Beginning with the discovery of rapid eye movement (REM) sleep 50 years ago, substantial advances have been achieved in our understanding of the importance of sleep for all mammalian species, the neurophysiology of sleep and circadian rhythms, and the consequences of acute and chronic sleep restriction on physiologic function and behavior.

Sleep-related problems affect 50-70 million Americans of all ages. Sleep-related problems have the same clinical relevance in women as men and some sleep problems are more common in women. Important disparities in prevalence and severity of individual sleep disorders have been identified in racial and ethnic minorities and underserved populations. Sleep problems and disorders have major impacts on society, but have not received sufficient attention in clinical practice, in the education of health care providers and future biomedical researchers, or in public health education and intervention programs.

The three broad categories of problems include:

• Sleep Restriction: resulting from imposed or self-imposed lifestyles and work schedules. Many children, adolescents, and adults regularly fail to get sufficient sleep to function effectively during waking hours.
• Primary Sleep Disorders: More than 70 types of sleep disorders chronically affect people of all ages. Fifty percent or more of patients remain undiagnosed and therefore untreated.
• Secondary Sleep Disorders: People having a chronic disease associated with pain or infection, a neurological or psychiatric disorder, or an alcohol or substance abuse disorder often experience poor sleep quality and excessive daytime sleepiness. The end result can be exacerbation of the primary medical condition and further impairment in health and safety, mood and behavior, and quality of life.

As part of the authorizing legislation establishing the National Center on Sleep Disorders Research (NCSDR) within the National Heart, Lung, and Blood Institute, a Sleep Disorders Research Advisory Board (SDRAB) was established to provide a primary source of advice on matters related to planning, conduct, support, and evaluation of research in sleep and sleep disorders. The SDRAB consists of 12 non-federal members appointed by the Director, NIH, eight of whom are representatives of health and scientific disciplines related to sleep disorders and 4 of whom represent the interests of individuals with a sleep disorder (see Appendix). The Director, NCSDR, serves as Executive Secretary of the SDRAB.

The Trans-NIH Sleep Research Coordinating Committee (SRCC) was established in 1986 by the Director of NIH for the purpose of facilitating interchange of information on sleep and sleep-related research. When the NCSDR was established in 1993, responsibility for the Trans-NIH SRCC was transferred to the NCSDR and its Director serves as Chair of the Trans-NIH SRCC. The Trans-NIH SRCC in 1993 was comprised of only 5 Institute representatives but membership has progressively increased in parallel with increasing interdisciplinary scope of sleep research and especially since release of the first Sleep Disorders Research Plan in 1996.

Ten NIH Institutes/Centers are now members of the Trans-NIH SRCC:

NIH INSTITUTE/CENTER	REPRESENTATIVE(S)
Heart, Lung, and Blood (NHLBI)	Carl E. Hunt, MD	Michael Twery, PhD
Aging (NIA)	Andrew Monjan, PhD, MPH
Arthritis, Musculoskeletal, and Skin Diseases (NIAMS)	Deborah Ader, PhD
Alcohol Abuse and Alcoholism (NIAAA)	Ellen Witt, PhD
Child Health and Human Development (NICHD)	Marian Willinger, PhD
Drug Abuse (NIDA)	Harold Gordon, PhD
Mental Health (NIMH)	Israel Lederhendler, PhD
Neurological Disorders and Stroke (NINDS)	Paul Nichols, PhD
Nursing Research (NINR)	Karin F. Helmers, PhD, RN
Complementary and Alternative Medicine (NCCAM)	Nancy Pearson, PhD

The Task Force appointed to revise the Sleep Research Plan met three times and conducted multiple conference calls. Administrative and staff support were provided by NCSDR and the Trans-NIH SRCC. A draft of the revised plan was broadly circulated to solicit comments from biomedical professionals involved in sleep-related research and clinical practice, and relevant professional and public organizations representing individual scientific disciplines and sleep disorders. A special session was held at the 2002 Annual Meeting of the Associated Professional Sleep Societies to present the plan and receive comments, and the draft Plan was posted on the NCSDR web site for two months. Many comments were received and were carefully considered by the Task Force in preparation of the final Plan.

On behalf of the SDRAB and the Trans-NIH SRCC, we are pleased to distribute this 2003 Revision of the NIH National Sleep Disorders Research Plan. This Plan fully represents the deliberations and recommendations of the Task Force, summarizes the dramatic advances in knowledge since 1996, and identifies current gaps in our knowledge base. The recommendations for future research will not only guide prioritization of future sleep research within NIH and other Federal and non-Federal entities, but should also be helpful in identifying opportunities for new investigators from an ever-increasing diversity of scientific and clinical disciplines. The recommendations regarding training of sleep research scientists, the education of health care professionals, and community-based public education programs should also stimulate much-needed progress in these areas.

Carl E. Hunt, MD
Director, National Center on Sleep Disorders Research
NCSDR e-mail: ncsdr@nih.gov