Participate in On Demand Activity
	Activity Details PDF
	There are no course materials for this activity
	Download Slides
	Subscribe to Podcast
	Download MP3 File
	See All Journal Club Dates
	Complete Post-Test/ Print CE Certificate

	Faculty
	Statement of Need
	Activity Goal
	Learning Objectives
	Target Audience
	Financial Support
	Credit Information

neuroscienceCME Journal Club

Premiere Date: Tuesday, September 29, 2009

This activity offers CE credit for:

1. Physicians (ACCME/AMA PRA Category 1)
2. Nurses (CNE)
3. Pharmacists (ACPE)
4. Psychologists (APA)
5. Social Workers (NASW)
6. Certified Case Managers (CCMC)

All other clinicians will either receive a CME Attendance Certificate or may choose any of the types of CE credit being offered.
Credit Expiration Date:
Wednesday, September 29, 2010

Faculty

Thomas Roth, PhD (Guest Host) Director, Sleep Disorders and Research Center Henry Ford Hospital Clinical Professor of Psychiatry University of Michigan School of Medicine Detroit, MI

Derk-Jan Dijk, PhD (Featured Author) Professor of Sleep and Physiology Director, Surrey Sleep Research Centre The University of Surrey Guildford, UK

Statement of Need

Evolving research in the field of sleep-wake medicine has offered insights regarding the linkage between sleep disturbances and adverse consequences related to performance, mood, behavior, and medical illness. Unremitting symptoms of excessive sleepiness related to sleep disordered breathing or circadian misalignment can have a significant impact on overall health and quality of life. As developments in the science of sleep-wake medicine emerge, there is a need to understand the implications of the data for clinical practice and for improved patient outcomes. In these interactive, evidence-based neuroscienceCME Journal Club sessions, the faculty will explore data on the genetic link to sleep loss and circadian misalignment, the impact of sleep disordered breathing on quality of life, and the neurobiology of sleep-wake control and translate the evidence into clinical insights that can improve patient outcomes.

---

• Shepard JW Jr, Buysse DJ, Chesson AL Jr, et al. History of the development of sleep medicine in the United States. J Clin Sleep Med 2005;1:61-82.

Featured Article: Viola AU, Archer SN, James LM, et al. PER3 polymorphism predicts sleep structure and waking performance. Curr Biol 2007;17:613-618.
View Abstract

Summary: PERIOD genes are known to regulate circadian rhythm. Antoine Viola and Simon Archer, et al looked at the circadian clock gene, PERIOD3 (PER3) as a predictor for sleep structure and waking performance. The gene PER3 has been thought to affect differences in sleep structure and waking performance, i.e., sleep timing and circadian rhythmicity, but not sleep homeostasis.

A variable-number tandem repeat (VNTR) polymorphism is present in the coding region of PER3 where a motif encoding 18 amino acids is repeated either four times, allele PER3⁴ or five times, allele PER3⁵. This polymorphism has previously been reported to be associated with diurnal preference and delayed-sleep-phase syndrome (DSPS). Out of an initial population of 404 men and women, 24 patients were selected solely on the basis of their genotype, as matched pairs of individuals who were homozygous for the PER3⁴ and PER3⁵ alleles. Ten PER3^5/5 (4 women, 6 men; age ± standard error of the mean = 25.2 ± 1.1yr) and 14 PER3^4/4 (6 women, 8 men; 24.8 ± 1.0 yr) closely matched for age, sex, and ethnicity and without sleep complaints completed both the field and laboratory studies. Subjects participated in a field study where the timing of their sleep-wake cycle was characterized, followed by an additional intensive study in which circadian rhythms and homeostatic aspects of sleep regulation and performance were quantified under baseline conditions and during sleep loss; subjects were kept awake in dim light (< 5 lux) for approximately 40 hr in a semirecumbent posture.

The circadian rhythms of plasma cortisol and melatonin were found to be “remarkably similar” in the two genotypes. The two genotypes differed greatly with regard to sleep propensity, electroencephalogram (EEG) during wakefulness and sleep, and waking performance. “Whereas during baseline, no differences were observed in rapid eye movement (REM) sleep, stage 1 or 2 sleep, or total sleep time, PER3^5/5 [long repeat allele] subjects fell asleep more readily then PER3^4/4 [short repeat allele] subjects, indicating a greater sleep propensity.” The biggest difference between the two genotypes was observed early in the morning on the second day of sleep deprivation. Of note, PER3^5/5 homozygotes performed very poorly in the hours after melatonin midpoint, but the decrement in waking performance of PER3^4/4 homozygotes was far less. For those patients homozygous for the long repeat allele or PER3^5/5, there appears to be a higher sleep pressure during the waking day, and harder for this genotype to sustain good performance during the biological night than for patients homozygous to PER3^4/4. As stated by the authors, the major differences occurred during nadir (late night and early morning hours) during which performance is poorest and sleep propensity is strongest and a time when vulnerability to sleepiness-related accidents and impairment related to shift work sleep disorder is observed. The PER3⁵ allele has been associated with “extreme morning preference,” and the PER3⁴ allele has been linked with DSPS. This prospective study suggests that PER3 VNTR affects key markers of sleep homeostasis, including sleep latency, slow-wave sleep (SWS), theta activity in the waking EEG, and the decrement in waking performance in response to sleep loss.

