Annual Summit on Sleep Disorders and Medicine August 10-12, 2015 San Francisco, USA

Chair

Sona Nevsimalova

Charles University, Czech Republic

Session Introduction

Joannes M Hallegraeff

Hanze University Groningen, Netherlands

Title: Nocturnal leg cramps: stretching is effective however diagnosing may be confused with other motor sleep disorders

Biography:

Joannes M Hallegraeff has completed his PhD as Clinical Epidemiologist from University of Groningen, the Netherlands. He is researcher; lecturer and coordinator of the Lifelong Learning musculoskeletal program at SOMT University, The Netherlands. His fi eld of interest is two fold: Nocturnal leg cramps in older adults and non-specifi c low back pain. He has published in Journal of Physiotherapy on nocturnal leg cramps and a recent systematic review about diagnosing nocturnal leg cramps is submitted.

Abstract:

Background: Many suff erers from nocturnal leg cramps stretch their legs when night cramps occur and pain is then decreased. However, can a pre-sleep stretching regimen be eff ective in preventing nocturnal leg cramps and decrease frequency and severity of cramps? Many older adults suff er from one of these sleep related motor disorders, which are oft en conducted with sleep disruption, distress and decreased quality of life, however a clear defi nition of nocturnal leg cramps is lacking. Nocturnal leg cramps, restless legs syndrome and periodic limb movement disorder are oft en confused in diagnosing as diff erent sleep related movement disorders. Two research questions must be answered: Will a pre-sleep stretching regimen be eff ective in nocturnal leg cramps? To identify all evidence based valid criteria with respect to diagnosing nocturnal leg cramps and which conditions must be ruled out. Materials & Methods: Eighty adults over 55 years with nocturnal leg cramps who were not being treated with medication were taken into consideration. In a six-week period, the experimental group performed a nightly pre-sleep stretching regimen of the calf and hamstrings muscles immediately before going to sleep. Th e control group performed no specifi c exercises. A comprehensive systematic literature search has been executed 1990 up till now. Results: All participants completed the study. At six weeks frequency and severity of nocturnal leg cramps decreased both signifi cantly in the experimental group. Although diagnostic studies about nocturnal leg cramps could not be identifi ed this is the fi rst attempt to systematically review all literature on nocturnal leg cramps: Systematic and narrative reviews, randomized trials and observational studies. Th e included studies revealed a total of twelve diagnostic criteria described in these primary studies and are used in their inclusion criteria. Conclusion: Night stretching before going to sleep is eff ective on frequency and severity of nocturnal leg cramps and might be an eff ective alternative as a non-drug intervention. Consensus is reached about criteria for clinical diagnosing of nocturnal leg cramps.

Kathy Sexton Radek

Elmhurst College, USA

Title: Sleep Quality in Young Adults

Time : 12:10-12:40

Biography:

Kathy Sexton-Radek has received her Doctorate of Philosophy degree from Illinois Institute of Technology in 1989 and interned at Rush Medical University 1988- 1989 in sleep medicine, behavioural medicine, geriatric psychology and health psychology rotations. Currently, she is working as Professor in Elmhurst College, Psychology Department since 1988. She received her board certifi cation in behavioural sleep medicine. She completed a two year Post-doctorate Certifi cate program in Clinical Psychopharmacology which included a yearlong preceptorship with psychiatry and pulmonary medicine rotation.

Abstract:

The results of several cohorts that participated in a sleep education intervention called Sleep 101 will be presented. Th e context of the problems specifi c to this at risk population will be underscored. Finally, clinical implications for future study of young adult sleep quality will be presented for discussion.

Roger L Price

Breathing Well LLC, USA

Title: Breathing disordered sleep

Biography:

Roger L Price has completed his Post-graduate studies in Physiology, Pharmacology, Toxicology, Clinical Nutrition, Remedial Massage Therapy in 1968; Graduated BSc Pharmacy (Hons) in South Africa in 1961; Certifi ed as Buteyko Method Practitioner and Trainer in 2001. He worked as Assistant Professor in Health Sciences and Medicine department in Bond University Australia from 2005. He had received a certifi cate on integrative medicine from Queensland University in 2008. He introduced the principle of bio-feedback capnometric assessment and evaluation to produce a real-time, accurate and meaningful picture of breathing mechanics, dynamics, physiology and biochemistry. He created the concept of Integrative Health Care Education - combining the principles of all of the above into a simple integrated package designed as a support service for the medical, dental and allied health professions. He is involved in Academy of Clinical Sleep Disorder Disciplines (ACSDD), American Academy of Gnathalogical Orthopedics (AAGO), American Academy of Physiologic Medicine and Dentistry (AAPMD), Australasian Sleep Association (ASA), Australian Asthma Research and Education Association (AAREA). At present he is the CEO and Consultant Respiratory Physiologist at Breathing well LLC.

