1. 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

2. Why do we sleep?

4. Sleep Drives Metabolite Clearance from the Adult Brain
Lulu Xie and colleagues; Science 342, 373 (2013);

6. Sleep Drives Metabolite Clearance from the Adult Brain
Glymphatic system
Labelled β-Amyloid protein
Lulu Xie and colleagues; Science 342, 373 (2013);

7. Why do we sleep at night?

10. Circadian rhythm pioneers win 2017 Nobel Prize in Physiology or Medicine

12. Awake

13. Asleep?

14. Asleep

15. 23%

16. 38% Insomnia Difficulty initiating sleep Difficulty maintaining sleep
Early morning awakening
Nonrestorative sleep

17. Persistent insomnia is associated with mortality risk
Parthasarathy et al, Am J Med Mar;128(3):268-75

18. Persistent insomnia and Systemic Inflammation
Parthasarathy et al, Am J Med Mar;128(3):268-75

19. INSOMNIA AND RISK FOR HOSPITALIZATION
Vasquez et al, Am J Respir Crit Care Med 2016; 301: A7909

20. Tucson Epidemiological Study of Airway Obstructive Disease [TESAOD]
Insomnia over 40 years
Parthasarathy et al, unpublished

21. Obstructive Sleep Apnea
(Continuous Positive Airway Pressure)

22. 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

24. Parthasarathy et al, 2018 [Unpublished]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Parthasarathy et al, 2018 [Unpublished]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

25. 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):

26. Pack et al. Sleep 1995

27. Pack et al. Sleep 1995
Konowal et al. Sleep 1999

28. Motionlogger

29. Motion logger data during naps
Raw
Processed
Sleep
Wake
15 min

30. Parthasarathy et al, Chest 2006
Days of the ICU month
Noon
Midnite
Noon
Midnite
Parthasarathy et al, Chest 2006

31. Objective sleepiness of ICU staff
Cumulative proportion awake
65% are sleepy
Mean Sleep Latency, minutes

32. Talk slowly, think quickly
Josie King ( )

33. Quality and effect size of associations between
shift length and patient care
Reed et al, Ann Intern Med 2010; 153:829

34. Thank you