This joint position statement of Australian sleep and primary care organisations provides information to healthcare providers on the management of adults with insomnia symptoms in Australia. Perspectives of sleep researchers, psychologists, sleep physicians, general practitioners, pharmacists, nurses, advocacy and implementation experts, and people with lived experience of insomnia are represented. Insomnia may present as an acute disorder (lasting up to 3 months) or a chronic disorder (lasting for 3 months or longer). Untreated insomnia is associated with lowered mood, daytime function, productivity, and quality of life. Insomnia assessment and diagnosis is based on self-reported symptoms. Insomnia occurring in the context of other conditions should be considered a ‘comorbid condition’ that requires concurrent and targeted assessment and management. Recommendations about healthy sleep practices (sleep hygiene) are not an adequate stand-alone treatment for chronic insomnia. Multi-component Cognitive Behavioral Therapy for insomnia (CBTi) is the recommended ‘first line’ treatment for insomnia. There is evidence that CBTi is effective in a range of settings, in the presence of comorbid conditions, and when delivered in different modalities (e.g., individual sessions, group settings, tele-health, self-guided digital programs). Other evidence-based psychological and behavioral therapies may be appropriate for specific presentations, and in people that do not respond to CBTi. Medicines used for insomnia management are not recommended as the ‘first line’ treatment for insomnia but may be appropriate in conjunction with CBTi or as second-line treatment if CBTi is not effective or appropriate. Sleep medications may be considered in people with acute insomnia that is caused by a clear precipitant (e.g., bereavement, medical crisis, psychosocial stressors) and resulting in significant distress and/or functional impairment. If used, specific benzodiazepines and ‘z-drugs’ may be indicated for up to 2-4 weeks of use at the lowest effective dose, melatonin may be used for up to 13 weeks, and dual orexin receptor antagonists are generally only recommended for chronic insomnia. Sedating antihistamines, antidepressants, antipsychotics, cannabinoids, and complementary medications are not recommended. Collaboration between people with insomnia and a range of clinicians is important for the management of insomnia and associated sleep, mental and physical health conditions. Collaboration between sleep and primary care organisations has led to the development and implementation of healthcare provider education programs on insomnia assessment and management.

Study Objectives

Emerging evidence indicates that Indigenous peoples experience disproportionately high rates of obstructive sleep apnea (OSA). This systematic review aimed to examine OSA prevalence, contributing factors, and intervention or treatment outcomes among Indigenous peoples worldwide.

Methods

We systematically searched PubMed, Embase, CINAHL, Cochrane CENTRAL, ATSI Health, Web of Science and PsycINFO (last searched 30 June, 2025), and grey literature for original research involving Indigenous peoples (≥18 years) diagnosed with OSA via self-report or laboratory-based measures (e.g., polysomnography). Data extraction focused on study characteristics and key findings. Methodological quality was assessed using NIH tools, and cultural appropriateness was evaluated using the CREATE Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was conducted.

Results

From 599 records, 41 studies from six countries were included. OSA prevalence among Indigenous populations varied widely (community-based samples, 6.5%-69%; referred samples, 85-95%; self-reported diagnosis, 1.2%-8.4%; hospital audit diagnoses, 0.8-11.4%), with only one study reporting a robust population-based estimate (~6.5% among Māori). Severe cases predominated in referred samples. Factors associated with OSA included male sex, age, BMI, neck circumference, craniofacial and geographic factors, and symptoms such as snoring. Treatment evidence was limited to CPAP, with low adherence.

Conclusions

Findings suggests that OSA is common among Indigenous peoples across diverse settings. However, prevalence estimates are heterogeneous and limited by differences in study design, sampling frame, and diagnostic approaches, with most evidence based on referred clinical samples. Improving awareness and culturally responsive screening and management may improve outcomes. Sleep health among Indigenous peoples warrants a higher priority in research, policy and practice.

Registration

The protocol for this systematic review was registered with Prospero (CRD42024466932).

