- Email: [email protected]
PS03.2 Sleep disordered breathing: 2007 update
S6
2nd WASM World Congress, Bangkok, 4–8 February 2007 / Sleep Medicine 8 Suppl. 1 (2007) S5–S9
and under-recognized problem. Assessment of sleep should be part of the routine evaluation of patients with PD while patients with insomnia should be screened for RLS. PS02.2 REM-sleep behavior disorder: current knowledge and future directions C.H. Schenck. Minnesota Regional Sleep Disorders Center (MRSDC), and Department of Psychiatry at the Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, USA REM sleep behavior disorder (RBD) is typically a chronic, violent dream-enacting disorder affecting middle-aged or older men who do not demonstrate increased aggressiveness during wakefulness. Clonazepam is a highly effective treatment. The core electromyographic (EMG) abnormalities of RBD consist of intermittent loss of the usual skeletal muscle atonia of REM sleep (“REM atonia”), with increased muscle tone and/or excessive phasic muscle twitching during REM sleep. Periodic limb movements and non-periodic twitching during NREM sleep are common, indicating generalized REM/NREM sleep motor dyscontrol in RBD. There is increased slow-wave sleep for age and increased EEG delta power across sleep in RBD. During wakefulness, olfactory dysfunction, cortical EEG slowing, and visuospatial constructional dysfunction & visuospatial memory impairment on neuropsychological testing have been documented in both idiopathic and symptomatic RBD. Also, SPECT and PET brain scan studies have found impaired striatal dopamine transporter activity in idiopathic RBD. Therefore, RBD is a global disorder of REM sleep, NREM sleep and wakefulness. There is an experimental animal model of RBD induced by dorsal pontine tegmental lesions in cats, which has identified specific neuronal centers and pathways in the brainstem (pons, medulla) projecting to the alphamotoneurons in the spinal cord responsible for the generating REMatonia. Therefore, destruction of these centers and/or interruption of these pathways, together with disinhibition of motor pattern/behavioral generators, can presumably result in RBD. Although RBD can initially emerge with diverse neurologic disorders (particularly neurodegenerative disorders, narcolepsy and stroke), it can also manifest as an idiopathic disorder that is now known to commonly herald the future emergence of Parkinson’s disease and other parkinsonian (“synucleinopathy”) disorders. Furthermore, autopsy findings indicate that when associated with dementia and/or parkinsonism, RBD usually predicts an underlying synucleinopathy. Chronic RBD can also be triggered by psychotropic medications such as SSRIs, venlafaxine, tricyclic antidepressants, and mirtazapine. Most of the disorders causing RBD can also manifest as “sub-clinical RBD,” in which the PSG markers of RBD are present, but without any clinical parasomnia behaviors. It is currently unknown to what extent patients with sub-clinical RBD will eventually develop frank clinical RBD, and so these patients merit long-term follow-up. Future directions in RBD research also include the need to distinguish the boundaries of abnormal vs. normal EMG activity in REM sleep during PSG monitoring; the need to determine whether a comparable percent of elderly woman have RBD, but with less sleep violence and reduced clinical consequences; the need to understand whether dopaminergic therapy has comparable efficacy to clonazeapam; the need to compare patients with synucleinopathy vs. tauopathy neurodegenerative disorders in regards to the prevalence of RBD; the need to conduct largescale brain autopsy studies; the need to develop early intervention strategies in RBD to further prolong or perhaps eliminate the progression to frank parkinsonism; the need to follow-up on patients with drug-induced RBD to understand the natural history of this subtype of RBD (including any risk for future parkinsonism); etc. PS02.3 Sleep related paroxysmal motor phenomena P. Montagna. Neurology, University of Bologna, Italy Several paroxysmal motor phenomena occur during nocturnal sleep or at sleep onset: propriospinal myoclonus, arousal and other NREM and REM sleep parasomnias, and epileptic, especially frontal lobe related seizures. Video-polysomnographic recordings are necessary but sometimes insufficient to differentiate among these various clinical entities. Moreoever,
some overlap, especially between the parasomnias and epilepsy, may exist. Abnormal arousal responses during sleep have been proposed as the unifying theme underlying possible common mechanisms.
