patients. Obese patients with this problem have poorer medical outcomes (Nowbar et al., 2004).

Thus, this research in sleep and sleep disorders is vibrant and has great potential to improve public health problems related to sleep-disordered breathing.


A turning point in this area may have been the recent NIH-sponsored State-of-the Science Conference on chronic insomnia (Dolan-Sewell et al., 2005). In this conference, a decision was made to abandon the concept of secondary insomnia. The rationale for this change was that it is difficult in most cases to distinguish causes and consequences for insomnia. The possibility that insomnia is associated with abnormalities of sleep microarchitecture and brain metabolism, as measured by imaging studies, is also increasingly recognized. This, together with the concept of hyperarousal in patients with insomnia (Nofzinger et al., 2004), is leading to the discovery of objective markers and a pathophysiological model for insomnia. It was also recognized that insomnia is not only frequently associated with depression but may be an independent predictor of it (Roth and Roehrs, 2003).

Treatment modalities for insomnia are changing. Prescribed hypnotic use is reported in children and adolescents, a pattern that raises concern as there are limited data in this area (Owens et al., 2003). An increasing number of well-designed studies are showing efficacy and safety for cognitive-behavioral therapies (Morin, 2004). This, together with the introduction and development of a large number of new hypnotics of various modes of action, is changing clinical practice in insomnia.

Pediatric Sleep Sciences

There have been several advances in the field of pediatric sleep medicine in the last two years: the discovery of the gene for congenital central hypoventilation syndrome, improved understanding of the pathogenesis and epidemiology of sleep apnea, and better understanding of the complications associating OSA in children. However, pediatric sleep remains relatively understudied, and there are still many gaps in the knowledge base. For example, although the Back to Sleep Campaign has been very successful there is still very little information concerning the etiology of sudden infant death syndrome (SIDS).

In 2003, Amiel and colleagues described a mutation of the PHOX2B gene in 62 percent of their patients with congenital central hypoventilation syndrome (Amiel et al., 2003). Following refinement of the technique, 97

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