The 19th meeting of the SDRAB was convened at 8:45 a.m. on Tuesday, December 9, 2003, in Room D of the Natcher Conference Center on the National Institutes of Health (NIH) campus in Bethesda, Maryland. Stuart Quan, M.D., presided as Chair.

TABLE OF CONTENTS

Attendees
Opening Comments
Adoption of June, 2003 Advisory Board Meeting Minutes
Report of the Director NCSDR
Chronic Insomnia: Characteristics And Research Priorities
Education Activities
The NIH Road Map: FY 2004 Initiatives, Multidisciplinary and Interdisciplinary Research
Old Business
Announcements
Public Reports
Adjournment
Certification

Sleep Disorders Research Advisory Board Page

BOARD MEMBERS PRESENT

Dr. Stuart F. Quan (Chair)
Dr. Gene Block
Ms. Sheila Connolly
Dr. Sarah Caddick
Dr. Kathryn Lee
Dr. Rafael Pelayo
Dr. Susan Redline
Dr. Clifford Saper (participated by telephone)
Dr. Michael Sateia
Dr. Lorraine Wearley

BOARD MEMBERS ABSENT

Dr. Gina Poe
Mr. Phillip L. Williams

EX OFFICIO MEMBERS PRESENT

Dr. Carl E. Hunt, SDRAB Executive Secretary
Dr. Israel Lederhendler
Dr. Merrill Mitler
Colonel Gregory Belenky

EX OFFICIO MEMBERS ABSENT

Colonel Gregory Belenky, Walter Reed Army Institute of Research

LIAISON MEMBERS PRESENT

Dr. Kathy Mann Koepke
Dr. Nancy Pearson
Ms. Adrienne Oneto
Dr. Daniel Chapman (participated by phone)
Dr. Roger Rosa

FEDERAL EMPLOYEES PRESENT

Mr. Al Golden, NHLBI
Mr. Glen Bennett, NHLBI
Ms. Sue Rogus, NHLBI
Ms. Susan Sagusti, NHLBI
Ms. Ellen Sommer, NHLBI

MEMBERS OF THE PUBLIC PRESENT

Mr. Stanley Bard, Narcolepsy Network
Mr. Jerry Barrett, American Academy of Sleep Medicine
Dr. Dan Buysse, University of Pittsburgh
Ms. Pat Britz, National Sleep Foundation
Mr. Robert Balkam, Restless Legs Syndrome Foundation
Dale Dirks, National Sleep Foundation
Ms. Sandra McGinnis, Patient Advocate
Ms. Laura Silverstein, National Sleep Foundation
Ms. Joanne Hawana, The Blue Sheet
Ms. Judy Milton, Sleep Research Society
Dr. Emmanuel Mignot, Sleep Research Society
Dr. Andy Pope, Institute of Medicine

Return to Table of Contents

OPENING COMMENTS - Drs. Carl E. Hunt and Stuart Quan

Dr. Stuart Quan welcomed Board members and other members of the audience. Dr. Hunt asked Board members and all others present to introduce themselves. Dr. Hunt called attention to the materials in the meeting book, and asked members to review the statement on Conflict of Interest. Dr. Hunt noted that this was an important meeting with a significant agenda and encouraged Board members to be active and proactive in discussion. Dr. Hunt introduced the new members of the Board: Ms. Connolly, Dr. Poe (not present), and Dr. Wearley. Ms. Connolly is a registered nurse who is a founding member of the RLS Foundation, a member of the RLS Foundation Board of Directors and its chair from 1996 to 1998. She is also a member of the RLS Foundation's Advisory Council, a sleep disorder patient, and a patient advocate. Dr. Poe is a member of the anesthesiology and physiology departments at the University of Michigan, and a sleep neurophysiologist. Dr. Poe's research interests include sleep deprivation and memory, REM sleep, and memory and aging, and she was a Minority Fellow of the National Science Foundation. Dr. Wearley is Vice President for Drug Development and Research and Development at Johnson & Johnson Consumer and Personal Products Research and Development. She has served as a board member of the Narcolepsy Network and of the National Sleep Foundation (including 3 years as President).

