Conference Schedule

Day1: July 16, 2018

Keynote Forum

Biography

G D Singh holds three doctorates, including Doctor of Dental Medicine; a PhD in Craniofacial Development, and a DDSc in Orthodontics. He was invited to relocate to the Center for Craniofacial Disorders, USA where he led a NIH-funded program of craniofacial/cleft lip and palate research. Currently, he is a Board Member of the American Sleep and Breathing Association, a member of the World Sleep Federation, an Academic Fellow of the World Federation of Orthodontists, and Fellow of the International Association for Orthodontics, where he was awarded prizes in 2005, 2013 and 2014. He has published over 200 articles and books in the peer-reviewed medical, dental and orthodontic literature, and has lectured in Australia, Asia, Europe, Africa and North America. Currently, he is President of Vivos BioTechnologies, Inc.

 

Abstract

Several modalities are available for the treatment of adult obstructive sleep apnea (OSA) such as: continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs). However, both of these therapies require life-long compliance and do not address the underlying cause of the condition. A 25 year old male reported to our office with symptoms of excessive daytime sleepiness. He was screened for OSA, and this screening was followed by an ambulatory, type III, home sleep study (HST), which demonstrated an AHI of 10.8 hr-1, a mean oxygen saturation (SpO2) of 86%, and 539 snoring events. A subsequent diagnosis of mild OSA was reached. On craniofacial and intra-oral examination, it was found that the patient had mild, bilateral torus mandibularis and maxillary hypoplasia, with a transpalatal bone width of 35 mm. Therefore, treatment with biomimetic oral appliance therapy (BOAT) was discussed. This type of therapy differs from MADs in that it consists of non-surgical, mid facial redevelopment. After obtaining informed consent, the patient elected to undergo treatment with BOAT, since these devices are FDA-cleared for use in mild to moderate cases of OSA in adults. After 12 months of BOAT, the patient reported that his sleep quality had improved and he was snoring less frequently. On intra-oral examination, it was found that the transpalatal bone width had increased to 36 mm. Therefore, another HST was performed with no device in the patient’s mouth while sleeping. This follow-up HST demonstrated the sleep architecture appeared to be good: the AHI fell to 4.5 hr-1; with a mean SpO2 of 95%, and 257 snoring events without any device in the mouth while sleeping. These findings suggest that biomimetic oral appliance therapy might be able to eliminate OSA in certain adult cases. However, further follow-up studies are needed to determine whether the sleep quality is maintained in the long term.

 

Biography

Mark A K Patterson has his interest in narcolepsy and cataplexy crystalized, when a close family member was diagnosed with the condition in 2004. Since that time, he has been active in raising awareness about the condition to his medical colleagues and general public and currently serves as the President of Narcolepsy Network. He practices as a General Pediatrician with the Carilion Clinic in Roanoke, Virginia, USA. He received his medical training from Albany (New York) Medical College with specialty education from the University of Virginia, Charlottesville. Prior to his medical career, he received a PhD in Biological Chemistry from the Massachusetts Institute of Technology, Cambridge and worked in the fledgling biotechnology industry.

 

Abstract

Statement of the Problem: Narcolepsy is a chronic neurological condition. A pentad of symptoms is often associated: excessive daytime sleepiness, cataplexy, hypnagogic/hypnopompic hallucinations, fragmented sleep, and sleep paralysis. Cataplexy, the transient loss of voluntary muscle tone, is pathognomonic for type 1 narcolepsy, a presumed autoimmune condition. Cataplexy can be as subtle as diplopia due to ocular muscle involvement or as pronounced as full-body collapse. Consciousness is preserved during these attacks. Triggers for cataplexy include the sudden onset of emotions: laughter, anger, excitement. Due to its sporadic development and often subtle nature, many clinicians have rarely observed cataplexy and tend to underestimate its impact. In contrast, anecdotal reports indicate that people with narcolepsy (PWN) often view cataplexy as having a significant psychosocial impact on their lives. This study’s purpose was to evaluate the burden cataplexy has on the daily functioning of PWN.

Methodology: Data from the Nexus Narcolepsy Registry, Narcolepsy Network member interviews, and the US FDA’s “The Voice of the Patient - Narcolepsy” were reviewed and evaluated.

