Scientific advances can inform medical practice and help people better understand why sleep is a requirement for health and how sleep deficiency and untreated sleep disorders contribute to an increased health burden both in local communities and nationwide. Untreated sleep-disordered breathing is associated with a twofold increased risk of all-cause mortality among middle-aged men, hypertension, stroke, heart failure, and diabetes. Sleep deficiency is linked to many chronic health problems, including heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity, and depression. These research findings emerge at a time when cardiometabolic disease has emerged as an immense burden on public health, and underscore the potential contribution of sleep health as a promising avenue for translational research, health care provider education, and community outreach that is well poised to improve the health of the nation.
TODAY’S NEED: TRANSLATING AND APPLYING SCIENTIFIC ADVANCES IN SLEEP
Sleep deprivation is emerging as a pervasive characteristic of modern community lifestyles. National health surveillance data indicate that one in five US adults obtain insufficient rest and sleep every day. Emerging research insights into the relationship of sleep to social and behavioral health risk factors need to be translated and applied when developing educational materials and approaches. This approach will help to inform the public that sleep deficiency is a potential lifestyle risk factor. Sleep fact sheets, developed by the Behavioral Risk Factors Surveillance Study, part of the Centers for Disease Control and Prevention (CDC), can guide potential educational interventions by providing baseline information on the prevalence of insufficient sleep at a community level (county-by-county statistics). Educational research also is needed to reverse the pattern of sleep disorder underdiagnosis. Findings from the National Health and Nutrition Examination Survey (2005-2008, CDC) indicate that the prevalence of sleep apnea symptoms is similar to that of obesity; however, fewer than 10% of these cases have been medically evaluated.
One rate-limiting factor in translation and application of scientific advances in sleep and circadian research has been the relatively slow integration of these concepts into biomedical research, caregiver education, and public outreach health programs. Sleep and circadian mechanisms appear to universally regulate genomic function and cellular metabolism in all tissues and physiological pathways. However, these concepts are present in only 2% of funded research projects across the National Institutes of Health (NIH) (Research, Condition, and Disease Categorization, FY2008). Cross-disciplinary educational research is needed to introduce sleep and circadian concepts to appropriate cutting-edge research fields such as integrative genomics, where similarities unifying function across all biota are leveraged to increase the pace of scientific discovery. US medical schools are estimated to provide less than 2 hours of sleep disorders education in a typical 4-year program. Educational programs are urgently needed to interpret and target the transfer of new knowledge coupling sleep problems with disease risks across many domains of primary health care where sleep-related symptoms are pervasive and can potentially complicate patient care.
STIMULATING RESEARCH AND HEALTHY SLEEP
To help develop such programs, the National Heart, Lung, and Blood Institute, in partnership with the Eunice Kennedy Shriver National Institute of Child Health and Human Development, both part of the NIH, launched an initiative in 2011 to stimulate Education Research in Sleep Health and Sleep-Circadian Biology (PAR-11-098). This initiative is intended to accelerate the translation of sleep and circadian scientific advances into health messages, community outreach, and new research opportunities. In addition, this initiative provides a grant mechanism that supports proposals to develop communication strategies promoting sleep health research and the integration of sleep concepts into healthy lifestyle choices. Specific types of sleep education grant programs supported by this initiative include:
- Innovative educational programs designed to motivate biomedical researchers and trainees to meld sleep and circadian concepts with emerging scientific programs in targeted communities of heart, lung, and blood investigators.
- Innovative educational programs that will enhance the knowledge of clinicians and community health care providers in evidence-based sleep medicine and its role related to the treatment, prevention, and control of heart, lung, and blood diseases.
- Effective and innovative approaches to disseminate the knowledge gained from integrated sleep, heart, lung, and blood science into public health and community applications.
The main purpose of the sleep education initiative is to facilitate the diffusion of sleep and/or circadian concepts to biomedical research, therapy, disease risk factors, and palliative care coupled to heart, lung, and blood disorders within relatively short periods of time. Grant applications under this initiative should link education and dissemination activities to knowledge-transfer approaches such as research-practice partnership models. These would include community-based or clinic-based participatory research, Push-Pull-Infrastructure models, diffusion of innovation models, expanding intervention reach models, and virtual approaches to research dissemination. Ideally, research proposals will incorporate well-established education evaluation methodologies to assess project outcomes and include plans for dissemination or actual replication of programs in other settings. The development of educational strategies that are portable, scalable, and sustainable with measurable outcomes will facilitate the adoption of these interventions in public health agendas.
The application of knowledge gained from advances in sleep and circadian research exemplifies the NIH role in fostering creative discovery to ultimately protect health and prevent disease. Enhancing knowledge transfer and dissemination is recognized as a priority by the 2011 NIH Sleep Research Plan in three areas. This plan was developed by the NIH through public discussion during 2010-2011 with the NIH’s Sleep Disorders Research Advisory Board and with input from the public, academia, and health care professionals. One area is improving the prevention, diagnosis, and treatment of sleep and circadian disorders. Despite advances in the recognition and description of sleep and circadian disorders and disturbances, nationally representative estimates suggest that a majority of individuals with sleep and circadian disorders are undiagnosed and inadequately treated.
There is an unmet need to increase awareness of sleep health requirements across the full breadth of health care providers, academic researchers, bioengineers, and health economists to accelerate the development and recognition of cost-effective diagnostic, preventive, and therapeutic approaches. A second area directly addresses the need for translation and dissemination of sleep and circadian findings to improve health care systems, inform public policy, and enhance human health in communities. Research is needed to better understand the impact of sleep deficiency on health and society. Educational research is needed to develop effective messages addressing specific attitudes, beliefs, and values about the risks associated with sleep deficiency for targeted populations and communities. The plan notes that sleep health education has the potential to dramatically improve public health and safety in communities as well as a diverse range of occupational sectors.
A third area of the plan recognizes the critical need for a pipeline of well-trained researchers and health care providers whose combined efforts will determine the future pace of scientific discovery and the momentum of advancing public awareness. Unique educational opportunities exist in merging recent developments in sleep and circadian sciences, evidence of emerging health needs, and the evolution of technological capabilities that routinely define community needs and health expectations.
Recently, sleep health goals were incorporated into Healthy People 2020, the nation’s 10-year vision for a society in which all people live long, healthy lives. It is the first time that increasing public awareness of sleep health has stood apart as a focus of concern on the health agenda for the nation. The initiative Web site, healthypeople.gov, discusses an array of strategies and examples on how national health goals might be implemented by communities and concerned organizations.
Increasing awareness that healthy sleep practices and the treatment of sleep disorders serve as a “rising tide” that lifts most every other aspect of physical and mental health remains a significant challenge facing the nation.
Michael Twery, PhD, is director, National Center on Sleep Disorders Research, Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health. Please send questions or comments about this article to [email protected]