- Email: [email protected]
PS03.3 Cognitive-behavioral management of insomnia: recent advances and innovations
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.
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.