Biography
Alan Schwartz, MD, Co-Director
Dr. Schwartz has been a member of the Johns Hopkins University School of Medicine in Pulmonary, Critical Care and Sleep Medicine for the past 25 years. He has investigated sleep disordered breathing mechanisms with special emphasis on effects of obesity on sleep apnea pathogenesis. He has helped to elucidate the interrelationships between sleep apnea and metabolic dysfunction in severe obesity. He has also examined the metabolic effects of nocturnal intermittent hypoxemia on hemodynamic and metabolic stress biomarkers in heart failure patients. Dr. Schwartz has developed novel approaches for the diagnosis and management of these disorders. He has developed physiologic approaches for characterizing respiratory loads during sleep, and for alleviating these loads with hypoglossal nerve stimulation and high flow tracheal and nasal insufflation. He has collaborated extensively with colleagues on translational studies examining pathogenic mechanisms and consequences of sleep disordered breathing. He is an established investigator with a record of continuous NIH funding for over 20 years, an author of approximately 150 articles and inventor on 3 patents. He also serves as the Co-Director of the Center for Interdisciplinary Sleep Research and Education (CISRE), Director of the Johns Hopkins Sleep Center at Bayview Medical Center and the Director of the Sleep Medicine Fellowship Training Program at Johns Hopkins.
Una McCann, MD, Co-Director
Dr. McCann is Co-Director of the Center for Interdisciplinary Sleep Research and Education (CISRE) at the Johns Hopkins Bayview Medical Center. She joined the Department of Psychiatry and Behavioral Sciences at Hopkins in 1999, and has been conducting research related to sleep and sleep deprivation since 1989. Her work at the Walter Reed Army Institute of Research was focused on identifying brain mechanisms involved in cognitive and behavioral decline during prolonged wakefulness. Later, at the NIH, she conducted research on sleep problems in anxiety disorders, and the neurological and neuropharmacological underpinnings of sleep panic attacks. Current research seeks to identify the effects of monoaminergic neurotoxic injury from methylenedioxymethamphetamine (MDMA) and methamphetamine on sleep macro- and micro-architecture, as well as sleep disordered breathing. In addition, as Director of the Anxiety Disorders Program at Hopkins, she continues to conduct research directed at elucidating the role of disordered sleep in the pathophysiology of post traumatic stress disorder and other anxiety disorders. Dr. McCann serves as collaborator on a number of multidisciplinary sleep research efforts, including projects investigating sleep in traumatic brain injury, substance abuse and chronic pain.
Staff Model
The CISRE is staffed by registered polysomnographic technologists (RPSGT) and nurses (RN), 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.
Services
The CISRE facilities are comprised of eight private inpatient rooms with personal full-size bathrooms and the capability of monitoring up to 10 subjects simultaneously. Bariatric beds with a weight capacity of up to 1000 lbs are available, if required. Each room has a voice-activated intercom system that allows continuous on-demand communication between subjects and the monitoring staff. High-quality infrared cameras with zooming capability are integrated within the polysomnographic recording. “Through-the wall” access allows intermittent venous blood sampling or drug administration during sleep without disturbing research subjects. In addition to standard PSG studies, a specialized chronobiology suite of five beds is available for specific protocols that require time, light and sound isolation.
Polysomnographic recordings are obtained using state-of-the-art EMBLA acquisition equipment for recording polysomnographic data, including 32 referential channels, 8 bipolar channels, specialized sensors (position, oximeter, airflow, effort, snoring). Specialized auxiliary equipment and services (e.g.actigraphy, advanced airway monitoring, CPAP, Pcrit) are also available, when requested.
IT infrastructure
The signal acquisition data are streamed through a multi-directional network switch and the data are able to be recorded on any of 14 computers. The video is controlled using an HTML webpage, and is recorded along with audio via a coaxial cable in the polysomnographic (PSG) recording. Infrared light is used to illuminate the research participant without disrupting the study and while capturing the participant’s every movement. Post acquisition, the data are copied to a Network Attached Storage (NAS) unit, which has a redundant array of independent disks. There are multiple NAS units deployed to ensure additional redundancies to equipment and prevent potential data loss.
Electronic forms are used in the collection of questionnaire data (i.e. – Hopkins Morning and Evening questionnaires, The Epworth Sleepiness Scale, Sleep Apnea Quality of Life Index, etc). These forms reside within a custom tracking software, along with the quality assurance data for the PSGs. The tracking software uses Microsoft Access in the frontend and SQL server in the backend. The sleep report data obtained from the scoring of the PSGs are also stored in SQL. These unique tools enable CISRE to accurately database the entire spectrum of a principle investigators protocol.
