History of Sleep Med

8/4/2019 History of Sleep Med

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Why sleep?The origins and developmentofSleep Medicine

A.W.A.K.E.NOVEMBER 4, 2009


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2007Grand Rounds

RIH How many of you would aggressively treat

HTN in a patient with a TIA or stroke?

How many of you would treat a

hypercoaguable state in a patient with a TIA or

stroke?

How many of you would treat an O2 sat of 80%

in an acute stroke patient?

How many of you would test for OSA in

a patient with stroke or TIA?


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To tell a story


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Circadian rhythm disorder Obstructive Sleep Apnea

(OSA) REM sleep behavior disorder

Narcolepsy


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Circadian rhythm disorder

Obstructive Sleep Apnea (OSA)

REM sleep behavior disorder Narcolepsy


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You?


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Hypermetabolic state Skin lesions and erosions Hypothermia

Death (sepsis)


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as torture


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Discovery of theelectroencephalogram

1875 Caton

1929 Berger


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The original sleep stages

1937 Loomis


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Discovery of REM sleep

1951 Kleitman & Aserinsky


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Circadian rhythm disorders

Definition: Unable to sleep and wake at the times required fornormal work, school, and social needs. Unless they have anothersleep disorder, their sleep is of normal quality. Timing of sleep is theproblem.

Extrinsic type Jet lag Shift work sleep disorder

Intrinsic type Delayed sleep phase syndrome (DSPS) Advanced sleep phase syndrome (ASPS) Non-24-hour sleep-wake syndrome (Non-24) Irregular sleep-wake pattern


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Image:second scn image


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Treatments?


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Circadian rhythm disorders

Affect us health care shiftworkers

Affect our patients Neuroanatomy elucidates the problem

A clamor of incessant


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A clamor of incessantknocking besieged Mr.Pickwicks lodgings.Once opened, the doorwayrevealed a wonderfully

fat boy who stoodupright. His eyes closedas if in sleep, hisexpression one ofcalmness and repose.Asked his business, hesaid nothing, but noddedonce, and seemed . . .tosnore feebly, immobilethrough three repetitionsof the question. Then, as

the door was about toclose on him, hesuddenly opened hiseyes, winked severaltimes, sneezed once, andraised his hand as if torepeat the knocking.


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Pickwickian

Syndrome


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OSA Misconceptions

1956, Burwells obesity hypoventilation

(Pickwickian) syndrome

pulmonologists misconception

Not corrected until 1966 by Gastaut


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What happens?

Upper airway collapses during sleep

reduction, or cessation, of airflow

less oxygen saturation

increases in inspiratory efforts sleep fragmentation


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1993 Wi i Sl


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AHI > 5

9% women

24% men

1993, Wisconsin SleepCohort Study


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Epidemiology ofOSA

Cadilhac 2005


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OSAtreatment up to early 1980s


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Why ask about OSA? Worsens hypertension

Causes endothelial cell dysfunction

Increases inflammatory response

Alters cerebral hemodynamics

Increases hypercoagulability Increases insulin resistance and obesity

Increases atrial fibrillation

Increased cholesterol (dyslipidemia) Proven stroke prevention


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Dr. Johnsons Summary Slide:

OSA and Stroke

1. OSA is an independent stroke risk factor andworsens other stroke risk factors

2. OSA is common in stroke patients and increases

stroke mortality and morbidity, which can bedecreased with CPAP

3. Treating OSA with CPAP in asymptomaticpatients decreases cardiovascular morbidity and

mortality 4. Decision to test for OSA cant be based on

positive sleep history alone, so screening withpolysomnography is necessary


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REM sleep behavior disorder (RBD)


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http://med.stanford.edu/news_releases/2009/may/narcolepsy.html

VIDEO

narke numbness stupor +
http://med.stanford.edu/news_releases/2009/may/narcolepsy.htmlhttp://med.stanford.edu/news_releases/2009/may/narcolepsy.html


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narkenumbness, stupor+

lepsisattack, seizure

Narcolepsy Tetrad (1957)

Cataplexy

sleep paralysis

hypnagogic

hallucinations

automatic behavior


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http://med.stanford.edu/news_releases/2009/may/narcolepsy.html

VIDEO
http://med.stanford.edu/news_releases/2009/may/narcolepsy.htmlhttp://med.stanford.edu/news_releases/2009/may/narcolepsy.html


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You can go back to sleep now.


