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Conclusion: Directions for future research into optimizing outcomes measurement in sleep medicine
Sleep Medicine 9 Suppl. 1 (2008) S35
www.elsevier.com/locate/sleep
Editorial
Conclusion: Directions for future research into optimizing outcomes measurement in sleep medicine The preceding articles based on proceedings of The International Sleep Disorders Forum – The Art of Good Sleep constitute a valuable contribution to the current knowledge base in this field. They also provide some stimulating and clear guidance on potential future research and clinical development required. The associations revealed between sleep and memory and learning processes are fascinating and will call for further research into the specific nature of the complex relationships between certain sleep states and certain memory processes. One of the key areas of current research is the development of more valid measures of sleep quality so that we can improve our evaluation of the management of sleep disorder patients. We have seen that there is much to be done in this area in developing valid sleep quality models, particularly in patients with comorbidities such as depression which further confound the self assessment of sleep quality. Obviously, there is much to be learned of the mechanisms for sleep disturbances in patients with depression and sleep disorders and, in these patients, relating sleep outcomes measures to the underlying neurobiology would appear to be a valid and productive approach. One of the largest groups of patients suffering from insomnia is the elderly. Not only do they have a greater prevalence of insomnia but they also experience more negative consequences associated with insomnia and are at greater risk for falls, possibly due both to the sleep disorder and to the medication prescribed. We can do more for this
1389-9457/08/$ – see front matter © 2008 Elsevier B.V. All rights reserved.
group of patients by individualizing the management and by increasing our awareness of the increased risk of falls due to inappropriate treatment. This will be aided by the availability of more clinical evidence on the impact of sleep and its treatment on falls, especially with regard to use of the newer non-benzodiazepine GABA receptor agonists in elderly patients. The observation that the effect of treatment on the risk of falls and fall risk factors (such as postural stability, balance, gait and reaction time) should be included as clinical endpoints in studies of sleep disorder treatments is pertinent given the challenges of treating this patient population. In conclusion, although there have been considerable advances in the development of outcome measures for sleep, sleep loss and insomnia presented and discussed at the Art of Good Sleep forum, there is much still to be learned. These papers provide us with some indication of the scope of future research in sleep outcomes, all of which will help to improve the quality of our clinical studies and will contribute to improvements in the management of sleep disorders. Thomas Rotha,b Sleep Disorder and Research Center, Henry Ford Health System, 2799 West Grand Bd, CEP-3-Detroit, MI 48202, USA b Department of Psychiatry, Wayne State University College of Medicine, Detroit, MI, USA E-mail address: [email protected] a
www.elsevier.com/locate/sleep
Editorial
Conclusion: Directions for future research into optimizing outcomes measurement in sleep medicine The preceding articles based on proceedings of The International Sleep Disorders Forum – The Art of Good Sleep constitute a valuable contribution to the current knowledge base in this field. They also provide some stimulating and clear guidance on potential future research and clinical development required. The associations revealed between sleep and memory and learning processes are fascinating and will call for further research into the specific nature of the complex relationships between certain sleep states and certain memory processes. One of the key areas of current research is the development of more valid measures of sleep quality so that we can improve our evaluation of the management of sleep disorder patients. We have seen that there is much to be done in this area in developing valid sleep quality models, particularly in patients with comorbidities such as depression which further confound the self assessment of sleep quality. Obviously, there is much to be learned of the mechanisms for sleep disturbances in patients with depression and sleep disorders and, in these patients, relating sleep outcomes measures to the underlying neurobiology would appear to be a valid and productive approach. One of the largest groups of patients suffering from insomnia is the elderly. Not only do they have a greater prevalence of insomnia but they also experience more negative consequences associated with insomnia and are at greater risk for falls, possibly due both to the sleep disorder and to the medication prescribed. We can do more for this
1389-9457/08/$ – see front matter © 2008 Elsevier B.V. All rights reserved.
group of patients by individualizing the management and by increasing our awareness of the increased risk of falls due to inappropriate treatment. This will be aided by the availability of more clinical evidence on the impact of sleep and its treatment on falls, especially with regard to use of the newer non-benzodiazepine GABA receptor agonists in elderly patients. The observation that the effect of treatment on the risk of falls and fall risk factors (such as postural stability, balance, gait and reaction time) should be included as clinical endpoints in studies of sleep disorder treatments is pertinent given the challenges of treating this patient population. In conclusion, although there have been considerable advances in the development of outcome measures for sleep, sleep loss and insomnia presented and discussed at the Art of Good Sleep forum, there is much still to be learned. These papers provide us with some indication of the scope of future research in sleep outcomes, all of which will help to improve the quality of our clinical studies and will contribute to improvements in the management of sleep disorders. Thomas Rotha,b Sleep Disorder and Research Center, Henry Ford Health System, 2799 West Grand Bd, CEP-3-Detroit, MI 48202, USA b Department of Psychiatry, Wayne State University College of Medicine, Detroit, MI, USA E-mail address: [email protected] a