Day 1 :
Keynote Forum
Roger L Price
Breathing Well LLC, USA
Keynote: Breathing disordered sleep
Time : 10:00-10:40
Biography:
Roger L Price has completed his Post-graduate studies in Physiology, Pharmacology, Toxicology, Clinical Nutrition, Remedial Massage Therapy in 1968; GraduatedrnBSc Pharmacy (Hons) in South Africa in 1961; Certifi ed as Buteyko Method Practitioner and Trainer in 2001. He worked as Assistant Professor in Health Sciencesrnand Medicine department in Bond University Australia from 2005. He had received a certifi cate on integrative medicine from Queensland University in 2008. Hernintroduced the principle of bio-feedback capnometric assessment and evaluation to produce a real-time, accurate and meaningful picture of breathing mechanics,rndynamics, physiology and biochemistry. He created the concept of Integrative Health Care Education - combining the principles of all of the above into a simplernintegrated package designed as a support service for the medical, dental and allied health professions. He is involved in Academy of Clinical Sleep DisorderrnDisciplines (ACSDD), American Academy of Gnathalogical Orthopedics (AAGO), American Academy of Physiologic Medicine and Dentistry (AAPMD), AustralasianrnSleep Association (ASA), Australian Asthma Research and Education Association (AAREA). At present he is the CEO and Consultant Respiratory Physiologist atrnBreathing well LLC.
Abstract:
IT’S ALL ABOUT THE AIRWAY.-Historically, sleep, breathing, jaw, teeth and other dento-facial and oro-facial disordersrnhave been regarded as ‘specifi c conditions’ and ‘diseases’ and have been diagnosed and treated in isolation. Th is treatment hasrnlargely been interventive and aimed at relieving the symptoms.rnTh e reality is that all the above are primarily consequences of Airway Dysfunction, and are the compensations, compromises,rnPara functions and dysfunctions created by the body in order to maintain its prime function – breathing.rnTh e presentation creates logical links between the onset of compromise – as early as the birth process – and shows how thernsystem compensates in order to maintain breathing.
Keynote Forum
Yuichi Inoue
Tokyo Medical University, Japan
Keynote: Electroencephalographic fi nding in idiopathic REM sleep behavior disorder
Time : 10:40-11:20
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. Hernworked as a Professor of Psychiatry in Tokyo Medical University in 2007 and became Director of Japan Somnology Center Neuropsychiatric Research Instituternin 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 isrninvolved in The Japanese Society of Sleep Research, Japanese Society of Biological Psychiatry, Japan Society of Neurovegetative Research, World Federationrnof Sleep Research Society and World Sleep 2015 as Board of Director, Board of Councilor, Board of Councilor, Programme Committee Co-chair and OrganizingrnCommittee Chair respectively. He has more than 190 publications on his name in English language.
Abstract:
The REM sleep behavior disorder (RBD) is a type of parasomnia manifested by vivid, oft en frightening dreams associatedrnwith motor behaviors during REM sleep, sometimes causing injuries to patients themselves or to their bed partners. Th ernpolysomnographic features of RBD include increased muscle activity during REM sleep (REM sleep without atonia). Th ernmajority of RBD-aff ected persons are older men. Th e disorder might be idiopathic (iRBD) or secondary to neurological disordersrnof various kinds. iRBD management with pharmaceutical measures is usually straightforward and eff ective. Several longitudinalrnstudies have revealed that a high proportion of iRBD patients convert to α-synucleinopathies such as Parkinson’s disease andrndementia with Lewy body disease (DLB). Considering this, many studies have been conducted to identify common clinicalrnmarkers between α-synucleinopathies and iRBD or indicators for the future development of α-synucleinopathies in iRBDrnpatients. In this context, electroencephalographic (EEG) slowing occurring while awake and asleep, which is frequently observedrnin DLB, has received much attention. Clarifi cation of the association between EEG slowing and the presence of mild cognitivernimpairment, which is also commonly seen in early stages of DLB, has been particularly expected to off er a breakthrough for thernidentifi cation of cases which might convert to α-synucleinopathies. In this article, we introduce the progress in quantitative EEGrnresearch in iRBD during the past decade. We also discuss the relationship between EEG fi ndings and cognitive decline as well asrnthe mechanisms of EEG changes or cognitive abnormalities in patients with the disorder.
- Sessions on: Novel Insights to Sleep Disorders, Common Sleep Disorders: Causes and Treatment, Dental Sleep Medicine, Pediatric Sleep Disorders: Diagnosis and Treatment
Location: Sierra A
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.
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.
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.
- Workshop
Location: Sierra A
Chair
Anna Thenappan
White Memorial Medical Center, USA
Co-Chair
Kavitha Palaniappan
University of Newcastle Singapore Pte Ltd., Singapore