Findings: Symptoms consistent with cataplexy led to initial medical consultation in 25% of patients. Unfortunately, diagnosis can be delayed up to 12 years from symptom onset. Compared to PWN without cataplexy (type 2), those with cataplexy had significantly higher scores on the Epworth sleepiness scale, the clinical global impression of severity scale, and shorter maintenance of wakefulness test latency times. Patients with cataplexy report the symptom as frustrating, embarrassing, and terrorizing. Intentionally avoiding and repressing responses to strong emotional stimuli are common coping mechanisms to prevent an attack.

Conclusions & Significance: Cataplexy is an underdiagnosed and underappreciated symptom of type 1 narcolepsy which can have a profound impact on the psychosocial well-being of those affected. Significant efforts are needed to increase awareness of the symptom and develop treatment options to mitigate its impact.

 

Tracks

  • Sleep Disorders | Neural Control And Neurologics Sleep Disorder | Addiction & Mental Health | Addiction & Behavioral Studies
Location: London, UK
Speaker

Mark A K Patterson

Carilion Children s Clinic, USA

Chair

Biography

Melissa Mansukhani has her expertise in pediatric sleep evaluation. Her hard work and dedication to her patients and families have shaped the pediatric sleep center at Joe DiMaggio Children’s Hospital. Her 11 years of pediatric clinical sleep experience and 15 years of clinical and research helped shape pathways to improve healthcare and technological training for her staff. She has built this program, after years of experience teaching, evaluating and managing in hospital and research institutions. The Joe DiMaggio Children’s Hospital Sleep Center is a patient-family centered organization that diagnosis, evaluates and treats patients with pediatric sleep disorders. She is a member of the American Association of Sleep Technologists (AAST), where she sat on the Standards and Guidelines Committee, authored the pediatric split night protocol and contributed to other protocols.

Abstract

Statement of the Problem: Individuals who have sustained traumatic brain injury have a higher risk of suffering from sleep disorders. The most common of the sleep disorders is sleep apnea. Sleep apnea is defined as the cessation of breathing in conjunction with frequent arousals and hypoxemia. Researchers have found that untreated sleep apnea has been linked to cognitive decline and behavioral deficits. However, not much light has been shed on the effect of untreated sleep disorders in traumatic brain injury. The purpose of this analysis is to describe what the impact is on executive function when traumatic brain injury occurs and sleep apnea is not treated along with other more common treatments for this condition.

 

Methodology & Theoretical Orientation: Review and evaluate published work related to sleep apnea. An ecological framework was utilized to focus on the interaction between the counselors and the staff to understand this relationship and the context in which it occurs.

 

Findings: There continues to be a need for more research in the longitude effects of untreated sleep apnea in traumatic injury patients. When the brain is injured the normal pathways for executive function are disturbed. Hypotension and hypoxia both contribute to poor cognitive outcomes. Depending on the incidents duration and extent of tissue hypoxia it is linked to poor neuropsychological outcomes post traumatic brain injury. Many studies have concluded the relationship between sleep apnea and cognitive deficits, including executive function, attention/vigilance, language, memory and psychomotor speed. Authors also believe that untreated childhood obstructive sleep apnea could permanently alter a developing child’s cognitive potential. In more severe OSA cases the gold standard is still continuous positive airway pressure without oxygen. Another important connection is the relationship between sleep apnea executive dysfunction and post-TBI is comorbid psychopathology. Patient’s post-TBI has a risk of developing depression but with sleep apnea the risk is nearly twofold for major depression.

 

Conclusion & Significance: Patients with post-TBI would benefit from proper sleep evaluation to determine what the right intervention is to effectively treat his/her overall condition. Untreated OSA or SA will result in decline in cognitive as well as executive functions. Gold standard of OSA treatment is CPAP without oxygen. Recommendations are made for proper treatment of post traumatic brain injury patients.

 

Biography

William M Brown was a Natural Science and Engineering Research Council (NSERC) and Killam Scholar whilst completing a PhD at Dalhousie University, Canada. Subsequently, he received a NSERC Postdoctoral Fellowship to study Genomic Imprinting in the USA. In 2006, he founded the Centre for Culture and Evolutionary Psychology at Brunel University teaching evolutionary biology and research methods. In 2009, he moved to Queen Mary, University of London and University of East London to teach research methods and behavioral biology. He has been at the University of Bedfordshire since 2011 and was appointed Senior Lecturer in the School of Psychology in 2015. His interests reside in the evolution of cooperation, development and genomic imprinting. The three topics merge in his work on sleep disturbance, which suggests that frequent night waking mediated by paternal genes was designed to extract social resources from mothers. Cooperation between parental genomes may facilitate more restful sleep and secure attachment between mother and child.   

