Sleep Disorders Research Advisory Board (SDRAB) Meeting – April 7, 2022

BOARD MEMBERS PRESENT

Dr. Gabriel Haddad, Chair
Dr. Si Baker-Goodwin
Dr. Jeffery Durmer
Dr. Mariana Figueiro
Dr. Erik Herzog
Ms. Ebony Lay
Dr. Alberto Ramos
Dr. Tom Scammell
Dr. Esra Tasali
Dr. Wendy Troxel
Ms. Alexandra Wharton

BOARD MEMBERS ABSENT

Dr. Judette Louis

EX OFFICIO MEMBERS PRESENT

Dr. Marishka Brown, NHLBI, Executive Secretary
Dr. Yejun He
Dr. Shahla Jilani
Dr. Karen Lee
Dr. Miroslaw Mackiewicz
Dr. Donald Shell

FEDERAL EMPLOYEES: Thirty Federal employees were in attendance via Zoom

MEMBERS OF THE PUBLIC: The total number of public attendees (including researchers, clinicians, patients, and other stakeholders) watching online reported by Zoom was forty.

CALL TO ORDER, Dr. Marishka Brown

• The meeting was called into session at 12:00 PM ET as announced in the Federal Register on March 9th, 2022 [FR Doc. 2022-04982]. This meeting was fully open to the public according to provisions of US code and Federal Advisory Committee Act as amended. The Chair, Dr. Haddad introduced members of the Sleep Disorders Research Advisory Board (SDRAB) and the Ex Officio members.

OPENING REMARKS, Dina Paltoo, Ph.D., M.P.H, Assistant Director, Scientific Strategy and Innovation in the Immediate Office of the Director at NHLBI

• Dr. Paltoo thanked SDRAB members for their service, and appreciated the commitment of NHLBI for driving sleep and circadian research forward. The three retiring members (Dr. Louis, Dr. Figueiro, Dr. Troxel) were acknowledged for their valuable service to the Board and the new members (Dr. Durmer, Dr. Herzog, Ms. Lay, Dr. Ramos, Dr. Scammell, Dr. Tasali, and Ms. Wharton) were welcomed. She thanked the NCSDR director for her leadership and reiterated NHLBI’s full support for her and for NCSDR as a whole.

DIRECTOR’S REPORT FROM THE NATIONAL CENTER ON SLEEP DISORDERS RESEARCH, Dr. Marishka Brown

• Thanked retiring members and highlighted their immense role in preparing the Sleep Research plan and other sleep research related activities.
• Introduced and welcomed incoming SDRAB members.
• Highlighted the Congressional Briefing organized by the sleep and circadian research and sleep and circadian disorder patient advocacy communities.
• Future research directions in sleep medicine that could be pursued were highlighted and recommendations on research directions were requested from the board.
  • The AHRQ draft recommendation statement for Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea and the Draft Recommendation Statement from the U.S. Preventative Services Task Force for screening Obstructive Sleep Apnea (OSA) in adults was presented and guidance sought from the Board in the area of OSA research as it pertains to the screening of OSA, the definitions of asymptomatic and symptomatic OSA, and what research directions should be considered.
• Upcoming national meetings and conferences including American Thoracic Society, Society for Research on Biological Rhythms, and SLEEP 2022 were highlighted. Expiring Sleep and Circadian funding opportunities were highlighted.
• Leadership Lens participation for the next two SDRAB meetings were communicated: the Deputy Director of the Division of Neuroscience and Behavior at NIDA (August) and the NIMHD director (December).

LEADERSHIP LENS: National Institute on Aging Director, Richard J. Hodes, M.D.

• NIA’s current strategic mission and budget appropriations were presented.
• High-priority topics of interest were described including increasing interest in sleep and circadian clock research in aging and Alzheimer’s Disease (AD) across the NIH indicating NIA is the second largest supporter of sleep and circadian clock research at NIH.
• Active NIA Alzheimer’s Disease and Related Dementias AD/ADRD clinical trials were demonstrated with data presented on various interventions.
• Activities and interest in sleep and circadian research across the four divisions of NIA (Behavioral and Social Research, Neuroscience, Aging Biology, Geriatrics and Clinical Gerontology) and NIA’s small business programs were described.
• Recent research examples and scientific advancement on sleep research was demonstrated.
• Upcoming funding and research opportunities were shared and encouraged to contact NIA program official to discuss interest and for more information.