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GENERAL REFERENCESRechtschaffen A, Bergmann BM, Everson CA, et al. Sleep deprivation in the rat: X.

Integration and discussion of the findings. Sleep. 1989;12:6887.Everson CA. Sustained sleep deprivation impairs host defense. Am JPhysiol. 1993;265(5 Pt 2):R114854.

Bonnet MH. Sleep deprivation. In: Kryger MH, Roth T, Dement W, editors. Principles andPractice of Sleep Medicine. 3rd ed. WB Saunders Co; Philadelphia: 2000. pp. 5371.

Kripke DF, Simons RN, Garfinkel L, et al. Short and long sleep and sleeping pills. Isincreased mortality associated? Arch Gen Psychiatry. 1979;36:10316.

Kripke DF, Garfinkel L, Wingard DL, et al. Mortality associated with sleep duration andinsomnia. Arch Gen Psychiatry. 2002;59:1316.

National Commission on Sleep Disorders Research. Wake up America: a national sleepalert. 1993;1:1574.

Knipling R, Wang J. Revised estimates of the U.S. drowsy driver crash problem sizebased on general estimates system case reviews. Association for the Advancementof Automotive Medicine; 39th Annual Proceedings; 1995;Oct.pp. 1618.

American Sleep Disorders Association. International Classification of Sleep Disorders,

Revised: Diagnostic and Coding Manual. American Sleep Disorders Association;Rochester, MN: 1997.Partinen M, Hublin C. Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement

W, editors. Principles and Practice of Sleep Medicine. 3rd ed. WB Saunders Co;Philadelphia: 2000. pp. 55879.

Beninati W, Harris CD, Herold DL, et al. The effect of snoring and obstructive sleepapnea on the sleep quality of bed partners. Mayo Clin Proc. 1999;74:9558.

Caton R. The electric currents of the brain. Br Med J. 1875;2:278.


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GENERAL REFERENCES

Berger H. ber das elektroenkephalogramm des menschen. Arch PsychiatrNervenkr. 1929;97:626.

Loomis AL, Harvey EN, Hobart GA. Cerebral states during sleep as studied by humanbrain potentials. J Exper Psychol. 1937;21:12744.

Aserinsky E, Kleitman N. Regularly occurring episodes of eye mobility and concomitantphenomena during sleep. Science. 1953;118:2734.

Dement WC, Kleitman N. Cyclic variations in EEG during sleep and their relation to eye

movements, body motility and dreaming. Electroencephalogr ClinNeurophysiol. 1957;9:67390.Gelineau GBE. De la narcolepsie. Lancette Fr. 1880;53:6268.Vogel G. Studies in the psychophysiology of dreams, III: the dream of narcolepsy. Arch

Gen Psychiatry.1960;3:4218.Juji T, Satake M, Honda Y, et al. HLA antigens in Japanese patients with narcolepsy. All

the patients were DR2 positive. Tissue Antigens. 1984;24:3169.Matsuki K, Grumet FC, Lin X, et al. DQ (rather than DR) gene marks susceptibility to

narcolepsy. Lancet.1992;339(8800):1052.Mignot E, Lin X, Arrigoni J, et al. DQB1*0602 and DQA1*0102 (DQ1) are better markers

than DR2 for narcolepsy in Caucasian and black Americans. Sleep. 1994;17(8Suppl):S607.

