Sleep and Obesity Conference Draws Leading Experts
Exceeding the expectations of the organizers, the National Sleep Foundation (NSF) Sleep and Obesity Conference gathered more than 250 attendees in Washington, DC, in March for a 2-day series of lectures.

“We were very pleased at the range of experts that attended, including public health and federal officials from many institutes and centers from the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and other Department of Health and Human Services agencies,” said Marci V. Cleary, senior public relations director for the NSF.

The number of sleep researchers, obesity researchers, occupational medicine physicians, dieticians, and nutrition representatives gathered indicated the seriousness of the nation’s obesity epidemic. According to figures presented at the conference, the prevalence of obesity has increased for the past 100 years, and will continue to rise rapidly in the future, burdening the world’s health system.

“To be normal weight is in fact now to be in the minority,”said conference presenter David B. Allison, PhD, adding that while the two big suspect causes of the obesity epidemic—food marketing practices and reduced physical activity—are clearly important, there are likely more factors at work than just these two. Allison, who is the director of the NIH-funded Clinical Nutrition Research Center, thought that one of the additional factors could be changes in sleep patterns that have come about since the industrial revolution.

Research has shown that people are spending more time awake and “less sleep is associated with obesity,” he said.

In sleep deprivation studies, volunteers who curtailed their sleep experienced neuroendocrine abnormalities that caused them to not only feel hungrier, but also increased their appetite for calorie-dense foods with high carbohydrate content—in other words, exactly the types of foods that are most likely to cause weight gain, added Karine Spiegel, PhD, a research associate at the Université Libre de Bruxelles, in her presentation later the same day.

The conference also presented evidence of the links between obesity and sleep in children, and between obesity and sleep apnea and diabetes. In total, nearly 30 presenters spoke about the problems of sleep deprivation, sleep disorders, and obesity.

In conjunction with the conference, the NSF also arranged a personal screening of the documentary Who Needs Sleep? by the Academy Award-winning film-maker Haskell Wexler and hosted its annual Night of a Thousand Dreams gala. Honored at this year’s gala were Takeda Pharmaceuticals North America, sleep researcher James K. Walsh, PhD, and Sleep Review editorial advisory board member Theresa Shumard, who took home the NSF’s first ever humanitarian award for her work helping sleep medicine professionals hurt by Hurricane Katrina in 2005.

NSF 2006 Poll Resonates in Media
In March, the 2006 National Sleep Foundation (NSF) poll made news both nationally and internationally as large media outlets, including CNN and the Associated Press, reported its findings that teenagers across the United States are losing out on quality of life because of a lack of sleep. The results cite sleeping in class, lack of energy to exercise, feelings of depression, and driving while drowsy as only some of the consequences for teens who get insufficient sleep.

This year’s NSF Sleep in America survey focused on the sleep patterns of US adolescents (ages 11-17) and found that only 20% of people in this age group get the recommended 9 hours of sleep on school nights, and nearly one half (45%) sleep less than 8 hours on school nights. Furthermore, the poll found that parents were mostly in the dark about their adolescents’ sleep. While most students knew they were not getting the sleep they needed, 90% of parents polled believed that their adolescent was getting enough sleep at least a few nights during the school week.

“This poll identifies a serious reduction in adolescents’ sleep as students transition from middle school to high school. This is particularly troubling as adolescence is a critical period of development and growth—academically, emotionally, and physically,” says Richard L. Gelula, NSF’s CEO. “At a time of heightened concerns about the quality of this next generation’s health and education, our nation is ignoring a basic necessity for success in these areas: adequate sleep. We call on parents, educators, and teenagers themselves to take an active role in making sleep a priority.”

The annual poll has been a very effective way for the NSF to get large-scale media coverage of sleep deprivation issues, which also benefits the sleep medicine field. “The results of NSF’s annual Sleep in America poll are once again resounding with the American public, as there was widespread media coverage in print, TV, radio, and online outlets this year,”said Marci V. Cleary, senior public relations director for the NSF. “Importantly, both the national media outlets and local outlets felt that the data on America’s sleep-deprived teens was a crucial story that needed to be told to their audiences across the country and, in fact, included some international coverage as well. As with our other polls, we expect that the 2006 Sleep in America poll findings will be newsworthy for many months to come.”