 

 

Abstract

Statement of the Problem: Genomic imprinting — parent-of-origin dependent gene expression evolves at a locus when there is a conflict of interest between parental genomes within offspring over the optimal level of maternal investment. Conflicts emerge due to relatedness asymmetries within families (e.g., caused by multiple paternity and sex-biased dispersal). Here it is argued based on Haig (2014) and McNamara (2014) -- that sleep disturbance is caused by underlying genetic conflicts over the optimal amount of maternal investment. The purpose of this study is to outline the neurobiological and behavioral evidence that imprinted genes and intragenomic conflicts cause sleep disturbance. Furthermore, I outline the possibility of how intragenomic conflict resolution may occur to reduce sleep disturbances.

 

Methodology & Theoretical Orientation: Three studies are discussed from evolutionary and attachment theoretical perspectives. Study one outlines the case for imprinted gene involvement in sleep regulation. Study two and three investigate the degree to which poor attachment style is a positive correlate of nightmare occurrence.

 

Findings: As expected, study one shows that the frequency of imprinted genes involved in sleep regulation is greater than chance (i.e., considering imprinted genes are rare). Studies two and three reveal that young adults with insecure attachment styles self-report more nightmares.

 

Conclusion & Significance: Preliminary evidence is consistent with an intragenomic conflict perspective and previous work on sleep regulation. It is expected that paternal genes increase offspring sleep disturbance, whilst maternal genes minimize night waking. Future work should explore whether self-reports of disturbed sleep are valid (e.g., behavioral sleep lab work) and parent-of-origin gene network activation whilst sleeping. It is important to note that intragenomic conflict resolution may be mediated by secure attachment style providing a potential pathway for treatment of sleep disturbance.

 

Biography

Abdolrasoul Aleezaadeh completed his Post–Doctorate in Psychology from USA. He completed his master’s Degree in Clinical Psychology and bachelor’s Degree in General Psychology from Iran. He is full expert international faculty professorship member in the Brooklyn Central University, USA. Associate expert international faculty professorship member in the Pacific Albion University, USA & Associate expert international faculty professorship member in the Green Lake (GreenLake) University, USA.

 

Abstract

Statement of the Problem: Since the Sleep Disorders treatment is difficult by the chemical routine drugs; then, therapist must be thought beyond these routine treatments. Choosing Aromatherapy by some Plants considering with innate humor or, temperament of the same plants and, matching of these by patients’ innate humors or, temperaments based on Traditional Islamic-Iranian and, Chinese Medicines with combination of Hahnemann’s Classical Homeopathic Medicine Rubrics, can extract inner Miasma of the sleep disorder pathology of patients and, recover and, cure them in the best way of Neurobiological base of Cognitive Science – in the cellular base of neural control.

 

Orientation: The method used in this research is a library analysis; therefore, after collecting information and data from the sources, using the library method, according to the subject and the problem of the present study, after the critique, the data, have been analyzed in order to explain the research problem.

 

Findings: As sleeping is a powerful energetic compensatory behavior in creatures’ circadian living cycle – even in cold-blooded creatures, that they sleeping almost in cold season for a long time in the year, in compare with hot-blooded creatures, especially human being – and, although almost all creatures have major common points in their neurobiological themes level; but, the human being, among other creatures has his/her specifications in this theme level; why, he/she has wise, thinking, and such abilities that these separate him/her from other creatures. Thinking, as a power of wise of human, in combination with Action Potential Simulation Therapy/A.P.S.T and, odors, considering the type of food and, feeding and, based on the base humor/temperament and, main innate miasma, affects his/her neural biology – as its secretions, neurotransmitters and, in additions, neural intracellular interactions in cellular basis – and, in psychological cognitive science basis, attitudes and, mind cognitive space; and, follow of this, sleeping has influence by these determinants. The conclusion of these cases, in reductionism base, have establish a neural control that it due to homeostasis or, balancing or, not – it means, Sleep Disorders/S.Ds. Of course, sleeping isn’t excluded of these counted cases.

