The Tasmania-London (TASLON) 3-step home-based video-polysomnography approach to detect iRBD in the community: protocol and preliminary results

The Tasmania-London (TASLON) 3-step home-based video-polysomnography approach to detect iRBD in the community: protocol and preliminary results | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Tasmania-London (TASLON) 3-step home-based video-polysomnography approach to detect iRBD in the community: protocol and preliminary results Samantha Bramich, Alastair J Noyce, Anna E King, Sean Higgins, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6697512/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Study Objective: Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is an early manifestation of alpha-synuclein-related neurodegenerative diseases (NDD). There is an average delay in iRBD diagnosis of 9 years showing that we need easier methods of detection to improve access to specialist care and disease modifying clinical trials. We designed a 3-step approach to detect iRBD in a community of older adults (>50years) in Tasmania, Australia using home-based video-polysomnography (vPSG). Methods: The Tasmania-London (TASLON) iRBD detection protocol comprised 3 steps: participants completed an online iRBD screening question; those who screened positive were invited to undertake the TASLON iRBD Screening Interview by telephone; a sample then completed a home-based vPSG based on iRBD screening risk level. Results: A total of 2891 participants (mean [SD] age 64 [7.7] years; 26% male) without any known NDD were recruited from throughout Tasmania. 267 (9%; age 63[7.7] years; 45% male) were identified as having ‘probable’ RBD through positive online screening; 85 (32%) agreed to complete the clinical screening interview; 48 (56%) underwent home-based vPSG; and 21(44%; age 68[7] years; 48% male) were found to have iRBD. Conclusion: The TASLON 3-step approach is a feasible method of improving timely access to iRBD diagnoses in the community. It streamlines the path to vPSG by identifying those at highest risk of iRBD, thus improving access to diagnostic testing and clinical trial opportunities for those who otherwise may not have been identified. Neurology Preventive Medicine Neurodegenerative Diseases Parasomnias Diagnosis ISLAND Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a parasomnia that is characterised by a loss of normal atonia during REM sleep, which often results in dream enactment ( 1 ). It is an early manifestation of alpha-synuclein-related neurodegenerative disease (NDD), including Parkinson’s disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA) ( 2 ). Identification of people with iRBD is a key research priority worldwide as approximately 80% will progress to an NDD within 14 years ( 3 ). Early detection offers a critical opportunity to intervene with disease modifying clinical and pharmaceutical trials to potentially delay or even prevent the onset of NDD. However, it can be challenging to detect iRBD in the community and it is vastly under-diagnosed ( 4 , 5 ). Currently, diagnosis is made according to criteria detailed in the International Classification of Sleep Disorders, Third Edition (Text Revision; ICSD-3-TR) 2023 (published by the American Academy of Sleep Medicine (AASM)); this states that evidence of REM sleep without atonia (RSWA; loss of muscle tone in REM sleep) needs to be confirmed via polysomnography (PSG) (a specialist sleep study) together with a convincing clinical history of dream enactment behaviour ( 6 ). This approach is problematic due to limited access to PSG and sleep specialist services, especially in rural and remote parts of the world ( 7 ). Hence, those with iRBD may go undiagnosed for years before overt symptoms of other NDD appear. This is a clear barrier to treatment and intervention, with recent studies showing that a substantial number of people with iRBD go on to develop either DLB (50% of cases), PD (45% of cases), or MSA (5% of cases) ( 8 ). Furthermore, under-detection reduces the opportunity to engage in disease modifying clinical trials. Alongside PSG, clinical interview is used to gather details of dream enactment behaviour based on the ICSD-3-TR criteria. This relies on an in-depth understanding of the symptoms and presentation of iRBD and potential mimics of the disorder. Whilst a small number of specialist clinicians, such as neurologists who specialise in neurodegenerative disorders and sleep specialists/physicians, will have knowledge of iRBD, most medical training programs do not provide detailed education on the intricacies of sleep, still less on sleep disorders like iRBD ( 9 – 11 ). As such, clinical interviews vary in consistency due to a lack of formal knowledge or terminological ambiguity ( 10 , 12 ). Unfortunately, no standardised clinical iRBD interview exists to aid clinicians in these assessments. Several validated screening questionnaires are available to assist, and these are usually short and succinct, but vary in accuracy, with sensitivity values ranging from 64–100% and specificity between 36–100% ( 13 ). When compared to gold-standard PSG, all have been found to show low specificity estimates and low positive predictive values ( 14 ). This is likely due to their inability to rule out other sleep disturbances and disorders that can mimic iRBD symptoms, such as OSA and severe periodic limb movement disorder (PLMD)( 7 ). One of the most commonly used screening questions is the REM Sleep Behavior Disorder Single Question Screen (RBD1Q) that simply asks, “ Have you ever been told, or suspected yourself, that you seem to ‘act out your dreams’ while asleep (for example, punching, flailing your arms in the air, making running movements, etc.)?”. It has been shown to have a sensitivity of 80% and specificity of 75.3% for PSG-confirmed iRBD ( 13 ) making it one of the most reliable screening measures for iRBD currently available ( 7 ). However, as outlined by Stefani et al, clinical diagnoses cannot be made on screening questionnaires alone as the specificity and positive predictive values are too low ( 14 ). In response to this urgent need for more accessible pathways to iRBD diagnosis, the Tasmania-London (TASLON) 3-step method was proposed as a pragmatic approach to overcome some of these “real world” challenges to iRBD detection. The aim of this protocol paper is to describe the TASLON approach which uses a combination of screening questionnaire, semi-structured clinical interview and a home-based video-recorded PSG (vPSG). For Tasmania, an island state in Australia, there is a lack of accessibility to sleep specialists and sleep investigations, and this protocol was developed with these challenges in mind. The Tasmanian ISLAND Sleep Study is an ongoing project that aims to characterise iRBD and the detailed protocol has previously been published ( 15 ). Here, we outline the TASLON protocol and preliminary results from the ISLAND Sleep Study cohort. We hypothesise that, by using this approach, we will accurately identify a cohort of people with iRBD in Tasmania, Australia. We envisage that this will then provide future researchers and clinicians with a valuable protocol to detect iRBD more easily, efficiently and with less expense. Method Ethics This study has been approved by University of Tasmania's Health and Medical Human Research Ethics Committee (HREC 26435 and HREC 18264) and was conducted in accordance with the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research (NHaMR, 2018). Participants were given up-to-date information and asked to provide consent at each stage of the research project. Study population Participants were recruited from the general population of Tasmania Australia. Eligibility criteria were (i) being a resident in Tasmania and (ii) being aged 50 years or older, and (iii) being a participant in the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Project. The ISLAND Project is a 10-year public health initiative launched in 2019 by the Wicking Dementia Research and Education Centre, aiming to build dementia risk management self-efficacy and decrease dementia risk in Tasmanians aged 50 or older ( 16 ). The Tasmanian ISLAND Sleep Study is a sub study of the ISLAND Project and inclusion criteria and recruitment strategies for the ISLAND Project and its sub-study have been previously published ( 15 , 16 ). In short, this sub-study is a longitudinal, prospective observational study investigating the prevalence and profiles of iRBD in Tasmania, Australia. It aims to determine the population prevalence of iRBD in adults aged ≥ 50 years in Tasmania, explore iRBD characteristics and biological markers to determine profiles that are specific to people with iRBD and investigate their contributions to α-synuclein NDD phenoconversion. Study Procedures The TASLON protocol to detect vPSG confirmed iRBD in the community comprises 3 steps as follows: Step 1. Participants completed a battery of online validated questionnaires (see Supplementary Table 1), including the Single Question Screen for REM Sleep Behaviour Disorder (RBD1Q) ( 17 ) to screen for ‘probable’ RBD (pRBD) status. Step 2. Participants who screened positive on the RBD1Q in (pRBD) were invited to undertake a 15-question, telephone screening interview (with their bed partner, if applicable) to ascertain further details about iRBD symptoms (see Table 1 ). This was constructed based on established iRBD symptomatology ( 1 ) in collaboration with experts in the field of neurology and sleep medicine (LPC, AJN, CS, SB, JA). Specifically, questions 5, 6 and 7 were replicated from the Oxford-Luxembourg collaboration with permission (reference pending). Table 1 Tasmania-London (TASLON) iRBD Screening Interview questions with inclusion rationale Introduction - Thank you for speaking with me. We are calling because we wish to clarify some of the questionnaires that you filled in as part of the ISLAND Sleep Study. We are especially focusing on sleep problems. Based on your answers in the online survey, it seemed like you may have REM sleep behaviour disorder. Let me explain what this is and let’s decide together if you really might be affected by this sleep disorder. - REM sleep behaviour disorder is a sleep problem in which people 'act out their dreams' at night. Normally, when we dream in REM sleep, we are paralysed, but in this disorder, we are not; so whatever we are dreaming about, we can do. When the disorder is mild, people may just talk - generally this is more than a brief mumbled phrase - often one may appear to be carrying on a conversation. Sometimes with this there will be laughing, or crying, etc. People may also move - for example, they may reach for imaginary objects or make running movements in bed. If the disorder is severe, the movements can be dangerous, such as punching or kicking, or throwing oneself out of bed. Usually, it looks like the person is acting out a dream, and often, if they are woken, people might say that their behaviour was matching the content of their dream. Questions 1. Do you suspect that you ‘act out your dreams’ while asleep (for example, movements such as punching, flailing your arms in the air, kicking, shouting, swearing, laughing in your sleep etc.) Rationale: The RBD1Q is used to confirm original response to the online question ( 17 ). 2. Do you have frequent vivid dreams, often of a distressing content (e.g. being attacked, needing to defend yourself from a threat)? Rationale: Vivid and distressing dreams are commonly reported by people with iRBD ( 18 ). 3. Do you have a bedpartner/someone that sleeps in the same bed/room as you sometimes? a) if yes, have they told you that you seem to act out your dreams? Rationale: Bed partner interview is known to increase the sensitivity of the RBD1Q ( 19 ). 