The Sleep Disorders Toolkit

While the US Department of Health and Human Services recommends a sodium intake of less than 2,300 mg/day, about 9 of 10 American adults exceed that limit. Increased sodium intake is believed to have a direct effect on a variety of negative cardiovascular outcomes such as coronary heart disease, left ventricular hypertrophy, and stroke. Recognizing the impact of dietary sodium on diseases like hypertension and CVD, the FDA recently released voluntary guidance for industry on the target mean and upper concentrations for sodium in commercially processed, packaged, and prepared foods. The guidance was intended to provide a measurable voluntary goal to help Americans to reduce their average sodium intake by 12% over the next 2.5 years, and plans for further iterative reductions in the future. In addition to daily dietary (food and drink) sodium, both prescription and over-the-counter medications can contribute to increasing patients’ total sodium intake per day. Additionally, other risk factors—such as smoking the absence of physical activity, and poor sleep hygiene—that contribute to developing cardiovascular conditions can be modified by maintaining a healthy and balanced lifestyle. This episode is produced by Sleep Review. It is episode 5 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 5, listen as Sleep Review’s Sree Roy and cardiologist-sleep specialist Barbara Hutchinson, MD, PhD, FACC, discuss:

• The FDA recently released guidance on voluntary target concentrations for sodium, in commercially processed packaged and prepared foods. What are your thoughts on this reduced goal for sodium intake, in terms of impact on cardiovascular risk?
• What are some links between high sodium intake and adverse cardiovascular outcomes?
• What should people be aware of with regard to medication use and sodium intake?
• How should cardiovascular risk be discussed when determining the management plan for sleep disorders?
• Can you share an example of modifying a sleep disorder patient's management plan, due to an emerging cardiovascular risk or disease?
• Beyond sodium intake, what are some of the other modifiable cardiovascular risk factors that everyone, regardless of whether they have a sleep disorder or not, should be aware of?

The prevalence of certain comorbidities is higher in people with narcolepsy compared with matched controls—both at diagnosis and at prolonged follow up.

Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions.

Hypocretin (orexin) dysfunction in patients with narcolepsy may partially explain the increased risk of certain comorbidities in these patients.

An increased prevalence of cardiovascular and cardiometabolic conditions, such as hypertension, obesity, diabetes, and hypercholesterolemia have been reported in people with narcolepsy compared with matched controls. One interview study of 320 patients with narcolepsy and 1,464 age-matched individuals from the general population identified that the odds of heart disease in patients with narcolepsy (5.9%) were twice that compared to the age-matched general population (2.9%) (AOR, 2.07 [95% CI, 1.22 to 3.51]). By an average age of 38 (mean age during study), an increased incidence of cardiovascular comorbidities has been observed among patients with narcolepsy compared with matched non-narcolepsy controls.

This episode is produced by Sleep Review and is episode 4 of a 5-part series sponsored by Jazz Pharmaceuticals.

Visit Jazzpharma.com and NarcolepsyLink.com for more information. In episode 4, listen as Sleep Review’s Sree Roy and cardiologist-sleep specialist-intensivist Younghoon Kwon, MD, MS, FACC, discuss:

• Narcolepsy is linked with multiple cardiovascular risk factors and comorbidities. Can you inform our audience to any of the specifics of the cardiovascular burden among patients with narcolepsy?
• Why is it that patients with narcolepsy commonly present with cardiovascular comorbidities? Is there a potential mechanistic link between narcolepsy and these conditions?
• Does sleep disruption itself impact cardiovascular risk? If so, what is the evidence for the connection between sleep disruption that's a hallmark of narcolepsy and increased cardiovascular risk?
• How do you balance narcolepsy management with the management of cardiovascular health factors, both in terms of lifestyle and pharmacotherapy?
• Are there any published studies about narcolepsy and cardiovascular risk that you'd recommend for additional information?

For supporting material on this episode, visit: 

The increased frequency of comorbidities among people with narcolepsy should be thoroughly reviewed while creating individualized management strategies. Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions. Hypocretin dysfunction in patients with narcolepsy may partially explain the increased risk of certain comorbidities in these patients. An increased prevalence of cardiovascular and cardiometabolic conditions, such as hypertension, obesity, diabetes, and hypercholesterolemia have been reported in people with narcolepsy compared with matched controls. One interview study of 320 patients with narcolepsy and 1464 age-matched individuals from the general population identified that the odds of heart disease in patients with narcolepsy (5.9%) were twice that compared to the age-matched general population (2.9%) (AOR, 2.07 [95% CI, 1.22 to 3.51]). By an average age of 38 (mean age during study), an increased incidence of cardiovascular comorbidities has been observed among patients with narcolepsy compared with matched non-narcolepsy controls.

This episode is produced by Sleep Review and is episode 3 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information. 

In episode 3, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist W. Chris Winter, MD, discuss:

What comorbidities do you typically see in patients who are newly diagnosed with narcolepsy?
What about comorbidities that tend to develop over time in people with narcolepsy?
What health conditions do you screen for when you have a patient who is newly diagnosed with narcolepsy?
How, if at all, does the existence or emergence of comorbidities impact decision making?
Can you share any best practices for monitoring the emergence and management of narcolepsy-related comorbidities?
What other specialists and healthcare professionals do you recommend sleep physicians develop reliable referrals with to adequately manage comorbidities in their patients with narcolepsy?
Are there any particular screening tools such as specific questionnaires that you'd recommend to other sleep physicians for this demographic?

