A
Study Process

The committee reviewed and considered a broad array of information in its work on issues involving sleep disorder research. Information sources included the primary scientific literature, books and scientific reviews, and presentations from researchers, as well as representatives from federal agencies and academic, professional, and nonprofit organizations.

LITERATURE REVIEW

Extensive bibliographic searches were conducted, resulting in a reference database of more than 2,000 entries. Searches of the primary biomedical bibliographic databases, MEDLINE and EMBASE,1 were supplemented with searches of Dissertation Abstracts Online, LexisNexis, and THOMAS (a federal legislative database). The Dissertation Abstracts database provided information on the current level of Ph.D. thesis production in the field of sleep disorders.2

1

Excerpta Medica.

2

Institute of Medicine staff searched the Dissertation Abstracts database using the search terms sleep, sleep disorders, sleep apnea, dream, insomnia, hibernation, periodic limb movement, restless legs syndrome, circadian rhythm, narcolepsy, and sudden infant death syndrome. The question mark is used to search for terms with multiple endings. For example, the search term sleep disord? resulted in hits that included sleep disorder and sleep disorders.



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A Study Process The committee reviewed and considered a broad array of information in its work on issues involving sleep disorder research. Information sources included the primary scientific literature, books and scientific reviews, and presentations from researchers, as well as representatives from federal agen- cies and academic, professional, and nonprofit organizations. LITERATURE REVIEW Extensive bibliographic searches were conducted, resulting in a refer- ence database of more than 2,000 entries. Searches of the primary bio- medical bibliographic databases, MEDLINE and EMBASE,1 were supple- mented with searches of Dissertation Abstracts Online, LexisNexis, and THOMAS (a federal legislative database). The Dissertation Abstracts data- base provided information on the current level of Ph.D. thesis production in the field of sleep disorders.2 1Excerpta Medica. 2Institute of Medicine staff searched the Dissertation Abstracts database using the search terms sleep, sleep disorders, sleep apnea, dream, insomnia, hibernation, periodic limb move- ment, restless legs syndrome, circadian rhythm, narcolepsy, and sudden infant death syndrome. The question mark is used to search for terms with multiple endings. For example, the search term sleep disord? resulted in hits that included sleep disorder and sleep disorders. 325

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326 SLEEP DISORDERS AND SLEEP DEPRIVATION GRANT ANALYSIS To identify information on funding mechanisms and trends from the National Institutes of Health (NIH), Institute of Medicine (IOM) staff que- ried the Computer Retrieval of Information on Scientific Projects (CRISP) database. This database collects information on the number of federally funded biomedical research projects. Data from the CRISP database were used to assess the number of fellowships (F grants), career grants (K grants), research grants (e.g., R01 grants), project grants (P grants), training (T grants), cooperative agreements (U grants), and Small Business Innovation Research and Small Business Technology Transfer awards funded by the NIH. To discern the number of NIH grants directed toward sleep-related research, IOM staff used appropriate keywords (which appeared in a 9,000- word thesaurus) for various sleep disorders, including: insomnia, periodic limb movement disorder, restless legs syndrome, circadian rhythm, sudden infant death syndrome, sleep disorder, narcolepsy, sleep apnea, sleep, hiber- nation, and dream. To limit the number of grants that were not relevant to somnology or sleep disorders the committee included only grants in which the keywords appeared in the thesaurus terms and not the abstract. Addi- tional information on general funding trends at NIH was located in pub- lished documents and was provided by NIH staff. PUBLIC WORKSHOPS The committee held five meetings over the course of the study to ad- dress the study charge, review the data collected, and develop the report. Three of those meetings included public workshops: April 11–12, 2005; June 29–30, 2005; and September 15–16, 2005. The first workshop (Box A-1) included three sessions that covered the public health significance of sleep deprivation and disorders, sleep depriva- tion and society, sleep apnea, and the impact of sleep deprivation and disor- ders on specific populations. The committee held the second public workshop (Box A-2) in Washing- ton, D.C. In that workshop the committee heard from 17 speakers who had expertise in surveillance and monitoring programs and technologies, model interdisciplinary programs, and training and education in sleep research. The third meeting took place at the Jonsson Conference Center in Woods Hole, Massachusetts. The public workshop (Box A-3) consisted of two sessions that included a review of results from a survey and commis- sioned paper on sleep and a discussion with Dr. Charles Czeisler, director of Harvard Medical School’s Division of Sleep Medicine and president-elect of the Sleep Research Society.

