NATIONAL CENTER ON SLEEP DISORDERS RESEARCH
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Sleep Disorders Research Advisory Board Meeting Minutes

December 6, 2006


TABLE OF CONTENTS

Attendees
Introduction
Adoption Of Minutes From The June 14, 2006 SDRAB Meeting
Remarks - Director, Division of Lung Diseases, NHLBI
Report of the Director NCSDR
Presentation - Public Health Education
Public Reports
Trans-NIH Sleep Research Coordinating Committee Reports
Report of Sleep Research Directions/Priorities - National Institute on Aging
Open Discussion
Next Meeting
Certification


Sleep Disorders Research Advisory Board Page


BOARD MEMBERS PRESENT

Dr. Phyllis Zee, Chair
Dr. Sonia Ancoli-Israel
Ms. Sheila Connolly
Dr. Estelle Gauda
Dr. F. Javier Nieto
Dr. Gina Poe
Dr. Stuart Quan
Dr. Howard Roffwarg
Dr. Michael Smolensky
Dr. Lorraine Wearley

BOARD MEMBERS ABSENT

Ms. Elizabeth Johns

EX OFFICIO MEMBERS PRESENT

Dr. Michael Twery, SDRAB Executive Secretary
Dr. Andrew Monjan, National Institute on Aging
Dr. Merrill Mitler, National Institute of Neurological Disorders and Stroke
Dr. Dante Picchioni (representing Dr. Thomas Balkin), Department of Defense
Dr. William Riley, National Institute of Mental Health

LIAISON MEMBERS PRESENT

Dr. Harold Gordon, National Institute on Drug Abuse
Dr. Lindsey Grandison (representing Dr. Ellen Witt), National Institute on Alcohol Abuse and Alcoholism
Dr. Roger Rosa, Centers for Disease Control and Prevention

FEDERAL EMPLOYEES PRESENT

Mr. Al Golden, National Heart, Lung, and Blood Institute, NIH
Ms. Susan Rogus, National Heart, Lung, and Blood Institute, NIH
Ms. Ellen Sommer, National Heart, Lung, and Blood Institute, NIH

MEMBERS OF THE PUBLIC PRESENT

Mr. Robert Balkam, Restless Legs Syndrome Foundation
Mr. Richard Gelula, National Sleep Foundation
Mr. Edward Grandi, American Sleep Apnea Association
Dr. Eveline Honig, Narcolepsy Network
Dr. Beth Osowski, Restless Legs Syndrome Foundation
Dr. Allan Pack, University of Pennsylvania

INVITED GUESTS PRESENT

Dr. James Kiley, Director, Division of Lung Diseases, National Heart, Lung, and Blood Institute, NIH

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INTRODUCTION

  • Phyllis Zee, MD, PhD, SDRAB Chair, called the meeting to order at 8:30 AM.
  • Members in attendance introduced themselves. Four new SDRAB members, Drs. Ancoli-Israel, Gauda, Nieto and Quan, gave a brief description of their respective backgrounds and interest in sleep science and research.
  • Conflict of interest issues and responsibilities associated with NIH Advisory Board membership, included in the SDRAB briefing book materials provided to each member, were identified for members to review.
  • Dr. Michael Twery, NCSDR Director and SDRAB Executive Secretary, announced that this is a public meeting and pursuant to the Federal Advisory Committee Act, notice of the meeting was published in the Federal Register on October 25, 2006 (Volume 71, Number 206, Page 62478).
  • The current Sleep Disorders Research Advisory Board charter expires in June 30, 2007. NHLBI Committee management staff will initiate and forward the appropriate paperwork in 2007 for renewing the SDRAB Charter.
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    ADOPTION OF MINUTES FROM THE JUNE 6, 2006 SDRAB MEETING

  • Dr. Gina Poe moved that the Minutes of the June 14, 2006 SDRAB meeting be adopted without amendment. Dr. Howard Roffwarg seconded the motion, and the motion carried unanimously.
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    REMARKS: DIRECTOR, DIVISION OF LUNG DISEASES, NHLBI

  • Recent changes in the NHLBI organization were highlighted including the appointment of Dr. Michael Twery as Director of the National Center on Sleep Disorders Research (NCSDR), and the NHLBI Strategic Planning Process. A draft of the NHLBI Strategic Plan will be released in early 2007 for a period of public comment and before consideration by the NHLBI Advisory Council. Additional information can be found online at http://www.nhlbi.nih.gov/strategicplan/.
  • SDRAB serves a critical role as a pipeline through which to enhance communication between NIH and a broad spectrum of communities and disciplines with which Board members interact on the topics of science, training, and the translation of sleep-related information and research.
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    NCSDR DIRECTOR'S REPORT