Abstract:

Everybody talks about sleep disordered breathing where the emphasis is that problems with sleep cause problems with breathing. For too long now the industry has been focusing on machines, mouthguard, drugs, surgery and other invasive and interventive devices to try to manage the sleep problems once they have happened. Th is is usually not that successful and the compliance rate is very low. My approach is that it is the other way round and that it is problems with breathing that cause problems with sleep. Th at makes much more sense to me because people spend 16-18 hours a day awake and only 6 or so hours asleep or trying to sleep. It is much more likely that the bad habits created during the day will carry over to the night and cause sleep problems than the other way around. My focus is on teaching people how to manage their daytime habits and functions so that they will not have such bad problems at night and in this way we provide a very important service to the sleep and medical industry by making it much easier for people to comply with night time intervention.

Yuichi Inoue

Tokyo Medical University, Japan

Title: Short sleep duration, sleep disorders and traffi c accidents

Biography:

Yuichi Inoue has completed his MD from Tottori University Faculty of Medicine, Tottori Pref. in the year 1987, BS from Tokyo Medical University-Tokyo in 1982. He worked as a Professor of Psychiatry in Tokyo Medical University in 2007 and became Director of Japan Somnology Center Neuropsychiatric Research Institute in 2008, in the same year he was the Professor of Somnology at Tokyo Medical University and became President of Yoyogi Sleep Disorder Center in 2011. He is involved in The Japanese Society of Sleep Research, Japanese Society of Biological Psychiatry, Japan Society of Neurovegetative Research, World Federation of Sleep Research Society and World Sleep 2015 as Board of Director, Board of Councilor, Board of Councilor, Programme Committee Co-chair and Organizing Committee Chair respectively. He has more than 190 publications on his name in English language.

Abstract:

Sleepiness is known as an important cause of traffi c accidents and previous studies have shown that the rate of individuals having excessive daytime sleepiness (EDS) reached as much as 15% of general population.Th e main causes of EDS are (1) chronic sleep debt, (2) deterioration in the quality of sleep, (3) disruption of circadian rhythms and (4) primary hypersomnia. Among these, chronic sleep debt is the most frequent cause of EDS. However, although an accumulated lack of nocturnal sleep can result in serious defi cits in neurobehavioral function, the increase in subjective sleepiness under such conditions remains mild. Th at is, people with chronic lack of adequate sleep may underestimate their own sleepiness. Unwanted sleepiness may also occur due to the disruption of circadian rhythms in situations such as jet lag or shift work as well as primary circadian rhythm sleep disorders such as delayed sleep phase. People whose quality of sleep deteriorates as a result of sleep disorders that cause frequent interruption of nocturnal sleep such as obstructive sleep apnea syndrome and periodic limb movement disorder can develop secondary hypersomnia. In addition, while primary hypersomnia such as narcolepsy and idiopathic hypersomnia is relatively rare, it can cause sleepiness-related traffi c accidents. In this meeting, I will discuss about the impact of the lack of sleep on the incidence of traffi c accidents as well as the individual eff ects of various sleep disorders on accidents. In addition, I will introduce recently established methods for detecting sleepiness and strategies for preventing sleepiness at the wheel.

Agneta Markstrom

Uppsala University Hospital,Sweden

Title: Cognitive behavioral theraphy as an adjunct treatment to light therapy for delayed sleep phase disorder in young adults

Biography:

Agneta Markstrom is since 2009 working as an Associate Professor and Senior Consultant at the Centre of Sleep and Breathing at Uppsala University Hospital, Sweden. She works full time taking care of diagnostics in persons with insomnia, parasomnia, circadian rhythm disorders, hypersomnia, narcolepsy and people with sleep breathing disorders. She works as a Consultant at the Department of Women’s and Children’s Health at Karolinska Institutet in Stockholm, Sweden and is a national expert in initiating CPAP and home mechanical ventilation in children. Her research interests lay in the fi elds of sleep particularly in the treatment of insomnia, circadian rhythm disorders, concrete delayed sleep phase disorder and sleep breathing disorder.

Abstract:

Delayed sleep phase disorder (DSPD) is common among young people and is characterized by a mismatch between the desired timing of sleep and the ability to fall asleep and remain asleep. Th e underlying cause of this could be related to biological or behavioral reasons. Individuals with DSPS have problems in falling asleep and consequently struggle with waking up in the morning. Sleep diffi culties, excessive sleepiness leads to poor performance and they acquire diffi culty with school and employment. Th is may result in adverse medical, psychological and social consequences. Light is the most eff ective environmental cue for circadian entrainment and light therapy (LT) has been shown eff ective for treatment of DSPS. Unfortunately, compliance is a concern and also the high amount of relapse. Cognitive behavioural therapy (CBT) might contribute as an adjunct therapy in DSPS. A randomized controlled short and long term trial with DSPS individuals aged 16 to 26 years was performed. Subjects received LT for 2 weeks and thereaft er one group received CBT for 4 weeks while the other group received no further treatment at all. LT advanced sleep onset 1 hour 50 min and sleep off set 2 hour 20 min during the second week of LT for all participants and this was maintained at a 6 months follow-up. Insomnia sleepiness score (ISI) was the primary outcome measure for sleep diffi culties and there was a signifi cant decrease in ISI over time. Anxiety and depression scores decreased signifi cantly more in the group that has received CBT and subjects in this group were able to retain the eff ect of LT better compared to the group that only received LT. It was concluded that CBT given aft er LT can maintain the eff ect of LT better and can decrease sleep diffi culties beyond those improvements observed with light therapy alone.