PS03. Sleep updates
PS03.1 Restless legs syndrome: from bedside to bench and back again C.J. Earley. Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Our understanding of the pathophysiology of RLS has made significant advancements in the last 10 years. This presentation will start at the “bedside” with Nordlander’s seminal work of the 1950s, which was the first to demonstrate the importance of iron deficiency in RLS and then move over time to the “bench” where Nordlander’s prediction of finding “an iron deficiency in the tissues in spite of normal serum iron” proved to be true. This presentation will also examine the role that the dopaminergic system plays in the pathophysiology of RLS. Although the currently held dopamine hypothesis contends that a hypo-dopaminergic condition may prevail in RLS, recent studies in brain autopsy material from RLS suggests that some component of the dopaminergic system may be hyperactive. The putative point of interaction between iron and dopamine and what that hold for the future direction of research in RLS will bring us “back again” to the patient and their future. PS03.2 Sleep disordered breathing: 2007 update P. L´evy1,2 . 1 Physiology and 2 University Respiratory Research Team (HP2) Inserm unit ERI17, Faculty of Medicine, University J Fourier, Grenoble, France Obstructive Sleep Apnea consequences resulting from sleep fragmentation are mostly excessive daytime sleepiness, attentional deficits and neurocognitive dysfunction. Cardiovascular diseases such as systemic hypertension, coronary heart disease, arrhythmias, and stroke are likely mainly resulting from intermittent hypoxia. Although the mechanisms underlying the relationship between OSAS and cardiovascular morbidity are poorly understood, there is substantial evidence that OSAS is strongly associated with inflammation, which also plays a major role in atherosclerosis. Inflammation in OSAS has been attributed, in part, to systemic hypoxia. IH has been reported to increase oxidative stress and inflammation. Moreover, IH has been shown to selectively activate inflammatory pathways in OSAS thus suggesting a possible molecular mechanism of cardiovascular disease. As regards evidence-based medicine, there are now strong data supporting a causal relationship between OSA and hypertension, arrhythmias, stroke and Coronary Heart Disease. Although there are recent data demonstrating a major impact of CPAP on cardiovascular morbidity and mortality at least in the most severe OSA patients, there are on-going studies in selected sub-groups (i.e. mild to moderate OSA) and also studies of comparison between CPAP and cardiovascular drugs impact on OSA-related cardiovascular consequences. There is also a major research effort both in humans and in animals regarding the relationship between Sleep Disordered Breathing and glucose metabolism. There is an increased associated risk of insulin resistance and diabetes and CPAP may help in controlling glucose metabolism in OSA patients. However, there are major confounding factors in this field and additional studies are required. Cheyne–Stokes respiration (CSR) with central sleep apnoea (CSA) [CSRCSA] is a breathing disorder seen in 30−80% of patients with advanced congestive heart failure (CHF). The Canadian Continuous PositiveAirway Pressure Trial for Congestive Heart Failure (CANPAP) included patients withCHF with CSR-CSA and demonstrated an absence of benefit in terms of survival and even a deleterious initial effect on mortality, apparently in the patients being non adequately corrected by CPAP for their SDB whilst the CPAP responders had an improved survival. Other treatments such as Atrial overdrive and Cardiac Resynchronization Therapy have been evaluated either in OSA or in CSR. Large trials including CSR patients and
Plenary Symposia / Sleep Medicine 8 Suppl. 1 (2007) S5–S9 evaluating assisted servo-ventilation impact on morbidity and mortality are to be starting very soon. PS03.3 Cognitive-behavioral management of insomnia: recent advances and innovations C.M. Morin. Universit´e Laval, Quebec City, Canada Insomnia is a prevalent condition, both as a symptom and a disorder. Chronic insomnia carries an important burden for the individual and for society, as evidenced by reduced quality of life and increased functional impairments, risks of depression and health-care costs. Although medication is the most frequently used treatment for insomnia, significant advances have been made in the psychological and behavioral management of insomnia in the past decade. These approaches are well accepted by patients, although they remain under-utilized by health-care practitioners. This presentation summarizes recent advances and innovations in the use of cognitive behavioral therapies (CBT) for chronic insomnia. The evidence indicates that CBT is an effective therapy, with 70%-80% of patients responding to treatment and sleep improvements being well sustained after treatment completion. There is increasing evidence that CBT is also of benefits to older adults and patients with insomnia comorbid with medical disorders. Recent innovations include the use of group therapy, telephone consultations, and the Internet to make CBT more accessible in various clinical settings. Areas of ongoing clinical research include the investigation of combined CBT with medication, expanded focus on treating insomnia comorbid with psychiatric disorders, and evaluation of acute and maintenance therapies to optimize therapeutic outcomes.