4. Can you tell me about a time when you thought or were told that you acted out your dreams whilst asleep? - how many times has this happened? - approximately what time of night did this/do these occur (first half/second half)? - at what age did you have one of these episodes for the first time? - have you ever walked around the bedroom or gone to other areas of the house during one of these episodes? - how severe were the movements/did you injure yourself or your bedpartner? - have you fallen out of bed as a consequence of episodes where you were acting out your dreams? - have you ever spoken to a doctor about these night-time movements? Rationale: Clinical history of dream enactment episodes is an ICSD-3-TR requirement for iRBD diagnosis ( 6 ) 5. There are a few other explanations for movements that can happen during the night other than REM sleep behaviour disorder. One is sleepwalking and sleep talking. This often starts when you are younger (childhood or adolescence). During an episode, it seems like the person is half asleep and half awake. With this, people can talk, walk around, etc. There are some clues that can help us distinguish this, which I will ask you about: - during the episodes, might you walk? - can you interact with someone during the episode, or does interaction happen only after you are woken? For example, if someone will talk to you during an episode, you might reply (while still in the episode)? - other than grabbing or hitting something in the immediate vicinity, might you interact with the environment during episodes (for example, reaching out to take an object, drinking from a glass of water, brushing teeth with a toothbrush, opening a door)? - are these episodes what you were referring to when you answered yes to the first questions, or are there other movements as well? Rationale: Non-REM parasomnias, such as sleepwalking, can mimic iRBD symptoms. Agreement to questions in this section may explain sleep-related motor behaviour other than iRBD ( 20 ), however sleep talking can also be a feature of iRBD ( 21 ). Additionally, adult-onset episodes of wandering around in sleep may also be seen in association with iRBD ( 22 ). 6. Another frequent sleep problem is bad snoring and sleep apnoea. - Do you know if you have sleep apnoea or snore? - Bad snoring episodes can also cause movements sometimes. Do you snore loudly enough to be heard in the next room? - Do most of the movements seem to occur related to snoring? Rationale: Snoring and sleep apnoea can also cause movements in sleep. Agreement to this section may explain sleep-related motor behaviour other than iRBD, however sleep apnoea can occur alongside iRBD ( 20 , 23 ). 7. There are some other simple movements that people might do while sleeping, that aren't acting out dreams. These include generalized body jerks especially when falling asleep, or a need to move the legs or arms before falling asleep, or rhythmic movements in the legs while asleep. Do these happen to you? Hypnic jerks, sleep-related head jerks or severe PLMD may account for some described movements ( 20 , 24 – 26 ). 8. Have you ever been diagnosed with a neurological disorder, such as Parkinson’s disease, dementia, traumatic brain injury, stroke etc (may already be extractable from sleep study/ISLAND questionnaires) Rationale: RBD can be a symptom of Parkinson’s disease and dementia and may also result from head injury or stroke. The presence of these conditions may negate the possibility of ‘isolated’ RBD ( 27 – 30 ). 9. Have you ever been diagnosed with any form of epilepsy or had a seizure/fit? Rationale: Nocturnal epileptic seizures may account for the description of sleep-related motor behaviour ( 31 ). 10. Have you ever been diagnosed with post-traumatic stress disorder? Rationale: Patients with post-traumatic stress disorder can also experience nightmares and behaviours in sleep, with a similar clinical presentation and PSG findings to those observed in iRBD ( 29 ). 11. Have you ever been diagnosed with a sleep disorder such as obstructive or central sleep apnoea, restless legs syndrome, or periodic limb movement disorder? Rationale: Several sleep disorders may mimic iRBD and should be ruled out as potential explanations for described symptoms of dream enactment ( 20 , 32 ). 12. Have you ever experienced visual hallucinations (saw things that were not really there) at night? Rationale: Visual hallucinations are a common feature of dementia with Lewy bodies and Parkinson’s disease ( 33 ). People may be undiagnosed and therefore exhibiting RBD and hallucinatory symptoms, rather than iRBD. Additionally, nocturnal hallucinations may also be reported in prodromal phases of α-synuclein-related NDD ( 34 ). 13. Do you have a history of sleepwalking or night terrors in childhood or adolescence? Rationale: Sleepwalking/night terrors may have persisted throughout adult years, explaining some sleep-related motor behaviour ( 35 ). A childhood onset of sleep-related behaviours would point against iRBD. 14. Do you take any regular antidepressant or sleep medication? Rationale: There is a strong association between antidepressant use and the emergence of RBD . Antidepressants are known to unmask, trigger or worsen RBD. ( 36 ). 15. Do you ever drink one or more alcoholic beverages within 2 hours of going to bed? Rationale: Alcohol consumption can fragment sleep and has been proposed as a risk factor for the development of probable RBD ( 37 , 38 ). Participants were contacted by a research team member (SB), who is a qualified sleep scientist and asked each interview question remotely, over the telephone. If a bed partner was available, they were included in a conference call or phoned separately, and answers were combined with those of the participant. Interviews took between 20 and 40 minutes to complete, depending on the depth of detail available. Questions were asked in the order presented in Table 1 and participants and bed partners were free to provide additional details at any time throughout the interview process. All answers were written down verbatim throughout the interview and then transcribed into a secure database. The researcher, advised by the sleep medicine specialist; LPC – (who was blinded to any iRBD screening question results) evaluated participants’ answers to interview question based on key words or phrases, and determined those who were most likely to have symptoms consistent with iRBD. Answers were categorised into three groups based on risk for iRBD: high, medium and low (see Table 2 ). The ‘high risk’ and ‘medium risk’ sub-groups were then invited to undertake a home-based vPSG to detect true iRBD. Examples of key ‘high risk’ participant interview responses included: “Yes, I have fallen out of bed and knocked things off the bedside table”; “I often dream of running away or trying to defend myself or others”; and “I have never sleepwalked, but I have stood up in my sleep, maybe twice”. Key bed partner responses included: “He does frequently kick and punch in his sleep, at least once per week”; “He does lash out and hit me. He hit me harder than normal recently and kicked me quite hard”; and “She has gotten out of bed a few times, still asleep, and fallen over. She has hit her head on the bedside table before”. Table 2 Examples of high, medium and low risk iRBD interview responses High Risk Q. # Response 1 Yes, I do this 2 Yes, I often dream of running away or trying to defend myself or others 3 Yes, my husband notices regular dream enactment behaviour, always in the 2nd half of night, usually around 3-4am. 4 My husband often sees me reaching out with my arms and I remember dreaming of rescuing children (I am an ex-school teacher). I think it started when I was in my late 50s, after high work stress situation. Husband reports: it happens 3–4 times/week. Sometimes she might go a fortnight without anything but then every night for a week. I need to wake her up fully for it to stop, otherwise she goes straight back to sleep and continues moving. I sleep with my hands in front of my face to prevent being punched. She rarely gets out of bed, as done it maybe 2–3 times, but her arm movements are frequent, kicking not as often but does happen. 5 I’ve never sleepwalked but have stood up maybe twice. Husband: She sleep talks regularly though - like full conversations. 6 Husband: Occasionally she snores, not very often, but always in the first part of the night. 7 No, not that I can remember. 8 No 9 No 10 No 11 No 12 No 13 No 14 No 15 No Medium Risk Q. # Response 1 Yes, I think I have had dreams where I’ve kicked out and I’ve been told I sleep talk a lot 2 Not frequently distressing, but frequently vivid. 3 No, but I was holidaying with a friend recently and she reported a lot of sleep talking. Years ago, when I was younger someone also told her I was yelling in my sleep when I stayed in a youth hostel. 4 3 years ago, I was dreaming about kicking a monster and I kicked my toe into the bookshelf and broke it. Last night I was yelling in my dream and woke myself up. I think I move my hands around a lot as often things on the bookshelf next to my bed have fallen off when I wake up. These episodes are not regular, I think I’ve had maybe a dozen that I know of. I have kicked my cats across the room when dreaming before but I don’t think I’ve ever gotten out of bed. I think they happen in the 2nd half of the night. I cannot remember when they first started as an adult, but I do remember sleepwalking as a child and I strongly recall vivid dreams in my 30s. I haven’t talked to my doctor about it. 5 Yes sleep talking is often reported whenever I share a room with friends. I have a history of sleep walking when I was young but I don’t think I’ve done it as an adult. 6 I don’t know if I snore, but my friend did not report snoring when we were away together. 7 Yes, hypnic jerks are fairly common but different to these other movements. 8 No, but I have wondered if I had a TIA 10 years ago, it was never diagnosed though. 9 No 10 No 11 No 12 No 13 Yes, I was told I sleepwalked to my nan's house next door when I was a child, and I remember possibly falling out of a bunk bed, but not 100% sure if that was me or my sister. 14 Yes, I take an antidepressant (escitalopram) 15 Sometimes, but not regularly and not in the last year. Low Risk Q.# Response 1 Maybe, I did have home sleep study done recently though and it found severe OSA. Since started CPAP my sleep has been much better 2 Yes, I have always had nightmares and very vivid dreams. Over all my years I have done a lot of kicking and punching with my nightmares. It used to happen 3 or 4 times per year, but I haven’t noticed them since I started CPAP. My husband said I snored and moved a lot so my doctor sent me for a sleep study. 3 Yes, my husband 4 I used to be a sleepwalker, not for decades though. Last week I had a nightmare, and my husband said I was making distressing noises but not really moving at all. Husband: yes, her sleep is much quieter since she started CPAP. 5 No I haven’t sleep walked for many year. Husband: she does sleep talk sometimes though. 6 Yes I was recently diagnosed with OSA and now use CPAP. 7 Yes, I sometimes have hypnic jerks but not frequently. I think they are different to my other movement. 8 No 9 No 10 No 11 OSA 12 No 13 Yes, I sleepwalked but I don’t think I had night terrors. 14 No 15 No Step 3. The home-based vPSG was conducted in the participants home or in a hotel room, by either the researcher (SB; qualified sleep scientist) or a research assistant (RA) who had healthcare experience and was familiar with the medical equipment and building rapport with patients. The RA was trained to perform a full vPSG set-up to meet AASM standards (please see below details on montage used)( 6 ). The researcher demonstrated the sleep study set-up to the RA three times, provided two supervision sessions, after which the RA undertook study set-up independently. The researcher and RA met intermittently to set-up sleep studies together to ensure accurate application for all sensors. The home-based vPSG equipment for this study was configured in collaboration with Compumedics Australia, a commercial company that develops, manufactures, and commercialises diagnostic technologies ( https://www.compumedics.com.au/en/ ). This system was chosen because it was ambulatory and could be configured to include all data acquisition needed to detect iRBD. It consisted of an ONsight A.V.S. recording computer, configured to a Grael 4K PSG amplifier. This allowed for the collection and recording of all physiological data required to determine the presence of iRBD, or other sleep disorders, in line with the AASM Manual for the Scoring of Sleep and Associated Events ( 6 ). Data collected included: 10 EEG ( channels (F3, F4, C3, C4, O1, O2, A1, A2, reference and ground), electrocardiogram (ECG), electrooculogram (EOG), thoracic and abdominal respiratory effort, nasal airflow, oximetry, and EMG assessment of the following muscles: submentalis (chin), bilateral flexor digitorum superficialis (arms), bilateral anterior tibialis (legs), and synchronised video and audio recording. If participants had a previous diagnosis of OSA and were on PAP therapy, this was used on the night of the study as usual. The researcher or RA transported the vPSG equipment to the participant’s home and positioned the Grael headbox next to the patient’s bed (usually on a bedside table) and the ONSight system at the foot of the bed (see Fig. 1 ). All sensors were then attached to the participant prior to bedtime (usually in the late afternoon), to obtain data for one night of sleep. Step 4. Participants were informed about the need for each sensor and what data they were collecting and were encouraged to keep them intact until the following morning. The Grael headbox was able to be removed from its cradle during the evening so that the participant could carry it with them and continue with their evening activities prior to their usual sleep time, whilst also being able to use the bathroom overnight if needed. The researcher was available overnight by telephone to provide phone-based technical support if the participant required assistance throughout the night. The researcher or RA then returned to the home the following morning to remove the sensors, collect the equipment, and then upload the recorded data from the ONsight computer to a secure database in preparation for scoring. Data Analysis All vPSG data was scored in line with the AASM manual ( 6 ), first by the researcher and then by a qualified sleep physiologist with expertise in RBD detection (SH) who was blinded to all clinical data and the interview screening answers. Each participant’s scored data set was reviewed by the sleep medicine specialist (LPC; who was also blinded to all clinical data and the interview screening answers) to determine the presence of iRBD or other sleep disorders. Results A total of 2891 participants (mean [SD] age 64 [7.7] years; 26% male) without any diagnosed NDD were recruited from throughout Tasmania. 