Introduction Chronic insomnia negatively impacts quality of life for millions of Australians. Most people with insomnia do not receive the recommended treatment Cognitive Behavioural Therapy for insomnia (CBTi), and many are prescribed sedative-hypnotic medications. This study aims to better understand the help seeking behaviours of people with ins...

Study objectives Prospective studies examining associations of sleep microarchitecture with future cognitive function predominantly recruited from small samples with relatively short follow-up. Therefore, this study examined sleep microarchitecture predictors of cognitive function (visual attention, processing speed, and executive function) after 8...

Introduction Clinical guidelines for the treatment of insomnia recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment, ideally provided by a psychologist. However, previous research shows most people with insomnia are not referred to a psychologist, and many are prescribed sedative-hypnotic medicines. This study sur...

Research with ‘good sleepers’ is ubiquitous, yet there are no standardised criteria to identify a ‘good sleeper’. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale‐15 items (GSS‐15). Data were derived from a population‐based survey of Australian a...

Sleep Epidemiology. Background: Co-morbid insomnia and sleep apnoea (COMISA) is a highly prevalent condition associated with negative health outcomes. This population-based study aimed to investigate the association between COMISA and all-cause mortality. Methods: Sleep data in 6,877 participants (Age median [IQR]=45 [33,57], 50.1% male) were draw...

Background Sleep difficulties are common in people with multiple sclerosis (MS), but whether associations between poor sleep quality and quality of life are independent of MS symptoms, obesity and other MS-related factors remains unclear. Methods Cross-sectional analyses of data from the Australian MS Longitudinal Study (n=1717). Sleep was assesse...

Background Poor sleep quality is associated with increased incident hypertension. However, few studies have investigated the impact of objective sleep structure parameters on hypertension. This study investigated the association between sleep macrostructural and microstructural parameters and incident hypertension in a middle‐ to older‐aged sample....

Introduction Most prior research into relationships between sleep and health and daytime functioning have focused on average sleep duration or efficiency and ignored individual differences in sleep need. This study tested if sleep need is more strongly correlated with self-rated health and daytime function than sleep duration. Methods Data were dr...

Introduction Estimating insomnia prevalence in epidemiological studies is hampered by variability in definitions and interpretation of criteria. We addressed the absence of a population-based estimate of insomnia in Australia using the widely accepted contemporary International Classification of Sleep Disorders (ICSD-3) criteria, which includes sle...

Study objectives: In a population-based survey, we determined sex-differences in health profiles and quality of life between individuals who have a confirmed diagnosis of obstructive sleep apnea (OSA) and those who are at high risk of OSA yet remain undiagnosed. Methods: An online survey of Australian adults ≥18 years (n= 3818) identified partic...

Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help seeking behaviours for sleep in shift workers is limited. The primary aim of this...

Study Objectives To determine if a novel EEG-derived continuous index of sleep depth/alertness, the odds ratio product (ORP), predicts self-reported daytime sleepiness and poor sleep quality in two large population-based cohorts. Methods ORP values which range from 0 (deep sleep) to 2.5 (fully alert) were calculated in 3s intervals during awake pe...

Study objectives: Most studies on diet and sleep apnea focus on calorie restriction. Here we investigate potential associations between dietary quality [healthy eating index (HEI), dietary inflammatory index (DII)] and overall healthy lifestyle with sleep apnea risk. Methods: National Health and Nutrition Examination Survey data (waves 2005-2008...

Objectif Déterminer l’association entre la microstructure du sommeil évaluée par électroencéphalogramme (EEG) quantitatif et l’incidence d’hypertension artérielle (HTA) à 5 ans dans une cohorte représentative de la population générale. Méthodes 1131 sujets (42 % hommes, 55 ± 10 ans) sans HTA à l’inclusion ont réalisé une polysomnographie à l’inclu...

Study objectives: Sleep microarchitecture parameters determined by quantitative power spectral analysis (PSA) of electroencephalograms (EEGs) have been proposed as potential brain-specific markers of cognitive dysfunction. However, data from community samples remains limited. This study examined cross-sectional associations between sleep microarch...

Insomnia and obstructive sleep apnoea (OSA) commonly co-occur (COMISA), and their cooccurrence has been associated with worse cardio-metabolic and mental health. However, it remains unknown if people with COMISA are at a heightened risk of incident cardiovascular events. This study used longitudinal data from the Sleep Heart Health Study (N=5,803)...