PS04. Child sleep
PS04.1 Cross-cultural perspectives on sleep in children and adolescents J. Owens. Pediatric Sleep Disorders Clinic at Hasbro Children’s Hospital and the Learning, Attention, and Behavior Program at Rhode Island Hospital, USA Learning Objectives: • Appreciate how culturally-determined factors impact on children’s sleep • Understand important cultural differences in sleeping practices around the world, including napping, use of transitional objects, sleep amounts, and treatment of sleep problems • Differentiate between causes and consequences of the practice of cosleeping in different cultures An appreciation of and sensitivity to cultural differences in sleeping practices is not only vital to understanding the development of sleep patterns, behaviors, and problems in children, but also plays an important role in counseling families in clinical practice settings. This presentation will focus on some of the complex interactions among cultural factors (eg, parenting practices and beliefs, sleeping environment) and sleep practices in infants, children, and adolescents around the world. Emphasis will be placed on cultural differences in infant and child co-sleeping practices, as well as napping, sleep amounts, the role of electronic media in bedtime practices, and treatment of sleep problems. Future research, clinical, and educational goals incorporating culturally sensitive and appropriate tools will be discussed. PS04.2 Arousals and their implications for children with disturbed sleep O. Bruni. Center for Pediatric Sleep Disorders, Dept. Developmental Neurology and Psychiatry, University of Rome “La Sapienza”, Via dei Sabelli 108, 00185 Rome, Italy In recent years, the role of arousals in sleep of children has been assessed and investigations have been carried out in order to establish normative data. The maturation of spontaneous and evoked arousals parallels that of the sleep structure, showing characteristic age-related changes. The studies on the Cyclic Alternating Pattern (CAP) during development have shown
S7
a similar linear increase expressed by A2 and A3 subtypes. In contrast, A1 subtypes seem to undergo a complex development, in association with specific maturational epochs, with a peak in the pre-adolescents and adolescents, probably associated to specific metabolic age-related variations especially, the secretion of growth hormone. We should consider that arousals are markers of sleep disruption but also that they represent elements weaved into the texture of sleep and play an important role in the regulation of the sleep process. Understanding the role of arousals and CAP can provide insight into the pathophysiology of sleep disturbances in children in whom, often, sleep macrostructure is preserved due to the stable homeostatic mechanism of their sleep. In the last few years, our research group has studied the course of sleep microstrucuture in childhood and its modifications related to different sleep pathologies or different diseases in children. We have identified specific microstructure patterns in Attention Deficit Hyperactivity Disorders and in narcolepsy, in sleep respiratory disorders, and in mentally retarded children. The novelty of our approach resides not only in the quantization of arousals and of EEG slow components (A1 CAP subtypes) of NREM sleep but also in the evaluation of the perturbation of the time structure of these oscillating patterns during sleep. PS04.3 The cardiovascular consequences of childhood sleep-disordered breathing D.K. Ng1,2 . 1 Hong Kong Society of Paediatric Respirology; 2 Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China The impact of obstructive sleep apnea on cardiovascular system has been well studied in adults. Paediatric data are more limited. A review of the paediatric data on sleep disordered breathing and obstructive sleep apnea (SDB/OSA) and cardiovascular diseases will be presented. A meta-analysis suggested that OSA/SDB contributed to a significant increase in the risk of hypertension in children (combined odds ratio = 2.93, 95% CI: 1.18−7.29). Limited evidence also suggested that SDB/OSA is associated with increased sympathetic activation and ventricular hypertrophy. Primary snoring may also be associated with a higher blood pressure and a decreased arterial distensibility. In conclusion, examination of the cardiovascular system is important even in childhood OSA.
