CISRE - Projects

IT Infrastructure

The CISRE’s versatile IT backbone combines fixed in-lab and mobile domiciliary testing suites to record, score, analyze and archive raw and summary data. Customized SIFT software provides a robust, secure mechanism for transmission of sleep recordings and summary data to and from the CISRE scoring hub from fixed on-site study beds and remote locations throughout the region and across the global. For example, the IT environment has been recently deployed to support sleep studies in Peruvian highlanders to examine effects of sleep disordered breathing on cardiopulmonary outcomes. CISRE’s IT infrastructure is also supporting similar high throughput nocturnal domiciliary studies to examine effects of pain, illicit drugs and PTSD on sleep architecture.

Hardware \ Equipment

Physiologic signals are streamed through a flexible multi-directional network that is capable of recording signals on any of 14 workstations referential channels, 8 bipolar channels, specialized sensors (position, oximeter, airflow, effort, snoring) airway monitoring, non-invasive positive airway pressure devices, high fidelity respiratory parameters (airflow, airway pressures, TCCO2, ETCO2, EMG, pharyngeal collapsibility equipment server providing database access using specialized software
State-of-the-art EMBLA N7000 acquisition equipment for recording polysomnographic data: 32 referential channels, 8 bipolar channels, specialized sensors (position, oximeter, airflow, effort, snoring)
Specialized auxiliary equipment, including instrumentation for actigraphy, advanced airway monitoring, non-invasive positive airway pressure devices, high fidelity respiratory parameters (airflow, airway pressures, TCCO2, ETCO2, EMG, pharyngeal collapsibility
Advanced sound recording equipment, that is integrated into polysomnographic equipment
Multiple redundant array data storage units to prevent potential data loss; SQL server providing database access using specialized software

Software

RemLogic 1.3 is used to record, score, and database polysomnographic data
Institute-wide customizable polysomnography sleep report
Specialized patient Index software manages the workflow of polysomnographic data, and databases the quality assurance of the overnight technicians and scorers
Survey tools and a web portal to collect and manage individual protocol elements
Sort Info From-To (SIFT) software to coordinate databasing and data transfer for multi-centered clinical trials

Basic Science

The CISRE has provided:

Fundamental insights into pathogenic mechanisms of obstructive sleep apnea in severe obesity.

In collaborative studies between pulmonary medicine, sleep medicine and bariatric surgery groups, recent publications demonstrate that obesity produces twin defects in the mechanical and neuromuscular control of pharyngeal collapsibility during sleep. CISRE facilities and personnel were utilized to deploy sophisticated experimental paradigms for measuring pharyngeal collapsibility during sleep. The findings have significant implications for predicting resolution of sleep apnea in response to medical and surgical weight loss.

Significant perspective on long-term effects of sleep apnea on cardiovascular risk profiles.

In a series of mechanistic studies, investigators in sleep and pulmonary medicine and endocrinology have demonstrated that acute physiologic perturbations in sleep architecture and gas exchange produce pronounced disturbances in glucose homeostasis. To accomplish these studies, investigators utilized the CISRE’s state-of-the-art sleep laboratory to induce and quantify disturbances in sleep and oxygenation along with the adjoining blood processing and monitoring facilities in the Clinical Research Unit. These findings suggest that sleep apnea promotes the development of diabetes mellitus and/or exacerbates glucose intolerance in patients with pre-existing diabetes mellitus.

New understanding about the impact of sleep disordered breathing on cardiovascular disease.

A series of nocturnal studies in patients with heart failure has demonstrated an exceedingly high prevalence of sleep disordered breathing in this population, and evidence that sleep disordered breathing and, specifically, intermittent hypoxemia produces significant nocturnal hemodynamic and metabolic stress, as reflected by acute responses in circulating biomarkers (brain natriuretic peptide and free fatty acids, respectively). These studies relied upon dedicated CISRE staff and facilities, which provided frequent venous sampling throughout the night. These studies serve to establish acute stress biomarkers as surrogates for long-term cardiovascular stress in vulnerable patients populations.

Groundbreaking studies establishing distinct nocturnal “phenotypes” of sleep disordered breathing in patients with and without COPD.

