SLEEP DISORDERS Applying the Evidence in Sleep Medicine
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VOLUME 1 NUMBER 3 2007 The International Journal of SLEEP DISORDERS Applying the evidence in sleep medicine EDITOR-IN-CHIEF Alan F Schatzberg Insomnia and Depression: Birds of a Feather? Wilfred R Pigeon and Michael L Perlis Sleep and Aging Tamar Shochat, Giora Pillar, and Atul Malhotra The Pharmacology of Insomnia: Targeting GABAA Receptor Function Matt T Bianchi www.journalofsleepdisorders.com This journal is supported by an educational grant from Pfizer. Jointly sponsored by the University of Kentucky Colleges of Pharmacy and Medicine and Remedica Medical Education and Publishing. The University of Kentucky is an equal opportunity university. Editor-in-Chief Associate Editor Alan F Schatzberg Rafael Pelayo Kenneth T Norris Jr, Professor and Chairman, Department Assistant Professor, Stanford Sleep Disorders Clinic, Stanford of Psychiatry and Behavioral Sciences, Stanford University University School of Medicine, Stanford, CA, USA School of Medicine, Stanford, CA, USA Editorial Advisory Board Hadine Joffe Wallace B Mendelson Director of Endocrine Studies, Perinatal and Reproductive Professor of Psychiatry and Clinical Pharmacology (ret), Psychiatry Clinical Research Program, Massachusetts General The University of Chicago, Chicago, IL; Consultant in Hospital, Assistant Professor of Psychiatry, Harvard Medical Psychopharmacology, Galveston, TX, USA School, Assistant Professor of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Thomas Roth Director, Sleep Disorders and Research Center, Henry Ford Ned H Kalin Hospital, Detroit, MI, USA Hedberg Professor of Psychiatry and Psychology; Chair, Department of Psychiatry, University of Wisconsin Medical John W Winkelman School, Madison, WI, USA Medical Director, Sleep Health Center, Brigham and Women's Hospital, Assistant Professor in Psychiatry, Harvard Medical David J Kupfer School, Boston, MA, USA Professor and Chair, Department of Psychiatry, University of Pittsburgh Medical Center, Phyllis C Zee Pittsburgh, PA, USA Professor of Neurology, Director, Sleep Disorders Program, Northwestern University School of Medicine, Chicago, IL, USA Editors Christopher L Drake Pedram Navab Senior Staff Scientist, Henry Ford Hospital Sleep Center; Consultant, American Sleep Medicine, San Diego, CA, USA Assistant Professor, Psychiatry and Behavioral Neurosciences, Wayne State College of Medicine, Detroit, MI, USA Andrew Krystal Associate Professor, Psychiatry & Behavioral Sciences, Director, Insomnia and Sleep Research Program, Duke University Medical Center, Durham, NC, USA Editorial Policy The International Journal of Sleep Disorders is an independent journal published by Remedica Medical Education and Publishing. Editorial control is the sole responsibility of the Editor-in-Chief, Associate Editor, Editorial Advisory Board, and the Editors. Before publication, all material submitted to the journal is subjected to rigorous review by the Editor-in-Chief, Associate Editor, Editorial Advisory Board, Editors, and/or independent reviewers for suitability of scientific content, scientific accuracy, scientific quality, and conflict of interest. Aims and Scope The International Journal of Sleep Disorders is designed to bring a critical analysis of the world literature on sleep disorders, written by clinicians, for clinicians, to an international, multidisciplinary audience. Our mission is to promote better understanding of the treatment of sleep disorders across the global healthcare system by providing an active forum for the discussion of clinical and healthcare issues. Leading Articles – These major review articles are chosen to reflect topical clinical and healthcare issues in sleep disorders. All contributions undergo a strict editorial review process. Clinical Reviews – The most important papers from the best of the international literature on sleep disorders are systematically selected by an internationally recognized panel of experts. The Editors then prepare concise and critical analyses of each paper, and, most importantly, place the findings into clinical context. Meeting Reports – The International Journal of Sleep Disorders also provides incisive reportage from the most important international congresses. Publisher’s Statement © 2007 Remedica Medical Education and Publishing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of the copyright owners. While every effort is made by the publishers and editorial board to see that no inaccurate or misleading data, opinions, or statements appear in this journal, they wish to make it clear that the material contained in the publication represents a summary of the independent evaluations and