PS05. Science of sleep
PS05.1 Sleep and the immune system T. Pollm¨acher1,2,3 . 1 Center of Mental Health, Klinikum Ingolstadt; 2 Psychiatry, Ludwig-Maximilians-University Munich; 3 Max Planck Institute of Psychiatry, Munich, Germany Among the many attempts to unravel the functions of sleep, those addressing its interactions with the host defense, or immune system is of particular interest. It is very clear now that the host defense system affects sleep regulation, but still it is an unresolved issue to what extend sleep is a behaviour supporting the organisms fight against infectious challenges. Today there is compelling evidence from animal studies that humoral components of the immune system, particularly inflammatory cytokines such as interleukins or tumor necrosis factor are involved in both, altered sleep during infection and inflammation, and physiological sleep regulation. Studies in healthy volunteers support that the situation in humans is quite similar. Experimental studies to document an influence of altered sleep behaviour on host response or immune parameters have yielded interesting, but also conflicting results. Just very recently studies are being conducted to answer the most important question, whether clinically relevant chronic sleep disturbances, such as insomnia or sleep apnoea are associated with clinically relevant immune abnormalities.
2nd WASM World Congress, Bangkok, 4–8 February 2007 / Sleep Medicine 8 Suppl. 1 (2007) S5–S9
and under-recognized problem. Assessment of sleep should be part of the routine evaluation of patients with PD while patients with insomnia should be screened for RLS. PS02.2 REM-sleep behavior disorder: current knowledge and future directions C.H. Schenck. Minnesota Regional Sleep Disorders Center (MRSDC), and Department of Psychiatry at the Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, USA REM sleep behavior disorder (RBD) is typically a chronic, violent dream-enacting disorder affecting middle-aged or older men who do not demonstrate increased aggressiveness during wakefulness. Clonazepam is a highly effective treatment. The core electromyographic (EMG) abnormalities of RBD consist of intermittent loss of the usual skeletal muscle atonia of REM sleep (“REM atonia”), with increased muscle tone and/or excessive phasic muscle twitching during REM sleep. Periodic limb movements and non-periodic twitching during NREM sleep are common, indicating generalized REM/NREM sleep motor dyscontrol in RBD. There is increased slow-wave sleep for age and increased EEG delta power across sleep in RBD. During wakefulness, olfactory dysfunction, cortical EEG slowing, and visuospatial constructional dysfunction & visuospatial memory impairment on neuropsychological testing have been documented in both idiopathic and symptomatic RBD. Also, SPECT and PET brain scan studies have found impaired striatal dopamine transporter activity in idiopathic RBD. Therefore, RBD is a global disorder of REM sleep, NREM sleep and wakefulness. There is an experimental animal model of RBD induced by dorsal pontine tegmental lesions in cats, which has identified specific neuronal centers and pathways in the brainstem (pons, medulla) projecting to the alphamotoneurons in the spinal cord responsible for the generating REMatonia. Therefore, destruction of these centers and/or interruption of these pathways, together with disinhibition of motor pattern/behavioral generators, can presumably result in RBD. Although RBD can initially emerge with diverse neurologic disorders (particularly neurodegenerative disorders, narcolepsy and stroke), it can also manifest as an idiopathic disorder that is now known to commonly herald the future emergence of Parkinson’s disease and other parkinsonian (“synucleinopathy”) disorders. Furthermore, autopsy findings