Purpose Insomnia symptoms and sleep apnea frequently co-occur and are associated with worse sleep, daytime function, mental health and quality of life, compared to either insomnia or obstructive sleep apnea (OSA) alone. This study aimed to investigate the association of symptoms of co-morbid insomnia and sleep apnea (COMISA) with all-cause mortalit...

Study Objectives Increased mortality has been reported in people with insomnia and in those with obstructive sleep apnoea (OSA). However, these conditions commonly co-occur and the combined effect of co-morbid insomnia and sleep apnoea (COMISA) on mortality risk is unknown. This study used Sleep Heart Health Study (SHHS) data to assess associations...

Study objectives Sleep spindles show morphological changes in obstructive sleep apnea (OSA). However, previous small studies have limited generalisability, leaving associations between OSA severity measures and spindle metrics uncertain. This study examined cross-sectional associations between OSA severity measures and spindle metrics among a large...

Background On-call research and guidance materials typically focus on ‘traditional’ on-call work (e.g., emergency services, healthcare). However, given the increasing prevalence of non-standard employment arrangements (e.g., gig work and casualisation), it is likely that a proportion of individuals who describe themselves as being on-call are not i...

Rationale: Conventional markers of sleep disturbance, based on manual electroencephalography scoring, may not adequately capture important features of more fundamental electroencephalography-related sleep disturbance. Objectives: This study aimed to determine if more comprehensive power-spectral measures of delta wave activity during sleep are stro...

There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This i...

Objective To determine the association of obstructive sleep apnea and nocturnal hypoxemia with serum lipid profiles in unselected community-dwelling men. Methods Cross-sectional data from participants of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study (n=753) who underwent full in-home polysomnography (Embletta X100)...

Introduction Most studies examining associations between sleep and health outcomes focus on sleep duration or efficiency, ignoring individual differences in sleep need. We investigated whether sleep need is a more influential correlate of self-rated daytime function and health than sleep duration. Methods This study is a secondary analysis of the...

Introduction Good sleep is not merely the absence of sleep disorder symptoms, yet this criterion is commonly applied in research studies. We developed the Good Sleeper Scale-13 (GSS-13) to standardise identification of good sleepers. Methods We conducted a secondary analysis of the 2019 Sleep Health Foundation online survey of adult Australians (N...

Introduction Co-morbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating condition. Previous studies have investigated associations between insomnia and mortality, and OSA and mortality, but not COMISA. Thus, this study investigated associations between OSA, insomnia and COMISA on mortality and cardiovascular event risks. M...

Introduction Shift work disorder is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help-seeking behaviours for sleep in shift workers is limited. Methods As a pa...

Introduction: Sleep microarchitecture metrics determined by quantitative power spectral analysis (PSA) of the electroencephalogram (EEG) have been proposed as potential biomarkers of cognitive function. However, there remain no data from community-based samples. This study examined cross-sectional associations between sleep microarchitecture metric...

The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well‐being in Australian adults. A cross‐sectional, national online survey of sleep...

Background Diet and sleep are strongly and bidirectionally linked. This study aims to assess the association between dietary inflammatory index (DII) and sleep duration using the National Health and Nutrition Survey (NHANS) of the United States. Methods A total of 27,999 (median age 47 years, 48.6% male) participants were included. Dietary data we...

Background Evidence shows that habitual short and long sleep is associated with higher mortality risk in the general population. However, studies on the association between sleep duration and mortality in people with diabetes are scarce. Methods Data from the National Health Interview Survey (NHIS) of the United States (US) between 2004 and 2014 (...

Background Evidence regarding the association between perinatal smoking and insomnia symptoms in adulthood is limited. Using the UK 1970 Birth Cohort Study, we determined the association of maternal smoking during pregnancy and early-childhood with insomnia symptoms at 42 years. Methods Participants were followed from birth (1970; N = 9020; male,...

Background The aims of our study were two-fold. Firstly, to determine if there is an association between gout and OSA in a representative Australian adult population. Secondly, to explore associations between gout and patient reported sleep outcomes. Methods A cross-sectional national online survey of a representative sample of Australian adults >...

Objective: A single, severe traumatic brain injury can result in chronic sleep disturbances that can persist several years after the incident. In contrast, it is unclear whether there are sleep disturbances after a sports-related concussion (SRC). Considering growing evidence of links between sleep disturbance and neurodegeneration, this review ex...