Sona Nevsimalova

Charles University, Czech Republic

Title: Paroxysmal sleep events and their differential diagnosis

Biography:

Sona Nevsimalova has devoted the greatest part of her life to sleep medicine. She has published over 200 scientifi c papers, 5 monographs and 30 monographic chapters. Her main interest is focused on narcolepsy and childhood sleep disorders. She received many scientifi c awards (including one from the American Academy of Neurology) and honorary prizes for her research, and participated in the Scientifi c Committees of the ESRS and WASM. At present, she is the Vice- President of the Czech Sleep Society, and President of the Czech Society of Child Neurology. She has organized several international congresses, the main organizing effort is now focused on the World Sleep 2017 to be held in Prague.

Abstract:

Diagnostic evaluation of abnormal movements in sleep covers up to 40% of all video-polysomnographic (v-PSG) examinations evaluated in our Sleep labin the past 15 years. Th e main categories were parasomnias and abnormal movement disorders in sleep and their diff erentiation from epilepsy. Childhood NREM parasomnias are regarded as a common and usually benign disorder. Our fi ndings showed a considerable percentage of perinatal risk factors and developmental comorbidities (motor coordination delay, dysphasia, learning and/or behavior disorder) in the aff ected children. Stereotypic behavior in abnormal developmental movements in sleep (bruxism, rhythmic movements) was also found to be a common feature of NREM parasomnias. Th erefore, a disorder of sleep maturation can be supposed to have a role to play in the clinical manifestation of childhood NREM parasomnias. REM parasomnias, mainly REM behavior disorder, are frequently underdiagnosed conditions in children.A connection with childhood narcolepsy will be mentioned. Th e diagnostic diffi culties can sometimes arise from abnormal movements in sleep. Benign neonatal sleep myoclonus as well as rhythmic movement disorder can sometimes be mistaken for epileptic involvement. Bruxism is very common in children can exceptionally be a sign of temporal lobe epilepsy. Epileptic discharges related to arousal instability and periodic leg movements have been described too. Abnormal movements can be connected also with childhood cataplexy attacks. A typical “cataplectic facies” with repetitive mouth opening, tongue protrusion and drooping eyelids appearing close to the disease onset in young children is a frequent feature. Th ese abnormal movements include also positive as well as negative myoclonic jerks aff ecting the neck and upper extremities. Diffi culties in distinguishing some paroxysmal motor events in sleep will be discussed, a series of diverse video-recordings will be shown and a general account of the history and clinical examination together with v-PSG analysis will be presented.

Lamia Medhat Afi fi

Cairo University, Egypt

Title: Correlation of the biochemical profi le with polysomnography in chronic kidney disease patients

Biography:

Lamia Afi fi completed her MD degree in Clinical Neurophysiology and Masters of Science in Clinical Neurophysiology at, Cairo University, Egypt in 2004 and 1999 respectively. She also possesses a GCE degree from the British council in Abu Dhabi, UAE in 1988. She is working as an Assistant Professor in Clinical Neurophysiology Unit, Department of Neurology, Kasr El-Aini Faculty of Medicine, Cairo University, Egypt. She is also associated with Sleep Disorders Center, Stanford University, Egyptian Society of Neurology (Psychiatry and Neurosurgery) and World Academy of Sleep Medicine.

Abstract:

Background: Th ere is an increased prevalence of sleep disorders in patients with end-stage chronic kidney disease (CKD). However no studies have ever correlated the biochemical profi le of these patients with sleep disturbances. Purpose: Th is work aims to assess the relationship between polysomnography fi ndings and the biochemical profi le of patients with CKD. Subjects & Methods: Th is study included 40 stage IV-V CKD patients. All subjects were subjected to an attended full overnight polysomnography. Fasting blood sugar, (FBS), hemoglobin, serum urea and creatinine, pH level, serum sodium, potassium, total and ionized calcium and phosphate levels were measured in all subjects. Results: Urea level showed a positive correlation with central apnea index and lowest oxygen saturation while the creatinine level did not show any correlation with the various sleep parameters. FBS negatively correlated with total sleep time (TST), sleep effi ciency, lowest and average oxygen saturation and positively correlated with N1 sleep stage and apnea hypone index (AHI). Hemoglobin level correlated positively with sleep effi ciency and correlated negatively with number of awakenings and AHI. Serum sodium correlated positively with number of awakenings, while serum sodium and pH levels showed a negative correlation with AHI. Phosphate levels showed a negative correlation with periodic limb movement index and stage N3 percentage. Potassium and total calcium levels showed a positive correlation with central apnea index. Conclusion: Striking correlations are found between sleep parameters and the biochemical profi le of patients with CKD. Correction of urea, hemoglobin, fasting blood sugar and serum electrolyte levels of these patients can lead to improvement in their overnight sleep, which has a profound eff ect on quality of life.

