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Trial registered on ANZCTR
Registration number
ACTRN12619000475145
Ethics application status
Approved
Date submitted
19/03/2019
Date registered
22/03/2019
Date last updated
3/04/2019
Date data sharing statement initially provided
22/03/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
A comparison between positional therapy and continuous positive airway pressure therapy for positional obstructive sleep apnoea..
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Scientific title
Prospective crossover trial of Positional and Continuous positive airway pressure Therapy for the treatment of mild-to-moderate positional obstructive sleep apnoea.
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Secondary ID [1]
297748
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Nil
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Universal Trial Number (UTN)
U1111-1230-3289
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Trial acronym
PaCT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Positional obstructive sleep apnoea
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Condition category
Condition code
Respiratory
310639
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0
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Sleep apnoea
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Positional Therapy (NightShift)
In the positional therapy arm, patients will wear a NightShift during sleep at home for a period of 8 weeks. The NightShift device is a small position monitoring device that is worn around the neck. The device vibrates when the wearer lays in the supine position and slowly increases in intensity until the wearer changes to a non-supine position.
Adherence will be measured through the data downloaded from the NightShift device post-treatment (8 weeks). There is no washout period between treatments.
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Intervention code [1]
313985
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Treatment: Devices
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Comparator / control treatment
Continuous Positive Airway Pressure (CPAP) Therapy
Patients will be asked to use CPAP therapy during sleep for a period of 8 weeks. CPAP will deliver a continuous level of positive airway pressure via a mask interface to maintain a patent airway. The CPAP settings and accessories (mask interface etc.) will be individually selected for each patient. Adherence will be measured through the data download from the CPAP device post-treatment (8 weeks).
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Control group
Active
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Outcomes
Primary outcome [1]
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Sleepiness as assessed by the Epworth Sleepiness Scale
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Assessment method [1]
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Timepoint [1]
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Baseline, 8 weeks after commencing each therapy.
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Secondary outcome [1]
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Patient-specified therapy preference via study-specific questionnaire.
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Assessment method [1]
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Timepoint [1]
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At end of the trial
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Secondary outcome [2]
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Adherence with therapy as assessed by download of device showing proportion of nights used by the patient
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Assessment method [2]
368408
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Timepoint [2]
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8 weeks after commencing each therapy.
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Secondary outcome [3]
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Quality of Life as assessed by the Functional Outcomes of Sleep Questionnaire.
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Assessment method [3]
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Timepoint [3]
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Baseline, 8 weeks after commencing each therapy.
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Secondary outcome [4]
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Depression, Anxiety, Stress Scale (DASS-21)
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Assessment method [4]
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Timepoint [4]
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Baseline, 8 weeks after commencing each therapy.
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Secondary outcome [5]
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Composite outcome of the following Neurocognitive tests: (PVT, Tower of London, Go/No-Go, Match to Sample, Corsi test, Wisconsin Card-sorting test)
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Assessment method [5]
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Timepoint [5]
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Baseline, 8 weeks after commencing each therapy.
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Secondary outcome [6]
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Quality of Life as assessed by the Short Form 36 item Quality of Life questionnaire.
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Assessment method [6]
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Timepoint [6]
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Baseline, 8 weeks after commencing each therapy.
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Eligibility
Key inclusion criteria
Supine predominant positional obstructive sleep apnoea (pOSA) as defined by a total AHI >5 with a supine-to-non-supine AHI ratio >=2 on diagnostic PSG
Mild-to-moderate (>=5 AHI <30) severity pOSA
Symptomatic as defined by Epworth Sleepiness Score (ESS) >10
English-speaking adult patients
Able to perform neurocognitive tests
Able to provide informed consent.
