2017 CSS Conference
Sunday April 30, 2017
7:00 am - 4:00 pmRegistration Open
8:00 am - 9:00 amKeynote 4 - Insomnia - A Transdiagnostic Approach
Prof. Dieter Riemann Ph.D., Dipl. Psych, Department of Clinical Psychology and Psychophysiology, Centre for Mental Disorders, Freiburg University Medical Centre, Germany
Till recently, insomnia was differentiated into primary/ secondary forms, indicating that insomnia can be due to somatic or mental disorders, can be substance-related or can occur as a primary disorder, unrelated to other disorders. Even more sophisticated insomnia subtypes were described as psychophysiologic, idiopathic or paradoxical forms. In contrast, DSM-5 introduced "insomnia disorder" as an umbrella category and NIH suggested a transdiagnostic approach towards insomnia with the RDoC criteria. Own work based on an extensive meta-analysis of the polysomnographic literature in mental disorders and insomnia indicates that insomniac symptoms like prolonged sleep latency or increased nocturnal awakenings are not specific for any given disorder but transdiagnostic in nature. The hyperarousal concept of insomnia, too, can be viewed as a transdiagnostic mechanism triggering and maintaining most insomnias. 

Own work focusing on autonomic, neurophysiologic and neuroimaging studies in insomnia, accumulated evidence that "hyperarousal" on several levels, including subjective perception ,is not specific for insomnia subtypes. CBT-I, as first-line treatment for insomnia, in the meantime also has been proven to be effective in so-called "secondary" insomnias, including severe somatic or mental disorders.
Learning Objectives

  1. Describe the diagnostic approach of DSM 5 towards insomnia
  2. Describe the transdiagnostic nature of insomnia symptoms for mental disorders
  3. Describe the major signs of hyperarousal for insomnia patients

9:00 am - 10:00 amKeynote 5 - Speaking, Smiling and Gesturing During Sleep - Ethology of Nocturnal Behaviors
Isabelle Arnulf MD, PhD, Professor of Neurology, Pierre and Marie Curie University, Paris, France

We are supposed to be quiet and immobile when sleeping, except for brief arousals and position changes. However, a fine examination of video and audio sounds during the night reveals numerous exceptions to this rule, including complex behaviors such as sleep talking, expressing facial emotions and gesturing. They can be seen in subjects with NREM and REM parasomnias, but also in normal adult subjects. These vocalizations, speeches, whispering and shouting, smiles, fear expressions, and movements have been insufficiently studied per se, whereas they can be seen as an extraordinary, open window upon mental content and brain functioning during sleep. What does the sleeping brain say? Are emotions visible on the sleeper face? What is the variety (and potential generators) of the behaviors observed in RBD and sleepwalking? We will expose the observations of several hundred of sleepers studied from an ethological point of view during the night. 

Learning Objectives

  1. To learn about the movements and behaviors displayed during sleep in patients with REM sleep behavior disorders, and to infer about their brain sources
  2. To learn about sleep talking and what is said by the sleeping brain
  3. To learn about facial expression during sleep

10:00 am - 10:30 amHealth Break & Exhibits Open
10:30 am - 12:00 pmSymposium 7 - Young Investigators Symposium
Introduction, John Peever, VP Research - Canadian Sleep Society 

Speaker 1: Julie Carrier, University of Montreal
The Canadian Sleep and Circadian Network: Research, training and knowledge mobilization opportunities.

Speaker 2: Sara Pintwala, University of Toronto, Winner of the Student Abstract Competition 
Activation of glutamate cells in the subcoeruleus nucleus triggers cataplexy-like attacks in wild-type mice.

Speaker 3: Matthew Tucker, University of South Carolina School of Medicine 
Spatial and Declarative Learning and Memory in Children Evaluated for Sleep Disorders

Speaker 4: Thaïna Rosinvil, University of Montreal
Waking EEG Connectivity Changes Differently in Young and Élderly Adults After a Total Night of Sleep Loss

Speaker 5: Kevin MacDonald, Brock University
Naps Containing REM Sleep Increase Stimulus-Preceding Negativity in Anticipation of Threat Judgements

Speaker 6: Thomas Lehoux, University of Montreal
NonREM sleep EEG slow waves in children with autism

Speaker 7: Cheryl Laratta, University of British Columbia
The impact of air pollution on obstructive sleep apnea and systemic inflammation

Speaker 8: Veronica Guadagni, University of Calgary
Left anterior insula activity and functional connectivity are modulated by sleep quality in an emotional empathy task

Speaker 9: Mazen El-Baba, Western University
Dynamic Functional Connectivity Analysis Reveals Temporal Features that Vary Between Wake and Stage 2 Sleep