Chair

Anna Thenappan

White Memorial Medical Center, USA

Co-Chair

Kavitha Palaniappan

University of Newcastle Singapore Pte Ltd., Singapore

Chair

Kathy Sexton-Radek,

Elmhurst college, USA

Co-Chair

G Dave Singh

BioModeling Solutions, Inc., USA

Session Introduction

Pernilla Garmy

Lund University, Sweden

Title: Sleep and media habits in school children and adolescents

Biography:

Pernilla Garmy is a School Nurse and a PhD student at Kristianstad University and Lund University, Sweden. She received the School Nurse of the Year Award in Sweden in 2010 and in 2012 she received an award from Her Royal Highness Queen Silvia of Sweden for her research on sleeping habits in school children. She took part in the EU-Marie Curie Training program in Sleep Research and Sleep Medicine 2008-2010. She has published more than ten papers in scientifi c, peerreviewed journals and has been serving as a Reviewer for fi ve journals.

Abstract:

The aim was to investigate the eff ects of sleep, television use and texting and computer habits on overweight, enjoyment of school and feelings of tiredness at school in school-age children and adolescents. Th is cross-sectional study was conducted in Sweden on school children aged 6-16. A questionnaire was distributed to the children (n=3011 in survey I; n=204 in survey II). Children who slept less than the median length of time reported enjoying school to a lesser degree. Fewer hours of sleep were found to be associated with having a bedroom television using the television or computer more than 2 hours a day, being tired at school and having diffi culties in sleeping and waking up. Overweight and obesity were found in 15.8% of the study population; obesity alone was found in 3.1%. Relationships between lifestyle factors and overweight were studied using multivariate logistic regression analysis. Having a bedroom television and using the television more than 2 hours per day were found to be associated with overweight but using the computer more than 2 hours a day was not. About 61% of the students aged 16 reported checking Facebook or social media at least once a day and 27% reported doing so for more than 10 times a day. One fourth of the students aged 16 had a habit of sending or receiving text messages at night at least once a week. Texting at night and frequent checking of Facebook and social media sites were related to sleep problems.

Hala A Shaheen

Fayoum Univerisity, Egypt

Title: Obstructive sleep apnea in epilepsy: A preliminary Egyptian study

Biography:

Hala A Shaheen is a Professor in Department of Neurology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

Abstract:

Purpose: Th e extent and clinical relevance of the association between epilepsy and sleep apnea are not previously studied in Egypt. What we wanted to know was the frequency of sleep apnea in Egyptian children with epilepsy and its infl uence on seizure frequency, other seizure characteristics, sleep complaint and architecture. Methods: All patients with epilepsy aged up to 18 years who underwent polysomnography were studied. Patients with any neurological disease apart from epilepsy with psychiatric illness had hypnotics or sedatives or those with liver or kidney failures were excluded from the study. Th e patients were divided into two subgroups according to apnea/hypopnea index: Group (1) patients without obstructive sleep apnea (OSA) and group (2) patients with OSA. For control group, we choose 12 healthy individuals with age and sex matched to that of our patients. We studied the clinical characteristics of epilepsy, sleep history and polysomnographic recording of the patients with epilepsy and the control. EEG digital and video monitoring was done for all patients. Results: Eleven patients (42.3%) were found to have obstructive sleep apnea. Seizure frequency was signifi cantly higher in the patients with OSA. Apart from apnea and hypopnea indices, all other sleep parameters did not diff er between patients’ subgroups. Hypopnea index in REM positively correlates with number of awaking. Apnea index in REM positively correlates with latency to deep sleep and to periodic leg movement. Conclusions & Recommendations: Sleep apnea is frequent in patients with epilepsy. OSA may contribute to increase seizure frequency. We recommend investigating sleep apnea in all patients with epilepsy.

Kathy Sexton Radek

Elmhurst college, USA

Title: Assessment issues related to parasomnia and psychiatric diagnoses

Biography:

Kathy Sexton-Radek has received her Doctorate of Philosophy degree from Illinois Institute of Technology in 1989 and interned at Rush Medical University 1988- 1989 in sleep medicine, behavioural medicine, geriatric psychology and health psychology rotations. Currently, she is working as Professor in Elmhurst College, Psychology Department since 1988. She received her board certifi cation in behavioural sleep medicine. She completed a two year Post-doctorate Certifi cate program in Clinical Psychopharmacology which included a yearlong preceptorship with psychiatry and pulmonary medicine rotation.