 

Biography

Ravi Shankar Singh has expertise in understanding mental engineering and neurological interactions and their complex functions including neurological programming. He is also engaged in finding some unconventional means of healing and relieving human being suffering from functional mental ailments by reviving and modifying ancient Indian methodologies. He is currently working at Foundation of Mind Awakening and Neuro Analytical Studies.

 

 

Abstract

Statement of the Problem: Every type and stage of sleep disorder can be eradicated easily and effectively by altering the neuro sensitivity of concerned brain in the required direction. Every brain suffering from any type and stage of sleep disorder is suffering primarily with the loss of its harmony (homeostasis) followed by altered secretion of necessary fluid, chemical and electrical activity resulting in alteration of neuro sensitivity of the concerned brain.

 

Purpose of the Study: Sleep disorders are becoming global epidemic and serious enough to interface with normal physical, mental, social and emotional functioning.

 

Methodology & Theoretical Orientation: Every brain is programmed differently than that of another. Some brain is more prone to receive and retain stress from surroundings then that of another. In order to understand the cause of any functional neurological disorder we have to understand the programming of that concerned brain which decides it’s: thinking pattern, behaving pattern, feeling pattern, responding pattern, etc. Human brain is an ultimate creation of nature. In order to understand the programming of the concerned brain we need to know the language of nature being illustrated clearly in different form, on the body of that concerned brain. Sleep is a natural mental process in which the secretion of required fluid and all activity becomes optimum when brain is in harmony. Every brain has a critical limit towards a thrust and it is also different for different brain.

 

Findings: Study was carried out on 673 brains suffering from different types of sleep disorders of different age groups about 69 percent (465) brain responded with sound sleep and 26 percent (175) with moderate benefit and 4 percent (27) with slight benefit (by revert signaling therapy).

 

Conclusion & Significance: Further study and analysis is required on more scientific axes in advanced laboratory.

 

Day2: July 17, 2018

Keynote Forum

Biography

Aman Gupta is involved in research and development activities with various academic and industry organizations and also at individual level. He has a Clinical background followed up by PhD in Neurosciences and Visiting Fellowship - Functional MRI - Harvard Medical School, Boston, MA, USA. He is currently associated with Nuffield Department of Clinical Neurosciences, Graduate reading Sleep Medicine. His research and clinical interest are sleep medicine, dementia of various aetiologies and other neuro-degenerative disorders.

 

Abstract

Statement of the Problem: We aim to understand and hypothesize the common pathophysiology of dementia & cognitive decline in chronic sleep deficiency and type 2 diabetes mellitus.

Methodology: We focus on the literature review to hypothesize the common pathophysiology of dementia & cognitive decline in sleep deficiency and diabetes.

Findings: We earlier investigated the association of poor diabetes control and corresponding cognitive decline in a pilot study (n=60). In this study, HbA1C (marker for average diabetes control) values in the diabetic group (n=30) were found to be significantly negatively correlated (Pearson’s coefficient of correlation) with the various cognitive batteries: general practitioner assessment of cognition (GPCOG) = -0.53; attendant informant tool (AI) = -0.43; memory impairment screen (MIS) = -0.37; negative values of the Pearson’s correlation “r” indicates that lower the respective battery score, poorer is the cognitive function. Similarly, literature suggests that chronic sleep deprivation can lead to cognitive decline and dementia. Research suggests that sleep is associated with the memory consolidation which actually occurs in the non–hippocampal area of the brain i.e. neocortex. This process can lead to the LTP (long term potentiation of the memory). This signifies the importance of the hippocampal and neocortical region of the brain associated with the memory retention and consolidation respectively. In uncontrolled and prolonged diabetes multiple factors like brain insulin resistance, micro-cerebral infarcts and advance glycemic end products can lead to brain ageing leading to cortical and hippocampal atrophy. This in turn impairs the retention and consolidation processes occurring during the sleep.

Conclusion: There is a strong evidence of correlation of poor diabetes control and cognitive decline. Since the memory retention & consolidation processes have been attributed to the sleep cycle, it is hypothesized that diabetes mellitus and sleep deficiency share common pathophysiology. Going forward, studies need to be conducted at a larger scale to validate this concept.