Return to Table of Contents

ADOPTION OF MINUTES FROM JUNE 25 2003 SDRAB MEETING - Dr. Stuart Quan

It was moved and seconded that the Minutes of the June 25, 2003 SDRAB meeting be accepted as submitted. The Minutes were adopted unanimously.

Return to Table of Contents

REPORT OF THE DIRECTOR, NCSDR – Dr. Carl E. Hunt

Dr. Hunt described a report by the Health Services and Resources Administration (HRSA) - U.S. Teens in Our World: Understanding the Health of U.S. Youth in Comparison to Youth in Other Countries. (available at www.hrsa.gov): The researchers conducted surveys of children ages 11, 13, and 15 in 29 countries every 4 years since 1986 (in the United States since 1998). The minimum sample size was 1500/country/age group. The survey measured the general health and well-being of respondents and asked questions in areas such as fitness, family and peer relationships, school relationships, smoking and alcohol use, and violence. U.S. data sources included the National Longitudinal Study of Adolescent Health and multiple other continuous surveys. Comparative statistics for several self reported sleep measures between US teens and teens in other countries were highlighted.

The following new NIH Initiatives have been released or funded:

Inter-relationship of Sleep, Fatigue, and HIV/AIDS: This RFA is the result of the realization that sleep and fatigue is a major issue for a growing population. In the long run, it may offer a way to help us understand the relationship of sleep and chronic diseases. Applications are due March 15, 2004.

The Role of Sleep and Sleep Disordered Breathing in Metabolic Syndrome. Twelve grants have been funded under this RFA co-sponsored by NHLBI and the National Institute on Aging (NIA):

- Sleep, Feeding and Metabolic Syndrome Predictors
- Predictors of Adverse Metabolic Effects of Sleep Loss
- Altered Glucose Homeostasis by Sleep Impairment
- Adiposity, BP, and Inflammatory response to Sleep Loss
- Sleep, Metabolism, and C-V Dysfunction
- Effects of SDB on Metabolic Function
- Effects of SDB Treatment on Metabolic Syndrome
- SDB and Metabolic Syndrome
- SDB and Metabolic Syndrome: Role of Oxidative Stress
- Mechanism of Hypoxia-induced C-V Dysfunction
- SDB, Metabolic Syndrome, and Vascular Function
- Carotid Mediators of Sympathoexcitation in SDB

Dr, Hunt informed participants that the National Sleep Conference dates are March 29-30, 2004. The agenda is now final, and more information is available at www.sleeptranslation.com. The conference is titled Frontiers of Knowledge in Sleep and Sleep Disorders: Opportunities for Improving Health and Quality of Life, and the program will focus on translational opportunities-from bedside to community. The meeting will have a targeted, proactive purpose, and the intended audiences include sleep medicine and other health care providers, public health educators and policymakers, experts in translational research, and patient advocates. The goal of the meeting is to capitalize on the unique interdisciplinary expertise of participants to develop an action plan for improving public health and quality of life.

A State-of-the Science (SOS) Conference on Chronic Insomnia: Manifestations and Management will be held in early 2005. The planning is being coordinated by NIH's Office of Medical Applications and Research (OMAR). The National Institute on Mental Health is the lead institute for this SOS Conference. The co-sponsors include NHLBI and the National Center on Sleep Disorders Research (NCSDR), National Institute on Aging, National Institute on Drug Abuse, National Institute of Nursing Research, National Institute on Alcohol Abuse and Alcoholism, National Institute of Neurological Disorders and Stroke, Office on Research on Women's Health, Veterans Administration, Food and Drug Administration, and the Federal Railroad Administration. The key questions to be addressed are:

- What defines chronic insomnia and what is its morbidity and natural history?
- What is the extent and magnitude of the public health burden associated with chronic insomnia?
- Who is at risk and should be treated for chronic insomnia?
- What are the benefits and harmful effects of available treatments alone or in combination?
- What are important future directions for insomnia-related research?

