February 4, 2011

Putting sleep disorders to rest

Nancy Collop and Ann Rogers.

Nancy Collop and Ann Rogers.

One of the biggest challenges sleep specialists face: explaining to people that the problems they're having while they're asleep may be causing the problems they're having when they're awake. But that's part of Nancy Collop's job.

This is thanks to patients having no awareness of what they're doing while they're sleeping, says pulmonologist Collop, the newly appointed director of the Emory Sleep Center.

"Collop's reputation is huge," says David Schulman, medical director of the Emory Sleep Center. "She brings with her a history of solid publications, especially in sleep epidemiology."

"A patient will come in to see a sleep specialist because of a sleep complaint or because of something their physician thinks might be related to a sleep disorder," says Collop. "So, a lot of time patients are unaware that a complaint they have during daytime may be related to a problem during sleep."

Yet, insomnia is likely the most common sleep disorder, says Collop.

"Most people will experience a bout of insomnia during their lifetime," she says. "Even over the course of a year, probably a third of people will have a bout of insomnia, but only when it becomes more chronic do people actually seek medical attention for it."

Collop recently finished a study looking at patients who are about to undergo cardiovascular surgery and is now analyzing the data.

"The prevalence of sleep apnea in the population is very high," says Collop. "At least two-thirds of them have sleep apnea. We wanted to see if sleep apnea would translate into a worse outcome for the surgery."

In fact, snoring, sleep apnea, sleepwalking and restless legs syndrome are just a few nocturnal events that can lead to not only daytime fatigue, but an erosion of overall health and well-being.

Less sleep, more pounds?

Researchers are seeing a link between a lack of sleep and weight gain and the chronic diseases that go with it.

Sleep medicine expert Ann Rogers is now heading up a pilot study to identify the relationship between reduced amounts of sleep and an increase in body mass.

"If you don't get enough sleep, it alters your appetite regulating hormones," says Rogers, who recently joined Emory's Nell Hodgson Woodruff School of Nursing and holds the Edith F. Honeycutt Chair in Nursing. "So, you're more likely to eat high calorie, high-fat food, which would be adaptive if we were starving and out hunting for food. But we're not."

Rogers and her collaborators are laying the groundwork for a clinical trial on whether healthy obese adults who get fewer than 7.5 hours of sleep per night lose more weight than healthy obese adults who sleep fewer than 6.5 hours per night. All participants will regulate their diet and exercise, but one group will get more sleep.

"We'll then look to see if our sleep intervention group lost more weight and whether their blood pressure and blood glucose improved," says Rogers. "It's not easy to do given our busy lifestyles, but if this helps, it's an inexpensive low-risk, high-benefit intervention."

Rogers is credited with conducting the Staff Nurse Fatigue and Patient Safety Study, a groundbreaking investigation that led to sweeping changes in nursing policies in clinical settings across the country.

Joining forces

Now Collop and Rogers, one of only six nurses credentialed as a diplomate by the American Board of Sleep Medicine, are collaborating to see patients.

"I'm seeing them as a nurse practitioner," says Rogers. "I saw patients in collaborative practice for 12 years at the University of Michigan, and I'm very excited to start seeing patients again down here."

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