Purpose We aimed to estimate the prevalence of probable shift work disorder (pSWD) in a representative sample of Australian workers and identify sleep, health and safety correlates. Patients and Methods In 2019, data were collected from working respondents as part of a cross-sectional national sleep health survey conducted online (n=964 total; n=4...

Introduction Sleep spindles are thought to play an important role in learning and memory. The association between sleep spindles and cognitive function and the potential confounding influence of obstructive sleep apnea (OSA) is uncertain. We examined the cross-sectional association between sleep spindles and cognitive function controlled for OSA in...

Evidence linking obstructive sleep apnea with cognitive dysfunction predominantly comes from clinical or select community samples. We investigated the independent cross-sectional association of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function in unselected community-dwelling middle-aged and older men. Four hund...

Introduction: Insomnia and obstructive sleep apnoea (OSA) are the two most prevalent sleep disorders, and frequently co-occur (COMISA) in sleep clinic samples. However, few studies have investigated the prevalence or associations of COMISA in the general population. Methods: We used population-based online survey data from 2,044 Australian adults....

Effective cardiovascular disease (CVD) prevention relies on timely identification and intervention for individuals at risk. Conventional formula-based techniques have been demonstrated to over- or under-predict the risk of CVD in the Australian population. This study assessed the ability of machine learning models to predict CVD mortality risk in t...

Objectives To examine the relationship between depression burden, health service utilisation and depression diagnosis in community-based men. Design Prospective cohort study. Setting Community-based. Participants Men aged 35–80 years at recruitment (2002–2005), randomly selected from the northern and western suburbs of Adelaide, Australia, witho...

Background Moderate to vigorous physical activity (MVPA) interventions reduce the severity of obstructive sleep apnoea, however, little epidemiological research exists to confirm these findings. Methods 789 participants from the population-based Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent polysomnography. MV...

BACKGROUND: The aims of our study were two-fold. Firstly, to determine if there is an association between gout and OSA in a representative Australian adult population. Secondly, to explore associations between gout and patient reported sleep outcomes. METHODS: A cross-sectional national online survey of a representative sample of Australian adults...

Purpose Reduced hand grip strength (HGS) is associated with poorer health in chronic conditions, yet there has been little research examining the association with hand grip strength and obstructive sleep apnea (OSA). Further, these studies have not examined, nor adjusted, for muscle mass. The aim of this study was to determine associations between...

Background The association of diabetes risk in the long-term, metabolic phenotypes (MP) and muscle strength is unclear. We aimed to investigate the association between strictly defined MP, grip strength (GS) and diabetes. Material and methods MP were defined according to BMI and presence of any individual metabolic abnormality for ≥18 years, in pa...

Introduction Obstructive sleep apnea (OSA) is linked with impaired vigilance, attention, memory and executive function. However, this evidence largely comes from small experimental studies or larger studies in clinical samples and therefore the scope and magnitude of OSA driven neurobehavioural dysfunction in the general population remains unclear....

Objective: Obstructive sleep apnea (OSA) is generally considered to lower serum testosterone concentration in men, although data supporting this as a direct effect are limited. The aim of this study was to determine the relationship between the presence and severity of OSA and testosterone in a community-based cohort of men aged over 40 years. Desi...

Background Mental health disorders are prevalent and costly to workplaces and individuals in Australia. Work-life interference is thought to contribute negatively. The interplay between work-life interference, depressive symptoms and sleep has not been explored to date in population data. The aims of this study were to establish whether sleep durat...

Use of smartphones/electronic devices and their relationship with outcomes are understudied in adult populations. We determined daytime functional correlates of using technology during the night in a population sample of Australian adults. A cross-sectional, national online survey of sleep health was conducted in 2019 (n=1984, 18-90 years). Nocturn...

Epidemiological evidence on the association between macronutrient intake and excessive daytime sleepiness (EDS) is scarce. Using data from the North West Adelaide Health Study, we aimed to determine the association between iso-caloric substitution of macronutrients and EDS. Data from 1997 adults aged ≥ 24 years were analyzed. Daytime sleepiness was...

Importance Life-course determinants of insomnia, particularly the long-term association of childhood behavioral problems with insomnia later in life, are unknown. As childhood behaviors are measurable and potentially modifiable, understanding their associations with insomnia symptoms may provide novel insights into early intervention strategies to...

Introduction Studies examining potential factors of all-cause mortality comprehensively at community level are rare. Using long-term community-based follow-up study, we examined the association of sociodemographic and behavioural characteristics, metabolic and chronic conditions, and medication and health service utilisation with all-cause mortalit...