Abstract:

Following the structured sleep interview, administration of brief questionnaires (Epworth Sleepiness Scale) and the sleep specialist typically purses the gathering of information about the chief sleep complaint. Patients with varying levels of awareness into their parasomnia events may present incomplete information about the experiences. Th is circumstance is further complicated by a patient’s emotional wake day state. Th is presentation will underscore the need to follow-up the initial assessment with questions and perhaps a questionnaire to further investigate potential parasomnia conditions and psychiatric diagnoses that may infl uence the patient’s sleep quality. Two case studies and information about the utility of some measures will be presented.

Sacchetti Maria Luisa

Sapienza University, Italy

Title: Thalamic connectivity in patients with sleep-disordered breathing after stroke

Biography:

Sacchetti Maria L has graduated and completed her Specialization in Neurology from Sapienza University of Rome-Italy. She has published in the research fi eld of acute stroke more than 100 original articles, abstracts, congress presentations, books’ chapters and book and has been serving as an Editorial Board Member of repute. At present she is involved and she is publishing in studies on the Pathophysiology of sleep apnea at the long-term of stroke.

Abstract:

Background: Th alamus-cortical connections are essential for normal sleep. Stroke can alter this circuit aff ecting also breathing during sleep. Aim: To compare the functional connectivity of VPL-TN in stroke patients aff ected by SDB(S-SDB) as respect to stroke cases not aff ected (S) and to healthy controls (HC). Methods: Stroke patients were submitted to clinical, neuroradiological and full nocturnal polysomnography (PSG) monitoring. Conventional and functional MR exams during resting state (rs-fMRI) were performed in a single session (3 Tesla Siemens- Verio) in 12 stroke patients and in 11HCs. Statistical analysis of rs-fMRI connectivity was performed using the FMRIB soft ware package. A seed analysis approach was performed using VPL-TN as region of interest. Signifi cant diff erence in rsfMRI connectivity among the groups (S-SDB, S, HC) was set at p<0.05. Results: Six stroke patients out of 12 had a SDB. No diff erences were found between S and S-SDB groups as to risk profi le and PSG data. rs-fMRI connectivity analysis indicated that precuneus (PreCu) and brainstem (BS) were signifi cantly more connected with VPL-TN in S-SDB as respect to HC. When comparing S-SDB to S patients, a further signifi cantly higher connectivity with anterior cingulate cortex (ACC) was revealed. Conclusions: A higher connectivity between VPL-TN and regions involved also in modulating chemosensitivity (AC and BS) or alertness (PreCu) was observed during wake in S-SDB as respect to S patients. Th ese preliminary data support the hypothesis that stroke may cause an SDB as the consequence of an altered sleep-wake circuit.

Nava Zisapel

Tel Aviv University, Isarel

Title: Piromelatine: A novel melatonin-serotonin agonist for the treatment of insomnia disorder and neurocognitive comorbidities

Biography:

Nava Zisapel is Founder and Chief Scientifi c Offi cer of Neurim Pharmaceuticals, Ltd. She is a full Professor at Tel-Aviv University with a specialization in Neuro-biochemistry and holds the Michael Gluck Chair in Neuropharmacology and ALS Research, USA. He holds a BSc in Chemistry, an MS. in Biochemistry and a PhD in Biochemistry from Tel-Aviv University. She has authored, together with her students and other scientists, over 160 original research publications in peer-reviewed journals.

Abstract:

Insomnia aff ects 30%-50% of the general population and even more so (63%) among patients with mild cognitive impairments (MCI). Alzheimer’s disease (AD) risk among insomnia patients is approximately 3 fold that of good sleepers. Furthermore, poor sleep quality is associated with faster cognitive decline and may be an early marker of cognitive decline in mid life. Improvement of sleep may be critically important for maintaining or enhancing cognitive function in patients with MCI or AD. Current hypnotic medications (benzodiazepines and benzodiazepines-like) are associated with cognitive and memory impairments, increased risk of falls, accidents and dependency. Melatonin receptors agonists are safe and eff ective drugs for primary insomnia and circadian rhythm sleep disorders and are potentially useful for cognition and sleep in. Piromelatine is a novel investigational MT1\\\\MT2 and 5HT1A\\\\D receptors agonist developed for primary and co-morbid insomnia. In Phase-I studies it demonstrated good oral bioavailability (Elimination half-life 2.8±1.4 hours), good safety & tolerability profi le across a wide dose range and provided the fi rst indication for benefi cial eff ects on sleep maintenance. In a Phase-II study in insomnia patients, piromelatine demonstrated signifi cant improvements in sleep maintenance based on objective assessments (polysomnography recorded wake aft er sleep onset, sleep effi ciency and total sleep time) and good safety profi le with no detrimental eff ects on next-day psychomotor performance and memory. Th e electroencephalographic (EEG) power spectral density (PSD) profi le of piromelatine indicated signifi cant reduction in beta power (p<0.05), a marker of cortical arousal and enhanced delta power (P<0.05), a marker of restorative sleep. In preclinical studies in rats, piromelatine enhanced memory performance, attenuated cellular loss and neuronal and cognitive impairment in intrahippocampal Aβ(1-42) injection-induced neurodegeneration and reversed memory, hippocampal BDNF, CREB and pCREB defi cits and hippocampal neurogenesis in chronic mild stress rats. Such unique eff ects suggest that piromelatine is a promising drug candidate in insomnia patients and particularly those with comorbid MCI or AD.