Epidemiological evidence between exposure to trihalomethanes (THMs) and adverse birth outcomes remains inconsistent. We examined the associations between maternal exposure to elevated THM concentration in drinking water during pregnancy and adverse birth outcomes, including preterm birth (PTB), low birthweight (LBW), and small-for-gestational age (SGA). We analysed population-based data of 134,966 singleton livebirths recorded across 25 local government areas (LGAs) between 2009 and 2020 using the Queensland Perinatal Data Collection, water quality monitoring data, meteorological data, and Australian Bureau of Statistics records. Maternal exposure to elevated THM exceeding thresholds of ≥ 250, ≥100, ≥ 80, and ≥ 70 µg/L was defined using monthly total THM concentrations. We applied Generalized Estimating Equation models to examine exposure-outcome associations. Overall, 6.8% of babies were born preterm, 5.0% LBW, and 9.2% SGA, with marked geographic disparities across background characteristics. Temporal analyses revealed an increase in LBW prevalence from 3.7% to 5.2% (average annual rate of change 1.6%). Lower odds of SGA were associated with maternal exposure to elevated THM concentrations at ≥ 100 µg/L (Adjusted Odds Ratio, AOR = 0.91, 95% CI [0.88–0.95]) and at ≥ 80 µg/L (0.93, [0.88–0.97]). Across individual disinfection by-products, bromodichloromethane exceedance at ≥ 250 µg/L was associated with higher odds of PTB (1.07, [1.01,1.13]), and bromoform exceedance at ≥ 70 µg/L was associated with higher odds of LBW (1.22, [1.01,1.48]). The disparities in adverse birth outcomes warrant identifying regional factors to inform targeted health interventions. Continued research employing improved study design and more accurate exposure measurement is needed to synthesize conclusive evidence and clarify causal relationships to inform decision-making.

Background

More than one-third of births in Australia are by caesarean section (C-section), projected to reach 45% by 2030. Understanding sociodemographic, clinical, and obstetric practice factors shaping C-section trends is critical for informing policy and maternity care.

Methods

We conducted a population-based study of 642,857 pregnancies in Queensland (July 2007–December 2017) using the Perinatal Data Collection. Births were classified with the Robson Classification System. Trends in group size, C-section rates, and indications were described. Modified Poisson regression with generalised estimating equations estimated crude and adjusted incidence rate ratios (IRRs) for major Robson groups (RGs).

Findings

Of 214,569C-sections, key contributors were repeat C-sections (RG5, 38.2%), nulliparous elective (RG2, 20.9%), nulliparous spontaneous labour (RG1, 10.7%), and preterm (RG10, 7.0%) births. Although overall C-section rates remained relatively stable (33.3% in 2007 vs 34.4% in 2017), increasing clinical, demographic, and service-related risk profiles and substantial within-group variation were observed. Between 2007 and 2010 and 2015–2017, C-section declined in RG1 (IRR 0.84) but increased with maternal age ≥ 40 years (IRR 2.27) and pharmacological induction (IRR 1.93). Smaller reductions occurred in RG2 (IRR 0.93), with higher risk for BMI ≥ 30 (IRR 1.24) and private care (IRR 1.18). Minimal change was seen in RG5 and RG10 (IRR 1.00), though hypertension (IRR 1.54) and fetal risk (IRR 1.44) strongly influenced RG10. Midwifery-led care consistently reduced C-section across RGs (IRR 0.83–0.95). Elective C-sections were largely due to non-absolute indications and maternal preference.

Conclusion

Stable overall C-section rates mask clinically important heterogeneity driven by maternal and fetal risk profiles and obstetric practices. Expanded analytic use of Robson classification can support group-specific benchmarking, identify modifiable drivers, and inform targeted strategies to optimise C-section use nationally.

Prolonged exposure to high concentrations of trihalomethanes (THMs), which are water disinfection by-products, poses a significant human health risk. This study investigated the spatial-temporal distribution of THM concentrations, the exceedance of the Australian drinking water guideline value (250 μg/L), and the environmental factors associated with THM concentrations in public drinking water supplies across Queensland, Australia, to help guide strategies for mitigating THM exposure. We employed a data linkage approach, integrating spatial water quality monitoring data covering 27 local government areas (LGAs) from 2009 to 2020 with environmental data from the Bureau of Meteorology. Key outcomes were THM concentrations and exceedances. Analyses included time-trends, multiple generalised linear models and logistic regression models. The median monthly THM concentration was 78 μg/L [IQR 49, 119 μg/L]. Between 2009 and 2020, the median THM concentration increased from 38 μg/L to 73 μg/L, while the incidence of exceedance increased from 2.3% to 3.0%. THM exceedances were significantly lower in water from treatment plants (AOR = 0.15, 95% CI [0.07, 0.30]), in LGAs within South-East Queensland (AOR = 0.07, 95% CI [0.01, 0.33]), during spring (AOR = 0.39, 95% CI [0.21,0.70]), in advantaged socio-economic areas and major cities. Increase in temperature was associated with greater THM exceedance (AOR = 1.21, 95% CI [1.07,1.37]), but lower during periods of bushfire (exp(β) = 0.85, 95% CI [0.76,0.95]). Rainfall and NDVI were not significantly associated with THM concentration and exceedances. The elevated concentrations and repeated exceedances highlight a persistent challenge coupled with systemic inequities. We recommend consistent THM data collection, monitoring, optimizing treatment and infrastructure upgrades in disadvantaged regions to improve water quality and protect public health.