Abstract
Sleep loss can induce a variety of serious problems, which have been largely neglected as objects of study. As an example, it is estimated obstructive sleep apnea occurs in 2% of children between the ages of 4 and 7; the resulting sleep loss may lead to significant behavioral and cognitive def including leaning problems in school. In the work place, a significant number of accidents involving shift workers are associated with sleep loss or poor quality sleep. A third area where sleep problems have been largely overlooked refers to traffic accidents. Brazil relies heavily on highway transportation (1.000.000 highway miles) to cover its vest territorial expanse. A common cause of traffic accidents involves drivers falling asleep at the wheel and alterations in motor and reaction time associated with sleepiness. Of the 25.000 deaths in traffic accidents each year in Brazil, 27% are attributed to sleep-related problems. Likewise various types of industrial accidents, many of which involving heavy machinery, have been attributed to insufficient sleep or sleep-related disturbances. A understanding of the causes and mechanisms of normal and pathological sleep could have a significant impact on all of these problems. There is at pr group at UNIFESP working under Prof. Dr. Sergio Tufik's direction that has been active for a number of years in clinical and basic sleep research, teaching patient care. The group seeks to elucidate the functions of sleep, to understand sleep-related pathology and to test new therapeutic approaches for sleep-related disorders. In view of the complexity of the subject, the approach taken is of necessity multidisciplinary. Undergraduate and graduate courses are offered y allow dissemination and discussion of current knowledge concerning the possible functions of sleep, biological rhythms, differences among sleep phases, disorders and therapy, among other topics. Research studies are carried out in humans and rodents. At present, however, this group is limited in its reseal scope and deficient in specific areas, particularly in the integration of clinical and basic findings and in extending these findings to society at large, including general population, students, physicians, and policy makers. To address these limitations, we are proposing the creation of a Center for Sleep Studies that expand and integrate our research activities, and will make it possible 1) to shorten the distance between research findings and clinical applications; 2) to basic research efforts more effectively towards relevant clinical issues; 3) to bridge the gap between research discovery and industrial application, and 4) to effectively disseminate research findings to society at large. Infrastructure Contribution from the parent institution to the Center will include a 1200 physical area for clinical and basic research. In the clinical area 10 beds are already available for polysomnographic assessments, which are essential for diagnosis and therapeutic, follow up, and physical space is available to accommodate 16 additional polysomnography systems. Current staff includes 6 MDs three of whom also have PhDs; 2 nurses specializing in sleep disorders and 20 specialized technicians. In the basic research area the current group includes 3 PhDs and another three with whom we maintain close collaborative ties (at the Federal University of Uberlandia, MG, at the Clarke Institute of Psychiatry, and the Department of Pediatrics at UNIFESP). Both clinical and basic research areas have at present a total of 15 graduate students, in addition to undergraduate students in entry level research programs and trainees. The creation of the Center will make it possible to implement additional collaborative this with researchers from other departments at UNIFESP (Pharmacology and Physiology) and from Claude Bernard University in France. These new partnerships will allow us to expand the multidisciplinary character of our research work and will also generate significant benefits in terms of training and technology transfer. Addition of these new investigators will allow us to increase the number of graduate students to 30 and increase the number of undergraduate trainees. Most importantly, it will provide access to training and teaching by experts in other areas. Our collaborators from abroad will make it possible to e our current techniques in basic research and will facilitate exchange initiatives involving researchers and graduate students. Research Focus the principal focus of our basic research studies have been on the effects of sleep deprivation (SD) on various neurochemical systems, using physiological, behavioral, pharmacologir.al and biochemical techniques. Sleep deprivation research is important in at least three different contexts: 1) SD can be a useful understanding the functions or normal sleep; 2) SD studies in normal animals and humans are critical for understanding mechanisms involved in condition such as insomnia, fibromyalgia, sleep apnea, affective disorders and rhythm disturbances, where sleep loss occurs; 3) SD serves a model for conditions where deprivation may be a primary cause of pathology. It may also result in neural damage. Our basic research effort has reached a stage where further pre clearly necessitates the introduction of refinements in technique in our sleep deprivation studies. The need to invest in molecular biology approaches is apparent and so is the need to expand our efforts into studies of normal sleep processes in rodents. The creation of the Center will make it possible for us to start systematic studies focused on normal sleep, with the introduction of single cell recording, microelectrophoresis and microdialysis. We will establish a new research front in the area of sleep deprivation, including interactions between various drugs and sleep. Substances such as alcohol and amphetamines a abused by individuals that have sleep disturbances but little is known about cause and effect relationships. Our current clinical research group original a survey of sleep complaints in the city of Sao Paulo in 1986. This group's work has focused on the study of mechanisms underlying sleep-related pathological conditions, and treatment strategies for these conditions. Sleep Medicine is an inherently multidisciplinary activity and involves disciplines such as Neurology Psychiatry, Pneumology, Otorhinolaryngology, Pediatrics and Orthodontics. A major focus of the proposed studies in clinical areas is obstructive sleep apt including diagnosis, treatment and cognitive effects in children; another are new approaches to diagnosis and treatment of insomnia and rhythm abnormalities Education and Technology Transfer We plan to offer a number of specific services to society at large, including: Publication of information packages booklets aimed at the scientific community and the general population. Training of elementary and high school teachers. Training of high school teachers students in entry level research programs (scientific initiation programs). Implementation of partnerships with organizations responsible for implement public policy, including work with government agencies to introduce measures and legislation to reduce workplace and traffic accidents related to sleepiness. Graduate courses and specialization courses. Development and possible commercialization of novel devices for diagnostic and treatment of sleep-related, disorders, possibly in partnership with government and industry. Increasing awareness among patients, families and government concerning the importance diagnosis and treatment of sleep disorders. A WEB page in Portuguese aimed at the lay public, MDs and other health care professionals dealing with of sleep hygiene, sleep physiology and sleep pathology. (AU)
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