  • The charge to SDRAB and progress represented by expansion of the Trans-NIH Sleep Research Coordinating Committee (SRCC) from 8 to 13 active NIH organizations was presented.
  • Recent accomplishments as represented by selected NHLBI Sleep Research Initiatives were summarized
    • - Sleep Heart Health Study, Phase III (Multi-site observational study, scheduled phase out August 2008);

      - Apnea Positive Pressure Long-term Efficacy Study (Multi-site randomized clinical trial, scheduled phase out 2008);

      - Impact of CPAP on Functional Outcomes in Milder OSA (Multi-site randomized clinical trial, scheduled phase out 2007);

      - Hispanic Community Health Study (Sleep Disordered Breathing) (Multi-site population-based epidemiology study, launch in 2007).

  • Summary findings from an NCSDR initiated keyword-based search for "sleep" and "circadian" topics in the NIH application database revealed several programmatic trends:
    • - Funding for research grants associated with the Congressional disease reporting category of 'sleep disorders' has remained largely unchanged at about 1% of the annual NIH research grant budget during the last decade (1996-2005).

      - Competing R01 sleep/circadian grant applications have increased from about 100 in FY1996 to 180 in FY2005. A substantial proportion of these competing applications were associated with RFA initiatives, and increases in the number of sleep/circadian applications submitted after the period of "NIH budget doubling" (1998-2003). The post-doubling trend also exists for NIH R01 applications overall.

      - The success rate for competing R01 sleep/circadian grant applications is approximately the same or better than the success rate for NIH R01 applications overall during the last decade.

      - Growth in the number of competing sleep/circadian applications has been paralleled by a declining number of competing amended applications during the last decade. This trend suggests that a growing proportion of sleep research grant applicants dropout of the R01 competition but does not reveal why.

      - R01 Grant applications identified by the keyword 'insomnia' numbered 20 in fiscal year 2005. The number of competing R01 insomnia applications has increased relatively rapidly and may reflect, in part, interest stimulated by conducting the NIMH/NCSDR co-sponsored State-of-the-Science Consensus Conference on Insomnia Management in 2005.

      - NIH-wide there were 5 institutional training grants (T32) in FY2005 as identified by 'sleep' or 'circadian' in the title based on NIH information reflecting award data.

      - Relatively few individual research training (K and F) applications are received in sleep/circadian sciences;

      - The ratio of R01 to F&K applications with the key words 'sleep' or 'circadian' in the title was about 5:1 (180/36) in FY2005. In comparison, the ratio of all R01 to F&K applications NIH-wide was 3:1 (6,762/21,745) in FY2005.

  • Discussion by the Board indicated concern that a regular 'pipeline' for training of new sleep researchers is insufficient, and that the number of competing applications does not seem to reflect the momentum added by recent scientific advances linking "sleep" to "health". It was generally agreed that this continues to be a significant challenge to the sleep and circadian community and to the professional sleep societies and advocacy organizations.

  • More broadly, the 'message' of what sleep and circadian science can contribute to other disciplines (e.g., genomics, systems biology, etc.) needs to be further enhanced and amplified.
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    PRESENTATION - PUBLIC HEALTH EDUCATION

  • Dr. Michael Smolensky gave a presentation outlining critical components of well established public health education and information dissemination models, and the challenges and opportunities inherent in developing appropriate public health messages regarding sleep.
  • Some of the major issues to be cognizant of in any public health education efforts include the need to:
    • - Assess/investigate community health needs, health risks & hazards;

      - Analyze determinants of health needs/risks;

      - Establish priorities;

      - Develop comprehensive policies/plans;

      - Implement policies/plans to address priority community needs;

      - Inform/educate the public, providers, policy-makers, other stakeholders;

      - Assess/evaluate outcomes of community based interventions.

  • Within any community health assessment model, there are 3 critical categories to consider in addressing development of any potential health education intervention:
    • - What is definitely known (sound scientific/medical evidence well accepted by most authorities);

      - What is probably known, (acceptable scientific or medical evidence based on odds ratio, relative risk, etc.);

      - What is unknown (requiring further research and investigation).

