Day 2 :
Keynote Forum
Sona Nevsimalova
Charles University, Czech Republic
Keynote: Paroxysmal sleep events in childhood
Time : 10:00-10:40
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 monographicrnchapters. Her main interest is focused on narcolepsy and childhood sleep disorders. She received many scientifi c awards (including one from the AmericanrnAcademy 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-rnPresident of the Czech Sleep Society, and President of the Czech Society of Child Neurology. She has organized several International Congresses, the mainrnorganizing 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) examinationsrnevaluated in our Sleep labin the past 15 years. Th e main categories were parasomnias and abnormal movement disordersrnin sleep and their diff erentiation from epilepsy. Childhood NREM parasomnias are regarded as a common and usually benignrndisorder. Our fi ndings showed a considerable percentage of perinatal risk factors and developmental comorbidities (motorrncoordination delay, dysphasia, learning and/or behavior disorder) in the aff ected children. Stereotypic behavior in abnormalrndevelopmental movements in sleep (bruxism, rhythmic movements) was also found to be a common feature of NREMrnparasomnias. Th erefore, a disorder of sleep maturation can be supposed to have a role to play in the clinical manifestation ofrnchildhood NREM parasomnias. REM parasomnias, mainly REM behavior disorder, are frequently under diagnosed conditionsrnin children. A connection with childhood narcolepsy will be mentioned. Th e diagnostic diffi culties can sometimes arise fromrnabnormal movements in sleep. Benign neonatal sleep myoclonus as well as rhythmic movement disorder can sometimes bernmistaken for epileptic involvement. Bruxism is very common in children which can exceptionally be a sign of temporal lobernepilepsy. Epileptic discharges related to arousal instability and periodic leg movements have been described too. Abnormalrnmovements can be connected also with childhood cataplexy attacks. A typical “cataplectic facies†with repetitive mouthrnopening, tongue protrusion and drooping eyelids appearing close to the disease onset in young children is a frequent feature.rnTh ese abnormal movements include also positive as well as negative myoclonic jerks aff ecting the neck and upper extremities.rnDiffi culties in distinguishing some paroxysmal motor events in sleep will be discussed, a series of diverse video-recordings willrnbe shown and a general account of the history and clinical examination together with v-PSG analysis will be presented.
Keynote Forum
G Dave Singh
BioModeling Solutions, Inc., USA
Keynote: Effect of biomimetic oral appliance therapy in adults with OSA
Time : 10:40-11:20
Biography:
G Dave Singh was born, educated and trained in England (Universities of Newcastle, Bristol and Dundee, UK). He holds three Doctorates and has numerous publicationsrnin the medical, dental and orthodontic literature. Previously, he was Visiting Professor, University of Michigan, USA. Currently, he is the CEO of BioModeling Solutions, Inc.
Abstract:
Biomimetic oral appliance therapy (BOAT) represents an alternative to continuous positive airway pressure or mandibularrnadvancement devices for treating obstructive sleep apnea (OSA) in adults. Th erefore, we tested the hypothesis that the upperrnairway can be improved in adults diagnosed with mild, moderate and severe OSA using BOAT. For this study, we recruited 17rnconsecutive adults aged >21 yrs diagnosed with OSA aft er an overnight sleep study that was interpreted by a sleep physician.rnTh e mean apnea-hypopnea index (AHI) of the sample was calculated prior to and aft er BOAT and the fi ndings was subjected tornstatistical analysis using paired T-tests. In this study, 9 subjects were diagnosed with mild to moderate OSA (mOSA; AHI<30)rnand 8 subjects with severe OSA (sOSA; AHI>30). Prior to treatment, the mean AHI was 13.2 ± 7.2 for the mOSA group. Th ernmean treatment time was 8.7 mos. ± 5.8 and the mean AHI fell by 66% to 4.5 ±3.6 (p=0.002) aft er BOAT. For the sOSA group,rnthe mean treatment time was 10.4 mos. ± 2.6 and the mean, pre-treatment AHI was 46.6±12.0. Aft er BOAT for the sOSA group,rnthe mean AHI fell by 70% to 13.9±10.5 (p=0.001). Th is study supports the notion that BOAT may be successful in reducing thernAHI in adults diagnosed with mild, moderate and severe OSA. However, long-term follow up and larger sample sizes are neededrnto determine whether these initial upper airway improvements can be maintained.
Keynote Forum
Joannes M Hallegraeff
Hanze University Groningen, Netherlands
Keynote: Nocturnal leg cramps: Diagnosing, therapy and associations with other sleep related movement disorders
Time : 11:40-12:10
Biography:
Joannes M Hallegraeff has completed his PhD as Clinical Epidemiologist from University of Groningen, the Netherlands. He is researcher; lecturer and coordinator of thernLifelong Learning musculoskeletal program at SOMT University, The Netherlands. His fi eld of interest is twofold: Nocturnal leg cramps in older adults and non-specifi c lowrnback 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: Nocturnal leg cramps (NLC) is a high prevalent painful musculoskeletal disorder characterized by suddenlyrnoccurring, episodic, painful, sustained, and involuntary contractions of calf, hamstrings or foot muscles during the night.rnSleeping disturbances and distress may be common in patients with NLC and may seriously aff ect quality of life. Clinicians inrndaily practice do not commonly identify clinical characteristics of this sleep related motor disorder, because other sleep or restrnrelated motor disorders are not ruled out. Cause and aetiology of NLC is not fully known and diagnosing is oft en confused withrnother sleep related motor disorders such as restless legs syndrome and periodic limb movement disorder. Besides, inconsistentrnevidence exists about therapy of NLC. Two research questions must be answered:rnTo identify all evidence based valid criteria with respect to diagnosing nocturnal leg cramps and which conditions must bernrule out. Can a pre-sleep stretching regimen be eff ective in preventing nocturnal leg cramps and decrease frequency and severityrnof cramps?rnMethods: A comprehensive systematic literature search has been executed 1990 up till now.rnIn a six-week period, the experimental group performed a nightly pre-sleep stretching regimen of the calf and hamstringsrnmuscles immediately before going to sleep.rnResults: Th e included and reviewed studies revealed a total of ten diagnostic criteria.rnAt six weeks frequency and severity of nocturnal leg cramps decreased both signifi cantly in the experimental group.rnConclusion: Th ere is evidence for clinical diagnosing of nocturnal leg cramps and nightly stretching before going to sleep isrneff ective on frequency and severity of NLC.
- Sleep Therapy Approaches , Hypersomnolence, Sleep The Heart and The Brain,Trends in Sleep medicine and therapy
Location: Sierra A
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.