Tabindeh J Khalid

King Faisal Specialist Hospital & Research Center, Saudi Arabia

Title: Perception of nurses regarding infl uence of local lifestyle on sleep while working in Saudi Arabia

Biography:

Tabindeh J Khalid is a Consultant at King Faisal Specialist Hospital, Saudi Arabia and worked as a Staff Physician in Michigan before joining the current position. She completed Family Medicine Residency at Henry Ford Hospital in Detroit and is a Diplomate of American Board of Family Medicine. With interest in clinical research, she has published ten papers in peer reviewed journals and presented numerous abstracts in international meetings.

Abstract:

Background: Studies report that the prevalence of excessive daytime sleepiness in the Saudi population is higher compared to that reported from other populations. It is related in part to a culture of sleep habits that leads to either insuffi cient sleep quantity or quality. However, whether this lifestyle impacts the sleep of non-native workers is unknown. Aim: We conducted this study to evaluate the perception of nonnative nurses regarding the infl uence of Saudi lifestyle on their sleep. Methods: A self-reported questionnaire that included demographics, work schedule, sleep-wake questions, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) was formulated and approved for the study by the Institutional Review Board. It was distributed among a convenience sample of 150 nurses working in inpatient and outpatient clinical units of a tertiary care hospital of a major metropolitan city in Saudi Arabia. Study respondents were divided into two groups based on their response; “Infl uenced” and “Not-Infl uenced” by local lifestyle. Student t-test and Chi-square test were used as appropriate for data analyses. Results: 116 (77%) nurses returned the completed survey. 80 were from the inpatient units and 36 from the outpatient units. 44 (38%) of the nurses felt that their sleep was aff ected by the local lifestyle and were placed in the “Infl uenced” group and remaining 72 (62%) were placed in the “Not-Infl uenced” group. Th ere were no diff erences between the groups in terms of age, gender, height, weight, hours slept during work days, sleep hygiene, working hours, work units, PSQI (3.9 vs. 4.4) and ESS (8.2 vs. 8.9). However, the nurses in “Infl uenced” group when compared to “Not-Infl uenced” nurses group, slept more during off -days (8.6 hours vs. 7.7 hours; p=0.02) had decrease in subjective sleep duration as compared to their sleep before coming to Saudi Arabia (p=0.02), wanted to sleep more (91% vs. 75%; p=0.03) had poor sleep environment and considered family or roommate as a factor in adversely aff ecting their sleep (p<0.03). Conclusion: In our study, about one third of the nonnative nurses felt that their sleep was adversely aff ected by the local lifestyle. Th ese nurses slept less than their prior routine before coming to Saudi Arabia but interestingly were not sleepy while awake based on their ESS. Further studies should address the impact of this perception on nurses’ mood, fatigue and work performance.

Chair

Yuichi Inoue

Tokyo Medical University, Japan

Session Introduction

Deok Won Lee

Kyung Hee University, Korea

Title: Simple and atraumatic technique for the advancement of the genioglossus muscle for treatment of obstructive sleep apnea

Biography:

Deok-Won Lee is currently working as an Associate Professor in the Department of Oral and Maxillofacial Surgery at Kyung Hee University Dental Hospital at Gangdong (Kyung Hee Neo Medical Center).

Abstract:

Obstructive sleep apnea (OSA) is the most common type of sleep apnea and a result of the upper airway obstruction. Untreated OSAS can cause various problems such as hypertension, diabetes, stroke, cardiac disease, daytime sleepiness. It has been demonstrated that genioglossus advancement (GA) is an eff ective procedure for the improvement of the upper airway in some of OSA patients. Th e various types of osteotomy have been designed for the advancement of genioglossus muscle and genial tubercle complex. Inferior saggital osteotomy (ISO), rectangular osteotomy and the circular osteotomy are commonly used for the surgical treatment of OSA. In this paper, we describe a new method for GA that uses specially designed two drills and “c-shaped” plate. Th is technique is more simple, atraumatic and cost eff ective comparing to traditional GA techniques. It helps surgeons to conduct GA surgeries in an effi cient way and shorten operation times. Also it can minimalize the patient’s damage during the surgery. Th is minimal invasive technique is expected to reduce postoperative complications like post-op bleeding, pain and swelling.

Kavitha Palaniappan

University of Newcastle, Singapore

Title: Bi-directional relationship between poor sleep and work-related stress: Management through transformational leadership and work organization

Biography:

Kavitha Palaniappan has completed her PhD in the fi eld of Environmental Health Engineering from Sri Ramachandra Medical University, India. She has been working as Occupational Health Lecturer at the University of Newcastle, Singapore for the past 5 years. Her research interests include lead exposure and its impacts in children including clinical, neurobehavioral and genetic changes. She is currently involved in research in the fi eld of mental health of foreign workers at Singapore and has published more than 15 papers in reputed journals.