The monograph entitled Sleep and Sleep Disorders in Women is in press and will be published in March of 2004. Development of this monograph was coordinated by NCSDR.

The National Children's Study is a large longitudinal study that is currently being planned by NICHD. It will follow 100,000 children between the ages of birth and 21 years. The proposed study has five outcome themes:

- Undesirable outcomes of pregnancy: birth defects and preterm birth
- Altered neurobehavioral development, developmental disabilities, and psychiatric outcomes
- Injury
- Asthma
- Obesity and altered physical development

NCSDR has proposed a brief set of core information regarding sleep problems and sleep-disordered breathing to be collected periodically in all subjects.

The 2003 National Sleep Disorders Research Plan

The 2003 National Sleep Disorders Research Plan is now available in print and on the Web (www.nhlbi.nih.gov/health/prof/sleep/res_plan/index.html). Several recent published editorials and commentaries have helped to reach important audiences, and additional editorials are still needed in basic science publications. The US Senate Appropriations Committee has commented on the plan as follows:

"The Committee commends NHLBI and the National Center for Sleep Disorders Research on the completion of the 2003 National Sleep Disorders Research Plan, which provides an enormous breadth of research topics ranging from better understanding sleep mechanisms and functions, to improved treatments for sleep disorders, to the effect of sleep on health outcomes. The Committee therefore expects NHLBI to move forward on these research initiatives and looks forward to a progress report on the implementation of the research plan at next year's budget hearings." (emphasis added)

Dr. Hunt asked the SDRAB to identify 5 to 7 research recommendations from the total of 66 prioritized recommendations in the Plan (there are also 131 unprioritized recommendations).

Dr. Hunt concluded with a summary of other recent activities of the NCSDR:

- An article on the National Center on Sleep Disorders Research is currently in press for the Sleep Research Society Bulletin and another is in press for Sleep Medicine's WebWatch Section.
- A Sleep Apnea and Cardiovascular Disease manuscript is being planned by the American Heart Association Council on High Blood Pressure, Professional and Public Education Committee.
- A section on sleep problems is being prepared for the NHLBI Long Term Plan for Research and Translation in Hypertension for Enhancing Public Health.
NHLBI Working Group Report on High Blood Pressure in Children and Adolescents, which is in preparation, includes a new section on sleep problems.
- The report of a workshop on Cardiovascular Consequences of SDB-Past, Present and Future, held in September 2002, is now in press in 'Circulation'.

Return to Table of Contents

CHRONIC INSOMNIA: CHARACTERISTICS AND RESEARCH PRIORITIES-Dr. Daniel Buysse

Dr. Buysse opened by discussing the definition of insomnia. In general, understanding of insomnia is intuitive: a subjective complaint of difficulty falling asleep, difficulty staying asleep, poor quality sleep, or inadequate sleep duration (despite adequate opportunity). Insomnia is not necessarily a symptom of another condition, but can be clearly a distinct disorder. Insomnia disorder is a syndrome consisting of specific diagnostic features, impairment or distress, and the absence of exclusionary features. People with insomnia disorder tend to feel both sleep deprived and over-stimulated.

Dr. Buysse then outlined factors that characterize insomnia and reviewed the challenge of defining insomnia from a range of etiological and pathophysiological perspectives. Although the cause of insomnia has not yet been identified, some biological factors seem related. There appears to be a relationship between insomnia and high levels of cortisol in the body, which relates to anticipatory arousal response. High-frequency EEGs separate insomnia patients from patients with depression. The regional metabolic condition identified by PET scans in evening and morning raises the question of how people accumulate sleep drive during the course of the day and still stay awake. Large variations in prefrontal brain cortex have been seen in preliminary studies of insomnia patients versus individuals without insomnia. Global hypermetabolism also has been noted during waking and sleep in these insomnia patients.

