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Adelaide Institute for Sleep Health Research Group

respiratory/sleep pathophysiology, sleep apnoea, treatments...

Members of the AISH Research Group 2015:

L-R Malcolm Battersby, Naomi Deacon, Ching Li
Chai-Coetzer, Karen Reynolds, Doug McEvoy,
Leon Lack, Andrew Vakulin, Peter Catcheside,
Nicole Lovato, Nick Antic, Neralie Cain.

Research Summary

The Adelaide Institute for Sleep Health (www.adelaidesleephealth.org.au) provides a clinical service for patients with sleep related problems, such as obstructive sleep apnoea (repeated obstructive breathing events in sleep), insomnia and sleep hypoventilation in patients with known respiratory muscle weakness or lung disease. Breathing disturbance and sleep fragmentation have important daytime consequences including pathological daytime sleepiness, neurocognitive impairments and a substantially increased risk of traffic and other accidents. Sleep apnoea is also associated with cardiovascular disease (eg hypertension and heart disease) and other adverse health outcomes. Mechanisms underpinning airway collapse in sleep remain remarkably poorly understood. AISH is one of the leading clinical research laboratories in Australia and has strong respiratory sleep physiology research interests, with a particular focus on understanding the mechanisms and consequences of sleep breathing disorders.

Research Projects

Breathing becomes much more stable in deep sleep, even in most patients with severe obstructive sleep apnoea (OSA). However, the mechanisms underlying this effect are unknown. Current and ongoing projects are designed to investigate factors that may help explain this effect; such as changes in breathing effort and upper airway muscle control changes, and changes in arousal propensity and breathing responses to arousal across sleep. A better understanding of these mechanisms could help with the design of new treatments to help stabilise upper airway function and breathing in OSA.

Obstructive sleep apnoea (OSA) and snoring are typically worse in the supine versus non-supine sleep postures and a significant group of patients could theoretically be effectively treated by simply avoiding back sleeping. Classic supine-discomfort (e.g. tennis-ball) treatments can be effective, but most patients abandon treatment due to the inherent discomfort of this approach. An ongoing collaborative study is trialling if a simple non-discomfort approach compared to current best-practice treatment is clinically effective and acceptable for the clinical management of this patient group.

Insomnia and OSA occur together much more than expected for 2 separate conditions overlapping purely by chance. OSA could worsen insomnia by making the transition into established sleep more difficult than normal, and insomnia could worsen OSA by promoting more light sleep where OSA events occur most frequently. In addition, patients with insomnia and OSA may find normal treatments more difficult to tolerate than most OSA patients. Flinders University and AISH are investigating potential links between OSA and insomnia and methods for improving treatments.

The Adelaide Institute for Sleep Health and Flinders University are an integral part of a national Federal Government funded CRC for Alertness, Safety and Productivity. The CRC aims to develop a range of innovative strategies to reduce fatigue and sleepiness and related injuries, enhance workplace performance and improve sleep related health and quality of life. The CRC includes an extensive education and training program to support PhD students and postdoctoral research fellows involved in the seven-year CRC program.

AISH in involved in 4 main themes of the CRC research program;
> Improving personalised sleep medicine through ‘phenotyping’ and targeting treatments to underlying causes of abnormal breathing in sleep.
> Identifying biomarkers of sleepiness and performance deficits to help reduce accident and adverse health outcome risks.
> Developing new technologies to assess alertness impairment.
> Individualising sleep and alertness management in safety critical occupations.

Developing new automated methods for improved diagnosis of REM sleep behaviour disorder from chin EMG activity changes during sleep.

Rapid eye movement (REM) sleep behaviour disorder (RBD) is a rare condition associated with body movements during REM sleep when motor system and skeletal muscle activity is normally disengaged from dream activity. Current diagnostic methods rely on patient history and a qualitative visual assessment of body movements and EMG activity measured during a sleep study. However, gross body movements are rarely captured in a single night sleep study so more subtle indicators would potentially be clinically useful. The aim of this study is to examine temporal relationships between eye-movements and muscle activity changes during REM sleep in RBD patients and non-RBD controls to guide the design of algorithms that may assist with the diagnosis of RBD.

Selected Publications

Van Ryswyk E, Weeks R, Bandick L, O'Keefe M, Vakulin A, Catcheside P, Barger L, Potter A, Poulos N, Wallace J, Antic NA (2017) A novel sleep optimisation programme to improve athletes' well-being and performance. European Journal of Sport Science, 17(2):144-151


Sweetman AM, Lack LC, Catcheside PG, Antic NA, Chai-Coetzer CL, Smith SS, Douglas JA, McEvoy RD (2017) Developing a successful treatment for co-morbid insomnia and sleep apnoea. Sleep Medicine Reviews, 33:28-38, Review.