SDRAB Discussion with NIA Director:

• NIA’s support and opportunities for early stage investigators and trainees.
• The role played by the research community to encourage publications and sleep and circadian work were highlighted and encouraged collaboration.
• NIA supported research in the intersection area of aging and sleep/circadian science, including supplemental support to add sleep and circadian study to existing studies and prioritizing areas for interventions with sleep and circadian rhythms.

Scientific Focus Presentation: North American Prodromal Synucleinopathy (NAPS) Consortium for REM Sleep Behavior Disorder. Bradley F. Boeve, M.D. and Yo-El S Ju, M.D., Co-Principal Investigators, NAPS Consortium

• The speakers described clinical features of REM sleep behavior disorder, historical perspectives including neurodegenerative disease association and synucleinopathy association, key knowledge gaps, hypothetical timeline of isolated RBD and associated clinical manifestations, and preparing for clinical trials to potentially delay the onset of and prevent the development of dementia/parkinsonism/autonomic dysfunction.
• Speakers provided full description of the NAPS Consortium and why it was formed to address research needs. NAPS1 and extension of the program with new NAPS2.
• SDRAB discussed whether there are hypotheses for sex differences across certain areas, late in seeking medical attention and potential limits in self-reported data, and social context of the condition including patient partner or relational outcomes. Also, if there are data available, about how partners are affected, RBD being a gating of consciousness issue, and relationship of alcohol with RBD; data collected by the NAPS Consortium.

NIH Federal Stakeholder Update: LTC/P Scott G. Williams, M.D., FACP, DFAPA, FAASM Director, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research

• An overview of the branches within behavioral biology branch and its components (performance assessment and chemical evaluation, sleep research center, and operational research team) were given.
• Discussion on the threat faced by soldiers with regard to sleep, phase misalignment and fatigue and current, interim, and future plans for interventional research to address these issue were described.
• SDRAB discussed rapid circadian shifting, effects of high light levels penetrating the eye-lids during sleep, details of transcranial electrical stimulation and potential effects on sleep stages as well as study applicability and tailoring of this intervention to this population and possible combination with pharmacological interventions.

NIH Federal Stakeholder Update: CDR Christopher Steele, Ph.D. Director, Military Operational Med Research Program Chair, Joint Program Committee-5, Department of Defense

• Discussed recent sleep initiatives in DoD, introduced Military Operational Medicine Research Program (MOMRP) program, its needs and requirements, and studies related to sleep and fatigue mitigation, and novel sleep mechanisms.
• Described MOMRP director roles, mission and portfolios (science in environment, injury, physiology, and psychology), and MOMRP executing intramural labs.
• Highlighted a few DoD’s sleep initiatives; applied efforts for fatigue with data capture, analytics with wearable support, making data available and easily integrated with planning, timely feedback to individual and leaders, and risk quantification.
• Described current programs like Crew Readiness, Endurance & Watchstanding (CREW) program with its primary initiatives, and progress of O2x workshop.
• Novel sleep mechanisms (monitoring & manipulating the human glymphatic system) and project goals and status were described.
• Openly welcomed collaborations with the DoD in sleep and circadian efforts.

Trans-NIH Sleep Research Coordinating Committee Programmatic Focus Office of Research on Women’s health (ORWH)
Jaime White, M.S. and Shilpa Amin, M.D., M.B.Sc., M.J., CAQ, FAAFP

• Described the ORWH mission, 2019-2023 NIH wide strategic plan and goals for women’s health research, how women’s health research is defined; demonstrated the multidimensional framework that represents intersection of factors affecting the health of women, why sex and gender matter in biomedical research, ORWH resources including E-learning to help educate biomedical enterprise on sex and gender; and all NIH wide programs.
• Brief overview were given on the various programs (R01, BIRCWH, SCORE, and administrative supplements); and how the NIH sleep research plan targets sex differences and sets high-priority research areas in the health of women.
• Described how sleep disorders strike women uniquely over the life course; sex and gender considerations in sleep (including ratio of OSA, menopausal transition state, physiology, atypical symptoms of SDB).
• Described current sex and gender research opportunities at NIH and needs for sleep research in women.