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Evidence of significant hypoxia (>=5% total sleep time <90% SpO2) on PSG
Clinically significant co-morbidity (including history of head injury, stroke or neuro-/psychiatric disorder)
Use of centrally-acting medications
Heavy alcohol consumption (>40g/day)
Pregnancy
Current shift worker;
Previous use of CPAP
Very severe symptoms which in the opinion of the treating physician requires urgent treatment with CPAP
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is concealed via the holder of a centralized allocation schedule. The holder has no role in determining eligibility of the subjects.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Randomization table created by the Randomizer.org program.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people analysing the results/data
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Intervention assignment
Crossover
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
All analyses will be conducted on an intention to treat basis and conducted with the CONSORT guidelines in mind. For the primary outcome, linear mixed effects models will be used to examine the change in sleepiness (ESS) over each treatment period. Tests of homoscedasticity and normality will be carried out to ensure model validity. Available literature suggests that the minimum clinically important difference (MCIS) in ESS is 2. We have powered to show non-inferiority. The null hypothesis is that the difference in mean ESS change between positional therapy and CPAP therapy is >=2 ESS units. Thus, based on previous clinic data and assuming a power of 80% and an alpha of 0.05 we determined that a sample size of approximately 21 patients in a crossover design is needed. Allowing for 30% attrition we will recruit 30 patients.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
4/04/2019
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
30
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Accrual to date
0
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Final
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
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Princess Alexandra Hospital - Woolloongabba
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Recruitment postcode(s) [1]
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4102 - Woolloongabba
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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Princess Alexandra Hospital Study Education and Research Trust Fund
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Address [1]
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MS SERTA Administration
Finance Services
Building 15, Level 3
Princess Alexandra Hospital
199 Ipswich Road
Woolloongabba Qld 4102
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Dr Mal Wilson
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Address
Department of Respiratory & Sleep Medicine
Level 2F, Building 1
Princess Alexandra Hospital
Woolloongabba Qld 4102
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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Brett Duce
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Address [1]
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Department of Respiratory & Sleep Medicine
Level 2F, Building 1
Princess Alexandra Hospital
Woolloongabba Qld 4102
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Country [1]
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Australia
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Secondary sponsor category [2]
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Individual
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Name [2]
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Dr Claire Ellender
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Address [2]
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Department of Respiratory & Sleep Medicine
Level 2F, Building 1
Princess Alexandra Hospital
Woolloongabba Qld 4102
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Country [2]
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Australia
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Secondary sponsor category [3]
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Individual
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Name [3]
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A/Prof Craig Hukins
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Address [3]
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Department of Respiratory & Sleep Medicine
Level 2F, Building 1
Princess Alexandra Hospital
Woolloongabba Qld 4102
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Country [3]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Metro South Human Research Ethics Committee
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Ethics committee address [1]
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Contracts Review Officer – Metro South Research Governance
Centres for Health Research
Level 7, Translational Research Institute
37 Kent Street
Woolloongabba Qld 4102
Email.
[email protected]
Ph. (07) 3443 8050
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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05/02/2019
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Approval date [1]
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20/02/2019
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Ethics approval number [1]
302948
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HREC
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Summary
Brief summary
Obstructive sleep apnoea syndrome (OSAS) is a chronic disorder characterised by recurrent episodes of complete or partial upper airway obstruction during sleep contributing to repetitive arousals and subsequent symptoms of non-restorative sleep. In a subset of patients with OSA, obstructive events occur much more frequently during supine sleep. In such patients, considered to have positional OSA (pOSA), vibrotactile positional therapy has been shown to restrict supine sleep thereby reducing the severity of OSA, improving sleep architecture and depression scores. These devices can also be used to accurately monitor adherence and other treatment outcomes. This study will undertake a prospective crossover trial of positional and CPAP therapy in eligible patients (see Inclusion and Exclusion Criteria) with mild-to-moderate positional OSA. In a prospective, randomized crossover trial, patients with pOSA will undergo an 8 week trial of both positional therapy (NightShift) and CPAP. The primary end-point for comparison will be change in subjective sleepiness, as measured by the Epworth Sleepiness Scale (ESS).
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Mal Wilson
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Address
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Department of Respiratory & Sleep Medicine
Level 2F, Building 1
Princess Alexandra Hospital
Woolloongabba Qld 4102
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Country
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Australia
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Phone
91942
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+61 7 3176 2698
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Fax
91942
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Email
91942
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[email protected]
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Contact person for public queries
Name
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Dr Mal Wilson
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Address
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Department of Respiratory & Sleep Medicine
Level 2F, Building 1
Princess Alexandra Hospital
Woolloongabba Qld 4102
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Country
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Australia
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Phone
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+61 7 3176 2698
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Fax
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Email
91943
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[email protected]
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Contact person for scientific queries
Name
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Dr Mal Wilson
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Address
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Department of Respiratory & Sleep Medicine
Level 2F, Building 1
Princess Alexandra Hospital
Woolloongabba Qld 4102
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Country
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Australia
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Phone
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+61 7 3176 2698
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Fax
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Current supporting documents:
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
1660
Ethical approval
377221-(Uploaded-19-03-2019-13-27-28)-Study-related document.pdf
1662
Study protocol
377221-(Uploaded-19-03-2019-13-29-41)-Study-related document.docx
1663
Informed consent form
377221-(Uploaded-19-03-2019-13-30-06)-Study-related document.docx
Updated to:
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
1660
Ethical approval
[email protected]
377221-(Uploaded-19-03-2019-13-27-28)-Study-related document.pdf
1662
Study protocol
[email protected]
377221-(Uploaded-19-03-2019-13-29-41)-Study-related document.docx
1663
Informed consent form
[email protected]
377221-(Uploaded-19-03-2019-13-30-06)-Study-related document.docx
23733
Analytic code
[email protected]
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF