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

Sleep Disorders Research Advisory Board Meeting Minutes

June 23, 2004

The 20th meeting of the SDRAB was convened at 8:45 a.m. on Wednesday, June 23, 2004, in Room D of the Natcher Conference Center on the National Institutes of Health (NIH) campus in Bethesda, MD. Dr. Stuart Quan presided as Chair.

TABLE OF CONTENTS

Attendees
Opening Comments
Report of the Director NCSDR
Population-Based Strategies-Dr. Richard Schuster
Education Activities
Public Reports
Police Officer Performance, Health, Safety, And Sleep Disorders-Dr. Bryan Vila
Other Business
Adjournment
Certification


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Sleep Disorders Research Advisory Board Page


BOARD MEMBERS PRESENT

Dr. Stuart F. Quan (Chair)
Dr. Gene Block
Dr. Sarah Caddick
Ms. Sheila Connolly
Dr. Kathryn Lee
Dr. Rafael Pelayo
Dr. Gina Poe
Dr. Susan Redline
Dr. Clifford Saper
Dr. Lorraine Wearley

BOARD MEMBERS ABSENT

Dr. Michael Sateia
Mr. Phillip L. Williams

EX OFFICIO MEMBERS PRESENT

Dr. Carl E. Hunt, SDRAB Executive Secretary
Colonel Gregory Belenky
Dr. Regina T. Dolan-Sewell
Dr. Robert W. Greene
Dr. Merrill Mitler
Dr. Andrew Monjan

LIAISON MEMBERS PRESENT

Dr. Deborah Ader
Dr. Lindsey Grandison (for Dr. Ellen Witt
Ms. Mariel John (for Dr. Bette Siegel)
Dr. Kathy Mann Koepke
Dr. Roger Rosa

FEDERAL EMPLOYEES PRESENT

Mr. Al Golden, NHLBI
Ms. Sue Rogus, NHLBI
Ms. Ellen Sommer, NHLBI
Dr. Bryan Vila, National Institute of Justice, Department of Justice

MEMBERS OF THE PUBLIC PRESENT

Ms. Georgi Bell, Restless Legs Syndrome Foundation
Dr. Neal Farber, Kleine-Levin Syndrome Foundation
Mr. Richard Gelula, National Sleep Foundation
Dr. Edward Grandi, American Sleep Apnea Association
Dr. Richard Schuster, Wright State University School of Medicine
Ms. Sharon Smith, Narcolepsy Network
Dr. Patrick Strollo, American Thoracic Society Assembly on Respiratory Neurobiology and Sleep
Dr. James Walsh, National Sleep Foundation

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OPENING COMMENTS - Drs. Carl E. Hunt and Stuart Quan

Dr. Quan welcomed the participants and asked them to introduce themselves.

Dr. Hunt called attention to NIH confidentiality/conflict of interest procedures and asked Board members to review them.

The minutes of the December 9, 2003, SDRAB meeting were adopted unanimously.

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REPORT OF THE DIRECTOR, NCSDR Dr. Carl E. Hunt

Dr. Hunt reported on the following issues:

Sleep Research Budget: NIH funding for sleep research has increased 159 percent since 1996 to almost $200 million in Fiscal Year (FY) 2003. The projected budget for FY 2004 is $205-$210 million. Details for projected sleep research funding for FY 2004 can be found in the 2003 Annual Report of the Trans-NIH Sleep Research Coordinating Committee (http://www.nhlbi.nih.gov/health/prof/sleep/sleep-03.htm )

NIH Roadmap: NIH Director Dr. Elias Zerhouni has established the NIH Roadmap to identify major gaps and opportunities in medical research that no single NIH Institute or Center can address independently but that need to be addressed by multiple NIH Institutes. The Roadmap's 5-year budget is $130 million for FY 2004 and $2.1 billion over 5 years.

NHLBI Research Initiatives: Request for Applications (RFA) HL-04-017, Specialized Centers for Cell-Based Therapy for Heart, Lung, and Blood Diseases. Sleep disorder-related applications are encouraged.

National Sleep Conference: The first National Sleep Conference-Frontiers of Knowledge in Sleep and Sleep Disorders: Opportunities for Improving Health and Quality of Life-was held March 29-30, 2004. The conference focused on developing strategies to more effectively apply what is known about sleep and sleep disorders to change clinical and public health practice and, therefore, sleep-related health. More than 350 attended the conference and another 120 viewed it by videocast. The videocast, a conference summary and other information can be found at http://www.nhlbi.nih.gov/meetings/slp_front.htm. Comments made at the meeting by U.S. Surgeon General Dr. Richard Carmona will also be placed on this Web site.

Dr. Hunt reported on the following postconference activities:

- The revised guidelines on congestive heart failure produced by the American Heart Association (AHA) and the American College of Cardiology (ACC) will address sleep apnea. The AHA's Hypertension Primer includes a section on sleep apnea/disorders. An AHA Scientific Statement on Sleep Apnea and Cardiovascular Disease (CVD) was commissioned. The writing group is chaired by Dr. Virend Somers and includes Drs. Hunt, Terry Young, and David White. The American Academy of Family Practitioners will be asked to include an article on the cardiovascular implications of sleep disorders in its journal.

- A sleep health translation project will target nurses and nurse practitioners. There will be e-mail contact with all conference attendees from nursing disciplines. At the June, 2005 meeting of the Associated Professional Sleep Societies, they will conduct a session related to health care cost reimbursement for nurses.

- The media showed considerable interest in the conference. Articles appeared in Newsday, JAMA Medical News, and several newspapers, and there was also wire coverage and online coverage. "A Nation's Wake-up Call," an article by Dr. Bernadine Healy, is available at http://www.usnews.com/.

- The SDRAB, the Trans-NIH Sleep Research Coordinating Committee (SRCC), and other Conference Co-Sponsors are developing recommendations for public health initiatives. These initiatives will be integrated with other population-based initiatives of the NHLBI's Office of Prevention, Education, and Control (OPEC) as appropriate, and will be circulated to other organizations represented at the conference. Follow-up with the Office of the U.S. Surgeon General will also explore opportunities for further collaboration. A task force will make final recommendations for dissemination and implementation.

State of the Science Conference: The State-of-the-Science (SOS) Conference on Manifestations and Management of Chronic Insomnia in Adults will be held in June 2005. Similar to Consensus Development Conferences, SOS Conferences are coordinated by the NIH Office of Medical Applications of Research (OMAR). A Consensus Panel will conduct a systematic literature review and then hold a 2-day conference that includes expert testimony, public input, a press conference, and a final statement. The lead sponsor for this SOS conference is the National Institute of Mental Health (NIMH); cosponsors include the NCSDR (NHLBI), seven other NIH Institutes and Offices, and other federal agencies. Dr. Alan Leshner will chair the Consensus Panel. He is CEO, AAAS and Executive Editor, Science, and is a past Director of NIDA.

The conference will address five questions:

1) What defines chronic insomnia and what is its morbidity and natural history?
2) What is the extent and magnitude of the public health burden associated with chronic insomnia?
3) Who is at risk and should be treated?
4) What are the benefits and harmful effects of available treatments alone or in combination?
5) What are important future directions for insomnia-related research?

The Planning Committee meets in late June to finalize the questions to be posed to the Consensus Panel, develop a draft conference agenda and potential speakers, suggest potential Consensus Panel members, finalize the conference date, and plan for conference publicity.

4th Report on High Blood Pressure in Children and Adolescents: This report will update clinicians on the latest evidence regarding blood pressure in children and provide recommendations for diagnosis, evaluation, and treatment. While the first three reports did not mention sleep, this report identifies sleep as one of the therapeutic lifestyle changes encouraged for normal children. For hypertensive children, it recommends evaluation for sleep disorders. The report will be a special supplement to the July 1, 2004, issue of Pediatrics. It was presented at meetings of the Pediatric Academic Societies and American Society of Hypertension in May 2004.