 

Tracks

  • Sleep Disorders | Addiction Rehabilitation & Recovery
  • Workshop
  • Poster Presentation
  • Keynote
Location: London, UK
Speaker

Mark A K Patterson

Carilion Children s Clinic, USA

Chair

Biography

Shireen W Eid is a PhD student at the Psychology Department in the ANU. She has a Master’s degree in Human Physiology from Jordan University of Science and Technology (JUST). She did her Bachelor’s in Physiotherapy from the University of Jordan. She has experience in conducting research studies in humans as part of her post-graduate degrees.

 

Abstract

Statement of the Problem: Many factors are reported to interfere with sleep in otherwise healthy adults. However, most relevant studies were only cross-sectional in nature or they tested only a small number of risk factors. Fewer of them have examined a large pool of potential predictors in a longitudinal study to determine which can most strongly predict impaired sleep. Thus, we examined demographics, symptoms/disorders, physical activity, other behavior (e.g. substance use, electronic device use) and work-contexts as predictors of sleep quality at T1 (cross-sectional) and 3-months later (T2, longitudinal), in a community sample.

 

Methodology & Theoretical Orientation: The sample included 161 participants aged 18–65 years. They completed questionnaires at T1 and T2 that asked about demographics and their recent experiences of sleep, night-eating, affective distress (i.e., stress, anxiety, depression), physical activity, substance use (e.g., caffeine, alcohol, drugs), work-context (i.e. shift-work) and parenting young children. Their physical activity and sleep were monitored via actigraphy for 24-hours at T1 and T2.

 

Findings: Hierarchical multiple regression analysis examined the factors as predictors of sleep quality at T1 and T2. At T2, longer sleep onset latency was predicted by parenting young children and watching TV at night; shorter sleep duration was predicted by female gender; and more awake time and less sleep efficiency were predicted by less alcohol intake. In contrast, all of the T1 sleep measures were predicted by physical activity, including total number of steps, METs and time spent travelling, with the exception of awake time, which was predicted also by less education.

 

Conclusion & Significance: A combination of demographics (e.g. female gender, less education), consumption behavior (i.e. alcohol intake) and other behavior (i.e. watching TV at night, parenting young children) may contribute to poor sleep quality in the short-term and longer-term.

 

Biography

A Voitiuk has graduated from Kharkiv National Medical University in 2013 with major in General Medicine. From 2013 till 2015 she studied as a Postgraduate student in Neurology at Kharkiv Medical Academy of Post-Graduate Education. During her residency she has shown interest and enthusiasm in treating patients with disorder of cerebral circulation, epilepsy and spinal diseases. She studied at the EAN Spring School and got a certificate about finishing in 2017. Currently she is a qualified Neurologist. She is an active participant in case report discussions and always ready to suggest original solutions. She takes active part in scientific conferences and has scientific publication.

 

Abstract

Introduction: Epilepsy is closely connected with the sleep-wake cycle: the disease often causes sleep disorder and its structure and this, in turn, worsens epilepsy. Sleep disorders often provoke the appearance of various paroxysmal conditions, which are then difficult to differentiate from epileptic phenomena. The objective of this study is to determine the nature of paroxysmal disorders occurring during sleep, and study the impact of antiepileptic drugs (AEDs) on sleep architecture.

 

Methods: Studies were conducted on the basis of the analysis of clinical symptoms and instrumental studies. EEG, EEG-video monitoring and polysomnography were used as screening methods.

 

Results: Data analysis of 300 patients aged 18-55 revealed the presence of epileptiform (25%) and non-epileptiform phenomena (28%), among which there were present parasomnias (somnambulism, nightmares, bruxism) – 5% and dyssomnias (difficulty falling asleep, frequent nocturnal awakenings, hypersomnia) – 23%. 10% of patients had a combination of both non-epileptiform and epileptiform phenomena, which greatly hampered the diagnosis. Fifteen patients (5%) didn’t have any sleep disorders. In the study of 137 patients with epilepsy during an inter-paroxysmal period, EEG showed certain increase in the number of "sleep spindles" and their high synchronization (amplitude, duration) in comparison with 163 patients with wakeful epilepsy. The influence of AEDs on sleep structure cannot be excluded either. In patients receiving carbamazepine (7%), the REM-sleep phase decreased, especially at the beginning of treatment. In patients treated with valproate (5%), the 1st stage of sleep increased while the clinical course of obstructive sleep apnea worsened as a result of side effects. In patients taking lamotrigine (3%), the slow-wave sleep stage decreased, while in patients treated with levetiracetam (8%), sleep continuity improved and there was some increase in the slow-wave stage.

