Goal 2: Reduce Human Disease

What causes the structural abnormalities that cause sleep apnea, and how can they be prevented?

It is estimated that up to 28% of the population suffer from sleep apnea, which impairs functioning and reduces quality of life, while increasing risk of accidents and a variety of cardiovascular, metabolic, and neuropsychiatric diseases. A large portion of sleep apnea cases are caused by abnormal oro-nasal-maxillo-mandibular features that result in crowding of the upper airway, making it vulnerable to collapsing or ...more »

Submitted by (@bmdixon)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Obstructive sleep apnea (OSA) is a common condition, which causes chronic fatigue and daytime sleepiness, as well as cognitive impairments affecting learning, concentration, and memory. Over the long term, it increases many health risks, including accidents, cardiovascular disease, and depression. OSA is characterized by partial, or complete, blockage of the airway during sleep, so that breathing repeatedly pauses or airflow is limited, causing repeated arousals from sleep. It is usually secondary to a narrow, or collapsible, airway due to either 1) obesity or overweight, or 2) abnormal morphology of the mandible or maxilla bones, which crowds facial structures, such as the tongue and nose, narrowing the pharynx. The causes of obesity are already being well studied, but there is relatively little research on the etiology of the structural abnormalities involved in OSA. Abnormalities of facial structure are widespread in the population causing, not only OSA, but also orthodontic problems that require many to get braces or have wisdom teeth extracted, and widespread temporomandibular joint (TMJ) problems. However, multiple studies have documented that these abnormalities are almost completely absent from populations living a preindustrial, agrarian or forager, lifestyle, making them a “disease of civilization”. In particular, the abnormalities are associated with consumption of a modern diet of processed foods during prenatal, infant, and early childhood development.

Feasibility and challenges of addressing this CQ or CC :

Current evidence implicates three factors in the development of these structural abnormalities: prenatal maternal nutrition (especially vitamin K2 status), breastfeeding vs. bottle-feeding, and frequency of consumption of tough foods after weaning (which provides exercise to the jaw). We need to form a large cohort and study orthodontic development prospectively from fetal development through mid-childhood, with data on diet, feeding practices, and physiological measures of nutrient status. Measurement methods are available using existing technologies to collect the necessary data on each of these measures. Determining the causes responsible for these structural abnormalities will enable further research to demonstrate effective methods of preventing them. Given that many patients with OSA are rendered so miserable by it that they undergo maxillomandibular advancement surgery to correct it, an expensive procedure with a lengthy recovery period, prevention would be a far better solution. This research will move us a big step closer to a future without sleep apnea and its formidable collection of negative effects on health and functioning.

Name of idea submitter and other team members who worked on this idea : Bonnie Dixon

Voting

6 net votes
44 up votes
38 down votes
Active

Goal 2: Reduce Human Disease

SLEEP DISORDERS AS A MODIFIABLE RISK FACTOR FOR CHRONIC DISEASE

There is developing evidence that sleep disorders, in particular obstructive sleep apnea and inadequate sleep, can influence the course of other chronic diseases. Observational studies show that CPAP treatment of patients with pre-diabetes who have OSA reduces the incidence of future diabetes. Moreover, animal and human data indicate that insufficient sleep and sleep apnea can affect the rate of progression of neurodegenerative ...more »

Submitted by (@jnoel0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

This question will have considerable impact. Sleep apnea is an independent risk factor for insulin resistance. Moreover, observational studies show that treatment of OSA reduces the rate of future diabetes compared to that which occurs in untreated OSA. Therefore, identifying OSA and treating this could have a profound impact on reducing the rate of diabetes, i.e., a preventative strategy.

 

Both sleep loss and obstructive sleep apnea have also been shown to be risk factors for subsequent development of Alzheimer’s disease. This has been shown in mouse models and in epidemiological studies to address whether insufficient sleep and sleep apnea are independent risk factors for development of Alzheimer’s disease, in particular accelerating their onset. Determining whether this is so and whether interventions to treat these sleep disorders delay onset of diabetes and Alzheimer’s disease would have profound public health significance.