Institute of Medicine (IOM) Proposal: A proposal is being developed for an IOM study entitled "Development of Strategies and Recommendations for Enhanced Support of Sleep Medicine and Sleep Research in Academic Health Centers." The total project cost is $810,000, and the application to the NIH Office of Evaluation for "1% Set-Aside" funding will be completed shortly. 55% of the total cost will be funded through the 1% Set-Aside, and the other 45 percent will be funded by non-Federal sponsors including the American Academy of Sleep Medicine, National Sleep Foundation (NSF), and Sleep Research Society. It will take approximately 18 months to complete the report for the study. (See "Other Business" for further discussion of this topic.)

National Children's Study: The National Children's Study will examine the effects of environmental influences on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study will begin enrollment in FY 2005 and will cost $150 million in its first year. Funds have thus far been committed for planning but not for the conduct of the study. The study's five outcome themes/hypotheses include (1) undesirable outcomes of pregnancy (birth defects and preterm birth); (2) altered neurobehavioral development, developmental disabilities, and psychiatric outcomes; (3) injury; (4) asthma; and (5) obesity and altered physical development.

NCSDR has proposed a brief series of questions regarding sleep history and sleep problems to be included as part of the core information collected periodically in all subjects. This study is led by a consortium of federal agency partners: the U.S. Department of Health and Human Services (including the National Institute of Child Health and Human Development [NICHD], National Institute of Environmental Health Sciences [NIEHS], Centers for Disease Control and Prevention [CDC]) and the U.S. Environmental Protection Agency (EPA). Information on this Study can be found at http://www.nationalchildrensstudy.gov/

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POPULATION-BASED STRATEGIES-Dr. Richard Schuster

Dr. Schuster noted that translation of research results to population-based strategies could help prevent what, typically, can be up to a 17-year delay from research to practice (as reported in the IOM's 2001 report, Crossing the Quality Chasm). He began by discussing the need for physician behavior change, which can change medical care delivery. "Eisenberg's Rules" for physician behavior change (in increasing order of importance) include education, administrative changes, participation, financial incentives, and feedback. Feedback is the most important because physicians are much more likely to respond when they see their data. Also, if you tell people you will study them, they will typically improve their performance (the "Hawthorne Effect"). Steps to improving quality include measuring physician outcomes and showing them their data, reviewing the guidelines (what they should be doing), giving them expectations (e.g., rates of testing), and showing them the data again. Information systems need improvement to allow utilization of electronic records.

Dr. Schuster discussed the need for a population-based approach to translate research to improve the health of a community. He spoke from his experience as Principal Investigator of one of the NHLBI's 12 Enhanced Dissemination Utilization Centers (EDUCs)-a project at the Wright State University School of Medicine's Division of Health Systems Management in Dayton, OH. The project's goals include improving physician practice behavior related to controlling cardiovascular disease (CVD) risk factors and increasing the number of people treated. Results of the project showed improvement in both blood pressure and cholesterol levels. The project also conducts the "Know Your Numbers" mass-media social marketing campaign in Dayton to increase knowledge and awareness of blood pressure and cholesterol. This campaign started 4 years ago and is funded at $200,000 per year. Partners include several pharmaceutical companies, and the campaign targets middle-aged women because they are the ones who generally make health care decisions. A successful commercial shows a woman and her family looking at a book of family photographs. The message is "Keep yourself in the picture. Know your numbers."

Dr. Schuster made the following suggestions to change behavior among physicians and the public.

To change physician behavior:

- Promote and conduct a social marketing campaign for sleep. This could be modeled on a campaign such as the Drug-Free America ("This is your brain on drugs") campaign. Social marketing campaigns last 3-5 years, so persistence in advertising is needed. Social marketing is expensive, but it can work. A spreadsheet demonstrated that for every $1,000 donated by local employers for the "Know Your Numbers" campaign, could save that employer $10,000 in reduced health care costs if the campaign reduced CVD incidence by 1 percent.

- Keep the message simple. See the IOM report Speaking of Health (2001) that provides advice on how to communicate health messages to the public. Educate the public about things they can influence themselves.

- Look for partners with the same mission and vision. Possible partners include pharmaceutical companies, insurance companies, WEB MD, and Holiday Inn Express.

