Goal 3: Identify Gaps and Opportunities to Accelerate the Clinical Implementation of Sleep and Circadian Research and Protect Public Health

Rapid advancements in informatics, targeted use of electronic health records (EHRs), and telemedicine in the delivery of health care hold great promise in addressing the need for quality health care for all. The immense potential inherent in digital health, which includes mobile health (mHealth) technologies to transform health care, personal health management, and basic health research offers scalable options for treating sleep deficiency and sleep and circadian disorders at a population level. Digital health could be particularly relevant to underserved populations as cell phones and Internet access become more ubiquitous – reducing barriers that limit access to quality health care and providers. Intriguingly, gamification of health care in under-resourced communities is an underexplored area that could have a global impact. By leveraging information technology and data science to deliver quality health care through innovative approaches, the research and medical communities can dramatically change the healthcare landscape. Evidenced-based medicine is needed to guide implementation of these novel approaches into health care systems and health services research. Dissemination and implementation trials will be critical to inform these new directions.

This research would:

  • Incorporate sleep and circadian research into healthcare delivery to enable natural experiments and continuous improvements in healthcare delivery.
  • Reduce barriers and promote facilitators for more widespread, efficient, and effective healthcare delivery.

High-Priority Research Areas

Innovations in Data Collection and Application to Treatment

  • Develop common measures and protocols to collect omics and sleep and circadian data and integrate that data with EHRs, databases, and platforms to better predict healthcare utilization, transitions of care, and cost effectiveness.
  • Identify patient, provider, and system-level factors that influence the detection, testing, and self-management of sleep and circadian disorders.
  • Develop and implement clinical decision support systems that can be integrated into EHRs to provide high-quality care to patients with sleep and circadian disorders. These efforts can also reduce geographic and provider-based variations in practice, particularly in low-resourced clinical settings.
  • Incorporate the Alcohol Use Disorders Identification Test (AUDIT) or AUDIT-Consumption (AUDIT-C) into sleep screening to identify patients who are hazardous drinkers or have active AUD and are at risk for developing alcohol-induced sleep disorders and/or sleep-disordered breathing (SDB) to improve patient outcome and reduce healthcare costs.

african american female doctor doing a consult via web conference with a young african american patient

woman sitting down on a hospital bed bed smiling at her partner

Improvements in Clinical and Implementation Trial Designs

  • Explore methods to circumvent “healthy volunteer bias” in conventional observational cohorts, clinical trials, registries, and repositories, and improve representation among populations that are typically under-represented (NIH-defined under-represented) such as older adults ages 65 and older, and individuals with disabilities.
  • Utilize/develop informatics-based approaches to determine areas of clinical interest and implementation requirements for appropriate implementation science trial design and execution.
  • Perform cost-effectiveness research on the treatment of sleep and circadian disorders in integrated healthcare systems, with an emphasis on meaningful patient outcomes (e.g., health-related quality of life, hospitalization, morbidity, and mortality).
  • Promote the dissemination and implementation of a stepped-care approach for the treatment of SDB in patients with prehypertension or treatment-resistant hypertension.