Sleep Scientists Research Articles

If I die before I wake: not a worry for sleep apnea patients

in theory, obstructive apneas can be terminated either by arousal or by increases in chemical drive that excite the upper airway dilating muscles ([1][1]). However, the still-prevalent view, which Younes et al. ([13][2]) test in their study in the Journal of Applied Physiology , is that obstructive

Mother–infant cosleeping, breastfeeding and sudden infant death syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine

Twenty years ago a new area of inquiry was launched when anthropologists proposed that an evolutionary perspective on infancy could contribute to our understanding of unexplained infant deaths. Here we review two decades of research examining parent-infant sleep practices and the variability of maternal and infant sleep physiology and behavior in social and solitary sleeping environments. The results challenge clinical wisdom regarding "normal" infant sleep, and over the past two decades the perspective of evolutionary pediatrics has challenged the supremacy of pediatric sleep medicine in defining what are appropriate sleep environments and behaviors for healthy human infants. In this review, we employ a biocultural approach that integrates diverse lines of evidence in order to illustrate the limitations of pediatric sleep medicine in adopting a view of infants that prioritizes recent western social values over the human infant's biological heritage. We review what is known regarding infant sleeping arrangements among nonhuman primates and briefly explore the possible paleoecological context within which early human sleep patterns and parent-infant sleeping arrangements might have evolved. The first challenges made by anthropologists to the pediatric and SIDS research communities are traced, and two decades of studies into the behavior and physiology of mothers and infants sleeping together are presented up to the present. Laboratory, hospital and home studies are used to assess the biological functions of shared mother-infant sleep, especially with regard to breastfeeding promotion and SIDS reduction. Finally, we encourage other anthropologists to participate in pediatric sleep research using the unique skills and insights anthropological data provide. By employing comparative, evolutionary and cross-cultural perspectives an anthropological approach stimulates new research insights that influence the traditional medical paradigm and help to make it more inclusive. That this review will potentially stimulate similar research by other anthropologists is one obvious goal. That this article might do so makes it ever more possible that anthropologically inspired work on infant sleep will ultimately lead to infant sleep scientists, pediatricians, and parents becoming more informed about the consequences of caring for human infants in ways that are not congruent with their evolutionary biology.

Concomitant sleep disorders—a reason for in-clinic sleep studies in patients with obstructive sleep apnea?

In their article, Steven Scharf and coworkers [1] present retrospective data for the prevalence of concomitant sleep disorders in 643 patients with a primary diagnosis of obstructive sleep apnea (OSA) out of 1,162 consecutive patients referred for polysomnography. The fact that 31% OSA patients had concomitant sleep disorders, and out of these 22.6% had either inadequate sleep hygiene or periodic limb movement disorder (PLMD) might not be very surprising to insiders. However, the fact that 12.5% had other sleep disorders than the two mentioned above might be of major political importance. Or to quote the authors of the paper: “The question of the role of the sleep specialist and polysomnographer in the evaluation of patients with sleep-disordered breathing is impacted by these findings”. On 21 September 2004 the Federal Board of Physicians and Public Health Care Insurances in Germany passed a federal law that polysomnography in OSA patients should be performed in an ambulant, out-patient status and reimbursed by the public health care fundings of the ambulant system for physicians in private practice (depending on the area, this means a reimbursement of 250–300 € per polysomnography for pulmonary specialists, neurologists, etc. in private practice). In-clinic sleep laboratories immediately received letters from some public health care insurances that their polysomnographies in OSA patients will not be reimbursed in the future. In the past we, the progressive fraction of sleep specialists (not to mention the English and Scotish Extremists), have pushed for the evidence-based, low-cost and simple method approach in sleep medicine. Do we have the pendulum pushed too far? Maybe! It is probably a law of nature that health insurances go for a maximum of cost reduction, no matter what. It is now our duty as sleep scientists to bring that pendulum back to the middle, where we actually, even the progressive group, wanted it to be. The data by Steven Scharf and his co-workers proves to me that not all those classified simply as OSA patients might be that simple as previously guessed. Adding heart disease patients with periodic breathing (left out intentionally in the actual study) into the equation would enlarge the number of difficult patients evenmore. The diagnosis and treatment of the concomitant sleep disorders like narcolepsy and insomnia requires definitely special sleep medicine knowledge, which can—in combination with the necessary knowledge for the respiratory part—not be delivered by just one specialist in private practice. One of the conclusions of the actual study might therefore be that the days of the good old in-clinic sleep laboratory with an array of inter-disciplinary working sleep specialists are not yet over.