According to Dr. Buysse, epidemiological data indicate that 25 to 35 percent of American adults complain of insomnia at some time, and approximately half of these complain of constant or chronic problems. Women are more likely than men to develop chronic insomnia.

Dr. Buysse identified significant current gaps in knowledge and suggested possible directions for future research. He suggested that the potential physical health risks, morbidity, and functional consequences of insomnia-distinct from its medical/ psychiatric comorbidities-should be defined more precisely. The public must receive the message that insomnia is more than a nuisance; the public also must understand how to define proper sleep balance. In addition, insomnia may be a risk factor for other health conditions; thus, researchers must consider whether there are benefits of early recognition and treatment.

There was general agreement that significant opportunities exist to "piggyback" on current NIH randomized controlled trials (RCTs). It may be worthwhile to examine the portfolio of RCTs for insomnia-related data obtained via research in other areas, such as the differences in the brains of women and men. Anxiety acquired over time could be the cause of increased cortisol, so one important research focus, for example, would be sorting out the relationship of insomnia to cortisol as opposed to anxiety.

Another question of concern is how to educate practitioners that insomnia can be a specific condition as opposed to a mere symptom of another condition and the importance of treatment being targeted in the long term. The public also should be made aware that the message of the importance of healthy sleep habits may not be an effective way of treating insomnia, as empirical evidence indicates that improving sleep habits alone may have little or no beneficial effect. Rather, emphasis should be given to adaptations of proven cognitive-behavior therapies, and judicious application of pharmacological treatments alone or in combination with behavioral therapies.

Return to Table of Contents

EDUCATION ACTIVITIES - Ms. Sue Rogus, Ms. Ellen Sommer, Mr. Glen Bennett

Ms. Rogus described the success of the Garfield Star Sleeper campaign, which communicates the key message of "Sleep well, do well" to the target audience of children aged 7 to 10 and the adults who influence them. She noted that schools, which are the best place to reach these children, are very difficult to penetrate, and that teachers throughout the country are highly limited in the resources they can apply to such efforts.

Current activities include:

- Several brainstorming sessions have been held to identify opportunities for "getting the message out." Some of the options that have been or will be explored include:

1) Development of an insert in Time for Kids weekly school-subscription magazine, to reach third-grade students, their teachers and parents. The insert will include student materials as well as a teacher's guide. A multi-year approach will be used.

2) Possible tie-in to the Garfield movie that is to be released in June or July of 2004. The campaign has contacted 20th Century Fox about the possibility of using some of the film's footage to develop a public service announcement that can be played in the theatres before or after the film.

- The Garfield Star Sleeper campaign won two awards in 2003. It was one of three finalists for the 2003 best public sector campaign award from PR Week, the national publication of the Public Relations Society of America (PRSA). It also received the same award from the National Capital Chapter of PRSA.

- The supplemental high school science curriculum entitled Sleep, Sleep Disorders, and Biological Rhythms is presently in press and should be in print by early 2004. A presentation regarding the curriculum has been made at the National Science Teachers Association annual meetings and there will be an electronic announcement of this new curriculum modules, The curriculum has been developed in collaboration with the NIH Office of Science Education, The module will be offered free of charge to high school science teachers across the country.. The supplemental curriculum contains six sessions, and incorporates the National Science Education Standards.

- A working group, co-chaired by the NCSDR and the American Academy of Pediatrics, has completed an article entitled "Excessive Sleepiness in Adolescents." The manuscript is being submitted to the journal Pediatrics.

- Initiatives from the upcoming National Sleep Conference (March 29-30, 2004) that can be translated into educational opportunities will be identified, prioritized, and pursued.

