Sleep and Neurodevelopment Service

National Institute Of Mental Health

Investigators

Linked publications, trials & patents

Abstract

This past year, we performed 157 studies across 8 institutes/centers (FY2024 N = 213, FY2023 N = 184). We currently see about 2-4 patients each week in the lab for sleep studies and have performed 18 Sleep Disorder Specialty Consultations this past year. We have collected sleep data on several distinct pediatric cohorts, including children with various behavioral and/or chronic medical disorders. We are working with our collaborators to try to identify unique sleep signals that will 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 Women’s 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. We propose promoting Electrophysiologic Sleep Phenotyping (ESP) as a mainstay of the clinical assessment of children at risk for neurodevelopmental. 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 58 children to date with 31 children completing the longitudinal protocol, and 23 visits occurring so far in FY2025. The last participant in this cohort is scheduled to complete the study in the fall of 2026. These longitudinal data will be added to the 1500 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, NSRR. 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 more than 80 children to this protocol with 18 studies occurring so far in FY2025. We are also a part of an NINDS evaluation of people with long term changes in function following COVID-19 infections and Gulf War Illness; we are characterizing the sleep phenotypes of these individuals and have completed 67 (45+22) consultations and sleep studies on these two groups with 11 and 15 in FY2025, respectively. Additional comprehensive clinical research evaluations include: the RASopathy study (2020-C-0107), 18 total studies/consultations since 2022 with 6 so far in FY2025; a study of intervention for airway tumors in NF1 (NCI, 2011-C-0161); and protocol 01-M-0254 (NIMH, Zarate), which documents clinical sleep disorders in patients with depression. Research was conducted under protocols NCT01778504, NCT04573062, NCT04639830, NCT05052216, NCT03206099, NCT05375812, NCT01362803, NCT00024635, NCT04888936, NCT024500851, NCT03952637, NCT05669703, NCT02504853