The CISRE has provided an experimental “home” for sophisticated physiologic monitoring systems, which have been utilized to establish unique mechanisms of sleep disordered breathing in COPD and to pilot a novel therapy with transnasal insufflation for unloading the respiratory system during sleep.

Sleep apnea in young abstinent recreational MDMA (“ecstasy”) consumers.

A series of studies in individuals who have been exposed to the brain serotonin neurotoxin and drug of abuse, 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) have revealed that abstinent MDMA users have altered sleep architecture, that alterations in sleep are related to reductions in brain serotonin axonal markers, that MDMA users are more sensitive to the negative cognitive effects of sleep deprivation than matched controls, and that MDMA users have increased rates of sleep-disordered breathing than non-MDMA users. None of these findings would have been possible without the staff and facilities made available by the CISRE.

Altered pain responses in abstinent (±)3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) users.

Studies conducted at the CISRE have demonstrated that sleep disruption leads to next-day reductions in diffuse noxious inhibitory controls (DNIC), a measure of central nervous system (CNS) pain inhibition, in both clinical populations (i.e., patients with temperomandibular joint syndrome) and non-clinical populations. Integration of CISRE and CRU has facilitated studies linking nocturnal sleep quantity and quality with state-of-the-art measurements of pain sensitivity during the daytime. Sleep studies conducted in daily cannabis users revealed that use of zolpidem during a 3-day period of acute abstinence led to significant improvements in sleep, and lessened the intensity of withdrawal symptoms. This observation has led to the suggestion that use of hypnotic medications may be useful in the treatment of cannabis use disorders. The findings also highlight the potential impact of nocturnal interventions on daytime function.

Ancillary Measures

The ancillary measures below are available as part of CISRE’s association with the broader CRU environment.

The dedicated nursing staff (RNs, LPNs, PCTs) provide essential support to the CISRE, including: phlebotomy, point of care testing, anthropometrics, drug administration, physical assessments, questionnaire administration, serial blood pressure measurements, vital signs, and 12-lead echocardiograms.

The Exercise Core of the CRU is staffed by exercise physiologists who are capable of providing the following services: body composition measurements (DEXA, anthropometry, bioimpedances), cardiopulmonary testing (ECG stress testing, VO2 max treadmill tests, VO2 Max cycle ergometer tests), muscular strength testing, exercise training, and functional assessments (6-minute walk, sit and reach, stair steps).

The Nutrition Core is staffed by registered dieticians who support the dietary needs of all protocols. The services of the department include: nutrition assessment, dietary recall (24h), food diaries, food frequency questionnaire administration, controlled diet supply, development of protocol-specific diets, dietary instrument data entry, and nutrient analysis

The CRU is also staffed by a team of echocardiographic technologists that can support protocols employing a variety of procedures, including: echocardiograms, vascular imaging (carotid, brachial), pulse wave velocity, and applanation tonometry.

The services listed above are a sample of the resources available within the CRU and CISRE.

Human Research

The CISRE is staffed by registered polysomnographic technologists (RPSGTs) and nurses (RNs), and is supported by a dedicated sleep informatics team that assists with database management and provides round-the-clock technical support for acquisition of polysomnographic studies.

Our services include:

Polysomnographic recordings (Polysomnographic recordings are scored by registered polysomnography technologists (RPSGTs) through a dedicated scoring hub.)
Actigraphy
Advanced airway monitoring
CPAP
P^CRIT
Medication administration
Intermittent venous blood sampling
Quantitative measures of ventilation

Daytime procedures

MSLT: Multiple Sleep Latency Tests (MSLTs) are a series of controlled nap sessions that clinically assess the degree of hypersomnolence. MSLTs have been clinically used to diagnose narcolepsy, idiopathic hypersomnia, and evaluate the effectiveness of therapeutic treatment on apneic patients.
PVT: Psychomotor Vigilance Task (PVT) is a reaction-timed task that measures the speed with which subjects respond to a visual stimulus. Previous research has indicated that increased sleep deprivation correlates with deteriorated alertness, decreased psycho-motor skills, and increased rate of false responding.

Late Breaking Sleep Updates

CISRE and it’s investigators have participanted in clinical trials and sleep research protocols. Please find links to recent reports on these projects below.

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Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Center for Sleep Research and Education