Mr. Bennett explained that the NHLBI is developing the Diseases and Conditions Index (DCI), a Web-based initiative to communicate health information to the general public on over 200 heart, lung, blood, and sleep diseases and disorders. The DCI content is being written in plain or simple language that most people can read and understand, and may also be used to produce printed fact sheets and other information. The DCI currently includes sleep apnea, and other planned sleep-related topics include insomnia, narcolepsy, restless legs syndrome, and problem sleepiness. The DCI Steering Committee welcomes input from the Board on these and other topics related to the DCI efforts.

Dr. Hunt acknowledged the involvement of Board members in vetting the science of the high school curriculum and noted that numerous publications and pamphlets available both by hard copy and the Web need to be updated to incorporate new information and scientific findings. A template will be prepared so that the 'Facts About' pamphlets -- targeted for lay audiences -- can be easily redesigned. Currently, there is no plan to revise the existing materials targeted for professionals, although options for revising materials for professionals will be subsequently explored.

Board members suggested the possibility of folding sleep related issues into the National Institute of Diabetes and Digestive and Kidney Diseases' school wide obesity initiative, which is targeted at middle schools. NHLBI also will be holding a strategy meeting in February during which it might be appropriate to address the relationship of sleep to some of the factors affecting obesity in children and youth.

Discussion ensued on how teachers can be better motivated to participate in the Garfield campaign and other education and information initiatives. One possible strategy is to add sleep questions to proficiency tests. Another is to expand venues to include essential resources such as children's and science museums. There is a special need to target African American children, especially boys. Statistics indicate that 21 percent of African American boys go to bed after 11 p.m. It might also be useful to target coaches of high school sports teams. For example, "advertorials"-one-page information pieces for different audiences-can be sent to coaches, many of whom also teach health classes.

Return to Table of Contents

THE NIH ROAD MAP: FY 2004 INITIATIVES, MULTIDISCIPLINARY AND INTERDISCIPLINARY RESEARCH-Dr. Lawrence Friedman

Dr. Friedman explained that the NIH Road Map (www.nihroadmap.nih.gov/index.asp) was developed as a way to identify major gaps in medical research across the National Institutes of Health. It also is designed to help speed the implementation of medical research by identifying new research pathways, building research teams for the future, and re-engineering the clinical research enterprise. The Road Map project has been funded at $130 million in FY 2004 and at $2.1 billion over 5 years. Dr. Friedman described the structure of the Road Map, which will include a position tentatively entitled Senior Advisor for Clinical Research Re-engineering Activities and an Assistant Director for NIH Road Map Coordination. One of the chief emphases of the Road Map is multidisciplinary and interdisciplinary research through Research Centers and will encourage transforming research that NIH can not afford NOT to do. The NIH Director's Innovator Award will recognize untested, potentially risky ideas, and will be vetted by a totally new approach to the peer review process. Although typical research networks revolve around central nodes, road map networks will be intra-operable. Clinical research has evolved haphazardly and is now complex; mentoring is not as easy as it once was, and the Road Map would encourage new approaches to mentoring. NIH is actively seeking input from stakeholders and potential partners.

In response to a query about specific plans to follow through on the development of research networks, Dr. Friedman said that the objective of the current initiative is not to create new networks. Rather, funding will be available to existing networks able and willing to collaborate and interact with each other; at present, NIH hopes to fund 10 feasibility awards.

It was noted that multi- and interdisciplinary research raise the issue of mounting indirect costs as a result of the need to hire subcontractors. Direct costs also will increase resulting from the need to hire additional staff, but Dr. Friedman indicated that the next few years are unlikely to see major increases in institute budgets. We need to develop more efficient use of existing teams and infrastructure.