267 (age 63(7.7) years; 45% male) were identified as having pRBD as per the RBD1Q. Between group differences were calculated, as shown in Table 2 . A significantly greater percentage of females, those with Aboriginal and/or Torres Strait Islander origin (first nations people of Australia), abnormal anxiety level, and antidepressant use was found in the pRBD group compared to controls. Table 2 Demographics of the complete cohort Control (N = 2624) pRBD (N = 267) P-value Age (in years) Mean (SD) 63.9 (7.72) 62.6 (7.59) 0.01 Median [Min, Max] 64.0 [50.0, 91.0] 62.0 [50.0, 88.0] Sex Female 1987 (75.7%) 147 (55.1%) < 0.001 Male 631 (24.0%) 119 (44.6%) Other 4 (0.2%) 1 (0.4%) Prefer not to say 2 (0.1%) 0 (0%) Marital Status Defacto 274 (10.4%) 25 (9.4%) 0.17 Married 1533 (58.4%) 174 (65.2%) Other 15 (0.6%) 4 (1.5%) Prefer not to say 4 (0.2%) 0 (0%) Separated or divorced 353 (13.5%) 32 (12.0%) Single 206 (7.9%) 19 (7.1%) Widowed 171 (6.5%) 10 (3.7%) Missing 68 (2.6%) 3 (1.1%) Highest Level of Education Bachelor's Degree 573 (21.8%) 43 (16.1%) 0.13 Certificate or Apprenticeship (including Cert 2, 3 or 4) 258 (9.8%) 37 (13.9%) Diploma / Associate Degree 478 (18.2%) 50 (18.7%) High School 332 (12.7%) 37 (13.9%) Higher University degree (Honours, Graduate Diploma, Masters or PhD) 847 (32.3%) 94 (35.2%) Other 84 (3.2%) 5 (1.9%) Primary School 1 (0.0%) 0 (0%) Missing 51 (1.9%) 1 (0.4%) Currently Employment No 1488 (56.7%) 145 (54.3%) 0.35 Yes 1090 (41.5%) 121 (45.3%) Missing 46 (1.8%) 1 (0.4%) Currently Retired No 210 (8.0%) 29 (10.9%) < 0.01 Yes 1312 (50.0%) 128 (47.9%) N/A 0 (0%) 1 (0.4%) Missing 1102 (42.0%) 109 (40.8%) Number of Children Mean (SD) 2.11 (2.44) 1.96 (1.41) 0.13 Median [Min, Max] 2.00 [0, 44.0] 2.00 [0, 11.0] Missing 102 (3.9%) 6 (2.2%) Remoteness Area Inner Regional Australia 1930 (73.6%) 196 (73.4%) 0.28 Outer Regional Australia 664 (25.3%) 67 (25.1%) Remote Australia 5 (0.2%) 2 (0.7%) Very Remote Australia 7 (0.3%) 0 (0%) Missing 18 (0.7%) 2 (0.7%) Country of Birth Australia 1628 (62.0%) 156 (58.4%) 0.01 Germany 21 (0.8%) 2 (0.7%) Ireland 12 (0.5%) 1 (0.4%) Netherlands 22 (0.8%) 2 (0.7%) New Zealand 56 (2.1%) 3 (1.1%) Other 137 (5.2%) 22 (8.2%) Philippines 1 (0.0%) 1 (0.4%) Poland 3 (0.1%) 0 (0%) UK 318 (12.1%) 24 (9.0%) Italy 0 (0%) 1 (0.4%) Missing 426 (16.2%) 55 (20.6%) Aboriginal and/or Torres Strait Islander origin No 2156 (82.2%) 200 (74.9%) < 0.001 Yes, Aboriginal 25 (1.0%) 10 (3.7%) Yes, both Aboriginal and Torres Strait Islander 2 (0.1%) 0 (0%) Yes, Torres Strait Islander 1 (0.0%) 0 (0%) Missing 440 (16.8%) 57 (21.3%) Sleep Quality Good Sleep Quality 1101 (42.0%) 93 (34.8%) 0.03 Poor Sleep Quality 1506 (57.4%) 173 (64.8%) Missing 17 (0.6%) 1 (0.4%) Anxiety Level Abnormal 240 (9.1%) 43 (16.1%) < 0.001 Borderline abnormal 403 (15.4%) 54 (20.2%) Normal 1945 (74.1%) 169 (63.3%) Missing 36 (1.4%) 1 (0.4%) Depression Level Abnormal 62 (2.4%) 11 (4.1%) 0.04 Borderline abnormal 128 (4.9%) 20 (7.5%) Normal 2398 (91.4%) 235 (88.0%) Missing 36 (1.4%) 1 (0.4%) Regular Antidepressant Use No 2223 (84.7%) 183 (68.5%) < 0.001 Yes 396 (15.1%) 82 (30.7%) Missing 32 (1.2%) 2 (0.8%) *NB: Relative geographic remoteness in Australia is measured by calculating road distance from various populated locations. Of the 267 who screened positive for pRBD, 90 responded to the project invitation and consented to be contacted to complete the TASLON screening interview. 53 bed partners also consented to contribute to the interview. 5 participants were non-contactable or unable to complete the phone call. 37 participants were determined to be high-risk for iRBD, 16 were medium-risk, and 31 were low-risk. 48 participants from the high- and medium-risk groups underwent a home-based vPSG and 21 were found to show evidence of iRBD (see Fig. 3 ). Of these, 6 were found to have comorbid OSA or central sleep apnoea (CSA), and 8 showed evidence of periodic leg movements in sleep (PLMS). Demographics of those with and without iRBD can be seen in Table 3 . Seven participants did not show any evidence of a sleep disorder, and the remaining participants showed evidence either OSA, CSA, PLMS, or a combination of these (see Fig. 4 .).Three participants had previously been diagnosed with OSA and used continuous positive airway pressure (CPAP) support overnight. Five vPSGs were not interpretable due to either EEG or EMG lead loss/misplacement, poor impedance, or technical failure of the recording, and participants were invited to undertake a repeat study. Three participants consented to a repeat, 1 declined, and 1 moved interstate and was unable to continue participation in the project. Table 3 Demographic characteristics of the confirmed iRBD group versus the negative iRBD group iRBD confirmed (N = 21) iRBD negative (N = 26) P-value 1 Age (in years) Mean (SD) 68 ( 7 ) 67 ( 8 ) 0.84 Median [Min, Max] 69 [55, 82] 68 [53, 79] Sex Female 11 (52%) 11 (42% 0.49 Male 10 (48%) 15 (58%) Marital Status Defacto 2 (9.5%) 3 (12%) 0.11 Married 17 (81%) 13 (50%) Separated or divorced 0 (0%) 5 (19%) Single 2 (9.5%) 4 (15%) Widowed 0 (0%) 1 (3.8%) Highest Level of Education Bachelor's Degree 6 (29%) 2 (23%) 0.46 Certificate or Apprenticeship (including Cert 2, 3 or 4) 2 (9.5%) 3 (12%) Diploma / Associate Degree 5 (24%) 6 (23%) High School 0 (0%) 4 (15%) Higher University degree (Honours, Graduate Diploma, Masters or PhD) 8 (38%) 7 (27%) Currently Employment No 14 (67%) 19 (73%) 0.63 Yes 7 (33%) 7 (27%) Currently Retired No 5 (24%) 7 (28%) 0.75 Yes 16 (76%) 18 (72%) Unknown 0 (0%) 1 Number of Children Mean (SD) 2.14 (1.29) 2.58 (3.06) 0.93 Median [Min, Max] 2.50 [0.00, 4.00] 2.00 [0.00, 13.00] Unknown 7 7 Remoteness Area* Inner Regional Australia 17 (81%) 22 (88%) 0.69 Outer Regional Australia 4 (19%) 3 (12%) Unknown 0 1 Country/Region of Birth Australia and New Zealand 13 (67%) 19 (83%) 0.06 United Kingdom and Europe 3 (11%) 0 (0%) Africa 1 (5.6%) 1 (4.3%) USA 0 (0%) 2 (8.7%) Asia 1 (5.6%) 1 (4.3) Unknown 3 3 Aboriginal and/or Torres Strait Islander origin No 17 (100%) 20 (87%) 0.25 Yes, Aboriginal 0 (0%) 3 (13%) Unknown 4 3 Sleep Quality Good Sleep Quality 9 (43%) 8 (31%) 0.39 Poor Sleep Quality 12 (57%) 18 (69%) Anxiety Level Abnormal 2 (9.5%) 2 (7.7%) 0.85 Borderline abnormal 1 (4.8%) 3 (12%) Normal 18 (86%) 21 (81%) Depression Level Abnormal 0 (0%) 0 (%) 0.36 Borderline abnormal 1 (4.8%) 4 (15%) Normal 20 (95%) 22 (85%) Regular Antidepressant Use No 14 (67%) 15 (60%) 0.64 Yes 7 (33%) 10 (40%) Unknown 0 1 1 Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test *NB: Relative geographic remoteness in Australia is measured by calculating road distance from various populated locations. Several participants also provided qualitative feedback regarding their home-based vPSG experience and a sample of this can be seen in Figure 5. Discussion Preliminary findings from the Tasmanian ISLAND Sleep Study show that the TASLONTASLON three-step approach to identifying iRBD in the community – remote from the research centre - is feasible and acceptable. This is a vital step to improving diagnosis and care in this population as only one participant in this study had received prior medical advice regarding iRBD related symptoms, showing that there is a significant under-recognition of iRBD in the community and amongst medical professionals. So far, the use of a semi-structured clinical interview in combination with home-based vPSG has identified 21 cases of iRBD (and 20 mimics) in Tasmania, Australia, from a pool of 90 who agreed to the be interviewed for this study. This demonstrates that our approach has strong potential predictive value. We utilised in-depth clinical knowledge from clinicians and researchers who work closely with iRBD populations in the development of this semi-structured interview and ensured that a wide range of relevant questions were included. It is envisaged that this interview can be used in both research and clinical environments to accurately identify those at highest risk of having iRBD. Several community screening approaches for iRBD have previously been published ( 39 – 41 ), and a comparable 3-step method for iRBD detection has recently been used in Germany, finding similar results ( 41 ). Seger et al recruited participants by advertising the RBD1Q in local newspapers, followed by a structured telephone screening consisting of several validated questionnaires to cover a broad range of sleep disturbances, before selecting certain participants to undergo vPSG. Their method detected 185 participants to undergo telephone screening, followed by 124 vPSG’s (at home or in a hotel room) based upon expert evaluation of questionnaire answers. This found that 62% of participants who had a vPSG (78/124) had iRBD, which is slightly higher than our findings of 44% (21/48). The proportion of females was higher in the current study compared to Seger et al’s, with 55% female compared to 20%. This resulted in a near equal sex split in the positive and negative iRBD groups in this study; 52 and 42% respectively, whereas Seger et al had a lower number of females in both their positive and negative groups (28 and 14% respectively). Such findings reveal the importance of including a greater proportion of females in iRBD research, as the higher prevalence of males with iRBD previously reported may need reassessment. Future work will build upon the efficacy of the interview used in this study by analysing a greater number of participant responses and vPSG results in depth, using regression and receiver operating characteristic analyses to determine the positive predictive value of the clinical interview to detect iRBD compared to gold-standard in-lab vPSG. Presently, gold-standard PSG assessment for iRBD requires an overnight stay in a hospital or sleep laboratory whilst being attended by a sleep technician, scientist or physiologist. The PSG required to detect iRBD is also more complex than standard PSG, as the current AASM manual for the scoring of sleep and associated events ( 6 ), recommends the use of additional sensors on upper limbs, which are not routinely included in a standard PSG. Not only is access to these services limited geographically, but they may also be costly, with fees reaching up to USD $ 2000 for a standard PSG admission ( 42 , 43 ). Wait times vary between countries but can be 12 months or more for those awaiting testing for common sleep disorders, such as obstructive sleep apnoea (OSA) ( 44 ), and are likely to be longer for those in need of the iRBD specific PSG. Additionally, travel to and from facilities can also pose a significant challenge for those with added comorbidities. In fact, one study from North America found that the average delay in diagnosis for people suspected of RBD was nine years ( 5 ). Researchers interested in iRBD recognise that reliable, ambulatory PSGs are urgently needed to detect iRBD within the home and the community in order to speed up accurate iRBD diagnosis, and to facilitate earlier treatment and recruitment into clinical trials ( 45 ). Home-based PSG is favoured over lab or hospital-based PSG for most individuals, as it is more convenient, comfortable and affordable ( 46 – 49 ). To our knowledge, this is one of the first studies to implement a home-based vPSG protocol