The PER3 polymorphism shows considerable effects on the three vigilance states and an individual’s propensity for being a “morning person,” i.e., PER3^5/5 or an “evening person,” i.e., PER3^4/4 which suggests this is an important marker for individual differences in sleep and susceptibility to sleep loss and circadian misalignment disorders such as shift work sleep disorder and jet lag disorder.

Activity Goal

To translate new evidence in the literature into improved treatment of sleep-wake disorders.

Learning Objectives

At the end of this CE activity, participants should be able to:

• Recognize the relationship between genetics and individual differences in susceptibility to sleep loss and circadian misalignment.

The following learning objectives pertain only to those requesting CNE credit:

• Recognize the prevalence and impairment associated with circadian rhythm misalignment.
• Discuss the relationship between genetics and individual differences in susceptibility to sleep loss and circadian misalignment.

Target Audience

Physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers, certified case managers, pharmacists, and other healthcare professionals interested in sleep-wake medicine.

Financial Support

CME Outfitters, LLC, gratefully acknowledges an independent educational grant from Cephalon, Inc., in support of this CE activity.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CME Outfitters, LLC, designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.

CNE Credit (Nurses):
This continuing nursing education activity was approved by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

It has been assigned approval code 7ZEJZA-10. 1.0 contact hours will be awarded upon successful completion.

CEP Credit (Psychologists):
CME Outfitters is approved by the American Psychological Association to sponsor continuing education for psychologists. CME Outfitters maintains responsibility for this program and its content. (1.0 CE credits)

NASW Credit (Social Workers):
This program was approved by the National Association of Social Workers (provider #886407722) for 1 continuing education contact hour.

CCMC Credit (Certified Case Managers):
This program has been approved for 1 hour by the Commission for Case Manager Certification (CCMC).

CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
Universal Program Number: 376-000-09-022-L01-P (Live), 376-000-09-022-H01-P
Activity type: Knowledge-based

Post-tests, credit request forms, and activity evaluations can be completed online at www.neuroscienceCME.com (click on the Testing/Certification link under the Activities tab–requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit www.neuroscienceCME.com/technical.asp.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Roth has disclosed that he receives grant support from Aventis, Cephalon, Inc., GlaxoSmithKline, Neurocrine Biosciences, Inc., Pfizer, Inc., Sanofi-aventis, Schering-Plough Corporation, Sepracor, Inc., Samaxon Pharmaceuticals, Inc., Syrex, Takeda Pharmaceuticals North America, Inc., TransOral Pharmaceuticals, Inc., Wyeth Pharmaceuticals, and XenoPort, Inc. He serves as a consultant to Abbott Laboratories, Acadia Pharmaceuticals Inc., Acoglix, Acorda Therapeutics, Actelion, Addrenex Pharmaceuticals, Inc., Alchemers, ALZA Corporation, Ancil, Arena Pharmaceuticals, AstraZeneca Pharmaceuticals LP, Aventis, AVER, Bayer, Bristol-Myers Squibb Company, BTG, Cephalon, Inc., Cypress Pharmaceutical, Inc., Dove Pharmaceuticals, Eisai Pharmaceuticals, Elan Pharmaceuticals, Inc., Eli Lilly and Company, Evotec Inc., Forest Laboratories, Inc., GlaxoSmithKline, Hypnion Inc., IMPAX Laboratories, Inc., Intec Pharma, Intra-Cellular, Jazz Pharmaceuticals, Johnson & Johnson Pharmaceutical Research & Development, L.L.C., King Pharmaceuticals, Inc., H. Lundbeck A/S, McNeil, MediciNova, Inc., Merck & Co., Inc., Neurim Pharmaceuticals, Neurocrine Biosciences, Inc., Neurogen Corporation, Novartis Pharmaceuticals Corporation, Orexo AB, Organon International, Otsuka America Pharmaceutical, Inc., Prestwick Pharmaceuticals, Inc., Proctor & Gamble, Pfizer, Inc., Purdue Pharma L.P., Resteva, Roche, Sanofi-aventis, Schering-Plough Corporation, Sepracor, Inc., Servier, Shire Pharmaceuticals, Somaxon Pharmaceuticals, Inc., Syrex, Takeda Pharmaceuticals North America, Inc., TransOral Pharmaceuticals, Inc., VANDA Pharmaceuticals, VivoMetrics, Wyeth Pharmaceuticals, Yamanouchi Pharma America, Inc., and XenoPort, Inc. He is on the speakers bureau for Cephalon, Inc., Sanofi-aventis, and Takeda Pharmaceuticals North America, Inc.

Dr. Dijk has disclosed that he receives grant support from Biotechnology and Biological Science Research Council (BBSRC), GlaxoSmithKline, H. Lundbeck A/S, Merck & Co., Inc., Organon International, Philips Lighting, Takeda Pharmaceuticals, US Air Force Office of Scientific Research (AFOSR), and Wellcome Trust. He serves as a consultant to, or is on the advisory boards of, Actelion, Cephalon, Inc., Eli Lilly and Company, GlaxoSmithKline, H. Lundbeck A/S, Merck & Co., Inc., Pfizer Inc., Philips Lighting, Sanofi-aventis, Takeda Pharmaceuticals, and Wyeth Pharmaceuticals.

Unlabeled Use Disclosure

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

CME Outfitters, LLC, the faculty, and Cephalon, Inc., do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).

JC-008-092909-05