Mignot E, Hayduk R, Black J, et al. HLA DQB1*0602 is associated with cataplexy in 509narcoleptic patients.Sleep. 1997;20:101220.


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GENERAL REFERENCES

de Lecea L, Kilduff TS, Peyron C, et al. The hypocretins: hypothalamus-specific peptideswith neuroexcitatory activity. Proc Natl Acad Sci USA. 1998;95:3227.Sakurai T, Amemiya A, Ishii M, et al. Orexins and orexin receptors: a family of

hypothalamic neuropeptides and G protein-coupled receptors that regulate feedingbehavior. Cell. 1998;92:57385.

Marcus JN, Aschkenasi CJ, Lee CE, Chemelli RM, Saper CB, Yanagisawa M, ElmquistJK. Differential expression of orexin receptors 1 and 2 in the rat brain. J CompNeurol. 2001;18(435):625.

Kilduff TS, Peyron C. The hypocretin/orexin ligand-receptor system: implications for sleepand sleep disorders.Trends Neurosci. 2000;23:35965.

Lin L, Faraco J, Li R, et al. The sleep disorder canine narcolepsy is caused by a mutationin the hypocretin (orexin) receptor 2 gene. Cell. 1999;98:36576.

Chemelli RM, Willie JT, Sinton CM, et al. Narcolepsy in orexin knockout mice: moleculargenetics of sleep regulation. Cell. 1999;98:43751.

Nishino S, Ripley B, Overeem S, Lammers GJ, Mignot E. Hypocretin (orexin) deficiencyin human narcolepsy.Lancet. 2000;355(9197):3940.

Thannickal TC, Moore RY, Nienhuis R, Ramanathan L, Gulyani S, Aldrich M, Cornford M,Siegel JM. Reduced number of hypocretin neurons in humannarcolepsy. Neuron. 2000;27:46974.

Peyron C, Faraco J, Rogers W, et al. A mutation in a case of early onset narcolepsy anda generalized absence of hypocretin peptides in human narcoleptic brains. NatMed. 2000;6:9917.

CIRCADIAN RHYTHM DISORDERS


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CIRCADIAN RHYTHM DISORDERSREFERENCES

Moore RY, Eichler VB. Loss of a circadian adrenal corticosterone rhythm followingsuprachiasmatic lesions in the rat. Brain Res. 1972;42:2016.Stephan FK, Zucker I. Circadian rhythms in drinking behavior and locomotor activity of

rats are eliminated by hypothalamic lesions. Proc Natl Acad Sci USA. 1972;69:15836.

Moore RY, Lenn NJ. A retinohypothalamic projection in the rat. J CompNeurol. 1972;146:114.

Welsh DK, Logothetis DE, Meister M, et al. Individual neurons dissociated from ratsuprachiasmatic nucleus express independently phased circadian firingrhythms. Neuron. 1995;14:697706.

DeCoursey PJ, Buggy J. Restoration of circadian locomotor activity in arrhythmichamsters by fetal SCN transplants. Comp Endocrinol. 1988;7:4954.

Ralph MR, Foster RG, Davis FC, et al. Transplanted suprachiasmatic nucleus determinescircadian period.Science. 1990;247(4945):9758.

Konopka RJ, Benzer S. Clock mutants of Drosophila melanogaster. Proc Natl Acad Sci US A. 1971;68:21126.

Hardin PE, Hall JC, Rosbash M. Feedback of the Drosophila period gene product oncircadian cycling of its messenger RNA levels. Nature. 1990;343(6258):53640.

Hardin PE, Hall JC, Rosbash M. Circadian oscillations in period gene mRNA levels aretranscriptionally regulated. Proc Natl Acad Sci U S A. 1992;89:117115.

Sehgal A, Rothenfluh-Hilfiker A, Hunter-Ensor M, et al. Rhythmic expression of timeless:a basis for promoting circadian cycles in period gene

autoregulation. Science. 1995;270(5237):80810.