for the detection of iRBD. The Compumedics ONsight A.V.S system, in combination the Grael 4K amplifier, allows for collection of the exact same data that would be captured in a lab or hospital-based vPSG, but in the comfort of one’s own home. Not only does this allow for the precise and accurate physiological data collection needed for iRBD detection, but it also ensures greater participant comfort and encourages better sleep quality and increased total sleep time. Unfortunately, unattended vPSG does pose a risk of failure, due to the potential loss or displacement of body sensors overnight, which would normally be replaced during a lab or hospital based vPSG by the attending technician. Our current limited data suggests a failure rate of 10% for this study, which is in line with previous home-based PSG studies for OSA estimating failure rates between 4 and 20% ( 50 ). This is also a particular risk for people suspected of having iRBD, as dream-related movements make it more likely for sensors to become displaced on the body or dislodged from the headbox. Of the two participants who have undergone a repeat study, both were confirmed to have iRBD on their second attempt. One way to mitigate this limitation is the inclusion of video recording, which has the potential to provide additional data if EMG signals are lost. For example, if leg or arm EMG signal is lost due to motor activity, but EEG is retained, sleep physiologists and specialists may still be able to determine that a dream enactment episode is evident if REM sleep is observed alongside visualisation of limb movements. Currently the ICSD-3-TR criteria for iRBD diagnoses does not require video-recorded evidence of iRBD, although the use of synchronised video recording during PSG is recommended by the AASM, and The International RBD Study Group ( 51 ) as a necessary addition. Nevertheless, interpretation of visual data depends on the scrutiny of the reviewer and would not be reliable if both vital EEG and EMG signals were lost. Another option could be to show bed partners the vPSG set-up whilst it is underway and then guide them on how to reattach or replace sensors if they are found to be lost overnight, though this would not be possible for people sleeping on their own. A further limitation to unattended home-based vPSG in this study is the use of a newly configured system. Technical troubleshooting was required by researchers and technical support staff whilst the equipment was in use in the field, which caused delay in data collection at some points throughout the project. Future research into failure rate improvements would benefit from better connectivity of sensor leads to the headbox, strengthened sensor adhesive, appropriate calibrations, and thorough testing of equipment prior to data collection. In conclusion, this preliminary data shows that the 3-step approach using the TASLON iRBD screening interview is useful for the assessment of people suspected of having iRBD. Unfortunately, iRBD is difficult to diagnose, as overnight movements can be misconstrued for other, more common sleep disorders. The use of a standardised semi-structured clinical interview alongside home-based vPSG would greatly improve the process of iRBD diagnoses in the community. It would streamline the path to PSG by identifying those at highest risk of iRBD, thus improving access to diagnostic testing for those who otherwise may not have been identified. Declarations Acknowledgement Statement: We would like to thank Professor Michele Hu of Oxford University, UK and Professor Rejko Krüger of the University of Luxembourg for generously sharing their Telephone Interview for RBD. 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Sleep Med Rev 18(4):341–347 Cesari M, Heidbreder A, St Louis EK, Sixel-Döring F, Bliwise DL, Baldelli L et al (2022) Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: guidelines from the International RBD Study Group. Sleep. ;45(3) Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6697512","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458617804,"identity":"e9559e6c-e531-42b1-b660-16d26d5dc027","order_by":0,"name":"Samantha 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set-up\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6697512/v1/facf664b0807d71d79e7eaf4.png"},{"id":83337348,"identity":"0b7f5810-90c9-44d1-a1fb-fb4bf63db744","added_by":"auto","created_at":"2025-05-23 09:28:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74051,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3. Flowchart of detection protocol\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6697512/v1/8161b19bc03e5b61ea3e817c.png"},{"id":83337349,"identity":"b6f40497-df5d-4718-8db9-5e564d7bac1b","added_by":"auto","created_at":"2025-05-23 09:28:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":17195,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4. Sleep disorders detected through home-based vPSG\u003c/strong\u003e\u003cbr\u003e\n \u003cem\u003eKey: iRBD – isolated REM sleep behaviour disorder; OSA – obstructive sleep apnoea; PLMS – periodic leg movements in sleep; CSA – central sleep apnoea.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6697512/v1/0f80cba447d7b5834bcd8761.png"},{"id":83337627,"identity":"4bd5cfe3-3680-4563-88f9-3414cd17fcc2","added_by":"auto","created_at":"2025-05-23 09:36:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":64522,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6697512/v1/1f513bb4645ae2cf51a1e63b.png"},{"id":83338196,"identity":"c0bfefc8-8ec7-4eb9-8a8d-b33927f48a6e","added_by":"auto","created_at":"2025-05-23 09:44:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2077242,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6697512/v1/5d41bc6c-b31d-4d38-91a5-ea048ef29d75.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eThe Tasmania-London (TASLON) 3-step home-based video-polysomnography approach to detect iRBD in the community: protocol and preliminary results\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIsolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a parasomnia that is characterised by a loss of normal atonia during REM sleep, which often results in dream enactment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is an early manifestation of alpha-synuclein-related neurodegenerative disease (NDD), including Parkinson\u0026rsquo;s disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Identification of people with iRBD is a key research priority worldwide as approximately 80% will progress to an NDD within 14 years (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Early detection offers a critical opportunity to intervene with disease modifying clinical and pharmaceutical trials to potentially delay or even prevent the onset of NDD.\u003c/p\u003e \u003cp\u003eHowever, it can be challenging to detect iRBD in the community and it is vastly under-diagnosed (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Currently, diagnosis is made according to criteria detailed in the International Classification of Sleep Disorders, Third Edition (Text Revision; ICSD-3-TR) 2023 (published by the American Academy of Sleep Medicine (AASM)); this states that evidence of REM sleep without atonia (RSWA; loss of muscle tone in REM sleep) needs to be confirmed via polysomnography (PSG) (a specialist sleep study) together with a convincing clinical history of dream enactment behaviour (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This approach is problematic due to limited access to PSG and sleep specialist services, especially in rural and remote parts of the world (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Hence, those with iRBD may go undiagnosed for years before overt symptoms of other NDD appear. This is a clear barrier to treatment and intervention, with recent studies showing that a substantial number of people with iRBD go on to develop either DLB (50% of cases), PD (45% of cases), or MSA (5% of cases) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Furthermore, under-detection reduces the opportunity to engage in disease modifying clinical trials.\u003c/p\u003e \u003cp\u003eAlongside PSG, clinical interview is used to gather details of dream enactment behaviour based on the ICSD-3-TR criteria. This relies on an in-depth understanding of the symptoms and presentation of iRBD and potential mimics of the disorder. Whilst a small number of specialist clinicians, such as neurologists who specialise in neurodegenerative disorders and sleep specialists/physicians, will have knowledge of iRBD, most medical training programs do not provide detailed education on the intricacies of sleep, still less on sleep disorders like iRBD (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). As such, clinical interviews vary in consistency due to a lack of formal knowledge or terminological ambiguity (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Unfortunately, no standardised clinical iRBD interview exists to aid clinicians in these assessments.\u003c/p\u003e \u003cp\u003eSeveral validated screening questionnaires are available to assist, and these are usually short and succinct, but vary in accuracy, with sensitivity values ranging from 64\u0026ndash;100% and specificity between 36\u0026ndash;100% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). When compared to gold-standard PSG, all have been found to show low specificity estimates and low positive predictive values (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This is likely due to their inability to rule out other sleep disturbances and disorders that can mimic iRBD symptoms, such as OSA and severe periodic limb movement disorder (PLMD)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). One of the most commonly used screening questions is the REM Sleep Behavior Disorder Single Question Screen (RBD1Q) that simply asks, \u0026ldquo;\u003cem\u003eHave you ever been told, or suspected yourself, that you seem to \u0026lsquo;act out your dreams\u0026rsquo; while asleep (for example, punching, flailing your arms in the air, making running movements, etc.)?\u0026rdquo;.\u003c/em\u003e It has been shown to have a sensitivity of 80% and specificity of 75.3% for PSG-confirmed iRBD (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) making it one of the most reliable screening measures for iRBD currently available (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, as outlined by Stefani et al, clinical diagnoses cannot be made on screening questionnaires alone as the specificity and positive predictive values are too low (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn response to this urgent need for more accessible pathways to iRBD diagnosis, the Tasmania-London (TASLON) 3-step method was proposed as a pragmatic approach to overcome some of these \u0026ldquo;real world\u0026rdquo; challenges to iRBD detection. The aim of this protocol paper is to describe the TASLON approach which uses a combination of screening questionnaire, semi-structured clinical interview and a home-based video-recorded PSG (vPSG). For Tasmania, an island state in Australia, there is a lack of accessibility to sleep specialists and sleep investigations, and this protocol was developed with these challenges in mind. The Tasmanian ISLAND Sleep Study is an ongoing project that aims to characterise iRBD and the detailed protocol has previously been published (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Here, we outline the TASLON protocol and preliminary results from the ISLAND Sleep Study cohort. We hypothesise that, by using this approach, we will accurately identify a cohort of people with iRBD in Tasmania, Australia. We envisage that this will then provide future researchers and clinicians with a valuable protocol to detect iRBD more easily, efficiently and with less expense.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003e This study has been approved by University of Tasmania's Health and Medical Human Research Ethics Committee (HREC 26435 and HREC 18264) and was conducted in accordance with the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research (NHaMR, 2018). Participants were given up-to-date information and asked to provide consent at each stage of the research project.