indicate that when associated with dementia and/or parkinsonism, RBD usually predicts an underlying synucleinopathy. Chronic RBD can also be triggered by psychotropic medications such as SSRIs, venlafaxine, tricyclic antidepressants, and mirtazapine. Most of the disorders causing RBD can also manifest as “sub-clinical RBD,” in which the PSG markers of RBD are present, but without any clinical parasomnia behaviors. It is currently unknown to what extent patients with sub-clinical RBD will eventually develop frank clinical RBD, and so these patients merit long-term follow-up. Future directions in RBD research also include the need to distinguish the boundaries of abnormal vs. normal EMG activity in REM sleep during PSG monitoring; the need to determine whether a comparable percent of elderly woman have RBD, but with less sleep violence and reduced clinical consequences; the need to understand whether dopaminergic therapy has comparable efficacy to clonazeapam; the need to compare patients with synucleinopathy vs. tauopathy neurodegenerative disorders in regards to the prevalence of RBD; the need to conduct largescale brain autopsy studies; the need to develop early intervention strategies in RBD to further prolong or perhaps eliminate the progression to frank parkinsonism; the need to follow-up on patients with drug-induced RBD to understand the natural history of this subtype of RBD (including any risk for future parkinsonism); etc. PS02.3 Sleep related paroxysmal motor phenomena P. Montagna. Neurology, University of Bologna, Italy Several paroxysmal motor phenomena occur during nocturnal sleep or at sleep onset: propriospinal myoclonus, arousal and other NREM and REM sleep parasomnias, and epileptic, especially frontal lobe related seizures. Video-polysomnographic recordings are necessary but sometimes insufficient to differentiate among these various clinical entities. Moreoever,
some overlap, especially between the parasomnias and epilepsy, may exist. Abnormal arousal responses during sleep have been proposed as the unifying theme underlying possible common mechanisms.
PS03. Sleep updates
PS03.1 Restless legs syndrome: from bedside to bench and back again C.J. Earley. Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Our understanding of the pathophysiology of RLS has made significant advancements in the last 10 years. This presentation will start at the “bedside” with Nordlander’s seminal work of the 1950s, which was the first to demonstrate the importance of iron deficiency in RLS and then move over time to the “bench” where Nordlander’s prediction of finding “an iron deficiency in the tissues in spite of normal serum iron” proved to be true. This presentation will also examine the role that the dopaminergic system plays in the pathophysiology of RLS. Although the currently held dopamine hypothesis contends that a hypo-dopaminergic condition may prevail in RLS, recent studies in brain autopsy material from RLS suggests that some component of the dopaminergic system may be hyperactive. The putative point of interaction between iron and dopamine and what that hold for the future direction of research in RLS will bring us “back again” to the patient and their future. PS03.2 Sleep disordered breathing: 2007 update P. L´evy1,2 . 