 

Conclusion: The study revealed that sleep disorders in patients with epilepsy are observed in 53% of cases. AEP affects the structure and quality of sleep. The differential diagnosis of epileptic and non-epileptic sleep disorders has a lot of problems in clinical practice. Adequate assessment of the syndrome is essential for developing optimal treatment strategies.

 

Location: London, UK

Biography

G D Singh holds three doctorates, including Doctor of Dental Medicine; a PhD in Craniofacial Development, and a DDSc in Orthodontics. He was invited to relocate to the Center for Craniofacial Disorders, USA where he led a NIH-funded program of craniofacial/cleft lip and palate research. Currently, he is a Board Member of the American Sleep and Breathing Association, a member of the World Sleep Federation, an Academic Fellow of the World Federation of Orthodontists, and Fellow of the International Association for Orthodontics, where he was awarded prizes in 2005, 2013 and 2014. He has published over 200 articles and books in the peer-reviewed medical, dental and orthodontic literature, and has lectured in Australia, Asia, Europe, Africa and North America. Currently, he is President of Vivos BioTechnologies, Inc.

 

Abstract

Currently, the management of pediatric obstructive sleep apnea (OSA) remains undecided. Often, the tonsils and adenoids are surgically removed but this intervention does not always produce the desired outcome, and alternatives must be sought. On the other hand, continuous positive airway pressure (CPAP) is often contra-indicated in pediatric OSA, unlike adult OSA. However, mandibular advancement devices (MADs) are often used as alternatives to CPAP in adult OSA. Therefore, alternative solutions to pediatric OSA are also required. Biomimetics is a science that studies natural models and uses these designs and processes to solve human health issues. For example, in modern humans (Homo sapiens sapiens), the natural design includes 32 teeth, which are symmetrically-arranged within the human craniofacial architecture. This structural pattern is achieved through developmental processes (e.g. temporo-spatial patterning) that are encoded within the human genome, including growth and development of the mandible and eruption of the teeth. Studies have shown that the growth and development of the mandible can be modified in 2D and 3D studies. In fact, monozygotic twins respond to removable appliances that reposition the mandible during growth favorably. However, not all pediatric devices are effective in mandibular repositioning during growth, and careful selection is mandatory. In responsive cases, however, both pre-formed and customized devices are cost effective. In fact, significant changes in upper airway morphology have been induced in children using these techniques. It is concluded that this pneumopedic approach may be considered for non-surgical upper airway remodeling in pediatric cases of obstructive sleep apnea.

 

 

Biography

Mark A K Patterson has his interest in narcolepsy and cataplexy crystalized, when a close family member was diagnosed with the condition in 2004. Since that time, he has been active in raising awareness about the condition to his medical colleagues and general public and currently serves as the President of Narcolepsy Network. He practices as a General Pediatrician with the Carilion Clinic in Roanoke, Virginia, USA. He received his medical training from Albany (New York) Medical College with specialty education from the University of Virginia, Charlottesville. Prior to his medical career, he received a PhD in Biological Chemistry from the Massachusetts Institute of Technology, Cambridge and worked in the fledgling biotechnology industry.

 

Abstract

Statement of the Problem: After over a century of study, the exact function of sleep remains elusive. Despite this uncertainty, the value of adequate sleep is undeniable. This value is especially critical in a population who spend almost half of their lives asleep, during the important developmental years: children. Sleep disorders in the paediatric population are often the result of a complex interplay between numerous factors, including medical, interpersonal, and societal. Children do not often complain about sleep problems; a medical evaluation is commonly initiated by an adult caregiver whose own sleep is being impacted. In evaluating a child with a sleep problem it is critical that the clinician to be able to determine what is the sleep problem, whose problem it is, and what is the etiology of the problem. The ability of the clinician to effectively communicate their findings and recommendations to the family is also essential.

Format: This presentation will provide the attendees with an overview of common paediatric sleep disorders, including insomnias, hypersomnias, and parasomnias. Case presentations will then be discussed, allowing for an open forum between the leader and participants. The discussion will focus on current recommendations for evaluation and treatment, strategies to improve clinician-parent communications, and address needs of those participating to enable them to optimize the care they provide to their patients.

Conclusions & Significance: This workshop should provide the clinician with the tools necessary to better understand common paediatric sleep disorders, how to differentiate between various etiologies, and how to work effectively with families to develop treatment strategies.