Adams RJ, Appleton SL, Vakulin A, Lang C, Martin SA, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Wittert GA (2016) Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men. Respirology, 21(7):1314-21


Ng JR, Aiyappan V, Mercer J, Catcheside PG, Chai-Coetzer CL, McEvoy RD, Antic N (2016) Choosing an Oronasal Mask to Deliver Continuous Positive Airway Pressure May Cause More Upper Airway Obstruction or Lead to Higher Continuous Positive Airway Pressure Requirements than a Nasal Mask in Some Patients: A Case Series. Journal of Clinical Sleep Medicine, 12(9):1227-32


Appleton SL, Vakulin A, Martin SA, Lang CJ, Wittert GA, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Adams RJ (2016) Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep. Chest, 150(3):495-505


Martin SA, Appleton SL, Adams RJ, Taylor AW, Catcheside PG, Vakulin A, McEvoy RD, Antic NA, Wittert GA (2016) Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men. Urology, 97:219-226


Appleton SL, Vakulin A, Wittert GA, Martin SA, Grant JF, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Adams RJ (2016) The association of obstructive sleep apnea (OSA) and nocturnal hypoxemia with the development of abnormal HbA1c in a population cohort of men without diabetes. Diabetes Research and Clinical Practice, 114:151-9


Jordan AS, Cori JM, Dawson A, Nicholas CL, O'Donoghue FJ, Catcheside PG, Eckert DJ, McEvoy RD, Trinder JA (2015) Arousal does not lead to reduced dilator muscle activity or elevated upper airway resistance on return to sleep in healthy individuals. Sleep, 38(1):53-9


Appleton SL, Vakulin A, McEvoy RD, Wittert GA, Martin SA, Grant JF, Taylor AW, Antic NA, Catcheside PG, Adams RJ (2015) Nocturnal Hypoxemia and Severe OSA are Associated with Incident Type 2 Diabetes in a Population Cohort of Men. Journal of Clinical Sleep Medicine, 11(6):609-14


Appleton SL, Vakulin A, McEvoy RD, Vincent A, Martin S, Grant JF, Taylor AW, Antic NA, Catcheside PG, Wittert GA, Adams RJ (2015) Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort. Sleep and Breathing, 19(4):1309-16


Deacon NL, Catcheside PG (2015) The role of high loop gain induced by intermittent hypoxia in the pathophysiology of obstructive sleep apnoea. Sleep Medicine Reviews, 22:3-14


Catcheside P, Mohtar A and Reynolds K (2014) Airflow resistance and CO2 rebreathing properties of anti-asphyxia pillows designed for epilepsy. European Journal of Epilepsy, 23(6):462-467


Kezirian EJ, Goding JR GS, Malhotra A, O'Donoghue FJ , Zammit G, Wheatley JR, Catcheside PG, Smith PL, Schwartz AR, Walsh JH, Maddison KJ, Claman DM, Huntley T, Park SY, Campbell MC, Palme CE, Iber C, Eastwood PR, Hillman DR, Barnes M (2014) Hypoglossal nerve stimulation improves obstructive sleep apnoea: 12-month outcomes. Journal of Sleep Research, 23(1):77-83


Vakulin A, Catcheside PG, Baulk SD, Antic NA, Banks S, Dorrian J, McEvoy RD (2014) Individual Variability and Predictors of Driving Simulator Impairment in Patients with Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 10(6):647-655


Rose AR, Catcheside PG, McEvoy RD, Paul D, Kapur D, Peak E, Vakulin A, Antic NA (2014) Sleep disordered breathing and chronic respiratory failure in patients with chronic pain on long term opioid therapy. Journal of Clinical Sleep Medicine, 10(8):847-852


Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG, Eckermann S, Vowles N, Williams H, Dunn S, McEvoy RD (2013) Effect of primary care versus specialist sleep center management of obstructive sleep apnea on daytime sleepiness and quality of life: A randomised trial. Journal of the American Medical Association (JAMA), 309:997-1004


Opie GM, Catcheside PG, Usmani ZA, Ridding MC, Semmler JG (2013) Motor cortex plasticity induced by theta burst stimulation is impaired in patients with obstructive sleep apnoea. European Journal of Neuroscience, 37:1844:1852


Catcheside PG (2010) Predictors of continuous positive airway pressure adherence. F1000 Medicine Reports, 2:70; http://f1000.com/reports/medicine/content/2/70



  • Peter Catcheside, BSc (Hons), PhD

  • Doug McEvoy, BMedSc, MBBS, FRACP, MD

  • Nick Antic, MBBS, FRACP, PhD

  • Leon Lack, BA, PhD

  • Karen Reynolds FTSE, FAHMS, FIEAust, PhD, MSc, MA, BA(Hons), Grad Cert Tert Ed

  • Simon Carney, BSc, MBChB, FRCSEd, FRCS, FRACS, MD

  • Ching Li Chai-Coetzer, MBBS, FRACP, PhD

  • Vinod Aiyappan, MBBS, MD, MRCP (U.K), FRACP

  • Richard Weeks, BAppSc BMBS FRANZCP FPOA

  • Andrew Vakulin, BSc (Hons), PhD

  • Nicole Lovato, BPsyc (Hons), PhD

Support Staff

  • Denzil Paul, Research Officer

  • Melanie Heath, Research Assistant

  • Dr Emer Van Ryswyk, Research Assistant

  • Dr David Stevens, Research Assistant

  • Laura Bandick, Senior Sleep Technologist

  • Michaela O’Keefe, Senior Sleep Technologist

  • Leanne Cox, Research Coordinator


  • Naomi Deacon, PhD Student

  • Rohit Philip, PhD Student

    Isabella Ellison, Honours Student

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