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Darlington TK, Wager-Smith K, Ceriani MF, et al. Closing the circadian loop: CLOCK-induced transcription of its own inhibitors per andtim. Science. 1998;280(5369):1599603.

Gekakis N, Staknis D, Nguyen HB, et al. Role of the CLOCK protein in the mammaliancircadian mechanism.Science. 1998;280(5369):15649.

Sangoram AM, Saez L, Antoch MP, et al. Mammalian circadian autoregulatory loop: atimeless ortholog and mPer1 interact and negatively regulate CLOCK-BMAL1-induced transcription. Neuron. 1998;21:110113.

Kramer A, Yang FC, Snodgrass P, et al. Regulation of daily locomotor activity and sleepby hypothalamic EGF receptor signaling. Science. 2001;294(5551):25115.

Jones CR, Campbell SS, Zone SE, et al. Familial advanced sleep-phase syndrome: Ashort-period circadian rhythm variant in humans. Nat Med. 1999;5:10625.

Toh KL, Jones CR, He Y, et al. An hPer2 phosphorylation site mutation in familialadvanced sleep phase syndrome. Science. 2001;291(5506):10403.

Czeisler CA, Khalso SBS. The human circadian timing system and sleep-wake

regulation. In: Kryger MH, Roth T, Dement W, editors. Principles and Practice ofSleep medicine. 3rd ed. W.B. Saunders Co.; Philadelphia: 2000. pp. 353375.

Wurtman RJ, Axelrod J, Phillips LS. Melatonin synthesis in the pineal gland: control bylight. Science.1963;142:10713.

Moore RY, Heller A, Wurtman RJ, et al. Visual pathway mediating pineal response toenvironmental light.Science. 1967;155(759):2203.




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Freedman MS, Lucas RJ, Soni B, et al. Regulation of mammalian circadian behavior bynon-rod, non-cone, ocular photoreceptors. Science. 1999;284(5413):5024.Berson DM, Dunn FA, Takao M. Phototransduction by retinal ganglion cells that set the

circadian clock.Science. 2002;295(5557):10703.Provencio I, Rodriguez IR, Jiang G, et al. A novel human opsin in the inner retina. J

Neurosci. 2000;20:6005.Hattar S, Liao HW, Takao M, et al. Melanopsin-containing retinal ganglion cells:

architecture, projections, and intrinsicphotosensitivity. Science. 2002;295(5557):106570.Gooley JJ, Lu J, Chou TC, et al. Melanopsin in cells of origin of the retinohypothalamic

tract. Nat Neurosci.2001;4:1165.Czeisler CA, Shanahan TL, Klerman EB, et al. Suppression of melatonin secretion in

some blind patients by exposure to bright light. N Engl J Med. 1995;332:611.Chesson AL, Jr, Littner M, Davila D, et al. Practice parameters for the use of light therapy

in the treatment of sleep disorders. Standards of Practice Committee, American

Academy of Sleep Medicine. Sleep. 1999;22:64160.Eastman CI, Stewart KT, Mahoney MP, et al. Dark goggles and bright light improve

circadian rhythm adaptation to night-shift work. Sleep. 1994;17:53543.Terman M, Terman JS. Light Therapy. In: Kryger MH, Roth T, Dement W,

editors. Principles and Practice of Sleep Medicine. 3rd ed. WB Saunders Co;Philadelphia: 2000. pp. 125874.




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Jewett ME, Kronauer RE, Czeisler CA. Phase-amplitude resetting of the human circadianpacemaker via bright light: a further analysis. J Biol Rhythms. 1994;9:295314.Boivin DB, Duffy JF, Kronauer RE, et al. Dose-response relationships for resetting of

human circadian clock by light. Nature. 1996;379(6565):5402.Czeisler CA, Duffy JF, Shanahan TL, et al. Stability, precision, and near-24-hour period

of the human circadian pacemaker. Science. 1999;284(5423):217781.Orem J, Lydic R. Upper airway function during sleep and wakefulness: experimental

studies on normal and anesthetized cats. Sleep. 1978;1:4968.Frederickson CJ, Rechtschaffen A. Effects of sleep deprivation on awakening thresholdsand sensory evoked potentials in the rat. Sleep. 1978;1:6982.