STAKEHOLDER UPDATES

Title: The American Academy of Dental Sleep Medicine: Bridging the Gap to Better Treat OSA.
David Schwartz, D.D.S., President, American Academy of Dental and Sleep Medicine

• Discussed oral device therapy research outcomes and how it is used for treating sleep apnea.
• Overview of how dentists are facilitating sleep apnea screening and treatment. Creation of American Academy of Dental Sleep Medicine (AADSM) Mastery Program in 2018 for screening sleep apnea and provide dental device treatment and follow up.
• Updated on provider and patient awareness activities and resources; AADSM Guidelines for standards of practice, defining and measuring compliance, and treatment efficacy resources.
• Ongoing AADSM-sponsored research initiatives were then described, brief update on AADSM 30th anniversary meeting, and showcased 2022 AADSM research achievements.
• SDRAB discussed medical insurance and Medicare coverage and effectiveness of oral devices and co-therapy with patients that are not adherent to CPAP.

Title: Sleep in America® Poll 2022: Opportunities for improving sleep health.
Erin Koffel, PhD, LP, Senior Director of Research and Scientific Affairs

• Described the National Sleep Foundation (NSF) mission and goals and indicated that NSF is a resource for the public and solely dedicated to public sleep health and well-being
• Provided results of Sleep in America Poll 2022: opportunities for improving sleep health, and results of sleep health during COVID-19 pandemic.

Title: American Academy of Sleep Medicine/American Academy of Sleep Medicine Foundation Updates
Jennifer Martin, Ph.D., Board of directors for the American Academy of Sleep Medicine (AASM)

• Described the mission of the AASM and highlighted several activities:
  • OSA awareness grant issued by the CDC,
  • The Sleep 101 symposium with NCSDR,
  • 2022 insomnia collaboration summit to discuss diverse practice models for screening, diagnosing and treating insomnia,
  • Advocacy activities to improve patient care,
  • Recent and upcoming publications including clinical practice guidelines and clinical guidance statements
• The Board discussed the planned insomnia summit, AI certification program goals, public policy communications and collaborations with other relevant societies (ATS, Neurology, etc.), importance of having patient advocates to participate during summits, and ongoing conversations around the apnea-hypopnea index (AHI) including utilizing additional data from PSG for diagnosis and to assess sleep health.

PUBLIC COMMENT

• There were no public comments.

SDRAB INPUT TO NCSDR

The Chair opened this portion of the meeting with a description to systematically garner input from the Board in terms of priorities for NCSDR over the next 1-2 years. SDRAB discussed the processes for gathering this input, and discussed questions, issues, and suggestions to move forward. This included the following:

• Each board member would connect with their respective research and patient communities and bring feedback to the Board.
• Multi-disciplinary research should be encouraged to advance sleep and circadian science and to address societal needs.
• SDRAB discussed the example of Daylight Saving Time to highlight how education and awareness are important to bringing the science to relevant disciplines that are outside of the sleep and circadian fields but can be informed by the science generated by them – for example, the AHA webpages about the importance of sleep in cardiovascular disease.
• The discussion around obstructive sleep apnea included the definition of asymptomatic OSA, the heterogeneity of OSA, sample size of OSA research, phenotyping of diverse populations and presentation of symptoms in all groups.
• It was reiterated that NIH is open to considering meritorious applications that address the identified gaps.

UPCOMING EVENTS/CLOSING REMARKS

• Upcoming events were highlighted including Sleep and Big Data seminar series (collaboration between NCSDR and NSRR) for 2022 , future SDRAB meetings, and NCSDR meetings with NCSDR staff in attendance (ATS, SRBR, Sleep 2022).
• Chair thanked the NCSDR director and her team, and thanked retiring SDRAB members for their service and again welcomed the new members to SDRAB. Meeting adjourned at 5pm.