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

neuroscienceCME Journal Club

Premiere Date: Monday, October 5, 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:
Tuesday, October 5, 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

Graciela E. Silva, PhD (Featured Author) Assistant Professor Southland Borders Scholar College of Nursing & Health Innovation Arizona State University Phoenix, AZ

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.

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• 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: Silva GE, An M, Goodwin J, et al. Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS). Sleep 2009;32:1049-1057.
View Abstract

Summary: Findings from population studies evaluating the progression and incidence of sleep disordered breathing (SDB) have shown evidence of longitudinal increase in severity of SDB. Some researchers have found that people with SDB will have lower quality of life. This study assessed the associations among changes in SBD, sleep quality, daytime sleepiness, and health-related quality of life (QOL) in participants in a multiethnic cohort design.

Initial baseline recruitment began in 1995, enrolling 6,441 subjects, 40 years of age and older, from several ongoing geographically distinct cardiovascular and respiratory disease cohorts that were initially assembled between 1976 and 1995.(1) The study focused on 3,078 participants who had sleep studies (polysomnogram) done during the initial and follow-up periods of the Sleep Heart Health Study. The primary outcomes were changes in the Physical Component Summary (PCS) and Mental Component Summary (MCS) scales obtained from the Medical Outcomes Study Short-Form Health Survey (SF-36). The primary exposure was change in the respiratory disturbance index (RDI) obtained from unattended overnight polysomnograms (PSG) performed approximately 5 years apart. Other covariates included measures of excessive daytime sleepiness derived from the Epworth Sleepiness scale (ESS) and difficulty initiating and maintaining sleep, derived from items in the Sleep Habits Questionnaire.

The mean age of participants was 62 years at baseline and 67 years at follow-up. Fifty-five percent were women, and most were Caucasian (75 percent) and married (77 percent). A higher proportion of men had CHD, whereas women had higher rates of respiratory disease at both surveys. Polysomnogram total sleep time increased slightly from at baseline (364 ± 60 minutes) to follow-up (368 ± 70 minutes), with women showing higher polysomnogram sleep time then men. After approximately 5 years of follow-up, the RDI increased slightly but significantly from 8.1 ± 11 SD at the baseline to 10.9 ± 14 (p < .0001) at follow-up. The mean PCS and MCS scores were 48.5 and 54.1 at baseline and 46.3 and 54.8 at follow-up.

Significantly lower scores for women than men were seen at baseline and follow-up for the PCS and MCS. Hispanics/Mexican Americans had lower baseline MCS and PCS scores compared with the other ethnic groups. Current smokers had significantly lower MCS scores during both surveys, while more highly educated subjects, with the exception of MCS at follow-up, reported higher scores for PCS and MCS, as compared to those with less education. Obese subjects had lower PCS scores than non-obese participants at baseline and follow-up; however, no difference was found for MCS at either survey. Scores for both summary scales were lower for subjects with respiratory diseases and those taking sleeping pills, while PCS but not MCS scores were significantly lower for subjects with coronary heart disease.

Adjusted models showed no association between RDI and worsening of either PCS or MCS scores. An increase in difficulty initiating and maintaining sleep however, was significantly associated with a change in MCS scales, while increasing severity of excessive daytime sleepiness measured by the Epworth Sleepiness Scale was associated with a change in both MCS and PCS scales. Significant association was found with longitudinal increases in Excessive Daytime Sleepiness (EDS) and worsening of physical and mental scales quality of life.

This study found that longitudinal worsening of quality of life is associated with subjective symptoms of sleep disturbances, but not with objective measures of severity of SDB. These results suggest that perception of sleep quality and not standard measurements of sleep quality have the most sleep-related impact on quality of life.

Patients with either heart disease or chronic respiratory disease tend to have lower quality of sleep related to these conditions. The causes and symptoms of these diseases are multiple and varied. Primary treatment to reduce morbidity and symptoms related to these diseases would aid in increasing sleep quality.

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1. Lind BK, et al. Recruitment of healthy adults into a study of overnight sleep monitoring in the home: experience of the Sleep Heart Health Study. Sleep Breath 2003;7:13-24.

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:

• Assess the impact of sleep disordered breathing, sleep quality, and excessive sleepiness on physical and mental quality of life.

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

• Identify the impact of sleep disordered breathing, sleep quality, and excessive sleepiness on physical and mental quality of life.
• Recognize drivers of poor sleep quality.

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 7ZEJTL-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: 376-000-09-023-L01-P (Live), 376-000-09-023-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. Silva has disclosed that she receives grant support from the National Heart, Lung, and Blood Institute.

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).

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