- Potential ads could feature a fire fighter, teacher, and doctor with the message: "I get a good night's sleep, do you?" Make it a national campaign.

- Identify a target market-middle-aged women. Enlist a champion, such as Dr. Carmona. Measure system changes that do not require physicians to remember more or take more time. Use Eisenberg's principles to change physician behavior. Focus on one key area that is important and changeable.

- Develop a translational research program-such as the EDUC-for sleep disorders. Promote outcome measures.

- Pick the right issue. (Dr. Schuster suggested sleep disordered breathing [SDB] because it is common and treatable, and there is already significant awareness.) Fund studies in translational research to improve mechanisms to diagnose SDB in hypertensive patients and to tie the diagnosis of SDB to hypertension.

- Promote the prominence of obstructive sleep apnea (OSA) in the reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

- Suggest the National Committee for Quality Assurance list sleep apnea as a measure in insurance industry standards. Promote health care policy changes, working with systems influencers' such as insurance companies and the Centers for Medicare & Medicaid Services.

- Promote easier diagnosis of SDB by simplifying the criteria and equipment for diagnosis. Determine whether patients need to spend the night in a Sleep Center.

- Train medical office assistants to ask all patients with hypertension to talk to their doctors about OSA. Measure the number of sleep study referrals.

To change public behavior:

- Conduct a social marketing campaign for sleep. This could be modeled on a campaign such as the Drug-Free America ("This is your brain on drugs") campaign. Social marketing campaigns last 3-5 years, so persistence in advertising is needed. Social marketing is expensive, but it can work. A spreadsheet demonstrated that for every $1,000 donated by local employers for the "Know Your Numbers" campaign, could save that employer $10,000 in reduced health care costs if the campaign reduced CVD incidence by 1 percent.

- Keep the message simple. See the IOM report Speaking of Health (2001) that provides advice on how to communicate health messages to the public. Educate the public about things they can influence themselves.

- Look for partners with the same mission and vision. Possible partners include pharmaceutical companies, insurance companies, WEB MD, and Holiday Inn Express.

- Potential ads could feature a fire fighter, teacher, and doctor with the message: "I get a good night's sleep, do you?" Make it a national campaign.

- Identify a target market-middle-aged women. Enlist a champion, such as Dr. Carmona. Measure outcomes with a survey.

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EDUCATION ACTIVITIES - Ms. Sue Rogus, Ms. Ellen Sommer

Ms. Rogus reported that the Garfield Star Sleeper Campaign, with a major focus of reaching children, teachers, and parents through schools, is in its third year. However, since trying to influence a curriculum is difficult, a potentially more successful approach would be one that utilizes existing channels of dissemination to schools. Exploration of such channels led to an agreement with Time For Kids (TFK) to reach children in schools.

Ms. Sommer reported that the NCSDR worked with TFK, the in-school education arm of TIME Inc., to develop supplemental materials to accompany their weekly magazine, News Scoop, which goes to 30,000 third grade teachers and the 750,000 children in their classes. The materials included 1) a 4-page teachers' guide with information about sleep and suggestions for how to teach about it, and 2) a 4-page magazine for children with interactive games about sleep, including a poster containing sleep tips that they could take home and hang on their bedroom wall.

The materials were distributed for use during National Sleep Awareness Week in March and also placed on the TFK Web site. Prior to their distribution, they were promoted heavily to teachers so they would expect them and be prepared to use them. In addition, TFK used the Poll Zone on their Web site to ask children about: the main reason they do not get enough sleep (58 percent responded homework); how many hours of sleep they get (46 percent said 8-9 hours); and what they do to get a good night's sleep (46 percent said they relax an hour before bedtime).

An evaluation component includes teacher responses to TFK's semi-annual survey of teachers, which includes several special questions on the Garfield Campaign. The results will be available late this summer. The program will be repeated next year with 3rd grade teachers and their new classes, although minor modifications may be made depending on the teacher survey results.