opinions of the authors and contributors. As a consequence, the board, publishers, and any supporting company accept no responsibility for the consequences of any such inaccurate or misleading data or statements. Neither do they endorse the content of the publication or the use of any drug or device in a way that lies outside its current licensed application in any territory. The International Journal of Sleep Disorders (ISSN 1750-869X) is published four times a year. Subscriptions are available at the following rates: Europe u150; USA, Canada and all other territories US$200. Additional subscription information is available from the publisher. Remedica Medical Education and Publishing Ltd., Remedica Medical Education and Publishing Ltd., 20 N. Wacker Drive, Suite 1642, Chicago, IL 60606, USA, Tel: +1 (312) 372 4020, Fax: +1 (312) 372 0217 Email: [email protected] Editorial Team: Emma Beagley, Scott Millar Editorial Director: Reghu Venkatesan Publishers: Ian Ackland-Snow, Simon Kirsch Design and Artwork: AS&K Skylight Creative Services ISSN 1450-869X Dear Colleagues, Welcome to the third issue of The International Journal of Contents Sleep Disorders. Leading Articles In our first article this quarter, Wilfred R Pigeon and Michael Insomnia and Depression: Birds of a Feather? L Perlis (University of Rochester, Rochester, NY, USA), review Wilfred R Pigeon and Michael L Perlis 82 the overlap between insomnia and depression, questioning the view of insomnia as merely a symptom of major Sleep and Aging depressive disorder and suggesting that they are in fact Tamar Shochat, Giora Pillar, and Atul Malhotra 92 separate entities. This review presents evidence for insomnia and depression as comorbid disorders, and considers The Pharmacology of Insomnia: whether targeted treatment for insomnia may influence the Targeting GABA Receptor Function clinical course of major depression. A Matt T Bianchi 102 Tamar Shochat, Giora Pillar, and Atul Malhotra (University of Haifa, Rambam Medical Center, Haifa, Israel, and Brigham Clinical Reviews and Women’s Hospital, Boston, MA, USA) provide an Insomnia 111 overview of the changes in sleep patterns seen with aging, discussing the vulnerability of this patient population to sleep Sleep-Disordered Breathing 116 abnormalities and reviewing the different presentations of these disorders and the treatments available. Due to the Restless Legs Syndrome 119 considerable morbidity that sleep disorders can cause, the authors suggest that further research into, and proper Positive Airway Pressure Therapy 119 treatment of, these disorders could help improve satisfaction and quality of life in elderly patients. Narcolepsy 120 The role of the γ-aminobutyric acid (GABA) receptor in the A Sleep Scales and Measures 121 pharmacology of insomnia is discussed by Matt T Bianchi (Massachusetts General Hospital and Brigham and Women’s Miscellaneous 124 Hospital, Boston, MA, USA) in the third article of this issue. GABAA receptor function has frequently been used as a target for insomnia therapeutics, such as classical benzodiazepines. Meeting Reports However, recent studies have provided further insights into 8th World Congress on Sleep Apnea the function of this receptor and its various subunits, (WCSA 2006) underscoring the potential for rational drug design and Montréal, QC, Canada, Sept 27–30, 2006 125 offering new possibilities for treating specific aspects of insomnia, while minimizing the unwanted side effects. As always, a synopsis of the latest and most important scientific findings are reviewed and placed into clinical context by our Editors, providing a digested read of the most critical developments from several key areas of sleep research. The issue concludes with highlights from the 8th World Congress on Sleep Apnea (Montréal, QC, Canada), presented by Nelly Huynh and Christian Guilleminault (Université de Montréal, Montréal, QC, Canada, and Stanford University Medical Center, Stanford, CA, USA). We would like to thank you for the positive response to The International Journal of Sleep Disorders and look forward to receiving your future comments and suggestions to help us continue to provide a useful resource for clinicians working in this rapidly developing field. Alan F Schatzberg Editor-in-Chief Insomnia and Depression: Birds of a Feather? Wilfred R Pigeon and Michael L Perlis Sleep and Neurophysiology Research Laboratory, University of Rochester, Rochester, NY, USA Over the course of the last 30 years there has been a great deal of research into sleep abnormalities in patients with major depression. However, only a small proportion of this work has focused on sleep continuity disturbance (as opposed to abnormalities in sleep micro- and macroarchitecture),