Return to Table of Contents

OLD BUSINESS

Institute of Medicine (IOM) Initiative

At the June 25 SDRAB meeting, a presentation was made regarding the IOM initiative to explore options for enhancing a new discipline of "sleep medicine." In concept, the Board supported this approach, and Dr. Quan drafted a resolution that was then reviewed and approved by the SDRAB (The Resolution can be found as part of the June 25, 2003 SDRAB Minutes at http://www.nhlbi.nih.gov/meetings/sdrab/6-25-03-sdrab.htm). An updated Statement of Task: "Sleep Disorders, Research, Education, Training and Practice" (dated 11-23-03) was included in the program book for this meeting. There is some precedent for NIH to fund IOM studies, and it is also possible that activities and initiatives developed through the Road Map process will help achieve this objective. There was discussion regarding potential overlap between Road Map initiatives and an IOM study, and the need to better define the specific objectives of an IOM study.

Dr. Quan noted that IOM carries with it a certain heightened credibility and impact, and that its efforts could inform and complement Road Map initiatives. In addition, sleep training across the multiple disciplines will be difficult to design and implement, and thus Road Map initiatives hence may not be sufficient to meet sleep-releated training program needs. Other resources (such as IOM) may therefore be needed to reach all potential stakeholders, including those interested overall public health. Discussants suggested that IOM can conduct a broad perspective analysis that includes opportunities created by the Road Map initiatives as well as identifying other potential strategies for ensuring that the number of well-trained multidisciplinary sleep investigators is in the future sufficient to address the many and diverse gaps in our knowledge of sleep and circadian rhythms, sleep restriction, and sleep disorders.

The Board unanimously agreed that a small working group should be convened to further define the objectives of an IOM study, possible methods, anticipated outcomes, and projected cost. This working group will be coordinated by Dr. Hunt, and its members will include Drs. Conrad Iber (American Academy of Sleep Medicine President), Lederhendler, Emmanuel Mignot , Mitler (Sleep Research Society President), Pope, and Quan. The recommendations of this subcommittee will be available to the Board by April 1, 2004.

Identification of Research Priorities based on the 2003 National Sleep Disorders Research Plan

Board members were asked to nominate 10-12 recommendations from the 2003 National Sleep Disorders Research Plan that should be considered first for implementation. The Board identified 13 recommendations. After combining recommendations with overlapping scientific focus, the Board was asked to rank order a total of 10 recommendations. These were subsequently ranked from one (highest priority) to 10 (lowest priority) and are listed as an Addendum to these Minutes according to priority (highest priority listed first)

Return to Table of Contents

ANNOUNCEMENTS

Dr. Rosa announced an upcoming conference: Long Working Hours, Safety, and Health: Toward a National Research Agenda to be held April 29-30, 2004. Additional information is available online at http://nursing.umaryland.edu/longworkhours/index.htm

Return to Table of Contents

PUBLIC REPORTS

Mr. Bolton of the Restless Legs Syndrome Association informed the Board that the medical bulletin was revised last year, and it is nearly double its original size. The patient booklet also has been revised. An International Restless Legs Syndrome Study Group has been formed. The Web content is in several languages and offers links to patient support groups and physicians.

Return to Table of Contents

ADJOURNMENT

Dr. Quan thanked the participants and adjourned the meeting at 3:00 p.m. EDT..

Return to Table of Contents

CERTIFICATION

We certify that, to the best of our knowledge, the foregoing minutes are accurate and complete.

Stuart Quan M.D., Chair
Sleep Disorders Research Advisory Board

Carl E. Hunt, M.D., Executive Secretary
Sleep Disorders Research Advisory Board

Return to Table of Contents

1: Sleep Duration (3.6)

Identify the full range of psychological, behavioral, and physiological (e.g., cardiovascular) consequences of long-term partial sleep deprivation and their underlying mechanisms, including host defense. Epidemiological longitudinal studies will need to be included to assess the relationships among sleep duration, sleep quality, and health outcomes among vulnerable populations
- Children, adolescents, young adults, shift workers, new parents. prolonged work hours, low socioeconomic status
- Depression, obesity, diabetes, and cardiopulmonary diseases.