Feasibility and challenges of addressing this CQ or CC :

These disorders are extremely common so that recruitment of subjects is not challenging. Moreover, new technology reduces protocol burden to assess individuals. All studies can be done in the patients’ home. There are existing cohort studies focused on diabetes and the Alzheimer’s Center program that could be used for these studies. Thus, the studies are extremely feasible in the near term.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

Voting

156 net votes
211 up votes
55 down votes
Active

Goal 2: Reduce Human Disease

Sleep apnea treatment and comorbidities

Does screening for and treating sleep apnea improve outcomes in HLB diseases, such as heart failure?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

15 net votes
24 up votes
9 down votes
Active

Goal 1: Promote Human Health

Maternal Sleep and Infant Health

How does maternal sleep health contribute to normal utero/fetal development and programming of heart, lung, and blood tissues?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

46 net votes
62 up votes
16 down votes
Active

Goal 3: Advance Translational Research

Screening for SDB and Sleep Disorders in School-Aged Chidren by School Nurses

Can school nurses effectively screen for SDB and Sleep Disorders in school aged children? Who else in the school setting could provide such screening? Should such screening be limited to "at risk" children who display identified markers, or be open to all children? What is the role of teachers to "identify" children in need of such screening? What role will such screening serve to mitigate learning, behavioral, developmental ...more »

Submitted by (@nancyh.rothstein)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

The impact of screening at risk children for sleep disorders and sleep disordered breathing, including subsequent referrals and professional treatment, may serve to mitigate future health, learning, developmental and behavioral risks/issues for children by addressing these issues in early childhood. Research based protocols will be accessed and used for screening.

Feasibility and challenges of addressing this CQ or CC :

Additional considerations:

Does the nurse refer an at risk child to the Pediatrician? Dentist? ENT?

What questionnaires or other identifiers would be used for screening? Is there a bio test to assess risk for a SD or SDB?

What should the target age level be for children undergoing proposed screening?

 

How can sleep education and training be integrated with this screening process to promote good sleeping habits/hygiene at home, for all children, parents and caretakers, as well as teachers. Who creates and provides the educational material? Who does the teaching?

 

Parental involvement- KEY!

Name of idea submitter and other team members who worked on this idea : Nancy Rothstein

Voting

5 net votes
6 up votes
1 down votes
Active

Goal 1: Promote Human Health

ELUCIDATING BASIC MECHANISMS OF SLEEP DEFICIENCY AND CIRCADIAN DISRUPTION ON HEALTH THROUGH THE LIFESPAN

There are developing data from clinical studies that sleep deficiency and circadian disruption have multiple adverse consequences for health. The clinical data provide the base for mechanistic studies. Studies in animal models indicate that both circadian disruption and insufficient sleep later gene expression in peripheral tissues. Moreover, the effect of sleep loss in molecular changes in brain changes with age. ...more »

Submitted by (@jnoel0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

There is no doubt that insufficient sleep and circadian disruption are very common in our society. There are also compelling epidemiological data that they are associated with multiple adverse consequences, including increased cardiovascular disease, increase in metabolic abnormalities such as insulin resistance and for shift work an increased incidence of specific concern. Animal studies based on microarrays are showing that inadequate sleep and circadian rhythm alter gene expression not only in brain but also in peripheral tissues. These studies are hypothesis-generating and there are many opportunities for hypothesis-driven research in this area to assess mechanisms. Identifying mechanisms will allow investigators to begin to assess mechanisms of individual differences and to identify new pathways for intervention.

Feasibility and challenges of addressing this CQ or CC :

Sleep and circadian research is in a very strong position. Sleep and clock function has now been identified in all the major model systems—C. elegans, Aphysia, Drosophila, zebra-fish, mice, etc. Thus, there is a strong platform to assess conserved pathways for effect of sleep loss and circadian disruption. Moreover, microarray studies have identified likely pathways thereby setting up hypothesis-driven research. There are major opportunities in this area.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

Voting

174 net votes
230 up votes
56 down votes
Active

Goal 2: Reduce Human Disease

Design interventions to improve sleep hygiene

Inadequate sleep is associated with risk of obesity. Electronic media devices interfere with our ability to sleep well - they delay sleep, interrupt sleep, and affect sleep quality. However these devices are addictive and ubiquitous. Can we develop interventions to help people obtain adequate sleep?

Submitted by (@anna.adachimejia)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Anna Adachi-Mejia

Voting

2 net votes
2 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Cardiometabolic Disease Risks Associated with Sleep Deficiency

How does insufficient sleep duration, irregular timed sleep schedules, and poor sleep quality contribute to the pathophysiology of lung, heart and blood diseases?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Sleep deficiency and untreated sleep disorders threaten the health of 20-30 percent of US adults through an increased risk of stroke, hypertension, diabetes, inflammatory disease, and all-cause mortality. Developing the scientific evidence-base of validated interventions will enhance the management of cardiometabolic and pulmonary risks to health, present new opportunities for secondary prevention, and reduce associated burden on health care systems.