Abstract:

Sleep is the most vital episode of human life as psychological and somatic restorative processes are said to happen during sleep. Several studies have recognized the causes for poor sleep as stress, worry, apprehension, everyday hassles, negative or positive experiences and work-related rumination. Likewise, the consequences of sleep deprivation have also been well established. Physiologically, sleep deprivation is said to cause hypometabolism of brain tissues and is also said to increase the risks of obesity, diabetes and cardiovascular diseases. However, it is also important to understand the two-way association between poor sleep and work-related stress which not only aff ects the physiology but also aff ects day time functioning, schematic thinking and causes diffi culties in concentrating and thereby increasing fatigue. Th us, poor sleep and work-related stress create a self-reinforcing vicious circle that slowly deteriorates a person’s well-being. Th is vicious circle can be interrupted by two management techniques: Transformational leadership and Work organization. Transformational leadership has oft en been used to improve productivity and health outcomes such as general well-being and job satisfaction. However, it can also be used to improve the sleeping patterns of individuals by lending them a high level of support and suitable mechanisms for the same need to be conceptualized. On the other hand, organization of tasks according to the nature, physical and mental demands of the job, time of day that the job can be performed, circadian cycles and homeostatic processes of the individuals who are going to perform those jobs would reduce work-related stress and also enable individuals to get a better sleep. Such work patterns need to be designed for every kind of work environment.

Sami Hamdan

Tel Aviv-Yaffo Academic College, Isarel

Title: The effect of Sleep problems on suicidal risk among young adults in the presence of depressive symptoms and cognitive processes

Biography:

Dr. Sami Hamdan is currently working as an Assistant Professor at the Academic College of Tel-Aviv Jaffa. He completed graduate studies in Clinical psychology at Bar-Ilan University. As a Fulbright scholar he spent his Post-doctoral fellowship at Western Psychiatric and Clinic Institution, University of Pittsburgh, with Prof. David Brent. His academic research focuses on Suicidal behaviors and Bereavement and psychopathology among minority groups. Dr. Hamdan has published several original papers and actively participated in scientific meetings.

Abstract:

We aimed to investigate the eff ect of sleep problems, depression and cognitive processes on suicidal risk among 460 young adults. Th ey completed self-report questionnaires assessing suicidal behavior, sleep quality, depressive symptoms, emotion regulation, rumination and impulsivity. Suicidal participants exhibited higher rates of depressive symptoms, sleep problems, expressive suppression, rumination and impulsivity. A confi rmatory factor analysis model revealed pathways to suicidal risk that showed no direct pathways between sleep problems and suicidal risk. Instead, sleep was related to suicidal risk via depression and rumination which in turn increased suicidal risk. Th ese results suggest that addressing sleep problems will be useful in either the treatment or prevention of depressive and rumination symptoms and reduction in suicidal risk.

Masako Okawa

Tokyo Medical University, Japan

Title: Circadian rhythm sleep disorders: Characteristics and entrainment pathology in delayed sleep phase and non-24 sleep-wake syndrome

Biography:

Masako Okawa completed her Postdoctoral Research Fellow in Sleep Laboratory Baylor College of Medicine, Houston, Texas, USA in 1975, MD in Gunma University School of Medicine, Maebashi in 1967. She worked as Senior Staff Associate in Department of Clinical Neurophysiology, Goteborg University, Sweden from 1979. She held the position as Director, Department of Psychophysiology National Institute of Mental Health, National Center for Neurology and Psychiatry, Ichikawa from 1991 & Japan Foundation for Neuroscience and Mental Health, Tokyo in 2013. She worked as Professor of Sleep Medicine, Shiga University of Medical Science, Otsu & Somnology, Tokyo Medical University, Tokyo in 2006 and 2013 respectively. In her career she was awarded with Baelz Prize for the research on “Biological Rhythms of Elderly Patients with Dementia and Paul Janssen Prize in 1989 and 2005 respectively.

Abstract:

The sleep-wake rhythm in humans is regulated by the circadian timing system and disorders of this system are known as circadian rhythm sleep disorders (CRSD) which can have multiple etiologies but result in mal-adjustment of the biological clock with respect to the environment. Th is presentation will focus on a clinical review of delayed sleep phase syndrome (DSPS) and non-24-h sleep-wake syndrome (non-24) which are representative syndromes in CRDS. Th ese syndromes seem to be common and under-recognized in society not only in the blind but also typicallyemerging during adolescence. Both types of syndrome can appear alternatively or intermittently in an individual patient. Psychiatric problems are also common in both syndromes. DSPS and non-24 could share common circadian rhythm pathology in terms of clinical process and biological evidence. Th e biological basis is characterized by a longer sleep period, a prolonged interval from the body temperature nadir-tosleep off set, a relatively advanced temperature rhythm, lower sleep propensity aft er total sleep deprivation and higher sensitivity to light than in normal controls. Th ere are multiple lines of evidence suggesting dysfunctions at the behavioral, physiological and genetic levels. Treatment procedures and prevention of the syndromes require further attention using behavioral, environmental and psychiatric approaches since an increasing number of patients in modern society suff er from these disorders.