For most people with narcolepsy, management plans require implementation of ongoing pharmacological therapy to keep symptoms under control. Patients may also need substantial lifestyle adjustments, such as maintaining nocturnal sleep hygiene and regular scheduling of daytime naps. Narcolepsy management plan development should consider balance between the tolerance to available medications and impact of certain comorbidities associated with the disorder. The prevalence of certain comorbidities is higher in patients with narcolepsy compared with matched controls; this is true both at diagnosis and at prolonged follow up. The increased frequency of comorbidities among patients with this condition should be thoroughly reviewed while creating individualized management strategies. Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions.

This episode is produced by Sleep Review and is episode 2 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information.

In episode 2, listen as Sleep Review’s Sree Roy and pulmonologist-sleep specialist Richard K. Bogan, MD, discuss:

What comorbidities you need to consider when determining whether a patient is an appropriate candidate for a given pharmacotherapy?
Why are these important in management decisions?
Can you share any best practices for monitoring the emergence and management of narcolepsy related comorbidities?
What sleep lifestyle changes are typically incorporated into a narcolepsy management plan?

Mayoor Patel, DDS, MS, is the owner of Atlanta-based Craniofacial Pain and Dental Sleep Center of Georgia and co-editor of the new textbook Dental Sleep Medicine: A Clinical Guide. He speaks with Sleep Review about medical and dental comorbidities of obstructive sleep apnea, continuing education for dentists, and offers several resources for dentists who want to learn about sleep medicine. Sree Roy of Sleep Review and Patel discuss:

How did this book, Dental Sleep Medicine: A Clinical Guide, come about?
Why should dentists have a basic knowledge of sleep medicine?
What are some of the most common medical comorbidities of obstructive sleep apnea?
What are some of the most common dental comorbidities and risk factors of sleep apnea?
How can dentists learn to conduct a basic screening for obstructive sleep apnea?
How does oral appliance therapy for sleep apnea work?

For supporting material on this podcast, visit: https://sleepreviewmag.com/sleep-disorders/hypersomnias/narcolepsy/narcolepsy-across-the-lifespan/

Narcolepsy is a chronic sleep disorder for which there is no known cure. The onset of symptoms can begin at any age but frequently occurs during childhood or adolescence. This condition continues to impact patients throughout their lifetime. Management plans require implementation of ongoing pharmacological therapy to keep the symptoms under control for most patients, and patients may need substantial lifestyle adjustment such as maintaining nocturnal sleep hygiene and regular scheduling of daytime naps. Narcolepsy management plan development should consider balance between the tolerance to available medications and impact of certain comorbidities associated with the disorder.

This episode is produced by Sleep Review. It is episode 1 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and NarcolepsyLink.com for more information.

In episode 1, listen as Sleep Review’s Sree Roy and neurologist-sleep specialist Michael Thorpy, MB, ChB, discuss:

 Since narcolepsy starts at a young age and there is no cure as of yet, what are the long-term management implications?

What are the key symptoms of narcolepsy, and how and when do they typically manifest?

Do narcolepsy symptoms evolve over the course of a lifetime?

What can you typically accomplish with an individualized management plan?

How often do you reassess narcolepsy patients to determine whether their management plan needs to be adjusted?

Are there specific guidelines that you recommend to the physicians in the audience with regard to managing narcolepsy?

Temitayo Oyegbile-Chidi, MD, PhD, became board chair of the National Sleep Foundation board of directors, on July 1, 2022. She speaks with Sleep Review about advocating for sleep on Capitol Hill, sleep health equity concerns, Drowsy Driving Prevention Week, and more. Sree Roy of Sleep Review and Oyegbile-Chidi discuss:

-You are a neurologist as well as a sleep and epilepsy specialist. How did your interest develop in understanding sleep disorders in relation to co-existent neurologic and psychiatric conditions?
-What areas of sleep health interest you most?
-Where can we improve for sleep health equity?
-What projects or initiatives is NSF working on that you'd like to highlight?
-You've won a Sleep Health Policy Advocacy Award from the National Sleep Foundation. What are some ways that can other healthcare professionals advocate for better sleep?

To dive deeper:
https://sleepreviewmag.com/tag/national-sleep-foundation/

Jennifer L. Martin, PhD, became president of the American Academy of Sleep Medicine (AASM) board of directors on June 6, 2022. She speaks with Sleep Review about the challenges faced by people with insomnia disorder in accessing cognitive behavioral therapy for insomnia (CBT-I) and pharmaceuticals to treat the sleep disorder, as well as posits several solutions. Sree Roy of Sleep Review and Martin discuss:

-What is a psychologist’s role in sleep medicine?
-How is the AASM collaborating with other stakeholders to identify and prioritize strategies to increase access to high-quality care for insomnia disorder?
-How can sleep medicine overcome reimbursement challenges when it comes to insomnia?
-Other goals for her 1-year AASM presidency term

Mitchell Levine, DMD, ABDSM, was recently installed as president of the American Academy of Dental Sleep Medicine (AADSM). In an interview with Sree Roy of Sleep Review, he discusses how COVID has changed the practice of dental sleep medicine, the role of telehealth, a consensus statement about oral appliance compliance, oral appliance monitoring sensors, what he wants to see in dental sleep medicine research, and what he hopes will have changed in dental sleep by the end of his 2-year term.

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https://aadsm.cnf.io/

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Ben Wipper is a current medical student at Harvard Medical School. He graduated from Williams College in 2019, and over the past two years has been a part of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital in Boston. Ben has co-authored numerous peer-reviewed research articles relating to restless legs syndrome and other sleep disorders.
 
Link to the study the interview was about: https://www.sciencedirect.com/science/article/pii/S1389945722000120?via%3Dihub

Sleep Disorder Clinical Research Program:
https://www.massgeneral.org/psychiatry/research/sleep-disorders-clinical-research-program

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