Sleep and Neurodevelopment Service

National Institute Of Mental Health

Investigators

Linked publications & trials

Abstract

This past year were performed 144 studies across 14 institutes and currently see 5-7 patients each week, between our research and clinical participants. We have collected sleep data on several distinct cohorts including children with obsessive compulsive disorder, autism, Sickle Cell Disease, Neurofibromatosis, as well as for people with various disorders of neurodevelopment with both known and unknown genetic causes. We are working with our collaborators to try to identify unique sleep signals that help define the disorders under study and therefore outline paths for potential therapeutic intervention. Some of our earliest work, looking at sleep in children with autism, helped us understand that there is a lot of information in the way the brain sleeps and that sleep neurophysiology also contains important information about the way the brain matures. We recently published our findings showing that in a large cohort of children with autism, sleep markers, called spindles, were reduced compared to children with typical development and also reduced when compared to children with developmental delays who did not also have autism. This work suggests that some markers only found in sleep, might be related to behavioral differences in children. These findings highlight the importance of looking at the sleeping brain during development for some of the earliest clues regarding neurodevelopmental disorders. Yet, considerable gaps in knowledge still exist in our understanding of sleep measurements and how these change during the early periods of brain development. Filling in these gaps may aid in the earliest identification of mental health disorders. We work closely with the Neurodevelopmental and Behavioral Phenotyping Service to best associate changes in the sleeping brain to neurodevelopmental stages in typical and atypical neurodevelopment. The Sleep Service at NIMH convened the first Sleep and Neurodevelopment Consortium meeting at intramural NIMH in September 2017. It included child neurologists and psychiatrists, sleep and pulmonary medicine specialists, geneticists, psychologists, neuroscientists, computational experts and bioengineers. The mandate was to develop a consensus understanding of how best to approach pediatric sleep data collection and assessment to best inform on neurodevelopment. This meeting began laying the groundwork for predictive biomarker work related to sleep-unique oscillatory signatures. Subsequent meeting convened in 2018 (Focus on Translation) and 2021 (Focus on The Earliest Years). Through work with the Consortium we continue to pursue oscillatory biomarkers in developmental and behavioral health. In partnership with the National Sleep Research Repository platform at Brigham and Womens Hospital, we are moving forward with an agnostic, sleep-mediated biomarker discovery initiative that includes answering questions about both risk/susceptibility and predictive markers for response and exacerbation in pediatric behavioral illness. Therefore, a major focus of the research arm of the Service is to develop a comprehensive battery of sleep measurements as a mainstay of clinical assessment of children at risk for neurodevelopmental disorders. Through our efforts with researchers from many different disciplines, we hope to create and initiate standardized protocols for collecting sleep data on children. The online summary of our efforts to promote Electrophysiologic Sleep Phenotyping (ESP) as a mainstay of the clinical assessment of children at risk for neurodevelopmental disorders can be found at the following link: https://www.nimh.nih.gov/archive/events/2017/sleep-and-neurodevelopment-workshop-electrophysiologic-sleep-phenotyping-esp. The prospective longitudinal ESP evaluation, including comprehensive behavioral assessment of children with typical development and those at risk for neuropsychiatric or neurodevelopmental disorders, opened recruitment in the summer of 2021. It uses the information found in the electrical sleep patterns recorded from the brain to help identify normal and abnormal neurodevelopmental trajectories at the earliest possible opportunity in order to help us develop comprehensive treatment strategies. We have enrolled 37 of 50 children to date. These longitudinal data will be added to the 1800 studies in the retrospective collection that the Sleep & Neurodevelopmental Consortium has already deposited forming the basis for a brain based, neurodevelopmental/neuropsychiatric hub at this NHLBI supported public database. Sleep is a highly interdisciplinary field and we collaborate closely with other intramural Institutes and Centers. The NIH Clinical Center sees many people with chronic illness undergoing novel therapeutic intervention. Optimizing medical therapy includes a comprehensive approach to sleep. For example, diagnosing primary sleep disorders, such as obstructive sleep apnea (OSA), and working with various specialties to identify sleep disrupters allows us to optimize the NIH mission across multiple disciplines. A joint project with NICHD/NIBIB/NIMH is underway to validate a device in pediatric patients with OSA. This validation is the first step in developing a point-of-care diagnostic that can be translated to the home setting and help identify which children might most benefit from treatment for apnea versus a watch-and-wait strategy. We have enrolled 36 of 47 children to this protocol. We are also a part of an NINDS evaluation of people with long term changes in function following COVID-19 infections; we are characterizing the sleep phenotypes of these individuals. Research was conducted under protocols NCT01778504, NCT04573062, NCT04639830, NCT05052216, NCT03206099