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SLEEP RESEARCH IN THE DEPARTMENT OF NEUROLOGY

Sleep medicine interacts with virtually every subspecialty of neurology, including epilepsy, stroke, neuromuscular diseases, and disorders of neurodevelopment. The study and treatment of sleep disorders represents an opportunity to improve daytime functioning and quality of life in individuals affected by neurological disorders.

The Vanderbilt Sleep Disorders Center is an accredited 10-bed, 7-night-a-week hotel-based facility that has been in existence since 2003 with a volume of approximately 70% adults and 30% children. We recently opened a second facility in Williamson County which operates 6 beds, 6 nights a week. We have performed overnight polysomnograms, including 21-channel EEG studies, multiple sleep latency tests, and related procedures on patients with a wide variety of sleep disorders and coexisting neurological disorders. Most patients undergo comprehensive sleep evaluations before their sleep studies. With IRB approval, these studies and clinical evaluations can be reviewed retrospectively for research proposals.

The Vanderbilt Sleep Core, directed by Dr. Beth Malow, was developed to facilitate interdisciplinary research in sleep medicine. Investigators from a variety of disciplines are encouraged to add sleep studies into their research protocols, which can be performed in a prospective fashion on a specific cohort of patients. The Sleep Core offers consultation with Dr. Malow and Peter Howard, RPSGT, regarding protocol development and implementation. The Sleep Core has two hard-wired state-of-the-art digital video-EEG-polysomnography systems and a third wireless system for portable studies. Two sleep technologists with experience in both adults and children carry out overnight polysomnography as well as daytime multiple sleep latency tests. Actigraphy, which assesses the sleep-wake cycle through the use of activity meters, is also available. For more information about the Vanderbilt Sleep Core, please contact Dr. Malow.

Below is a list of research that we would welcome your involvement in:

Sleep and Neurodevelopment: Dr. Beth Malow and colleagues
Sleep disturbances are common in children with disorders of neurodevelopment and can affect child and family functioning. Our current studies include two trials examining the impact of supplemental melatonin on insomnia in autism, and the role of parent education classes to improve sleep in children with autism. We are also studying the genetics of autism and sleep (Dr. Roberta Leu) and are planning to extend our work in sleep to adolescents with autism using polysomnography and actigraphy (Dr. Suzanne Goldman). We are also beginning a project of sleep in Angelman’s syndrome, using actigraphy and polysomnography (Dr. Suzanne Goldman). The EEG in children with autism is being analyzed in relation to sleep and behavior (Drs. Greg Barnes and Juliann Paolicchi). Click here to link to Dr. Malow’s research studies.

Sleep and Stroke: Dr. Kanika Bagai
Sleep apnea is an independent risk factor for stroke, although the precise mechanisms are not clear. Why some strokes occur during sleep and at certain times of the circadian cycle is also unknown. We are investigating the role of plasminogen activating inhibitor 1 (PAI-1) in promoting thrombosis in patients with sleep apnea, as well as the circadian profile of this substance.

Treatment of REM-related Obstructive Sleep Apnea and Mild Sleep Apnea: Dr. Kanika Bagai
Some individuals, including women, are more likely to have sleep apnea limited to REM sleep, resulting in under diagnosis and treatment due to an overall low rate of sleep apnea during the night. Others may have mild sleep apnea, although the severity of sleep apnea is not necessarily related to daytime symptoms, including daytime sleepiness. We are interested in several aspects of REM-related and mild sleep apnea, including their impact on daytime functioning and cardiovascular health, as well as how differences in scoring paradigms can affect their diagnosis.

CPAP adherence in the Vanderbilt population: Dr. Chris Nolte
While sleep apnea is extremely common (as many as 1 in 4 men and 1 in 10 women), and easily treatable with continuous positive airway pressure (CPAP), the majority of patients do not use CPAP long term. We offer a CPAP clinic at Vanderbilt that troubleshoots difficulties with CPAP and motivates patients to use their devices. In preliminary work, we have documented a CPAP adherence rate of >90% in our patients, as documented by adherence monitors. We would like to identify factors that promote success, the role of our CPAP clinic in improving adherence, and specific CPAP challenges in our neurological populations (eg, children, those with cognitive disorders).