Studies are needed to determine the extent to which sleep disturbance and sleep deprivation are related to markers of nonspecific inflammatory responses (e.g., leukocytes, cytokines, C-reactive protein). Studies are needed in transgenic or knock-out animals to identify the functional significance to infection resistance and susceptibility of candidate genes in linkage regions or of newly discovered cytokines, candidate neurohormones, or other molecules.

2: Basic Sleep Science: Sleep and Waking (3.7)

Further characterize the descriptive anatomy and neurochemistry of sleep/wake generating systems by investigating the hierarchies of neurotransmitter interactions within these complex circuits.
- Facilitate the development of drugs to treat sleep and waking disorders
- Better understanding of the neuropharmacology of behavioral states.

3: Altered Sleep and Chronic Disease (4.7)

Identify chronically ill populations at highest risk for sleep disturbances, determine the factors most associated with disturbed sleep, and the best ways to improve such sleep disturbances.
- Understand how sleep disturbances affect adherence to treatments for chronic disease and ways that improving sleep may improve treatment outcomes.
-Study the bidirectional relationship between sleep processes and disease development, progression, and morbidity.
- Determine identifiable, measurable characteristics of sleep quality that could serve as potential indicators of primary disease diagnosis, progression, and severity.

4: Sleep and Aging (4.8)

Investigate the neurobiological mechanisms of the effects of sleep, circadian regulation, and sleep disorders on the aging process and the diseases associated with late age.
- Circadian studies should investigate the neurobiological causes and consequences of age-related changes in circadian rhythm parameters other than period (e.g., amplitude, waveform). Genetic, neuroanatomic, neurophysiologic, and neurochemical approaches may be useful in such studies.

5: Neuropsychiatric Disorders in Children (5.3)

Describe the scope and magnitude of sleep disturbances in children and adolescents with ADHD, including the natural history of sleep disturbances as ADHD progresses into adulthood. Describe the impact of ADHD on sleep-related morbidity, including adverse behavioral outcomes such as injuries and motor vehicle crashes, substance abuse, and academic failure.

Describe risks and protective factors for sleep disturbances, and the impact of potential confounders, such as comorbid psychiatric disorders and medication use.

6-7: Psychiatric and Substance Use Disorders (6.0)

Evaluate whether insomnia and hypersomnia are modifiable risk factors for poor outcomes in mood, anxiety, and psychotic disorders, alcoholism, and substance abuse disorders.
- Investigate whether insomnia and hypersomnia are modifiable risk factors for the development of new-onset psychiatric disorders.
- Investigate whether insomnia or specific EEG sleep characteristics are modifiable risk factors for poor outcomes among individuals with existing psychiatric disorders.
- Elucidate possible mechanisms for the relationship between sleep disturbance and psychiatric disorders in the progression of sleep and psychiatric disorders from childhood into adulthood

6-7: Sleep Disordered Breathing (SDB) (6.0)

Conduct adequately powered clinical trials, particularly in high-risk populations, to assess the impact of therapy of SDB on functional status, psychiatric disorders, neurocognitive function, and other disease processes (hypertension, cardiovascular disease, metabolic syndromes, etc.). Studies assessing the impact of successful therapy of Cheyne-Stokes respiration on cardiac dysfunction, quality of life and survival are also needed.

8: Genetics and Proteomics (6.2)

Develop new methods to measure sleep, circadian physiology, and sleepiness in large numbers of animal and human subjects.
- Develop and validate surrogate measures.
- Define normal sleep-pattern variation in the general human population.
- Normative data will be critical to define and validate existing or novel sleep disorder phenotypes and to elucidate corresponding genetic factors.

9: Sleep Disordered Breathing (SDB) in Children (6.7)

Develop longitudinal normative data on sleep and cardiorespiratory patterning in children.

10: Narcolepsy and Hypersomnia (7.1)

Conduct basic research on hypocretins in animal models to better define the exact role of this system in the regulation of normal sleep and other behaviors.