Speaker 10: Cloé Blanchette-Carrière, University of Montreal
Effects of transcranial alternating current stimulation (tACS) on the nap dreams of frequent lucid dreamers, frequent nightmare sufferers and controls

Speaker 11: Antoine Benoit, University of Ottawa
Spectral EEG Correlates of Emotional Valence during REM Sleep Mentation

Speaker 12: Hisham Alshaer, University Health Network
Effect of head position on the Apnea-hypopnea index in patients with obstructive sleep apnea

Speaker 13: Kenneth Anujuo, University of Amsterdam, The Netherlands
The contribution of short sleep duration to ethnic differences in cardiovascular disease - the Helius study
10:30 am - 12:00 pmSymposium 8 - Sleep in Elite Athletes: Current Research and Clinical Insights
Session Chairperson: Charles Samuels M.D., CCFP, DABSM, Medical Director, Centre for Sleep & Human Performance

The purpose of this symposium is to offer unique sleep research and clinical perspectives on sleep in elite athletes from faculty that have been working with collegiate, Olympic, and professional athletes. The symposium will discuss a perspective and data from over a decade of sleep measurement in elite athletes; sleep-wake behaviours and interventions of Canadian National Team athletes; and methodology and results from sleep in retired professional athletes with history of multiple concussions. The symposium will target clinicians and basic research scientists interested in applied human physiology, sleep optimization strategies for better sleep and performance, and clinical insights and methodology of working with this specialized population. 

Learning Objectives 
  1. Describe and discuss both the history and most recent research on sleep in elite athletes 
  2.  Apply sleep interventions used in athletes to anyone wanting to optimize performance
  3. Learn new research methods to assess sleep and concussion in retired professional athletes     

Speaker 1: Charles R.Pedlar,    MSc, PhD, FBASES, St Mary’s University, Twickenham, UK ; Massachusetts General Hospital/Harvard Medical School, Boston, MA, USATitle: A British Perspective on the Importance of Sleep in Sport 

Speaker 2: Amy M. Bender, PhD, University of Calgary; Centre for Sleep & Human Performance Title:  Sleep and Wake Behaviours of Canadian National Team Athletes: Opportunities for Interventions   

Speaker 3: Catherine Wiseman-Hakes, PhD, University of Toronto; Toronto Rehab Institute; University Health Network Toronto Western Title: Sleep in Retired Professional Athletes with History of Multiple Concussions  
10:30 am - 12:00 pmSymposium 9 - Taking Polysomnography Outside of the Laboratory: Advances in Ambulatory Methods for the Detection of Sleep Disorders
Session Chairperson: Mark Boulos, University of Toronto

Sleep disorders are common in the general population; however, despite effective management strategies, they remain under-diagnosed and under-treated. A technologist-monitored, overnight sleep study in a sleep laboratory (polysomnography) is the gold standard for diagnosing sleep disorders, but high costs, lengthy wait times and patient unwillingness to spend a night in a sleep laboratory frequently prohibit assessments. Ambulatory devices for detecting sleep disorders are much less expensive, more accessible, and serve as suitable screening tools compared to full polysomnography in the detection of obstructive sleep apnea and other sleep-related issues. However, to date, the use of ambulatory sleep testing has been under-appreciated and under-utilized. The use of ambulatory sleep equipment may facilitate early detection of clinically-relevant sleep disorders in large numbers of patients, which could lead to expedited treatment and improved outcomes. The purpose of our symposium is to examine different approaches to the use of ambulatory techniques for the detection of various sleep disorders, as well as discuss the technical limitations and legal issues associated with their use.

Learning Objectives
At the end of this symposium, participants will be able to: 
  1. Choose the appropriate ambulatory screening device to assess for sleep apnea. 
  2. Describe current tools used for the assessment of sleep-wake disorders and periodic limb movements. 
  3. Be aware of the value and limitations of readily-available consumer sleep monitoring devices. 
  4. Describe privacy and legal concerns associated with the use of these devices. 