Sleep and Neuromuscular Disease: Dr. Amanda Peltier
Sleep is disrupted in neuromuscular disease on the basis of respiratory muscle weakness or other mechanisms. In turn, treating a sleep disturbance, such as hypoventilation in sleep, may improve daytime function in patients with these disorders. We are also interested in the relationship of diabetic peripheral neuropathy and autonomic neuropathy to sleep and the prevalence of sleep apnea in diabetes mellitus.

Sleep in ALS: Dr. Michael Yu (fellow) with Drs. Peltier and Malow
Sleep disordered breathing in ALS comes in many forms, including hypoventilation during sleep. We are proposing screening of ALS patients early in their course to determine prevalence of sleep disordered breathing and also the impact of its treatment on survival and quality of life.

Restless Legs Syndrome: Dr. Art Walters
There are multiple areas of research in RLS, including (a) performing brain MRIs to assess for silent stroke given recent evidence that hypertension and heart disease are linked to RLS; (b) comparing messenger RNA in drug-free RLS patients and controls to study gene activation; (c) studying CSF from RLS patients to examine endogenous opioids (endorphins, enkephalins); and (d) circadian study of RLS patients in which we will use bright light to phase delay the symptoms of RLS to a later time of night. This will more definitively show that RLS symptoms are triggered by circadian mechanisms and will also perhaps be of therapeutic benefit so that symptoms may be conscripted to the night. As a possible future benefit, patients who have symptoms in the late afternoon and night might only need to take one dose of medication before bedtime rather than multiple dosages in the afternoon and in the evening.

Sleep and Epilepsy: Dr. Beth Malow and Epilepsy Faculty
Insomnia and daytime sleepiness are common in patients with epilepsy, with seizures, antiepileptic drugs, or sleep disorders such as sleep apnea contributing to these symptoms. Treatment of sleep disorders in these patients may improve seizure control, daytime sleepiness, or quality of life. We are also interested in the role of the sleep EEG in the epilepsy surgery evaluation, and how seizures are affected by sleep.

Pediatric Sleep: Drs. Ramon Cuevas and Roberta Leu
Many aspects of sleep in children are in evolution, including the methods to best assess sleep disordered breathing, the role of end-tidal CO2 monitoring. We are interested in studying these questions in our pediatric sleep population.

ADHD and Restless Legs Syndrome: Dr. Ramon Cuevas
Children with the diagnosis of ADHD have recently been found to have symptoms suggestive of restless legs syndrome (RLS). Curiously, a significant number of these kids have also been found to have laboratory findings of iron storage deficiency, which is a known secondary cause of RLS. On collaboration with the General Pediatrics and Pediatric Psychiatry clinic on-campus, we are interested in exploring the prevalence of RLS in children with ADHD, and in assessing the significance of iron storage deficiency in this population.

Sleep Deprivation: Dr. Kim Hutchison
Sleep deprivation is a fact of life. Whether voluntary or involuntary, sleep deprivation results in impaired human functioning that can lead to fatal injuries and mistakes. In her current study, Dr. Hutchison is using functional magnetic resonance imaging (fMRI) to measure brain activation after normal sleep and 24 hours of sleep deprivation in two populations: normal volunteers and patients with chronic sleep fragmentation due to obstructive sleep apnea (OSA). The changes in activation patterns are correlated with performance on behavioral tasks and the degree of sleepiness using the Multiple Sleep Latency Test.

Sleep Medicine in Underserved Populations: Dr. Kim Hutchison
It is widely accepted that patients in low income and other medically underserved communities are receiving disparate care in the diagnosis and management of sleep disorders. Dr. Hutchison is interested in investigating the issues surrounding access to, quality of, and cost of diagnosis and treatment of sleep disorders, particularly sleep apnea. In addition, she would like to develop a program to increase the availability of CPAP machines to low income patients (through donor and exchange programs).

Links to articles on sleep and autism that features Dr. Malow’s research are available at:

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