A second major educational initiative is the Sleep, Sleep Disorders, and Biological Rhythms supplemental high school curriculum module that was developed jointly by the NHLBI and the NIH Office of Science Education (OSE). The curriculum was field tested, and received very positive reviews by teachers and students. The module has now been completed and was presented at the National Science Teacher's Association Meeting and announced by press releases from the OSE and NHLBI. It can be ordered from the OSE, or downloaded at http://science.education.nih.gov/supplements/nih3/sleep/default.htm

Another educational initiative involves the incorporation of sleep information into NHLBI's "Salud para su Corazon" (Health for Your Heart) program for CVD education in the Hispanic community. This program trains lay health workers (promotoras) who perform outreach in the community. During two promotora conferences in April and August 2004, Ms. Matilde Alvarado, who coordinates "Salud," organized sessions on sleep and sleep disorders to provide information to promotores, and to obtain their input regarding importance of each topic and need for language and cultural translation in future materials.

Ms. Rogus also reported that the current NCSDR public and professional sleep education materials need updating. Fact sheets for the public include those on sleep apnea, restless legs syndrome (RLS), narcolepsy, problem sleepiness, and insomnia. The NHLBI's new Diseases and Conditions Index (DCI) will be the vehicle for updating each of these fact sheets. The sleep apnea information has been completed, and the others are in process. DCI information for sleep apnea is available on the NHLBI Web site at http://www.nhlbi.nih.gov/health/health-topics/topics/SleepApnea/ , and there will be a template for quick-printing of hard copies developed.

NCSDR materials for health professionals include publications on sleep apnea, RLS, problem sleepiness, and insomnia. The insomnia information will be updated after the 2005 scientific conference Additional discussion is needed to prioritize the updating of all of these materials and to strategize a reasonable process for keeping the publications current. The results of the National Sleep Conference held in March 2004 will help shape these decisions.

The following comments were made during the discussion:

- The Sleep Research Society holds an annual high school essay contest. Consider incorporating this on the NCSDR Web site.

- Garfield Star Sleeper materials were shown at four prerelease screenings of the new Garfield movie, but other efforts to tie the program to the movie were not feasible.

- The Garfield messages have been tested in children, but it is difficult to do outcome evaluation. There is evidence that kids, parents, and teachers like Garfield. Parents are accepting of Garfield because he is less commercialized than some more recent characters, such as Power Rangers. A constraint is that perhaps not everybody is familiar with Garfield. Consider pairing a popular human with Garfield (e.g., the American Express ads with Jerry Seinfeld were successful).

- There are no current plans to focus on preadolescents (ages 11-13). Consider an outcome assessment to examine teenagers who were exposed to the Garfield program as young children.

- Overestimation of sleep hours is a problem. Instead of asking people how many hours they sleep (on the TFK online survey), ask what time they went to bed and what time they got up. A large sample of the population should be studied.

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PUBLIC REPORTS

Mr. Richard Gelula, Chief Executive Officer of the NSF, described NSF Alert, a weekly publication with a readership of 16,000 professionals, patients, and the members of the public. The NSF's National Sleep Awareness Week campaign (March 29-April 4) included 600 sleep community partners and two strategies: (1) to get others involved and (2) to institute policies and activities in the workplace, health care, education, and criminal justice. A patient brochure, "Driving When You Have Sleep Apnea," was developed in conjunction with the National Highway Traffic Safety Administration (NHTSA) and will be on the NHTSA Web site. A brochure titled "Melatonin-The Basic Facts" tells people to talk to their doctor rather than self-treat. Several materials, such as the Sleep Diary, are available in Spanish.

Dr. Neal Farber, Co-President of the Kleine-Levin Syndrome (KLS) Foundation, discussed efforts to raise awareness of KLS. Young teens with this rare neurologic syndrome have periodic episodes in which they sleep 20-22 hours per day for weeks, waking only to eat and go to the bathroom. They display altered behavior and loss of normal circadian patterns. KLS is underdiagnosed and underreported; the mean diagnostic delay is 4 years. The syndrome is found in 25 countries in all regions and ethnic groups. The KLS Foundation helps to network parents and provides a Web site, educational material for families and health care providers, data collection on the Web, and a Medical Advisory Board. Dr. Emmanuel Mignot is establishing a KLS research program at Stanford University.