Speaker 1: Mike     Fitzpatrick, Kingston General Hospital / Queen’s University, Kingston, Ontario 
Title: Ambulatory Approaches to the Detection of Obstructive Sleep Apnea   

Speaker 2: Mark I. Boulos,University of Toronto, Toronto, Ontario 
Title: Portable sleep equipment used to Detect of Periodic Limb Movements and other Sleep-Wake Disorders   

Speaker 3: Christopher Li, St. Michael’s Hospital / University of Toronto, Toronto, Ontario 
Title: Evaluating Popular Consumer Devices Used to Measure Sleep   

Speaker 4: Brian J. Murray, Sunnybrook Health Sciences Centre / University of Toronto, Toronto, Ontario 
Title: Data Security, Privacy and Legal Implications  

12:00 pm - 1:00 pmLunch & Exhibits Open
Sponsored by
12:15 pm - 1:00 pmICRH Strategic Directions and Opportunities for the Sleep Research Community
Speaker: Ryan Perry PhD, Assistant Scientific Director, Institute of Circulatory and Respiratory Health
The talk will provide an overview of ICRH, update on our strategic plan renewal and information on the CIHR open programs. I will also speak to the opportunities for the sleep research community, including potential partnership opportunities.
1:00 pm - 3:00 pmSymposium 10 - OSA in the Elderly and Risk of Cognitive Decline
Session Chairperson: Nadia Gosselin, Université de Montréal

This symposium is in line with the Canadian Sleep and Circadian Network Project 3 objectives, namely to evaluate how obstructive sleep apnea (OSA) impacts cognition, cerebrospinal fluid (CSF) biomarkers and neuroimaging (MRI and PET) in the elderly. We will present an overview of OSA in late-life in comparison to middle-age regarding clinical presentation, cardiovascular consequences and treatment options. We will address the detrimental consequences of OSA in patients with a neurodegenerative condition, such as Parkinson's or Alzheimer’s disease. We will show the attendees the latest evidence on how OSA correlates with changes in brain structure and function as well as with CSF biomarkers. Mechanism explaining the risk of accelerated cognitive decline among older individuals with OSA will be discussed. 

Learning Objectives
  1. To present an overview of older OSA patient characteristics in comparison with younger patients regarding clinical presentation, cardiovascular consequences and treatment.  
  2. To address the detrimental consequences of OSA in patients with a neurodegenerative condition.  
  3. To discuss biomarkers and mechanisms explaining the risk of accelerated cognitive decline among older individuals with OSA. 

Speaker 1: Andrea Loewen, Peter Lougheed Center, Calgary 
Title: OSA in the elderly: clinical presentation, cardiovascular consequences and challenge for treatment  

Speaker 2: Marta    Kaminska, McGill University Health Center, Montreal 
Title: Interaction between OSA and Parkinson’s disease: implications for cognitive function   

Speaker 3: Nadia Gosselin, Université de Montréal, Montreal 
Title:  OSA in aging and changes in brain structure and function: a neuroimaging perspective   

Speaker  4: Ricardo Osorio, NYU School of Medicine, New York 
Title: OSA and disturbed sleep: a new mechanistic pathway for Alzheimer's disease  

1:00 pm - 3:00 pmSymposium 11 - Predicting Oral Appliance Therapy Outcome: New Methods and Tests
Session Chairperson: John Remmers, University of Calgary
The purpose of the proposed symposium is: 
  1. to explore the sphere of precision medicine as applied to the long-term management of obstructive sleep apnea (OSA) 
  2. to highlight the pressing need for a CPAP-alternative therapy for OSA and 
  3. to demonstrate the importance of utilizing the predictive accuracy of various testing approaches to select patients who will respond favourably to oral appliance therapy (OAT). 
The symposium will outline a modern approach to managing OSA, one that relies on evidence-based decisions, emphasizes the importance of compliance with therapy, and focuses on long-term outcomes. Overall, the proposed session will lay out an important focus and stream of thought in sleep medicine which is assuming prominence in sub-specialty and, more broadly, in modern healthcare. This is the implementation of patient-centered management of chronic diseases by initiating patient-preferred therapy having high compliance. This symposium is particularly relevant with the addition of a dental course at this year’s conference with the goal to increase the participation and continuing education of dental professionals. The target audience for this symposium includes healthcare professionals active in the field of sleep-disordered breathing and dental practitioners with an interest in sleep medicine and those providing oral appliance therapy for OSA. 

Learning Objectives 
The attendee will be able to:  
  1. Understand the role of evidence-based patient-centered management of OSA and appreciate the methods for assessing a patient’s suitability for and benefits from CPAP or OAT. 
  2. Discuss the body of evidence related to the utility of clinical features, awake tests/imaging, and titration studies during sleep, and critically apply this knowledge to relevant clinical situations. 
  3. Learn how to use new methods and tests to prospectively identify OSA patients who will respond favorably to OAT. 

Speaker 1: Fernanda Almeida, University of British Columbia 
Title: Assessment of Outcome and Quality of Life: Clinical Features and Relevant Testing   

Speaker 2: Richard Schwab, Perelman School of Medicine, University of Pennsylvania
Title: Oral Appliance Therapy: Do Pharyngeal Images Help to Guide Therapy or Predict Outcome?  

