Sleep Disorders and Sleep Deprivation An Unmet Public Health Problem (2006) / Chapter Skim
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8 Bolstering Somnology and Sleep Disorders Research Programs
8 Bolstering Somnology and Sleep Disorders Research Programs
Pages 253-292
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From page 253... ...
As a consequence, NIH funding for sleep-related activities has reached a plateau, and the future outlook for somnology and sleep medicine is unclear. A detailed examination of the past and current investment in sleep-related research demonstrates that there are only 331 funded research projects and 253 independent investigators, far below the requirements of the field.
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From page 254... ...
The field of somnology and sleep medicine is poised to take great strides in elucidating and addressing the etiology, pathogenesis, and public health burden of chronic sleep loss and sleep disorders. This strong position is the result of the National Institutes of Health (NIH)
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From page 255... ...
In 2004 these two institutes each supported more sleep-related grants than 8 of the 13 current members -- close to 10 percent of all sleep-related research project grants. The Trans-NIH Sleep Research Coordinating Committee offers the somnology and sleep medicine field an exceptional resource for increasing and coordinating NIH support of interdisciplinary sleep-related research
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From page 256... ...
However, as will be discussed in greater detail later in this chapter, recently the coordinating committee has not taken a proactive role in developing new research programs. National Center on Sleep Disorders Research In direct response to the 1993 report of the National Commission on Sleep Disorders Research, Wake Up America: A National Sleep Alert, a provision of the NIH Revitalization Act instructed the Director of the NIH and the National Heart, Lung, and Blood Institute (NHLBI)
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From page 257... ...
; the Department of Transportation (crashes occurring from falling asleep at the wheel) ; the Occupational Safety and Health Administration (impact of sleep deprivation and sleep disorders on industrial accidents and shift work sleep disorder)
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From page 258... ...
This presents a strain on a small field such as somnology and sleep medicine, as those most knowledgeable about the field are frequently selected. It is important that the composition of the advisory board consists of members who are credible and who have the respect of the somnology and sleep medicine community, as well as an understanding of large research and educational enterprises, background as a practicing TABLE 8-2 Ex Officio Members of the NCSDR Advisory Board Director of the National Institutes of Health (NIH)
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From page 259... ...
It is the opinion of this committee that after an appropriate interval senior members of the somnology and sleep medicine fields should be permitted to be reappointed to serve an additional term on the advisory board, along with the most promising juniors member of the field. This should be permitted until the field has a large enough cadre of experienced leaders.
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From page 260... ...
The outline for this update uses the organization originally used in the executive summary of the 2003 National Sleep Disorders Research Plan. As the following sections will demonstrate, although there has been scientific progress leading to an even greater number of unanswered questions, over the last few years the field has not grown but has reached a plateau.
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From page 261... ...
. Sleep Neurobiology and Basic Sleep Research The importance of the hypothalamus in sleep regulation, beyond the generation of circadian rhythms and their genesis within the suprachiasmatic nuclei, is increasingly clear (Saper et al., 2005)
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From page 262... ...
. Similar sleep studies are also occurring with Alzheimer's dementia and stroke patients, where central and obstructive sleep apnea (OSA)
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From page 263... ...
. Given that commercial drivers with sleep apnea are likely to be at an increased risk for crashes, occupational screening of this group may provide an important opportunity to test the model for occupational screening for sleep disorders.
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From page 264... ...
The Sleep Heart Health Study has added further support for sleep apnea being a risk factor for insulin resistance independent of the effects of obesity (Punjabi et al., 2004)
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From page 265... ...
Pediatric Sleep Sciences There have been several advances in the field of pediatric sleep medicine in the last two years: the discovery of the gene for congenital central hypoventilation syndrome, improved understanding of the pathogenesis and epidemiology of sleep apnea, and better understanding of the complications associating OSA in children. However, pediatric sleep remains relatively understudied, and there are still many gaps in the knowledge base.
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From page 266... ...
In this regard, there is also a need to identify the efficacy of sleep apnea treatment in children, including tonsillectomy and adenoidectomy, for which there has not yet been a single randomized controlled study of treatment for sleep apnea. Sleep Deprivation The impact of sleep deprivation and shift work on driving and industrial accidents has been known for more than a decade.
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From page 267... ...
Consequently, the future outlook for somnology and sleep medicine is unclear. In 2004, for the first time since the NCSDR was established, there was a decrease of $846,000 in annual expenditures for sleep-related projects.
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From page 268... ...
It is difficult to accurately track the commitment of different NIH institutes to somnology and sleep disorders, in part because there is no uniform accounting system. Some NIH institutes count only a proportion of a grant when only a component of the grant is related to sleep research, but others count the entire grant, even though sleep-related research is only a minor part of the grant.
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From page 269... ...
Sleep-related R01s were collected by searching the CRISP database for all abstracts that were classified under the following thesaurus terms: insomnia, periodic limb movement disorder, restless legs syndrome, circadian rhythm, SIDS, sleep disorder, narcolepsy, sleep apnea, sleep, hibernation, and dream. To limit the number of grants that were not relevant to somnology or sleep disorders, the committee only included grants in which the key words appeared in both the thesaurus terms and abstract and not the abstract alone.
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From page 270... ...
270 / 2004 1995 in in 2.54 2.85 2.53 2.52 2.18 5.11 N/A 2.20 1.20 3.14 N/A 6.00 3.42 2.00 5.50 1.53 Number Number 0.23 2004 and Sleep 2 7 7 0 5 3 7 3 1995 Percentage of Grants 54 18 29 20 (R01) : Sleep 5 61 97 22 62 0 62 22 18 65 11 23 10 2004 Number of Grants 397 331 253 179 Grants Project Sleep 9 6 1 2 Percentage of Grants 61 24 16 16 13 11 Research Sleep 00 54 7 1 33 33 2 71 28 19 10 19 15 13 1995 Number of Grants 156 116 100 Disorders Sleep and movements rhythm)
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From page 271... ...