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited from the general population of Tasmania Australia. Eligibility criteria were (i) being a resident in Tasmania and (ii) being aged 50 years or older, and (iii) being a participant in the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Project. The ISLAND Project is a 10-year public health initiative launched in 2019 by the Wicking Dementia Research and Education Centre, aiming to build dementia risk management self-efficacy and decrease dementia risk in Tasmanians aged 50 or older (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Tasmanian ISLAND Sleep Study is a sub study of the ISLAND Project and inclusion criteria and recruitment strategies for the ISLAND Project and its sub-study have been previously published (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In short, this sub-study is a longitudinal, prospective observational study investigating the prevalence and profiles of iRBD in Tasmania, Australia. It aims to determine the population prevalence of iRBD in adults aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years in Tasmania, explore iRBD characteristics and biological markers to determine profiles that are specific to people with iRBD and investigate their contributions to α-synuclein NDD phenoconversion.\u003c/p\u003e\n\u003ch3\u003eStudy Procedures\u003c/h3\u003e\n\u003cp\u003eThe TASLON protocol to detect vPSG confirmed iRBD in the community comprises 3 steps as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003eStep 1.\u003c/em\u003e Participants completed a battery of online validated questionnaires (see Supplementary Table\u0026nbsp;1), including the Single Question Screen for REM Sleep Behaviour Disorder (RBD1Q) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) to screen for \u0026lsquo;probable\u0026rsquo; RBD (pRBD) status.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStep 2.\u003c/em\u003e Participants who screened positive on the RBD1Q in (pRBD) were invited to undertake a 15-question, telephone screening interview (with their bed partner, if applicable) to ascertain further details about iRBD symptoms (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This was constructed based on established iRBD symptomatology (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) in collaboration with experts in the field of neurology and sleep medicine (LPC, AJN, CS, SB, JA). Specifically, questions 5, 6 and 7 were replicated from the Oxford-Luxembourg collaboration with permission (reference pending).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTasmania-London (TASLON) iRBD Screening Interview questions with inclusion rationale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntroduction\u003c/p\u003e \u003cp\u003e- Thank you for speaking with me. We are calling because we wish to clarify some of the questionnaires that you filled in as part of the ISLAND Sleep Study. We are especially focusing on sleep problems. Based on your answers in the online survey, it seemed like you may have REM sleep behaviour disorder. Let me explain what this is and let\u0026rsquo;s decide together if you really might be affected by this sleep disorder.\u003c/p\u003e \u003cp\u003e- REM sleep behaviour disorder is a sleep problem in which people 'act out their dreams' at night. Normally, when we dream in REM sleep, we are paralysed, but in this disorder, we are not; so whatever we are dreaming about, we can do. When the disorder is mild, people may just talk - generally this is more than a brief mumbled phrase - often one may appear to be carrying on a conversation. Sometimes with this there will be laughing, or crying, etc. People may also move - for example, they may reach for imaginary objects or make running movements in bed. If the disorder is severe, the movements can be dangerous, such as punching or kicking, or throwing oneself out of bed. Usually, it looks like the person is acting out a dream, and often, if they are woken, people might say that their behaviour was matching the content of their dream.\u003c/p\u003e\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Do you suspect that you \u0026lsquo;act out your dreams\u0026rsquo; while asleep (for example, movements such as punching, flailing your arms in the air, kicking, shouting, swearing, laughing in your sleep etc.)\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: The RBD1Q is used to confirm original response to the online question\u003c/em\u003e (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Do you have frequent vivid dreams, often of a distressing content (e.g. being attacked, needing to defend yourself from a threat)?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Vivid and distressing dreams are commonly reported by people with iRBD\u003c/em\u003e (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Do you have a bedpartner/someone that sleeps in the same bed/room as you sometimes?\u003c/p\u003e \u003cp\u003ea) if yes, have they told you that you seem to act out your dreams?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Bed partner interview is known to increase the sensitivity of the RBD1Q\u003c/em\u003e (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Can you tell me about a time when you thought or were told that you acted out your dreams whilst asleep?\u003c/p\u003e \u003cp\u003e- how many times has this happened?\u003c/p\u003e \u003cp\u003e- approximately what time of night did this/do these occur (first half/second half)?\u003c/p\u003e \u003cp\u003e- at what age did you have one of these episodes for the first time? \u003c/p\u003e \u003cp\u003e- have you ever walked around the bedroom or gone to other areas of the house during one of these episodes?\u003c/p\u003e \u003cp\u003e- how severe were the movements/did you injure yourself or your bedpartner?\u003c/p\u003e \u003cp\u003e- have you fallen out of bed as a consequence of episodes where you were acting out your dreams?\u003c/p\u003e \u003cp\u003e- have you ever spoken to a doctor about these night-time movements?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Clinical history of dream enactment episodes is an ICSD-3-TR requirement for iRBD diagnosis\u003c/em\u003e (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. There are a few other explanations for movements that can happen during the night other than REM sleep behaviour disorder. \u003c/p\u003e \u003cp\u003eOne is sleepwalking and sleep talking. This often starts when you are younger (childhood or adolescence). During an episode, it seems like the person is half asleep and half awake. With this, people can talk, walk around, etc. There are some clues that can help us distinguish this, which I will ask you about: \u003c/p\u003e \u003cp\u003e- during the episodes, might you walk?\u003c/p\u003e \u003cp\u003e- can you interact with someone during the episode, or does interaction happen only after you are woken? For example, if someone will talk to you during an episode, you might reply (while still in the episode)?\u003c/p\u003e \u003cp\u003e- other than grabbing or hitting something in the immediate vicinity, might you interact with the environment during episodes (for example, reaching out to take an object, drinking from a glass of water, brushing teeth with a toothbrush, opening a door)?\u003c/p\u003e \u003cp\u003e- are these episodes what you were referring to when you answered yes to the first questions, or are there other movements as well?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Non-REM parasomnias, such as sleepwalking, can mimic iRBD symptoms. Agreement to questions in this section may explain sleep-related motor behaviour other than iRBD\u003c/em\u003e (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), \u003cem\u003ehowever sleep talking can also be a feature of iRBD\u003c/em\u003e (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). \u003cem\u003eAdditionally, adult-onset episodes of wandering around in sleep may also be seen in association with iRBD\u003c/em\u003e (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Another frequent sleep problem is bad snoring and sleep apnoea.\u003c/p\u003e \u003cp\u003e- Do you know if you have sleep apnoea or snore?\u003c/p\u003e \u003cp\u003e- Bad snoring episodes can also cause movements sometimes. Do you snore loudly enough to be heard in the next room?\u003c/p\u003e \u003cp\u003e- Do most of the movements seem to occur related to snoring?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Snoring and sleep apnoea can also cause movements in sleep. Agreement to this section may explain sleep-related motor behaviour other than iRBD, however sleep apnoea can occur alongside iRBD\u003c/em\u003e (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. There are some other simple movements that people might do while sleeping, that aren't acting out dreams. These include generalized body jerks especially when falling asleep, or a need to move the legs or arms before falling asleep, or rhythmic movements in the legs while asleep. Do these happen to you?\u003c/p\u003e \u003cp\u003e\u003cem\u003eHypnic jerks, sleep-related head jerks or severe PLMD may account for some described movements\u003c/em\u003e (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Have you ever been diagnosed with a neurological disorder, such as Parkinson\u0026rsquo;s disease, dementia, traumatic brain injury, stroke etc (may already be extractable from sleep study/ISLAND questionnaires)\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: RBD can be a symptom of Parkinson\u0026rsquo;s disease and dementia and may also result from head injury or stroke. The presence of these conditions may negate the possibility of \u0026lsquo;isolated\u0026rsquo; RBD\u003c/em\u003e (\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Have you ever been diagnosed with any form of epilepsy or had a seizure/fit?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Nocturnal epileptic seizures may account for the description of sleep-related motor behaviour\u003c/em\u003e (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Have you ever been diagnosed with post-traumatic stress disorder?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Patients with post-traumatic stress disorder can also experience nightmares and behaviours in sleep, with a similar clinical presentation and PSG findings to those observed in iRBD\u003c/em\u003e (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Have you ever been diagnosed with a sleep disorder such as obstructive or central sleep apnoea, restless legs syndrome, or periodic limb movement disorder?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Several sleep disorders may mimic iRBD and should be ruled out as potential explanations for described symptoms of dream enactment\u003c/em\u003e (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Have you ever experienced visual hallucinations (saw things that were not really there) at night?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Visual hallucinations are a common feature of dementia with Lewy bodies and Parkinson\u0026rsquo;s disease\u003c/em\u003e (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). \u003cem\u003ePeople may be undiagnosed and therefore exhibiting RBD and hallucinatory symptoms, rather than iRBD. Additionally, nocturnal hallucinations may also be reported in prodromal phases of α-synuclein-related NDD\u003c/em\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Do you have a history of sleepwalking or night terrors in childhood or adolescence?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Sleepwalking/night terrors may have persisted throughout adult years, explaining some sleep-related motor behaviour\u003c/em\u003e (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). \u003cem\u003eA childhood onset of sleep-related behaviours would point against iRBD.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Do you take any regular antidepressant or sleep medication?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: There is a strong association between antidepressant use and the emergence of RBD\u003c/em\u003e. \u003cem\u003eAntidepressants are known to unmask, trigger or worsen RBD.\u003c/em\u003e (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Do you ever drink one or more alcoholic beverages within 2 hours of going to bed?\u003c/p\u003e \u003cp\u003e\u003cem\u003eRationale: Alcohol consumption can fragment sleep and has been proposed as a risk factor for the development of probable RBD\u003c/em\u003e (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants were contacted by a research team member (SB), who is a qualified sleep scientist and asked each interview question remotely, over the telephone. If a bed partner was available, they were included in a conference call or phoned separately, and answers were combined with those of the participant. Interviews took between 20 and 40 minutes to complete, depending on the depth of detail available. Questions were asked in the order presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and participants and bed partners were free to provide additional details at any time throughout the interview process. All answers were written down verbatim throughout the interview and then transcribed into a secure database.