Feasibility and challenges of addressing this CQ or CC :

Improving sleep health through informed public recognition of decision-relevant science, and relatively low cost therapies for management of sleep disorders are available for immediate assessment of impact in appropriate clinical trials to demonstrate efficacy and effectiveness.

Discovery research advances implicate an array of cellular sleep and circadian mechanisms in pathophysiological pathways leading to cardiometabolic and pulmonary disease.

 

Irregular and disturbed sleep impairs cellular biological rhythm in all tissues and organs leading to oxidative stress, unfolded protein responses, and impaired cell function. The pathophysiological findings juxtaposed with epidemiological evidence of disease risk indicate that sleep deficiency contributes to an erosion of health across the lifespan over and above the effects of aging.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

94 net votes
122 up votes
28 down votes
Active

Goal 3: Advance Translational Research

Brief vs. teach-to-goal interventions in teaching patients with COPD to use inhalers

What is the comparative effectiveness of brief interventions to teach patients respiratory inhaler use (e.g., verbal and written instructions) vs. teach-to-goal interventions (brief interventions plus demonstration of correct technique, patient teach-back, feedback, and repeat instruction if needed) on respiratory inhaler technique and patient-reported outcomes (symptom frequency, activities of daily living, quality of ...more »

Submitted by (@jimandmarynelson)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Respiratory inhalers come in a staggering array of types, contents, and methods of use. It is not uncommon for the COPD patient to use two or more types of inhalers each day. The misuse of the application of these devices is rampant, due to confusion, forgetfulness, or lack of proper education in their use. If multiple inhalers are used by the patient, many of them must be used in a particular order, and the inhalation methods may will be vastly different.

Understanding on the part of the patient and/or caregiver begins with the initial instruction in the use of inhalers by medical personnel. They must find, and use, methods of instruction that are understandable and retainable by the patient.

Feasibility and challenges of addressing this CQ or CC :

The study of comparing the two type of instruction is entirely feasible, while the challenges lie with studying a large enough sample of patients to encompass the ranges of COPD stages, mental capacity, and degree of compliance of the patients.

Name of idea submitter and other team members who worked on this idea : Jim Nelson - Patient, Arizona State Advocacy Captain

Voting

13 net votes
16 up votes
3 down votes
Active

Goal 2: Reduce Human Disease

Sleep and obesity

What characteristics of sleep relate to obesity and does improving sleep using medication help with changes linked to obesity and in the end with weight?

Submitted by (@helenahillmanlaroche)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

We are getting more information that sleep is linked to obesity. Those of us treating obesity also try to address sleep but often need to try medication in those with chronic insomnia. Whether this will help with weight or perhaps make it worse and whether one medication might be better to choose over another are questions that impact medical practice.

Name of idea submitter and other team members who worked on this idea : Helena Laroche

Voting

27 net votes
36 up votes
9 down votes
Active

Goal 3: Advance Translational Research

treating sleep apnea without a nose or facial mask

I am lucky to still be alive. I developed heart failure at 41. I turn 60 this month. For the last five years, doctors have tried to get me on a CPAP. I have told them that I'd rather die. I have absolutely no interest in sleeping with a darth vader mask or some strange thing strapped to my nose. Furthermore I had sinus surgery 30 years ago that only partiallly cleared my sinus passage. So forcing air up my nose is very ...more »

Submitted by (@chriscage)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

If my doctors are correct, patients like myself are at high-risk. Before we die, we will need expensive hospital or nursing home based care. If some one can develop a mask or device that will work, he or she will literally save lives and reduce the financial burden on families, communities and hospitals.

Feasibility and challenges of addressing this CQ or CC :

This shouldn't be difficult research. We're talking about an air delivery system, not a cure for cancer or AIDS. The challenge is that this is not a prestige issue. There won't be a lot of research centers spending on on this.

 

Yet it could save lives and reduce healthcare costs. Maybe this research could be conducted as a joint project of associations for ENT doctors, cardiologists and dentists.

Name of idea submitter and other team members who worked on this idea : Mary Crystal Cage

Voting

26 net votes
43 up votes
17 down votes
Active

Goal 2: Reduce Human Disease

Sleep quality assessments in health

Develop algorithms/chemistries (i.e. biomarkers) differentiating between sleep deficiency and health in point-of-care diagnostic evaluation of health risks.

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

37 net votes
56 up votes
19 down votes
Active