Sleep, fatigue, and medical training: setting an agenda for optimal learning and patient care.

The difficult issues surrounding discussions of sleep, fatigue, and medical education stem from an ironic biologic truth: physicians share a common physiology with their patients, a physiology that includes an absolute need for sleep and endogenous circadian rhythms governing alertness and performance. We cannot ignore the fact that patients become ill and require medical care at all times of the day and night, but we also cannot escape the fact that providing such care requires that medical professionals, including medical trainees, be awake and functioning at times that are in conflict with their endogenous sleep and circadian physiology. Finally, we cannot avoid the reality that medical education requires long hours in a constrained number of years. Solutions to the problem of sleep and fatigue in medical education will require the active involvement of numerous parties, ranging from trainees themselves to training program directors, hospital administrators, sleep and circadian scientists, and government funding and regulatory agencies. Each of these parties can be informed by previous laboratory and field studies in a variety of operational settings. including medical environments. Education regarding the known effects of sleep. circadian rhythms, and sleep deprivation can help to elevate the general level of discourse and point to potential solutions. Empiric research addressing the effects of sleep loss on patient safety, education outcomes, and resident health is urgently needed: equally important are the development and assessment of innovative countermeasures to maximize performance and learning. Addressing the economic realities of any changes in resident work hours is an essential component of any discussion of these issues. Finally, work-hour regulations may serve as one component of improved sleep and circadian health for medical trainees. but they should not be seen as substitutes for more original solutions that rely less on enforcement and more on collaboration. By working together to address the problems of sleep and fatigue in its own trainees, the medical field can provide a valuable legacy to patients and to future generations of healthcare providers--a legacy or optimal medical education, healthy doctors, and healthy patients.

What is the purpose of sleep?

Sleep scientists admit that they neither know, nor do they really understand what the fundamental purpose or function of sleep is. Such an extraordinary admission seems to indicate that problems may exist both at the conceptual and the methodological levels. This paper attempts to offer reasoned and logical arguments, explaining the purpose of sleep at the conceptual level. It also draws attention to a fundamental linkage between sleep and fatigue. An insight into the underlying theoretical basis of fatigue is seen as an essential prerequisite for understanding the theoretical basis of sleep.

Upper airway resistance syndrome: sick, symptomatic but underrecognized.

Upper airway resistance syndrome (UARS) appears to be underrecognized or at least underreported in the medical literature. We have found that these children may suffer the same, if not more, severe consequences of sleep disordered breathing than obstructive sleep apnea patients. Seventy-five infants and children were age and gender matched from a heterogeneous patient population in Southern California. Each patient underwent clinical polysomnography. Twenty-five patients were in each of three groups. Group one patients were clinician referred to the sleep clinic and were found to be free of significant sleep pathology. Group two patients had UARS. Group three patients had frank obstructive sleep apnea. The three groups differed on respiratory, sleep and snoring parameters. A heuristic is presented to help clinicians tailor their treatment approach and sleep scientists to test the model to aid in the understanding of UARS.

Research activities on informal communication among research workers in Japan

Study on informal communication among scientists is a new field of research interest to librarians and information scientists in Japan, though the important role played by oral communication in scientific and technical information activities has been introduced to them for some time through original and even translated reports of studies in the field. Recently, stimulated by Crawford's research on informal communication among sleep scientists and by Korfhage's study based on Crawford's report, several studies on this subject of “informal communication among scientist” have been conducted by some students of Keio University School of Library and Information Science. The present paper introduces the results of these studies and analyses the discrepancy from the results of previous American studies. Exchange of preprints is not so commonly used among Japanese scientists. Instead, to attend many committee meetings of various departments of government ministries (and of other public organizations) and to be acquainted with other very selected scientists seems to be one of the major information sources for leading scientists. Existence of a peculiar situation of some of Japanese researchers who are maintaining closer relationship with their colleagues in foreign countries than with their domestic ones is also pointed out.