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327 APPENDIX A BOX A-1 Institute of Medicine Committee on Sleep Medicine and Research April 11–12, 2005 Monday April 11, 2005 Session I: Sponsors’ Perspective, Panel Discussion with Committee 10:15 National Sleep Foundation Richard Gelula, Executive Director National Institutes of Health Stuart Quan, Chair, NIH Sleep Disorders Research Advisory Board Carl Hunt, Director, National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute Merrill Mitler, Program Director, Extramural Research Program, National Institute of Neurological Disorders and Stroke Sleep Research Society Charles Czeisler, President-Elect Jerry Barrett, Executive Director American Academy of Sleep Medicine Michael Sateia, President Lawrence Epstein, President-Elect Jerry Barrett, Executive Director Jennifer Markkanen, Assistant Executive Director Tuesday, April 12, 2005 Session I: Public Health Significance of Sleep Deprivation and Disorders 8:25 Welcome and Introductions Harvey Colten, Chair 8:30 Impact of Insomnia and Periodic Leg Movements Thomas Roth, Henry Ford Health System of Detroit 9:00 Overview of the Public Health Significance of Sleep Deprivation and Disorders Terry Young, University of Wisconsin continued

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328 SLEEP DISORDERS AND SLEEP DEPRIVATION BOX A-1 continued 9:30 Sleep Duration: Neurobehavioral, Physiological, and Epidemiological Issues David Dinges, University of Pennsylvania School of Medicine Session II: Sleep Deprivation and Society 10:15 Accidents Caused by Sleep Deprivation and Disorders Allan Pack, University of Pennsylvania Medical Center 10:45 Metabolic Consequences of Sleep Deprivation Daniel Gottlieb, Boston University School of Medicine Session III: Sleep Apnea 11:15 Effect of Apnea on Cardiovascular Disease and Metabolic Functions Susan Redline, Case Western Reserve University School of Medicine 11:45 Discussion of Morning Session Session IV: Impact of Sleep Deprivation and Disorders on Specific Populations 1:00 Snoring in Children: Sound the Alarm! David Gozal, University of Louisville 1:30 Sleep Loss and Women’s Health Kathy Lee, University of California, San Francisco 2:00 Sleep Disturbance in Geriatrics Donald Bliwise, Emory University 2:30 Discussion of Afternoon Session

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329 APPENDIX A BOX A-2 Institute of Medicine Committee on Sleep Medicine and Research June 29–30, 2005 June 29, 2005 11:15 Lee Goldman University of California, San Francisco, Department of Medicine Surveillance Programs and Technologies 1:00 Welcome and Introductions Harvey Colten, Chair Paul Eggers, NIDDK, Co-Project Officer, United States Renal Data System Ed Sondik, Director, National Center for Health Statistics 2:15 Open Discussion 2:45 Roger Rosa Senior Scientist, National Institute for Occupational Safety and Health 3:15 Eugene J. Lengerich Co-Chair, Pennsylvania Cancer Control Consortium 3:45 Andrea Califano Co-Director, Center for Computational Biochemistry and Biosystems, Bioworks and the NCI caCORE platform 4:15 Open Discussion June 30, 2005 Organizational Impediments 8:30 David Lewis President and Chief Executive Officer, SleepMed, Inc. 9:00 Michael Martin Director of the Division of Physiology and Pathology in the Center for Scientific Review, NIH continued

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330 SLEEP DISORDERS AND SLEEP DEPRIVATION BOX A-2 continued 9:30 William Dement Director, Sleep Research Center, Stanford University School of Medicine 10:15 David White Director, Sleep Disorders Program, Brigham and Women’s Hospital 10:45 General Discussion Model Interdisciplinary Programs 12:30 Kathleen C. Buckwalter Codirector University of Iowa Center on Aging 1:00 Story Landis Director, NINDS, Co-chair NIH Pain Consortium 1:30 Hal Moses Founding Director of the Vanderbilt-Ingram Cancer Center 2:00 David J. Kupfer Chair, Department of Psychiatry, University of Pittsburgh School of Medicine 2:30 Steven Wolinsky Division Chief of Infectious Diseases Northwestern University 3:00 General Discussion Training and Education 3:30 Judith Owens Brown University Medical School, AASM MED Sleep Program 4:00 Daniel Buysse Department of Psychiatry, UPMC Sleep Medicine Center and Sleep Medicine Fellowship Training Program 4:30 Roger Bulger President, Association of Academic Health Centers 5:00 General Discussion

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331 APPENDIX A BOX A-3 Institute of Medicine Committee on Sleep Medicine and Research September 15–16, 2005 September 15, 2005 12:45 Results from AASM Academic Health Centers Survey Michael Sateia, Section of Sleep Medicine Chief, Dartmouth University Past President, American Academy of Sleep Medicine 1:30 Preliminary Findings of Commissioned Paper John Fontanesi, Center for Management Science in Public Health, University of California, San Diego September 16, 2005 10:15 Discussion with Charles Czeisler Director, Division of Sleep Medicine, Harvard Medical School President-Elect, Sleep Research Society