American Academy of Sleep Medicine/Sleep Research Society, June 6-11, 2009Last Updated: June 19, 2009.
SLEEP 2009 -- jointly sponsored by the American Academy of Sleep Medicine and the Sleep Research Society -- took place from June 6 to 11 in Seattle, attracted about 5,500 attendees from around the world, and presented more than 1,300 abstracts highlighting advances in the understanding of sleep processes and the diagnoses and treatment of sleep disorders such as sleep apnea, insomnia and narcolepsy.
"The biggest study to come out of this conference showed that teens who go to bed after midnight have an increased risk of depression and suicidal thoughts," said AASM spokesperson David Kuhlmann, M.D., medical director of sleep medicine at the Bothwell Regional Health Center in Sedalia, Mo. "Pediatricians have always been harping on late bedtimes. Now they have more of a sound basis to tell patients why it's important to get enough sleep."
James Gangwisch, Ph.D., of Columbia University in New York City, and colleagues analyzed data on 15,659 teens, including 1,143 (7.3 percent) who were diagnosed with depression and 2,038 (13 percent) who had expressed suicidal thoughts. Compared to teens with required bedtimes of 10 p.m. or earlier, the researchers' adjusted analysis showed that those allowed to stay up past midnight were 25 percent more likely to be depressed and 20 percent more likely to have suicidal ideation. They concluded that short sleep in adolescence could be a risk factor for depression in young adulthood.
"It is a common perception and societal expectation that adolescents do not need as much sleep as preadolescents, yet studies suggests that adolescents may actually require more sleep," Gangwisch said in a statement. "Studies have found that adolescents do not go to bed early enough to compensate for earlier school start times, and transitions to earlier school start times have been shown to be associated with significant sleep deprivation."
"Although the meeting had no unifying theme, the big push seemed to be on sleep apnea and how it affects overall health," Kuhlmann said. "One study looked at the relationship between obstructive sleep apnea and parasomnias such as sleep paralysis, hallucinations and sleepwalking. The researchers found that people with sleep disorders were twice as likely to have an underlying parasomnia. This might change clinical practice by prompting physicians to take a closer look at the cause of parasomnia."
Maria Viola-Saltzman, D.O., of the University of Washington in Seattle, and colleagues reviewed the medical charts of 537 adults who were referred for evaluation of obstructive sleep apnea, and identified 51 subjects who had one or more parasomnias. In patients diagnosed with obstructive sleep apnea, they found that the prevalence of parasomnia was 9.5 percent and that continuous positive airway pressure (CPAP) treatment led to a resolution of parasomnia symptoms in 20 percent of patients.
"We found it interesting that the parasomnia symptoms reported in this patient population were amongst all age groups, as parasomnias are most common in children and young adults," Viola-Saltzman said in a statement.
"A very interesting study showed reduced cortical thickness in obstructive sleep apnea patients," Kuhlmann said. "The researchers found that it affected multiple regions of the brain, including those involved in cognition, verbal expression, and autonomic regulation."
Paul Macey, Ph.D., of the University of California in Los Angeles, and colleagues compared MRI brain scans from patients who were recently diagnosed with moderate-to-severe obstructive sleep apnea with scans from healthy controls. In the apnea patients, they observed significantly decreased cortical thickness in the bilateral mid-parahippocampal gyrus, right amygdala, right medial prefrontal cortex, and left ventral medial prefrontal cortex.
"The consequences are likely manifested in the neuropsychological characteristics of obstructive sleep apnea, especially those that do not fully resolve with treatment, such as mood disturbances and cognitive deficits," Macey and colleagues conclude.
A related study showed improved function in Alzheimer's disease patients with obstructive sleep apnea who initiate CPAP treatment. "Sleep is a huge factor in the elderly," Kuhlmann said. "I can stay up all night and give a talk the next morning. But an 85-year-old, particularly one who already has cortical thinning from sleep apnea, is going to have much less mental reserve. In Alzheimer's patients, sleep quality often determines the difference between a good or bad day."
Researchers from the University of California in San Diego randomly assigned 54 patients with Alzheimer's disease and obstructive sleep apnea to receive either therapeutic or placebo CPAP for six weeks. Compared to placebo, they found that CPAP was associated with significantly improved executive function and concluded that clinicians should not hesitate to treat sleep disorders in dementia patients.
In another study, researchers from Flinders University in Adelaide, Australia, explored the relationship between obstructive sleep apnea severity and insomnia severity in 257 patients. In patients with some sleep apnea, they found that the prevalence of insomnia -- defined as a score of higher than 14 on the Insomnia Severity Index scale -- was 39 percent. Contrary to their expectations that the sleepiness associated with more severe forms of sleep apnea would protect against insomnia, they found no significant difference in insomnia prevalence among patients with moderate or severe sleep apnea (40 percent and 43 percent, respectively).
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