Dr. Patrick Strollo, reporting for the American Thoracic Society Assembly on Respiratory Neurobiology and Sleep, said that OSA/hypopnea is a significant health risk-a chronic condition that requires ongoing disease management. The current paradigm for diagnosis and treatment cannot address the needs of the at-risk population. He mentioned the need to establish the minimum level of technological uniformity for portable monitors; develop consensus on reliable outcome measures that are biologically and economically relevant; and pursue innovative research protocols that compare the conventional polysomnography (based on diagnosis and treatment in the laboratory) with unattended (in-home) diagnosis.

Ms. Georgi Bell, Executive Director of the Restless Legs Syndrome Foundation, reported that the revised Web site (http://www.rls.org/ ) has had a 39 percent increase in the number of visitors. RLS Awareness Day will be held September 23. The International RLS Awareness Coalition has been launched in 20 countries. A new treatment algorithm will be published in the Mayo Clinic Proceedings in July 2004, and a national patient meeting and support group will be held in the fall. Five projects totaling $225,000 have been funded; they focus on basic science and epidemiology.

Dr. Edward Grandi, the new Executive Director of the American Sleep Apnea Association (ASAA), reported that the ASAA is pursuing an expanded initiative in pediatric sleep apnea and is developing a video for parents and children. Two new education bulletins include one on OSA and oral appliances and another on OSA and bariatric surgery. There is a renewed focus on the Alert, Well, And Keeping Energetic (AWAKE) network of support groups for patient compliance. Educational materials for physicians have been provided at medical conferences.

Ms. Sharon Smith, President of the Narcolepsy Network, said that strategic planning initiatives include revamping the Network's newsletter and Web site and revising educational materials (including a brochure on medications and one that targets parents and teenagers).

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POLICE OFFICER PERFORMANCE, HEALTH, SAFETY, AND SLEEP DISORDERS-Dr. Bryan Vila

Dr. Vila said that one of the National Institute of Justice's (NIJ's) major goals is to improve police officer performance, health, and safety through research, evaluation, and dissemination. He began his presentation by briefly recounting an incident in which an unarmed man was shot to death by police when they were pursuing a serial rapist. This event was influenced by the environment, perception, and decision-making, which can be influenced by work hours and lack of sleep.

There are approximately 19,000 law enforcement agencies in the United States and 800,000 full-time officers. Two-thirds of the officers work shifts, and half work night shifts. Overtime assignments are used to compensate for understaffing that is due to new crime prevention initiatives, retirements, too few qualified applicants, the post-9/11 increase in duties, and military reserve callups. Most officers work 25-125 overtime hours per month. Double shifts are common, and some officers work more than 3,000 overtime hours per year.

There are no comprehensive policies regarding officer work hours, fatigue, or alertness. Fatigue tends to adversely affect police officer performance, health, and safety by degrading the police officers' ability to operate tools of the job, interact effectively with people, form sound judgments, and make decisions-especially in the uncontrolled, erratic environment in which they operate.

Dr. Vila reviewed the evidence that sleep restriction leads to decreased performance. Short-term sleep deprivation produces decreases in brain activity and relative regional glucose levels. Laboratory studies indicate that being awake 17-19 hours is equivalent to a 0.10 percent blood alcohol concentration. Ninety percent of troopers surveyed in 1996 reported driving when drowsy, and 25 percent reported falling asleep at the wheel. An NIJ-funded pilot study of 400 officers in 4 agencies found that 16 percent reported trouble staying awake more than once a week while driving, eating, or during other social activities. Officers involved in accidents or injuries on the job were much more likely to have chronic schedule disruption. Fifty percent of those who took a FITTM test within 48 hours of the accident or injury failed the test (compared with usual failure rate of 19 percent).

Some causes of fatigue are unavoidable, but those that can be controlled are disruption and overwork due to shift work, schedule changes, overtime and extra shifts, off-duty court appearances, and moonlighting. Fatigue tends to be ignored by both managers and employees. Managers should be educated about shift work and fatigue, personnel assignment, shift rotation, and scheduling. Employees should be trained to get enough sleep and view fatigue as a safety issue.