\u003c/p\u003e \u003cp\u003eThe researcher, advised by the sleep medicine specialist; LPC \u0026ndash; (who was blinded to any iRBD screening question results) evaluated participants\u0026rsquo; answers to interview question based on key words or phrases, and determined those who were most likely to have symptoms consistent with iRBD. Answers were categorised into three groups based on risk for iRBD: high, medium and low (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The \u0026lsquo;high risk\u0026rsquo; and \u0026lsquo;medium risk\u0026rsquo; sub-groups were then invited to undertake a home-based vPSG to detect true iRBD.\u003c/p\u003e \u003cp\u003eExamples of key \u0026lsquo;high risk\u0026rsquo; participant interview responses included: \u0026ldquo;Yes, I have fallen out of bed and knocked things off the bedside table\u0026rdquo;; \u0026ldquo;I often dream of running away or trying to defend myself or others\u0026rdquo;; and \u0026ldquo;I have never sleepwalked, but I have stood up in my sleep, maybe twice\u0026rdquo;. Key bed partner responses included: \u0026ldquo;He does frequently kick and punch in his sleep, at least once per week\u0026rdquo;; \u0026ldquo;He does lash out and hit me. He hit me harder than normal recently and kicked me quite hard\u0026rdquo;; and \u0026ldquo;She has gotten out of bed a few times, still asleep, and fallen over. She has hit her head on the bedside table before\u0026rdquo;.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExamples of high, medium and low risk iRBD interview responses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Risk\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ. #\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I do this\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I often dream of running away or trying to defend myself or others\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, my husband notices regular dream enactment behaviour, always in the 2nd half of night, usually around 3-4am.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMy husband often sees me reaching out with my arms and I remember dreaming of rescuing children (I am an ex-school teacher). I think it started when I was in my late 50s, after high work stress situation.\u003c/p\u003e \u003cp\u003eHusband reports: it happens 3\u0026ndash;4 times/week. Sometimes she might go a fortnight without anything but then every night for a week. I need to wake her up fully for it to stop, otherwise she goes straight back to sleep and continues moving. I sleep with my hands in front of my face to prevent being punched. She rarely gets out of bed, as done it maybe 2\u0026ndash;3 times, but her arm movements are frequent, kicking not as often but does happen.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u0026rsquo;ve never sleepwalked but have stood up maybe twice.\u003c/p\u003e \u003cp\u003eHusband: She sleep talks regularly though - like full conversations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHusband: Occasionally she snores, not very often, but always in the first part of the night.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo, not that I can remember.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedium Risk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eQ. #\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eResponse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I think I have had dreams where I\u0026rsquo;ve kicked out and I\u0026rsquo;ve been told I sleep talk a lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot frequently distressing, but frequently vivid.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo, but I was holidaying with a friend recently and she reported a lot of sleep talking. Years ago, when I was younger someone also told her I was yelling in my sleep when I stayed in a youth hostel.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 years ago, I was dreaming about kicking a monster and I kicked my toe into the bookshelf and broke it. Last night I was yelling in my dream and woke myself up. I think I move my hands around a lot as often things on the bookshelf next to my bed have fallen off when I wake up. These episodes are not regular, I think I\u0026rsquo;ve had maybe a dozen that I know of. I have kicked my cats across the room when dreaming before but I don\u0026rsquo;t think I\u0026rsquo;ve ever gotten out of bed. I think they happen in the 2nd half of the night. I cannot remember when they first started as an adult, but I do remember sleepwalking as a child and I strongly recall vivid dreams in my 30s. I haven\u0026rsquo;t talked to my doctor about it.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes sleep talking is often reported whenever I share a room with friends. I have a history of sleep walking when I was young but I don\u0026rsquo;t think I\u0026rsquo;ve done it as an adult.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI don\u0026rsquo;t know if I snore, but my friend did not report snoring when we were away together.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, hypnic jerks are fairly common but different to these other movements.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo, but I have wondered if I had a TIA\u0026thinsp;\u0026lt;\u0026thinsp;transient ischaemic attack\u0026thinsp;\u0026gt;\u0026thinsp;10 years ago, it was never diagnosed though.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I was told I sleepwalked to my nan's house next door when I was a child, and I remember possibly falling out of a bunk bed, but not 100% sure if that was me or my sister.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I take an antidepressant (escitalopram)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSometimes, but not regularly and not in the last year.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLow Risk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eQ.#\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eResponse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaybe, I did have home sleep study done recently though and it found severe OSA. Since started CPAP my sleep has been much better\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I have always had nightmares and very vivid dreams. Over all my years I have done a lot of kicking and punching with my nightmares. It used to happen 3 or 4 times per year, but I haven\u0026rsquo;t noticed them since I started CPAP. My husband said I snored and moved a lot so my doctor sent me for a sleep study.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, my husband\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI used to be a sleepwalker, not for decades though. Last week I had a nightmare, and my husband said I was making distressing noises but not really moving at all.\u003c/p\u003e \u003cp\u003eHusband: yes, her sleep is much quieter since she started CPAP.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo I haven\u0026rsquo;t sleep walked for many year.\u003c/p\u003e \u003cp\u003eHusband: she does sleep talk sometimes though.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes I was recently diagnosed with OSA and now use CPAP.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I sometimes have hypnic jerks but not frequently. I think they are different to my other movement.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOSA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, I sleepwalked but I don\u0026rsquo;t think I had night terrors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eStep 3.\u003c/em\u003e The home-based vPSG was conducted in the participants home or in a hotel room, by either the researcher (SB; qualified sleep scientist) or a research assistant (RA) who had healthcare experience and was familiar with the medical equipment and building rapport with patients. The RA was trained to perform a full vPSG set-up to meet AASM standards (please see below details on montage used)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The researcher demonstrated the sleep study set-up to the RA three times, provided two supervision sessions, after which the RA undertook study set-up independently. The researcher and RA met intermittently to set-up sleep studies together to ensure accurate application for all sensors.\u003c/p\u003e \u003cp\u003eThe home-based vPSG equipment for this study was configured in collaboration with Compumedics Australia, a commercial company that develops, manufactures, and commercialises diagnostic technologies (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.compumedics.com.au/en/\u003c/span\u003e\u003cspan address=\"https://www.compumedics.com.au/en/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). This system was chosen because it was ambulatory and could be configured to include all data acquisition needed to detect iRBD. It consisted of an ONsight A.V.S. recording computer, configured to a Grael 4K PSG amplifier. This allowed for the collection and recording of all physiological data required to determine the presence of iRBD, or other sleep disorders, in line with the AASM Manual for the Scoring of Sleep and Associated Events (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Data collected included: 10 EEG ( channels (F3, F4, C3, C4, O1, O2, A1, A2, reference and ground), electrocardiogram (ECG), electrooculogram (EOG), thoracic and abdominal respiratory effort, nasal airflow, oximetry, and EMG assessment of the following muscles: submentalis (chin), bilateral flexor digitorum superficialis (arms), bilateral anterior tibialis (legs), and synchronised video and audio recording. If participants had a previous diagnosis of OSA and were on PAP therapy, this was used on the night of the study as usual. The researcher or RA transported the vPSG equipment to the participant\u0026rsquo;s home and positioned the Grael headbox next to the patient\u0026rsquo;s bed (usually on a bedside table) and the ONSight system at the foot of the bed (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAll sensors were then attached to the participant prior to bedtime (usually in the late afternoon), to obtain data for one night of sleep.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStep 4.\u003c/em\u003e Participants were informed about the need for each sensor and what data they were collecting and were encouraged to keep them intact until the following morning. The Grael headbox was able to be removed from its cradle during the evening so that the participant could carry it with them and continue with their evening activities prior to their usual sleep time, whilst also being able to use the bathroom overnight if needed. The researcher was available overnight by telephone to provide phone-based technical support if the participant required assistance throughout the night. The researcher or RA then returned to the home the following morning to remove the sensors, collect the equipment, and then upload the recorded data from the ONsight computer to a secure database in preparation for scoring.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAll vPSG data was scored in line with the AASM manual (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), first by the researcher and then by a qualified sleep physiologist with expertise in RBD detection (SH) who was blinded to all clinical data and the interview screening answers. Each participant\u0026rsquo;s scored data set was reviewed by the sleep medicine specialist (LPC; who was also blinded to all clinical data and the interview screening answers) to determine the presence of iRBD or other sleep disorders.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 2891 participants (mean [SD] age 64 [7.7] years; 26% male) without any diagnosed NDD were recruited from throughout Tasmania. 267 (age 63(7.7) years; 45% male) were identified as having pRBD as per the RBD1Q. Between group differences were calculated, as shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. A significantly greater percentage of females, those with Aboriginal and/or Torres Strait Islander origin (first nations people of Australia), abnormal anxiety level, and antidepressant use was found in the pRBD group compared to controls.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographics of the complete cohort\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2624)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003epRBD\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;267)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (in years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.9 (7.