BRPT Swears in New President
Bonnie Robertson, CRT, RPSGT, recently assumed her position as president of the Board of Registered Polysomnographic Technologists (BRPT), having been named president-elect last year. Robertson is currently vice president of clinical operations for REM Medical Corp in Seattle. She has worked in sleep medicine for 22 years and has served on BRPT’s Exam Development Committee for the past 16 years. At the BRPT’s recent board meeting, three new members were also sworn in: Michael Brennen, RPSGT, director; Janice East, RPSGT, R. EEG T., director; and Ramon Werbeach, public member.

Poor Sleep Practices Hurting Americans
A report released by the Institute of Medicine (IOM) of the National Academies on the status of academic sleep research and sleep medicine in the United States outlines how sleep deprivation and sleep disorders are having damaging effects on the health and performance of tens of millions of Americans. The report, titled “Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem,” also finds that sleep problems are having a harmful effect on the nation’s productivity, health care, and public safety.

The report confirms links between sleep deprivation and sleep disorders to a wide range of health consequences, such as “an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.” Despite such huge societal consequences and costs, the IOM finds that the cumulative effects of sleep loss and sleep disorders are “under-recognized” and “awareness among the general public and health care professionals is low given the magnitude of the burden.”

The report includes recommendations to improve awareness and strengthen the field of sleep medicine including the following:

• Increasing public awareness about the importance of sleep and about sleep disorders through well-coordinated multimedia education and awareness campaigns starting with educators and school-aged children through graduate education for those entering health professions.

• Substantially upgrading access to medical services to prevent and manage sleep disorders by improving diagnostic and therapeutic technologies, especially portable technologies.

• Strengthening sleep research by prioritizing the training of more sleep researchers, by establishing interdisciplinary sleep programs in all academic health centers, and by establishing a national clinical network among sleep medicine research centers across the country.

• Developing federally supported surveillance and monitoring systems to track the public health burden of sleep loss and sleep disorders in the population.

With the recommendations in place, the next step is for those involved in sleep medicine to take action by moving forward to improve sleep well-being. “It is now up to the sleep community to create strategic partnerships and redouble its efforts to carry these findings forward and to translate them into better sleep health for patients, workers, and the population at large,” said Barbara A. Phillips, MD, MSPH, chairman of the board of directors of the National Sleep Foundation.

Near-death Experience and Sleep Link Found
A study in the April 11 issue of Neurology suggests that near-death experiences can be explained by looking into the sleep systems of individuals who have reported these episodes. According to the study, people who have had near-death experiences often have different arousal systems controlling the sleep-wake states than people who have not had such experiences.

People with near-death experiences are more likely to have a sleep-wake system where the boundaries between sleep and wakefulness are less clearly regulated, and the REM state of sleep can intrude into normal wakeful consciousness, the study found. Examples of REM-state intrusion include waking up and feeling unable to move, having sudden leg muscle weakness, and hearing sounds just before falling asleep or just after waking up that other people cannot hear.

“These findings suggest that REM-state intrusion contributes to near-death experiences,” said neurologist and study author Kevin R. Nelson, MD, FAAN, of the University of Kentucky in Lexington. “People who have near-death experiences may have an arousal system that predisposes them to REM intrusion.”

Nelson said other factors support this hypothesis. Several features of near-death experiences are also associated with the REM state. For example, the feeling of being outside of one’s body has been associated with the REM state and the conditions of sleep paralysis, narcolepsy, and seizures. The feeling of being surrounded by light could be based on the visual activity that occurs during the REM state, Nelson said.

Also, during the REM state, the muscles can lose their tone, or tension. “During a crisis that occurs with REM-state intrusion, this lack of muscle tone could reinforce a person’s sense of being dead and convey the impression of death to other people,” Nelson said.

The study compared 55 people with near-death experiences to 55 people of the same age and gender who had not had near-death experiences. Of the people with near-death experiences, 60% reported previously having had REM-state intrusion, compared to 24% of people who had not had near-death experiences. REM state intrusion is also associated with other disorders, including narcolepsy and Parkinson disease.