Lamia Medhat Afi fi

Cairo University, Egypt

Title: Polysomnography and anti-diuretic hormone secretion pattern in children with primary nocturnal enuresis

Biography:

Lamia Medhat Afi fi completed her MD degree in clinical neurophysiology and Masters of Science in clinical neurophysiology at, Cairo University, Egypt in 2004 and 1999 respectively. She also possesses a GCE degree from the British council in Abu Dhabi, UAE in 1988. Afi fi working as a assistant professor in Clinical Neurophysiology Unit, Department of Neurology, Kasr El-Aini Faculty of Medicine, Cairo University, Egypt. She is also associated with Sleep Disorders Center, Stanford University, Egyptian Society of Neurology (Psychiatry and Neurosurgery), and World Academy of Sleep Medicine.

Abstract:

Background: Data regarding sleep patterns in nocturnal enuresis (NE) and its relation to anti-diuretic hormone (ADH) secretion pattern is defi cient. Normally, ADH secretion is increased at night compared to morning so that urine volume decreases during sleep. NE can be caused by nocturnal polyuria due to ADH defi ciency or detrusor muscle hyperactivity. We aimed to evaluate the ADH secretion pattern in children with primary NE and compare the polysomnography (PSG) fi ndings between children with a normal ADH secretion pattern to those with a reversed secretion pattern. Subjects & Methods: Th is study included 28 children, aged 6-18 years with primary mono-symptomatic severe NE. Th ey were subjected to a single overnight attended full PSG. Assay of ADH levels was performed at 9-11 am and 9-11 pm. Results: Reversal of circadian rhythm of ADH secretion was present in 23 children (82%) and normal rhythm was present in 5(18%). PSG revealed that children with reversed ADH rhythm showed less stage N1 percentage and higher sleep effi ciency than the group with normal ADH rhythm. Th e apnea hypopnea index and periodic limb movements’ indices were similar between both groups. Conclusion: Reversed ADH secretion pattern is very frequent in children with NE. Children with reversed ADH secretion had a higher sleep effi ciency than NE children with a normal pattern implying that children with nocturnal polyuria have a more consolidated sleep than those with detrusor muscle hyperactivity.

Harmanjit Singh Hira

Mulana Azad Medical College, India

Title: Plasma level of hypoxanthine/xanthine as markers of oxidative stress with different stages of obstructive sleep apnea syndrome

Biography:

Dr. Harmanjit Singh Hira is currently working as Professor & Head in the Department of Internal and Pulmonary Medicine, Maulana Azad Medical College and Lok Nayak Hospital, University of Delhi, New Delhi, India.

Abstract:

Background: Increased plasma level of hypoxanthine/xanthine as a criterion of tissue hypoxia is established. We presumed that plasma levels of hypoxanthine/xanthine might be high among patients of obstructive sleep apnea syndrome (OSAS) due to oxidative stress. Material & Methods: A case control study of forty three patients with OSAS diagnosed by overnight polysomnography (PSG), were included in study. Age and sex matched 43 subjects in whom presence of OSAS ruled out by overnight PSG were enrolled as healthy controls. Severity of disease was based on apnea-hypopnea index (AHI). Out of 43 patients, nine were of moderate severity, other 14 were of severe OSAS; none was with mild OSAS. Venous blood sample was collected in morning following PSG. Hematological and biochemical investigations were done. Plasma levels of hypoxanthine/xanthine were measured by fl uorometric analysis. Data collected was analyzed statistically by SPSS version-14soft ware, student’s unpaired T test, Chi square test and Mann-Whitney U test and Pearson’s correlation coeffi cient. Results: Mean plasma levels of hypoxanthine/xanthine in patients of OSAS and controls were 5.38±5.11 mmol/L and 1.23±0.42 mmol/L respectively. Statistically signifi cant (p value 0.000) diff erence was found between them. Among patients, positive correlation between hypoxanthine/xanthine levels with age, AHI and serum triglyceride levels was observed. Joint explanatory power of these signifi cant factors was found to be 59.6% (p-value<0.001). Multivariate analysis revealed the positive correlation between neck circumference, serum cholesterol level, plasma levels of hypoxanthine/xanthine and severity of OSAS. Conclusion: Plasma levels of xanthine/hypoxanthine were signifi cantly elevated in patients of OSAS and these were positively correlated with age, serum triglyceride levels, AHI and severity of the disease. Probability of OSAS was higher with subjects with increased neck circumference, serum cholesterol and xanthine/hypoxanthine levels. Clinical Implications: Level of increase in marker of oxidative stress in the blood of OSAS patients varies with severity of the syndrome and therefore, its measurement may be suitable for a clinical follow-up of these patients.