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.6 (7.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian [Min, Max]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.0 [50.0, 91.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.0 [50.0, 88.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1987 (75.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e147 (55.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e631 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDefacto\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e274 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1533 (58.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e174 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeparated or divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e353 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e206 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest Level of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e573 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCertificate or Apprenticeship (including Cert 2, 3 or 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e258 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiploma / Associate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e478 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (18.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e332 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher University degree (Honours, Graduate Diploma, Masters or PhD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e847 (32.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94 (35.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently Employment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1488 (56.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1090 (41.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e121 (45.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently Retired\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e210 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1312 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128 (47.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1102 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.11 (2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.96 (1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian [Min, Max]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00 [0, 44.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00 [0, 11.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemoteness Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInner Regional Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1930 (73.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e196 (73.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOuter Regional Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e664 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRemote Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery Remote Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry of Birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1628 (62.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156 (58.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGermany\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIreland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNetherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNew Zealand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhilippines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e318 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e426 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (20.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAboriginal and/or Torres Strait Islander origin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2156 (82.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e200 (74.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, Aboriginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, both Aboriginal and Torres Strait Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, Torres Strait Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e440 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57 (21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Quality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood Sleep Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1101 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor Sleep Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1506 (57.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173 (64.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e240 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBorderline abnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e403 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1945 (74.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBorderline abnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2398 (91.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235 (88.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegular Antidepressant Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2223 (84.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183 (68.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e396 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e*NB: Relative geographic remoteness in Australia is measured by calculating road distance from various populated locations.\u003c/p\u003e\n\u003cp\u003eOf the 267 who screened positive for pRBD, 90 responded to the project invitation and consented to be contacted to complete the TASLON screening interview. 53 bed partners also consented to contribute to the interview. 5 participants were non-contactable or unable to complete the phone call. 37 participants were determined to be high-risk for iRBD, 16 were medium-risk, and 31 were low-risk. 48 participants from the high- and medium-risk groups underwent a home-based vPSG and 21 were found to show evidence of iRBD (see Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Of these, 6 were found to have comorbid OSA or central sleep apnoea (CSA), and 8 showed evidence of periodic leg movements in sleep (PLMS). Demographics of those with and without iRBD can be seen in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eSeven participants did not show any evidence of a sleep disorder, and the remaining participants showed evidence either OSA, CSA, PLMS, or a combination of these (see Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.).Three participants had previously been diagnosed with OSA and used continuous positive airway pressure (CPAP) support overnight. Five vPSGs were not interpretable due to either EEG or EMG lead loss/misplacement, poor impedance, or technical failure of the recording, and participants were invited to undertake a repeat study. Three participants consented to a repeat, 1 declined, and 1 moved interstate and was unable to continue participation in the project.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of the confirmed iRBD group versus the negative iRBD group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eiRBD confirmed\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eiRBD\u003c/p\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (in years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian [Min, Max]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 [55, 82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 [53, 79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDefacto\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeparated or divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest Level of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCertificate or Apprenticeship (including Cert 2, 3 or 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiploma / Associate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher University degree (Honours, Graduate Diploma, Masters or PhD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently Employment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently Retired\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.14 (1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.58 (3.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian [Min, Max]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.50 [0.00, 4.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00 [0.00, 13.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemoteness Area*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInner Regional Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOuter Regional Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry/Region of Birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia and New Zealand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnited Kingdom and Europe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfrica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAboriginal and/or Torres Strait Islander origin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, Aboriginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Quality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood Sleep Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor Sleep Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBorderline abnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBorderline abnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegular Antidepressant Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eWilcoxon rank sum test; Pearson\u0026rsquo;s Chi-squared test; Fisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*NB: Relative geographic remoteness in Australia is measured by calculating road distance from various populated locations.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeveral participants also provided qualitative feedback regarding their home-based vPSG experience and a sample of this can be seen in Figure 5.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePreliminary findings from the Tasmanian ISLAND Sleep Study show that the TASLONTASLON three-step approach to identifying iRBD in the community \u0026ndash; remote from the research centre - is feasible and acceptable. This is a vital step to improving diagnosis and care in this population as only one participant in this study had received prior medical advice regarding iRBD related symptoms, showing that there is a significant under-recognition of iRBD in the community and amongst medical professionals. So far, the use of a semi-structured clinical interview in combination with home-based vPSG has identified 21 cases of iRBD (and 20 mimics) in Tasmania, Australia, from a pool of 90 who agreed to the be interviewed for this study. This demonstrates that our approach has strong potential predictive value. We utilised in-depth clinical knowledge from clinicians and researchers who work closely with iRBD populations in the development of this semi-structured interview and ensured that a wide range of relevant questions were included. It is envisaged that this interview can be used in both research and clinical environments to accurately identify those at highest risk of having iRBD.\u003c/p\u003e \u003cp\u003eSeveral community screening approaches for iRBD have previously been published (\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), and a comparable 3-step method for iRBD detection has recently been used in Germany, finding similar results (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Seger et al recruited participants by advertising the RBD1Q in local newspapers, followed by a structured telephone screening consisting of several validated questionnaires to cover a broad range of sleep disturbances, before selecting certain participants to undergo vPSG. Their method detected 185 participants to undergo telephone screening, followed by 124 vPSG\u0026rsquo;s (at home or in a hotel room) based upon expert evaluation of questionnaire answers. This found that 62% of participants who had a vPSG (78/124) had iRBD, which is slightly higher than our findings of 44% (21/48). The proportion of females was higher in the current study compared to Seger et al\u0026rsquo;s, with 55% female compared to 20%. This resulted in a near equal sex split in the positive and negative iRBD groups in this study; 52 and 42% respectively, whereas Seger et al had a lower number of females in both their positive and negative groups (28 and 14% respectively). Such findings reveal the importance of including a greater proportion of females in iRBD research, as the higher prevalence of males with iRBD previously reported may need reassessment. Future work will build upon the efficacy of the interview used in this study by analysing a greater number of participant responses and vPSG results in depth, using regression and receiver operating characteristic analyses to determine the positive predictive value of the clinical interview to detect iRBD compared to gold-standard in-lab vPSG.