1 Physiology and 2 University Respiratory Research Team (HP2) Inserm unit ERI17, Faculty of Medicine, University J Fourier, Grenoble, France Obstructive Sleep Apnea consequences resulting from sleep fragmentation are mostly excessive daytime sleepiness, attentional deficits and neurocognitive dysfunction. Cardiovascular diseases such as systemic hypertension, coronary heart disease, arrhythmias, and stroke are likely mainly resulting from intermittent hypoxia. Although the mechanisms underlying the relationship between OSAS and cardiovascular morbidity are poorly understood, there is substantial evidence that OSAS is strongly associated with inflammation, which also plays a major role in atherosclerosis. Inflammation in OSAS has been attributed, in part, to systemic hypoxia. IH has been reported to increase oxidative stress and inflammation. Moreover, IH has been shown to selectively activate inflammatory pathways in OSAS thus suggesting a possible molecular mechanism of cardiovascular disease. As regards evidence-based medicine, there are now strong data supporting a causal relationship between OSA and hypertension, arrhythmias, stroke and Coronary Heart Disease. Although there are recent data demonstrating a major impact of CPAP on cardiovascular morbidity and mortality at least in the most severe OSA patients, there are on-going studies in selected sub-groups (i.e. mild to moderate OSA) and also studies of comparison between CPAP and cardiovascular drugs impact on OSA-related cardiovascular consequences. There is also a major research effort both in humans and in animals regarding the relationship between Sleep Disordered Breathing and glucose metabolism. There is an increased associated risk of insulin resistance and diabetes and CPAP may help in controlling glucose metabolism in OSA patients. However, there are major confounding factors in this field and additional studies are required. Cheyne–Stokes respiration (CSR) with central sleep apnoea (CSA) [CSRCSA] is a breathing disorder seen in 30−80% of patients with advanced congestive heart failure (CHF). The Canadian Continuous PositiveAirway Pressure Trial for Congestive Heart Failure (CANPAP) included patients withCHF with CSR-CSA and demonstrated an absence of benefit in terms of survival and even a deleterious initial effect on mortality, apparently in the patients being non adequately corrected by CPAP for their SDB whilst the CPAP responders had an improved survival. Other treatments such as Atrial overdrive and Cardiac Resynchronization Therapy have been evaluated either in OSA or in CSR. Large trials including CSR patients and
Plenary Symposia / Sleep Medicine 8 Suppl. 1 (2007) S5–S9 evaluating assisted servo-ventilation impact on morbidity and mortality are to be starting very soon. PS03.3 Cognitive-behavioral management of insomnia: recent advances and innovations C.M. Morin. Universit´e Laval, Quebec City, Canada Insomnia is a prevalent condition, both as a symptom and a disorder. Chronic insomnia carries an important burden for the individual and for society, as evidenced by reduced quality of life and increased functional impairments, risks of depression and health-care costs. Although medication is the most frequently used treatment for insomnia, significant advances have been made in the psychological and behavioral management of insomnia in the past decade. These approaches are well accepted by patients, although they remain under-utilized by health-care practitioners. This presentation summarizes recent advances and innovations in the use of cognitive behavioral therapies (CBT) for chronic insomnia. The evidence indicates that CBT is an effective therapy, with 70%-80% of patients responding to treatment and sleep improvements being well sustained after treatment completion. There is increasing evidence that CBT is also of benefits to older adults and patients with insomnia comorbid with medical disorders. Recent innovations include the use of group therapy, telephone consultations, and the Internet to make CBT more accessible in various clinical settings. Areas of ongoing clinical research include the investigation of combined CBT with medication, expanded focus on treating insomnia comorbid with psychiatric disorders, and evaluation of acute and maintenance therapies to optimize therapeutic outcomes.