 

Location: London, UK

Biography

Hyun Woo Kim is majoring in sleep and epilepsy in Seoul Asan Medical Center for fellowship. This is 2nd year for fellowship, and he has involved in many studies about sleep disorder and epilepsy with his colleague.

 

Abstract

Purpose: To document the clinical characteristics of rapid eye movement (REM)- related obstructive sleep apnea (OSA) and supine-only OSA and identify the effects of sleep state and posture in each subtype.

Method: In this cross-sectional study, we evaluated 967 OSA adults. REM-related only OSA was defined as 1) an overall apnea-hypopnea index (AHI) ≥5/h; 2) a AHI REM to AHI NREM ratio >2; 3) a AHI NREM <15/h regardless of positional tendency and 4) not fulfill the criteria of positional OSA. Positional-only OSA was defined as: 1) overall AHI ≥5/h; 2) supine AHI to non-supine AHI ratio >2; 3) non-supine AHI <15/h and 4) not fulfill the criteria of REM-related OSA. And, fitting to both the criteria of REM-related and positional OSA was REM-related with positional OSA subtype. To compare demographic, clinical, and polysomnographic features among the three subtypes of OSA.

Result: Of the 967 patients, 36 (5.7%) and 460 (73.2%) fulfilled the criteria for REM-related only and positional only OSA. REM-related only OSA had higher proportions of women (38.9%) and BDI scores ≥10 (63.9%). Patients with positional-only subtype had the most severe sleep apnea and the worst sleep architecture. In patients with REM-related only OSA, the effects of sleep posture were larger during REM sleep, and the effects of sleep state were also larger during supine sleep. However, in positional-only OSA, the postural effects regardless of sleep state were larger than the sleep state effects.

Conclusion: REM-related only OSA, positional-only OSA and REM-related with positional OSA subtype have different clinical characteristics. The effects of sleep state and posture were similar in REM-related OSA. However, the effects of sleep posture were significantly larger than the sleep state effects in positional OSA.

 

Location: London, UK

Biography

Aman Gupta is involved in research and development activities with various academic and industry organizations and also at individual level. He has a Clinical background followed up by PhD in Neurosciences and Visiting Fellowship - Functional MRI - Harvard Medical School, Boston, MA, USA. He is currently associated with Nuffield Department of Clinical Neurosciences, Graduate reading Sleep Medicine. His research and clinical interest are sleep medicine, dementia of various aetiologies and other neuro-degenerative disorders.

 

 

Abstract

Statement of the Problem: We aim to understand and hypothesize the common pathophysiology of dementia & cognitive decline in chronic sleep deficiency and type 2 diabetes mellitus.

Methodology: We focus on the literature review to hypothesize the common pathophysiology of dementia & cognitive decline in sleep deficiency and diabetes.

Findings: We earlier investigated the association of poor diabetes control and corresponding cognitive decline in a pilot study (n=60). In this study, HbA1C (marker for average diabetes control) values in the diabetic group (n=30) were found to be significantly negatively correlated (Pearson’s coefficient of correlation) with the various cognitive batteries: general practitioner assessment of cognition (GPCOG) = -0.53; attendant informant tool (AI) = -0.43; memory impairment screen (MIS) = -0.37; negative values of the Pearson’s correlation “r” indicates that lower the respective battery score, poorer is the cognitive function. Similarly, literature suggests that chronic sleep deprivation can lead to cognitive decline and dementia. Research suggests that sleep is associated with the memory consolidation which actually occurs in the non–hippocampal area of the brain i.e. neocortex. This process can lead to the LTP (long term potentiation of the memory). This signifies the importance of the hippocampal and neocortical region of the brain associated with the memory retention and consolidation respectively. In uncontrolled and prolonged diabetes multiple factors like brain insulin resistance, micro-cerebral infarcts and advance glycemic end products can lead to brain ageing leading to cortical and hippocampal atrophy. This in turn impairs the retention and consolidation processes occurring during the sleep.

Conclusion: There is a strong evidence of correlation of poor diabetes control and cognitive decline. Since the memory retention & consolidation processes have been attributed to the sleep cycle, it is hypothesized that diabetes mellitus and sleep deficiency share common pathophysiology. Going forward, studies need to be conducted at a larger scale to validate this concept.