  • Discussion included a request by the Board to the NCSDR to help the Board focus on 'what is definitely known', 'what is probably known', and 'what is uncertain' in the context of potential public health interventions, messages or campaigns regarding sleep and sleep disorders.
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    PUBLIC REPORTS

  • Representatives of organizations with an interest in sleep were invited to provide a brief verbal update on their organization's activities since the last SDRAB meeting, and to highlight any upcoming events or items of interest. This was in addition to the written reports each organization was invited to provide to the Board included in the meeting binders.
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    TRANS-NIH SLEEP RESEARCH COORDINATING COMMITTEE (SRCC) REPORTS

  • Representatives of SRCC Institutes in attendance presented a brief update on their IC's current sleep research activities, and potential areas for further expanding their sleep-related grant activities and areas of focus. There was brief discussion emphasizing the value of ongoing communication between SDRAB and SRCC members.
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    REPORT OF SLEEP RESEARCH DIRECTIONS/PRIORITIES: NATIONAL INSTITUTE ON AGING (NIA)

  • Dr. Andrew Monjan presented an in-depth update on sleep research activities and directions at the NIA and took questions. In brief, Dr. Monjan highlighted the following:
    • - Prevalence of the range of sleep disorders across the life-span, but particularly among those aged 65 and over;

      - NIA's interest in systemic metabolism, and multiple morbidities, in sleep and aging;

      - Associations on health impacts of sleep loss and aging.

  • Dr. Monjan presentation concluded with several issues for future research consideration, including:
    • - Are there different causal mechanisms or co-factors with the onset of sleep disorders later in life?

      - What are the most effective and appropriate interventions and treatments for the older population affected by sleep disorders?

      - Can sleep loss increase stress, possibly facilitating development of chronic conditions, with higher prevalence among those in the lower socioeconomic strata?

      - What are the brain mechanisms underlying age-dependent changes in sleep?

      - How does sleep causally affect aging and disease, and how do aging and disease causally affect sleep?

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    OPEN BOARD DISCUSSION

  • Several Action Items were identified:
    • - The Board will hold regular monthly planning conference calls to discuss and fine-tune the agenda for the next general meeting.

      - The Board requested NCSDR explore the feasibility and logistics required to use web-based conferencing in lieu of an in-person meeting on June 19, 2007. If feasible, the option of holding 1 of the 2 annual meetings via electronic conferencing on an ongoing basis will be further explored.

      - The Board requested that the issue of enhancing interactivity and ability to assess stakeholder needs be a future meeting agenda item.

      - The Board requested an evaluation of sleep applications and grants per investigator trends over the last decade for the next Director's Report.

      - The Board requested that NCSDR develop a planning exercise for the next monthly conference call to help the Board organize their views on what is "definitely" known, what is "probably" known, and what is "uncertain" with respect to potential approaches to better address the need for public health messages regarding sleep and sleep disorders.

      - The Board endorsed an NCSDR proposal to explore how existing administrative resources could be used to improve our understanding of how sleep/circadian research is developing as a discipline. As a first step, a "family tree" styled graphic will be attempted using automated software to portray various dimensions of interaction between authors and trainees-mentors. The idea was derived from a family-tree project started by the Society for Research on Biological Rhythms.

      - The NCSDR will explore options to incorporate additional information into its website regarding the NIH grants process, primarily via identifying specific links to NIH webpages that provide more information and guidance.

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    NEXT MEETING

  • The next regularly scheduled SDRAB meeting is June 19, 2007. As indicated, the plan is for this meeting to be held via electronic conferencing technology. Additional details and guidance will be forthcoming.
  • These Minutes will be presented to the full Board at its next regularly scheduled meeting for consideration, amendment as approved, and formal adoption.

    Note: The Video Archive file of this meeting, and prior SDRAB meetings, are available at no cost to view via the NIH Video Conferencing Website at http://videocast.nih.gov/PastEvents.asp?c=26. Additional requirements and technical information regarding accessing NIH Videocasts can be found at http://videocast.nih.gov/. Additional information about the Sleep Disorders Research Advisory Board (SDRAB) can be accessed online at http://www.nhlbi.nih.gov/meetings/sdrab/index.htm

    CERTIFICATION

    I hereby certify that the foregoing minutes are accurate and complete.

    Phyllis Zee, MD, PhD
    Chair, Sleep Disorders Research Advisory Board

    Michael Twery, PhD
    Executive Secretary, Sleep Disorders Research Advisory Board

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