\u003c/p\u003e \u003cp\u003ePresently, gold-standard PSG assessment for iRBD requires an overnight stay in a hospital or sleep laboratory whilst being attended by a sleep technician, scientist or physiologist. The PSG required to detect iRBD is also more complex than standard PSG, as the current AASM manual for the scoring of sleep and associated events (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), recommends the use of additional sensors on upper limbs, which are not routinely included in a standard PSG. Not only is access to these services limited geographically, but they may also be costly, with fees reaching up to USD\u003cspan\u003e$\u003c/span\u003e2000 for a standard PSG admission (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Wait times vary between countries but can be 12 months or more for those awaiting testing for common sleep disorders, such as obstructive sleep apnoea (OSA) (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), and are likely to be longer for those in need of the iRBD specific PSG. Additionally, travel to and from facilities can also pose a significant challenge for those with added comorbidities. In fact, one study from North America found that the average delay in diagnosis for people suspected of RBD was nine years (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Researchers interested in iRBD recognise that reliable, ambulatory PSGs are urgently needed to detect iRBD within the home and the community in order to speed up accurate iRBD diagnosis, and to facilitate earlier treatment and recruitment into clinical trials (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHome-based PSG is favoured over lab or hospital-based PSG for most individuals, as it is more convenient, comfortable and affordable (\u003cspan additionalcitationids=\"CR47 CR48\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). To our knowledge, this is one of the first studies to implement a home-based vPSG protocol for the detection of iRBD. The Compumedics ONsight A.V.S system, in combination the Grael 4K amplifier, allows for collection of the exact same data that would be captured in a lab or hospital-based vPSG, but in the comfort of one\u0026rsquo;s own home. Not only does this allow for the precise and accurate physiological data collection needed for iRBD detection, but it also ensures greater participant comfort and encourages better sleep quality and increased total sleep time.\u003c/p\u003e \u003cp\u003eUnfortunately, unattended vPSG does pose a risk of failure, due to the potential loss or displacement of body sensors overnight, which would normally be replaced during a lab or hospital based vPSG by the attending technician. Our current limited data suggests a failure rate of 10% for this study, which is in line with previous home-based PSG studies for OSA estimating failure rates between 4 and 20% (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). This is also a particular risk for people suspected of having iRBD, as dream-related movements make it more likely for sensors to become displaced on the body or dislodged from the headbox. Of the two participants who have undergone a repeat study, both were confirmed to have iRBD on their second attempt. One way to mitigate this limitation is the inclusion of video recording, which has the potential to provide additional data if EMG signals are lost. For example, if leg or arm EMG signal is lost due to motor activity, but EEG is retained, sleep physiologists and specialists may still be able to determine that a dream enactment episode is evident if REM sleep is observed alongside visualisation of limb movements.\u003c/p\u003e \u003cp\u003eCurrently the ICSD-3-TR criteria for iRBD diagnoses does not require video-recorded evidence of iRBD, although the use of synchronised video recording during PSG is recommended by the AASM, and The International RBD Study Group (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) as a necessary addition. Nevertheless, interpretation of visual data depends on the scrutiny of the reviewer and would not be reliable if both vital EEG and EMG signals were lost. Another option could be to show bed partners the vPSG set-up whilst it is underway and then guide them on how to reattach or replace sensors if they are found to be lost overnight, though this would not be possible for people sleeping on their own. A further limitation to unattended home-based vPSG in this study is the use of a newly configured system. Technical troubleshooting was required by researchers and technical support staff whilst the equipment was in use in the field, which caused delay in data collection at some points throughout the project. Future research into failure rate improvements would benefit from better connectivity of sensor leads to the headbox, strengthened sensor adhesive, appropriate calibrations, and thorough testing of equipment prior to data collection.\u003c/p\u003e \u003cp\u003eIn conclusion, this preliminary data shows that the 3-step approach using the TASLON iRBD screening interview is useful for the assessment of people suspected of having iRBD. Unfortunately, iRBD is difficult to diagnose, as overnight movements can be misconstrued for other, more common sleep disorders. The use of a standardised semi-structured clinical interview alongside home-based vPSG would greatly improve the process of iRBD diagnoses in the community. It would streamline the path to PSG by identifying those at highest risk of iRBD, thus improving access to diagnostic testing for those who otherwise may not have been identified.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement Statement:\u003c/strong\u003e We would like to thank Professor Michele Hu of Oxford University, UK and Professor Rejko Kr\u0026uuml;ger of the University of Luxembourg for generously sharing their Telephone Interview for RBD. We have used, with permission, three questions from this in the TASLON iRBD Screening Interview with minor, or no, adaptations and recognise that the Oxford-Luxembourg team conceptualised these three questions.\u003c/p\u003e\n\u003ch3\u003eEthical Compliance Statement\u003c/h3\u003e\n\u003cp\u003eThe University of Tasmania Human Research Ethics Committee reviewed and approved this study. All participants in this study gave their informed written consent via an online consent form, prior to the inclusion of their data in the study. All identifying information was removed prior to analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoeve BF (2010) REM sleep behavior disorder: Updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease association, evolving concepts, controversies, and future directions. 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Sleep Med 110:99\u0026ndash;105\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePostuma RB, Pelletier A, Berg D, Gagnon J-F, Escudier F, Montplaisir J (2016) Screening for prodromal Parkinson's disease in the general community: a sleep-based approach. Sleep Med 21:101\u0026ndash;105\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuškov\u0026aacute; J, Ibarburu V, Šonka K, Růžička E (2016) Screening for REM sleep behavior disorder in the general population. Sleep Med 24:147\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeger A, Ophey A, Heitzmann W, Doppler CEJ, Lindner M-S, Brune C et al (2023) Evaluation of a Structured Screening Assessment to Detect Isolated Rapid Eye Movement Sleep Behavior Disorder. Mov Disord 38(6):990\u0026ndash;999\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBramich S, King A, Kuruvilla M, Naismith S, Noyce A, Alty J (2022) Isolated REM sleep behaviour disorder: current diagnostic procedures and emerging new technologies. J Neurol 269:1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim RD, Kapur VK, Redline-Bruch J, Rueschman M, Auckley DH, Benca RM et al (2015) An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea. Sleep 38(7):1027\u0026ndash;1037\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J (2004) Access to diagnosis and treatment of patients with suspected sleep apnea. 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Sleep Breath 18(4):817\u0026ndash;823\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBruyneel M, Sanida C, Art G, Libert W, Cuvelier L, Paesmans M et al (2011) Sleep efficiency during sleep studies: results of a prospective study comparing home-based and in-hospital polysomnography. J Sleep Res 20(1 Pt 2):201\u0026ndash;206\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarie B, Walter L, Lieveke A, Vincent N (2015) Comparison between home and hospital set-up for unattended home-based polysomnography: a prospective randomized study. Sleep Med 16(11):1434\u0026ndash;1438\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarie B, Vincent N (2014) Unattended home-based polysomnography for sleep disordered breathing: Current concepts and perspectives. 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Sleep. ;45(3)\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"516c08e7-d29f-414a-950d-45f9fb154e49","identifier":"10.13039/100012503","name":"Royal Hobart Hospital Research Foundation","awardNumber":"22-204","order_by":0},{"identity":"c0c5d2cb-69ee-471c-b8ef-2b40d9e01586","identifier":"10.13039/100012697","name":"Clifford Craig Foundation","awardNumber":"N/A","order_by":1}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Wicking Dementia Research and Education Centre, University of Tasmania, Australia","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neurodegenerative Diseases, Parasomnias, Diagnosis, ISLAND","lastPublishedDoi":"10.21203/rs.3.rs-6697512/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6697512/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Objective:\u003c/strong\u003e Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is an early manifestation of alpha-synuclein-related neurodegenerative diseases (NDD). There is an average delay in iRBD diagnosis of 9 years showing that we need easier methods of detection to improve access to specialist care and disease modifying clinical trials. We designed a 3-step approach to detect iRBD in a community of older adults (\u0026gt;50years) in Tasmania, Australia using home-based video-polysomnography (vPSG).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The Tasmania-London (TASLON) iRBD detection protocol comprised 3 steps: participants completed an online iRBD screening question; those who screened positive were invited to undertake the TASLON iRBD Screening Interview by telephone; a sample then completed a home-based vPSG based on iRBD screening risk level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 2891 participants (mean [SD] age 64 [7.7] years; 26% male) without any known NDD were recruited from throughout Tasmania. 267 (9%; age 63[7.7] years; 45% male) were identified as having ‘probable’ RBD through positive online screening; 85 (32%) agreed to complete the clinical screening interview; 48 (56%) underwent home-based vPSG; and 21(44%; age 68[7] years; 48% male) were found to have iRBD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The TASLON 3-step approach is a feasible method of improving timely access to iRBD diagnoses in the community. It streamlines the path to vPSG by identifying those at highest risk of iRBD, thus improving access to diagnostic testing and clinical trial opportunities for those who otherwise may not have been identified.\u003c/p\u003e","manuscriptTitle":"The Tasmania-London (TASLON) 3-step home-based video-polysomnography approach to detect iRBD in the community: protocol and preliminary results","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-23 09:28:06","doi":"10.21203/rs.3.rs-6697512/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0fc742c9-804e-4b27-9cd0-f54a41495f7c","owner":[],"postedDate":"May 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48718565,"name":"Neurology"},{"id":48718566,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2025-05-23T09:28:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-23 09:28:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6697512","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6697512","identity":"rs-6697512","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}