Information is needed about the number of hours officers should work, best schedules to minimize police fatigue, and how to assess officer impairment and fitness for duty. Guidelines are needed in terms of limits for non-emergency work hours, characteristics of effective alertness assurance programs, and enforcement and education.

The NIJ is reviewing proposals for a study of comprehensive fatigue/alertness management strategies used by other occupational groups. An NIJ add-on, to examine variables related to fatigue and work hours, will be applied to a study at State University of New York at Buffalo, which has collected data on 700 officers in the Buffalo Police Department (including 19 percent women). A proposed NIJ supplement to an NIMH study of police academy recruits followed for 2 years into active duty work will include measures of sleep, fatigue, and performance.

Dr. Vila noted that results of these studies could help to untangle the relationship between stress, fatigue, and health-with results that are generalizable to other high-stress occupations. Though police are less able to resist change than the medical establishment, they are a powerful social icon and can help educate the public about drowsy driving and enforce drowsy driving laws.

During the discussion, the following points were made:

- Drug abuse is not included in any of the studies, though it is a concern. Urine samples are used to screen police for drug use.

- The results of studies of workload in police should be applied to physicians. There should be limits on physician work hours.

- Potential police departments for study are those with unions or with chiefs who want to change things.

- One of the new studies will include a cost/benefit analysis-the cost of overtime versus the cleanup of incidents resulting from fatigue.

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OTHER BUSINESS

Institute of Medicine (IOM) Initiative: The 1-Percent Set-Aside Evaluation Application for this study was reviewed by the Board. It was recommended that an emphasis on translational research be added to Section 1.3 (at the end under the fourth bullet). The Board voted unanimously to approve moving forward with finalizing and submitting this application.

National Sleep Conference Action Items/Priorities: The Board reviewed the proposed action items that were identified during Session 6 (Final Recommendations and Proposed Action Items). Dr. Hunt noted that education was a central theme in each of the sessions. Some key issues were increasing sleep literacy, promoting sleep as a vital sign, and focusing on sleep deprivation and its adverse consequences. The Board made the following comments and suggestions:

- Include more questions about sleep in JNC guidelines. The groundwork for this has been done; JNC 8 will likely include sleep in its document.

- Ask the NIH to issue an RFA for a demonstration project examining physician education and its results in terms of more referrals for sleep apnea.

- Consider whether education and awareness should be treated separately. Focus on decisionmaking-whether to screen, diagnose, and treat sleep disorders.

- Ask Dr. Carmona to make a public statement about sleep research. His comments at the National Sleep Conference will be widely distributed to articulate the charge and the direction we want to go. Dr. Quan suggested that Dr. Carmona's remarks could be published in the journal SLEEP.

- Dr. Jim Walsh said that the purpose of the translation conference was to jumpstart the identification of messages for the public. He said the NSF is ready to be a partner in the effort to push for public awareness.

- Identify mechanisms to fund translational research. Business partners are needed to help fund education efforts.

The Board noted that "translational" research is a new concept with many definitions. Although this term also refers to "bench-to-bedside," our focus is on bench-to-community and bedside-to-practice. Dr. Claude Lenfant's commentary in the New England Journal of Medicine (349; 9, 868-874 August 28, 2003) provides a rationale for translational research to address clinical practice and improve public health; this commentary will be distributed to all Board members. Public health education is an integral part of the NIH mission, but NCSDR and the Board will need to partner with other federal and non-federal partners to successfully improve sleep literacy, clinical practice, and sleep-related health and quality of life.

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ADJOURNMENT

Dr. Quan thanked the participants and adjourned the meeting at 3:00 p.m. EDT..

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CERTIFICATION

We certify that, to the best of our knowledge, the foregoing minutes are accurate and complete.


Stuart Quan M.D., Chair
Sleep Disorders Research Advisory Board



Carl E. Hunt, M.D., Executive Secretary
Sleep Disorders Research Advisory Board

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