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Is Lack of Sleep Killing Us?
Sairam Parthasarathy, MD. Professor of Medicine Director, UAHS Center for Sleep & Circadian Sciences Medical Director, Center for Sleep Disorders, BUMC-T Interim Chief, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine University of Arizona AHCJ 2018 April 11th, 2018
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Why do we sleep?
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Sleep Drives Metabolite Clearance from the Adult Brain
Lulu Xie and colleagues; Science 342, 373 (2013);
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Sleep Drives Metabolite Clearance from the Adult Brain
Glymphatic system Labelled β-Amyloid protein Lulu Xie and colleagues; Science 342, 373 (2013);
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Why do we sleep at night?
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Circadian rhythm pioneers win 2017 Nobel Prize in Physiology or Medicine
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Awake
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Asleep?
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Asleep
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23%
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38% Insomnia Difficulty initiating sleep Difficulty maintaining sleep
Early morning awakening Nonrestorative sleep
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Persistent insomnia is associated with mortality risk
Parthasarathy et al, Am J Med Mar;128(3):268-75
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Persistent insomnia and Systemic Inflammation
Parthasarathy et al, Am J Med Mar;128(3):268-75
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INSOMNIA AND RISK FOR HOSPITALIZATION
Vasquez et al, Am J Respir Crit Care Med 2016; 301: A7909
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Tucson Epidemiological Study of Airway Obstructive Disease [TESAOD]
Insomnia over 40 years Parthasarathy et al, unpublished
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Obstructive Sleep Apnea
(Continuous Positive Airway Pressure)
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Pre-specified group with CPAP usage > 4 hours/night, there was a trend toward a slightly lower risk of a primary end-point event in the CPAP group (hazard ratio, 0.80; 95% CI, 0.60 to 1.07; P=0.13), and the risk of a cerebrovascular event was significantly lower in the CPAP group (hazard ratio, 0.52; 95% CI, 0.30 to 0.90; P=0.02). McEvoy et al; N Engl J Med 2016;375:919-31
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Parthasarathy et al, 2018 [Unpublished]
Peer-Driven Intervention As An Alternate Model of Care Delivery and Care Coordination in Sleep Apnea Parthasarathy et al, 2018 [Unpublished] IHS
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Longitudinal Associations for Hospitalizations in the six months after
versus six months before positive airway pressure therapy. Vasquez et al; Am J Med Jul;130(7):
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Pack et al. Sleep 1995
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Pack et al. Sleep 1995 Konowal et al. Sleep 1999
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Motionlogger
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Motion logger data during naps
Raw Processed Sleep Wake 15 min
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Parthasarathy et al, Chest 2006
Days of the ICU month Noon Midnite Noon Midnite Parthasarathy et al, Chest 2006
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Objective sleepiness of ICU staff
Cumulative proportion awake 65% are sleepy Mean Sleep Latency, minutes
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Talk slowly, think quickly
Josie King ( )
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Quality and effect size of associations between
shift length and patient care Reed et al, Ann Intern Med 2010; 153:829
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Thank you
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