Sitaram N, Moore AM, Gillin JC. Induction and resetting of REM sleep rhythm in normalman by arecholine: blockade by scopolamine. Sleep. 1978;1:8390.



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SLEEP APNEA REFERENCES

Burwell C, Robin E, Whaley R, et al. Extreme obesity associated with alveolarhypoventilation: A Pickwickian syndrome. Am J Med. 1956;21:8118.Gastaut H, Tassinari CA, Duron B. Polygraphic study of the episodic diurnal and

nocturnal (hypnic and respiratory) manifestations of the Pickwickian syndrome. BrainRes. 1965;2:16786.

Remmers JE, deGroot WJ, Sauerland EK, et al. Pathogenesis of upper airway occlusionduring sleep. J Appl Physiol. 1978;44:9318.

Sullivan CE, Issa FG, Berthon-Jones M, et al. Reversal of obstructive sleep apnoea bycontinuous positive airway pressure applied through thenares. Lancet. 1981;1(8225):8625.

Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathingamong middle-aged adults. N Engl J Med. 1993;328:12305.

Peppard PE, Young T, Palta M, et al. Prospective study of the association betweensleep-disordered breathing and hypertension. N Engl J Med. 2000;342:137884.

Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep

apnea, and hypertension in a large community-based study. Sleep Heart HealthStudy. JAMA. 2000;283:182936.Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular

disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir CritCare Med. 2001;163:1925.


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REM SLEEP DISORDER REFERENCESSchenck CH, Bundlie SR, Ettinger MG, et al. Chronic behavioral disorders of human

REM sleep: a new category of parasomnia. Sleep. 1986;9:293308.Hendricks JC, Morrison AR, Mann GL. Different behaviors during paradoxical sleepwithout atonia depend on pontine lesion site. Brain Res. 1982;239:81105.

Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder:demographic, clinical and laboratory findings in 93 cases. Brain. 2000;123(Pt 2):3319.

Boeve BF, Silber MH, Ferman TJ, et al. REM sleep behavior disorder and degenerativedementia: an association likely reflecting Lewy body

disease. Neurology. 1998;51:36370.Ferman TJ, Boeve BF, Smith GE, et al. REM sleep behavior disorder and dementia:

cognitive differences when compared with AD. Neurology. 1999;52:9517.Boeve BF, Silber MH, Ferman TJ, et al. Association of REM sleep behavior disorder and

neurodegenerative disease may reflect an underlying synucleinopathy. MovDisord. 2001;16:62230.

Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder

in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleepbehaviour disorder. Neurology. 1996;46:38893.Eisensehr I, Linke R, Noachtar S, et al. Reduced striatal dopamine transporters in

idiopathic rapid eye movement sleep behaviour disorder. Comparison withParkinsons disease and controls.Brain. 2000;123(Pt 6):115560.

Albin RL, Koeppe RA, Chervin RD, et al. Decreased striatal dopaminergic innervation inREM sleep behavior disorder. Neurology. 2000;55:14102.


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Foutz AS, Mitler MM, Cavalli-Sforza LL, Dement WC. Genetic factors in caninenarcolepsy. Sleep. 1979;1:41321.

Glenn LL, Foutz AS, Dement WC. Membrane potential of spinal motoneurons duringnatural sleep in cats.Sleep. 1978;1:199204.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepinessscale. Sleep. 1991;14:5405.

Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S. Guidelinesfor the multiple sleep latency test (MSLT): a standard measure of

sleepiness. Sleep. 1986;9:51924.

NARCOLEPSY REFERENCES


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THE END


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