271 1.94 2.69 2.77 2.11 7.00 2.33 2.45 2.40 5.46 2.25 1.25 2.62 1.92 2.83 1.76 3.67 7.50 1.88 10.60 16.00 19 21 11 17 21 7 8 7 9 5 16 25 16 22 21 15 23 10 18 62 70 36 57 70 53 84 54 24 52 71 27 68 23 51 30 77 32 15 60 9 4 9 2 28 22 11 23 31 19 11 10 22 10 16 15 18 28 5 43 2 22 32 26 13 27 10 36 22 10 13 12 26 12 18 17 21 32 applicable. Not = N/A rounded.
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From page 272... ...
Seventeen percent of 2004 grants were focused on basic sleep research projects, and 29 percent were devoted to the study of circadian rhythms. The total percentage of nonclinical research projects devoted to circadian rhythms rose from 40 percent of nonclinical research projects in 1995 to 61 percent in 2004.
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From page 273... ...
Clinical research project grants focused on the elucidation of sleep apnea demonstrated an increase in support that is reflected in the increased appreciation of its public health burden that occurred over the same period -- 19 grants in 1995 (15 percent of total grants) and 65 in 2004 (22 percent of total grants)
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From page 274... ...
Names were also visually inspected by multiple members of the committee who had expertise in various aspects of somnology and sleep medicine. Membership to sleep or circadian rhythms societies was noted, together with area of expertise.
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From page 275... ...
reviewers were primarily interested in circadian rhythm research, rather than basic sleep research or clinical sleep disorders. Four other NHLBI review panels had more than 2 reviewers with sleep and circadian expertise; these included the mentored patient-oriented carrier development (K23)
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From page 276... ...
Therefore, this committee recommends that the NCSDR Advisory Board use their annual analysis to identify priority research and training areas and annually recommend an RFA to appropriate advisory councils of the Trans-NIH Sleep Coordinating Committee and other federal agencies including the CDC. NEXT STEPS IN ACCELERATING PROGRESS Given the multiple and varied sources of federal and private funding and support for the field and the numerous disciplines involved in research and clinical care, the challenge for the field of sleep medicine is to develop a collaborative and focused approach with a strong research infrastructure.
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From page 277... ...
should have adequate staff and resources to ensure its ability to fulfill its mission of coordinating and stimulating training, research, and health information dissemination relevant to somnology and sleep disorders. All relevant institutes with significant sleep portfo lios should become members of the Trans-NIH Sleep Research Coordinating Committee.
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From page 278... ...
They would serve as the centerpiece of the nation's effort to reduce morbidity and mortality from chronic sleep loss and sleep disorders. This investment would likely draw new senior-level researchers into the somnology and sleep medicine field and would heighten the interest of young investigators in devoting their research interests to chronic sleep loss
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From page 279... ...
The centers would deliver medical advances to patients, educate health care professionals and the public, and reach out to underserved populations. As described in detail in Chapters 5 and 7, enhancing career opportunities for researchers at all points in their careers is vital to accelerating progress in somnology and sleep medicine research.
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From page 280... ...
. Each of these attributes -- substituting somnology and sleep medicine focus for cancer -- is also likely to be critical for establishing and sustaining efficient and productive somnology and sleep medicine centers of excellence.
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From page 281... ...
· outreach that makes the public aware of the importance and implications of the center's research. A developing center must have a clearly articulated plan to develop a set of scientific core functions that will enhance and expand the capacity to move somnology and/or sleep disorders research and treatment into community settings.
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From page 282... ...
The proposed National Somnology and Sleep Medicine Research Network would improve the efficiency and capacity to research on rare sleep disorders. The Somnology and Sleep Medicine Centers of Excellence discussed above would spearhead this dedicated focus on basic, clinical, and translational research and would promote collaborations among all sites conducting research relevant to somnology and sleep medicine.
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From page 283... ...
The committee envisions a sustained network for somnology and sleep medicine in the United States that would facilitate public education, career development opportunities, translational research, and implementation of multi-center clinical trials. The process of developing components of the National Somnology and Sleep Medicine Research Network can draw on the experiences of several such networks that already exist, but with more focused objectives, such as the aforementioned National Cancer Institute centers.
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From page 284... ...
Although not consisting of large research components, a Type I program should have a data collection and management system that provides clinical data to a coordinating center within the network. A Type II training and research interdisciplinary sleep program includes the characteristics of a Type I program, but in addition is designed to provide optimal education, training, and research in somnology and sleep medicine.
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From page 285... ...
Recommendation 8.2: The National Institutes of Health should establish a National Somnology and Sleep Medicine Research Network. The National Center on Sleep Disorders Research, in collaboration with the Trans-NIH Sleep Research Coordination Committee, should establish a National Somnology and Sleep Medicine Re search Network.
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From page 286... ...
2005. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea.
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From page 287... ...
2004b. APOE ¤4 is associated with obstructive sleep apnea/hypopnea: The Sleep Heart Health Study.
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From page 288... ...
2005. Upper airway dynamic responses in children with the obstructive sleep apnea syndrome.
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2004. Whole genome scan for obstructive sleep apnea and obesity in African-American families.
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From page 290... ...
2003. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure.
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From page 291... ...
1993. The occurrence of sleep disordered breathing among middle-aged adults.
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