PS04. Child sleep
PS04.1 Cross-cultural perspectives on sleep in children and adolescents J. Owens. Pediatric Sleep Disorders Clinic at Hasbro Children’s Hospital and the Learning, Attention, and Behavior Program at Rhode Island Hospital, USA Learning Objectives: • Appreciate how culturally-determined factors impact on children’s sleep • Understand important cultural differences in sleeping practices around the world, including napping, use of transitional objects, sleep amounts, and treatment of sleep problems • Differentiate between causes and consequences of the practice of cosleeping in different cultures An appreciation of and sensitivity to cultural differences in sleeping practices is not only vital to understanding the development of sleep patterns, behaviors, and problems in children, but also plays an important role in counseling families in clinical practice settings. This presentation will focus on some of the complex interactions among cultural factors (eg, parenting practices and beliefs, sleeping environment) and sleep practices in infants, children, and adolescents around the world. Emphasis will be placed on cultural differences in infant and child co-sleeping practices, as well as napping, sleep amounts, the role of electronic media in bedtime practices, and treatment of sleep problems. Future research, clinical, and educational goals incorporating culturally sensitive and appropriate tools will be discussed. PS04.2 Arousals and their implications for children with disturbed sleep O. Bruni. Center for Pediatric Sleep Disorders, Dept. Developmental Neurology and Psychiatry, University of Rome “La Sapienza”, Via dei Sabelli 108, 00185 Rome, Italy In recent years, the role of arousals in sleep of children has been assessed and investigations have been carried out in order to establish normative data. The maturation of spontaneous and evoked arousals parallels that of the sleep structure, showing characteristic age-related changes. The studies on the Cyclic Alternating Pattern (CAP) during development have shown
S7
a similar linear increase expressed by A2 and A3 subtypes. In contrast, A1 subtypes seem to undergo a complex development, in association with specific maturational epochs, with a peak in the pre-adolescents and adolescents, probably associated to specific metabolic age-related variations especially, the secretion of growth hormone. We should consider that arousals are markers of sleep disruption but also that they represent elements weaved into the texture of sleep and play an important role in the regulation of the sleep process. Understanding the role of arousals and CAP can provide insight into the pathophysiology of sleep disturbances in children in whom, often, sleep macrostructure is preserved due to the stable homeostatic mechanism of their sleep. In the last few years, our research group has studied the course of sleep microstrucuture in childhood and its modifications related to different sleep pathologies or different diseases in children. We have identified specific microstructure patterns in Attention Deficit Hyperactivity Disorders and in narcolepsy, in sleep respiratory disorders, and in mentally retarded children. The novelty of our approach resides not only in the quantization of arousals and of EEG slow components (A1 CAP subtypes) of NREM sleep but also in the evaluation of the perturbation of the time structure of these oscillating patterns during sleep. PS04.3 The cardiovascular consequences of childhood sleep-disordered breathing D.K. Ng1,2 . 1 Hong Kong Society of Paediatric Respirology; 2 Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China The impact of obstructive sleep apnea on cardiovascular system has been well studied in adults. Paediatric data are more limited. A review of the paediatric data on sleep disordered breathing and obstructive sleep apnea (SDB/OSA) and cardiovascular diseases will be presented. A meta-analysis suggested that OSA/SDB contributed to a significant increase in the risk of hypertension in children (combined odds ratio = 2.93, 95% CI: 1.18−7.29). Limited evidence also suggested that SDB/OSA is associated with increased sympathetic activation and ventricular hypertrophy. Primary snoring may also be associated with a higher blood pressure and a decreased arterial distensibility. In conclusion, examination of the cardiovascular system is important even in childhood OSA.
PS05. Science of sleep
PS05.1 Sleep and the immune system T. Pollm¨acher1,2,3 . 1 Center of Mental Health, Klinikum Ingolstadt; 2 Psychiatry, Ludwig-Maximilians-University Munich; 3 Max Planck Institute of Psychiatry, Munich, Germany Among the many attempts to unravel the functions of sleep, those addressing its interactions with the host defense, or immune system is of particular interest. It is very clear now that the host defense system affects sleep regulation, but still it is an unresolved issue to what extend sleep is a behaviour supporting the organisms fight against infectious challenges. Today there is compelling evidence from animal studies that humoral components of the immune system, particularly inflammatory cytokines such as interleukins or tumor necrosis factor are involved in both, altered sleep during infection and inflammation, and physiological sleep regulation. Studies in healthy volunteers support that the situation in humans is quite similar. Experimental studies to document an influence of altered sleep behaviour on host response or immune parameters have yielded interesting, but also conflicting results. Just very recently studies are being conducted to answer the most important question, whether clinically relevant chronic sleep disturbances, such as insomnia or sleep apnoea are associated with clinically relevant immune abnormalities.