Speaker 3: Dr. Shouresh Charkhandeh, DDS, The Snore Centre, Alberta
Title: Selection of Patients for Oral Appliance Therapy: Titration Procedures in a Polysomnographic Setting   

Speaker 4: Carrie Magnuson, Premier Sleep 
Title: Home Sleep Testing: Can Oral Appliance Titration in the Home Accurately Predict Outcome and Efficacious Protrusive Position?

1:00 pm - 3:00 pmSymposium 12 - Do Dreams and Nightmares Affect Memory Consolidation? New Methodologies and Evidence
Session Chairperson: Tore Neilsen, Université de Montréal

This symposium will bring together both established and young investigators who are in the forefront of research on dreaming and memory consolidation. They will present new methods for studying, and new answers to, the long-standing question: Does dreaming play a role in sleep-related memory consolidation? The symposium will include a brief historical overview of the domain (De Koninck, 5-7 min) followed by four 20-min presentations: i) a summary of new findings concerning the association of dreaming with sleep spindles in nightmare sufferers and controls (Nielsen), ii) new and replicated evidence that semantic memory networks are altered in nightmare sufferers (Carr), iii) new findings showing that the richness of dream incorporation of a stimulus task is associated with both task improvement and high IQ (Fogel), and iv) new discoveries about how future-relevant stimuli influence memory consolidation and dreaming (Wamsley). In a question period moderated by De Koninck and Nielsen (30 min), presenters and audience members will discuss implications of these discoveries for an emerging understanding of memory consolidation mechanisms, the involvement of waking state cognitive factors such as intelligence and anticipation, and how sleep-dependent neurocognitive functions may be altered in individuals suffering from sleep disorders such as nightmares. 

Learning Objectives 
  1. To review the advent and growth of dreaming-related memory consolidation research in Canada 
  2. To understand newly discovered relationships between REM dreaming and NREM sleep spindles and their modification by nightmares
  3. To appreciate how frequent nightmares are related to changes in associative and executive processes underlying creative cognition 
  4. To critically evaluate new findings about how dreams reflect intellectual abilities, as revealed by novel quantitative approaches to dream analysis. 
  5. To understand and evaluate evidence that dreams are influenced by the activation of memory systems in the sleeping brain 

Speaker 1: Tore Nielsen, PhD, Professor, Department of Psychiatry, Université de Montréal 
Title: Dreaming is related to sleep spindles in normal and dysphoric dreamers   

Speaker 2: Michelle Carr, PhD, Post-doctoral researcher, Department of Biomedical Sciences, Université de Montréal 
Title : Associative memory in individuals with frequent nightmares   

Speaker 3: Stuart Fogel, Ph.D, Assistant Professor, School of Psychology,  University of Ottawa 
Title:  Inter-individual differences in intellectual abilities correlate with learning-related dream incorporation   

Speaker 4: Erin J. Wamsley, Ph.D., Assistant Professor of Psychology, Furman University  
Title: Memory consolidation in dreaming and waking thought  

3:00 pm - 3:30 pmHealth Break
3:30 pm - 4:30 pmKeynote 6 - Manual Scoring of Polysomnograms: What Are We Missing?
Magdy Younes MD, FRCPC, PhD, Distinguished Professor Emeritus , University of Manitoba
Manual scoring of polysomnograms is based on rules developed for visual scoring in the mid 1960’s, at a time when personal computers had not yet even been invented. It is truly amazing that it is still the main tool for assessing sleep quality after 50 years of dramatic advances in digital technology. The EEG is full of information that cannot be quantified by the naked eye. Utilizing this information through digital analysis may greatly enhance the clinical usefulness of sleep studies. In this presentation, I will present some of the new developments in this area including the Odds-Ratio-Product (ORP) a continuous index of sleep depth/quality, scaling of arousal intensity, regional differences in sleep depth, quantitation of alpha intrusion and spindle characteristics (frequency, duration and intensity), speed with which deep sleep returns following arousals and awakenings, enhancements to the multiple sleep latency test, and use of digitally scored spindles, K complexes and delta wave duration to reduce inter-scorer variability in staging sleep.

Learning Objectives:

  1. To appreciate the difficulty of evaluating sleep depth/quality from conventional scoring (R&K rules) of sleep data.
  2. To learn about emerging technologies in evaluating sleep
  3. To appreciate the potential clinical benefits of incorporating digital EEG analysis in routine polysomnography.

4:30 pm - 5:00 pmConference Wrap-up