Children Behave and Sleep Better After Tonsillectomy
A research paper published online in the April issue of the journal Pediatrics supports previous observations of a link between children’s sleep-related breathing problems—such as snoring and apneas—and daytime behavior problems. On the whole, the 78 children in the study who had their tonsils removed were much more likely than a comparison group of 27 children to have had behavior and sleep problems at the start of the study. However, by the end of the study, tests showed little difference between the two groups. According to the study, the growing body of evidence on this issue suggests that a significant number of children with inattention, hyperactivity, or sleepiness during the day—and also sleep-breathing problems at night—may benefit during both the night and day from tonsillectomy. The researchers cautioned that their results do not yet prove cause and effect, and that tonsillectomy is not usually a “cure” for attention deficit/hyperactivity disorder.

NSF Fights For Federal Sleep Research
The National Sleep Foundation (NSF) has submitted testimony to the House Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittee asking for an increase in funding for the Department of Health and Human Services. According to NSF, its representatives asked the committee to consider budget increases for the National Institutes of Health (NIH) and to provide support to the Centers for Disease Control and Prevention (CDC), National Center on Sleep Disorders Research (NCSDR), and the US Surgeon General for research and education initiatives related to sleep.

Among its recommendations are a request to provide a 5% increase for fiscal year 2007 to the NIH and a proportional increase of 5% to the individual institutes and centers, specifically, the National Heart, Lung, and Blood Institute (NHLBI). Also included was a call to provide $6.321 billion for 2007 to the CDC, the same amount Congress provided to the agency in 2005.

The NSF request faces an uphill battle as health services spending already took a big cut in last year’s federal budget, the 2006 Deficit Reduction Act, and spending cuts for health care on top of those made last year are a likely outcome of the 2007 budget as well. While House and Senate actions so far indicate that the cuts will not be as large as those advocated by the White House, there may be little money left for spending increases in medical research next year.

Obesity-Sleep Link Found in Kids
The less a child sleeps, the more likely he or she is to become overweight, according to researchers from Université Laval’s Faculty of Medicine in an article published in the March 14 online edition of the International Journal of Obesity. The risk of becoming overweight is 3.5 times higher in children who get less sleep than in those who sleep a lot, wrote researchers Jean-Philippe Chaput, Marc Brunet, and Angelo Tremblay.

Through body mass index measurement, the researchers determined that 20% of the boys and 24% of the girls were overweight. Children who slept less than 10 hours a night were 3.5 times more at risk of being overweight than those who slept 12 or more hours. No other factor analyzed in the study—parental obesity, parents’ level of education, family income, time spent in front of the TV or computer, regular physical activity—had as much of an impact on obesity than time spent sleeping. “It’s ironic that part of the solution to obesity might lie in sleep, the most sedentary of all human activities. In light of this study’s results, my best prescription against obesity in children would be to encourage them to move more and to make sure they get enough sleep,” Tremblay concluded.

Sleep Review’s New Online Look
If you have been enjoying the free online articles archive, resources list, and Expert Insight features on Sleep Review’s Web site,, you will really like our next step. In May, we relaunched our Web site to offer an even better online experience for our readers. If you have not visited us online lately, take a moment to stop by. In addition to a new design, we have added breaking news and an online poll. You can have your questions answered by our experts, get caught up on the latest in sleep medicine, and register your opinion on our monthly poll question with just a few quick clicks of the mouse.

More Studies Show OSA Treatment Benefits Heart
Patients with obstructive sleep apnea (OSA) have enlarged and thickened hearts that pump less effectively, but the heart abnormalities improve with CPAP use, according to a study in the April 4, 2006, issue of the Journal of the American College of Cardiology.

“Not only are the shape and size of the heart affected, the right side of the heart was dilated and the heart muscle on the left side was thicker in patients with OSA, but the pump function was also reduced,” said Bharati Shivalkar, MD, PhD, from the University Hospital Antwerp in Antwerp, Belgium. “The changes were directly related to the severity of the problem. Treating the problem brought significant improvements in the affected parameters, as well as in symptoms, in a relatively short period of time of 6 months,”

When given 6 months of CPAP therapy, the 25 sleep apnea patients in the study not only began sleeping better and feeling more alert during the day, but they also had significant improvements in the size, shape, and pumping action of their hearts.

Severe SDB Patients Have High Odds of Abnormal Heart Rhythms
In related news, a study appearing in the April 15 issue of American Journal of Respiratory and Critical Care Medicine states that patients with severe sleep disordered breathing are two to four times more likely to experience complex, ab-normal heart rhythms while sleeping than individuals without the problem, according to the Sleep Heart Health Study (SHHS).