Scoring Hub
The polysomnographic (PSG) recordings are scored by registered polysomnography technologists (RPSGT). The quality assurance of the scored PSG is regularly assessed using the American Academy of Sleep Medicine standards of inter-scorer reliability. CISRE provides virtual machines for RPSGTs to access the PSGs within the SQL server. This ensures that data integrity is maintained along with data security.
The development of a new customizable sleep report will give investigators complete access to raw and scored data in an easily accessible database format. The provision of on-line access to raw data and scored reports to investigators allows immediate access to polysomnographic recordings minutes after they are completed.
Studies
NIH 01/15/2005 - 07/31/2013
Mechanisms of sleep apnea in severe obesity
It is the goal of this study to elucidate the mechanisms and causal pathways linking obesity with upper airway dysfunction during sleep, and will provide novel approaches for the detection and treatment of sleep apnea in the clinical setting.
NIH 09/14/2007 – 08/31/2012
SCCOR: Mechanisms and Treatment of COPD Progression
Project 3 (PI: Alan R. Schwartz, M.D.): Mechanisms and Impact of Sleep Disordered Breathing in COPD”
The overall goal of this SCCOR program is to understand the complex interplay of mechanisms that promote the progression of COPD and to translate that understanding into treatments that can benefit persons who suffer from COPD. Project III will elucidate the mechanisms and impact of sleep disordered breathing in COPD.
Research Agreement (Schwartz) 01/05/2009 - 12/31/2012
ResMed Corporation
Sleep Apnea Treatment Device
The purpose of this project is the development and testing of novel treatment devices for sleep apnea.
NIH 07/01/2009 - 06/30/2012
Effects of sex and fat distribution on sleep disordered breathing
The major purpose of the proposal is to investigate the influence of visceral and peripheral obesity on reflex mechanisms leading to upper airway obstruction during sleep.
NIH 07/28/2010 - 04/30/2013
Mechanisms and Effectiveness of Weight Loss Methods on Diabetes and Sleep Apnea
This project is designed to pilot the use of bariatric surgery for treatment of diabetes and sleep apnea in moderately obese patients.
NIH 12/01/2011 - 11/30/2015
Pathogenesis and Outcomes of Sleep Disordered Breathing in COPD
This project pilots novel methods for exploring sleep disordered breathing pathogenesis and treatment in COPD.
NIH 07/01/2011 - 06/30/2014
Effect of Positive Airway Pressure on Reducing Airways Reactivity in Asthma
Project Goal: To determine the effects of low levels of nocturnal CPAP on airways reactivity and nocturnal symptoms in asthmatics.
Previous Studies
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]]> For more information contact:
Kerry Stewart, EdD
Phone: 410-550-0870
Email: kstewart@jhmi.edu
Services housed at green spring station
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The Bayview CRU can be contacted directly at 410-550-1850.
]]> full-service outpatient and inpatient facilities, with an emphasis on cardiovascular and sleep studies. Bayview also has strong laboratory core services (Core Laboratory for research assays, Cardiovascular Core, Body Composition Core). Exercise physiology facilities are also available.
The NBRU is dedicated to research on disorders of the developing central nervous system. Inpatient scatter research beds are available for subjects who cannot be safely managed on other CRUs. Outpatient clinical evaluations are available for protocols requiring such data.
]]> Beds in the Brain Injury Unit (BIU) are available for patients requiring intensive neurorehabilitation as the result of acute head injury, including those in coma. This unit is the primary acute brain injury resource in the region, and because of the close proximity to the neuroimaging center two floors below, imaging studies with this population can be safely carried out.
For more information email crus@jhmi.edu or call 410-614-2717.
]]> 14 inpatient research beds on a general medical floor that includes capacity for continuous cardiac monitoring and biological isolation of subjects receiving potentially infectious agents.
A full-time clinical research nurse manager is assisted by Johns Hopkins Hospital staff nurses who are trained in research procedures and attend in-service orientations for all ICTR-supported protocols.
For more information email crus@jhmi.edu or call 410-614-2717.
Full-time clinic support staff include three registered research nurses, as well as a phlebotomist and technicians. The unit staff assist investigators with protocol specific evaluations as requested (including vital signs, collection and processing of biologic specimens and administration of questionnaires.) Qualified nurses administer protocol guided medications for ICTR-approved protocols.
The unit also offers tutorials on creating research order sets and other study-related paperwork for investigators.
For more information email crus@jhmi.edu or call 410-614-2717.
]]> 7-bed inpatient unit, a 4-room outpatient clinic, a multi-purpose procedure room, pediatric phlebotomy laboratory, spirometry, metabolic formula room, and pediatric sleep lab. Pediatric-oriented nursing support and child life services are also provided.
The PCRU is slated to move into the new Charlotte R. Bloomberg Children’s Center at Johns Hopkins by June, 2012.
For more information email crus@jhmi.edu or call 410-614-2717.
The ICTR CRUs are part of the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded by the National Institutes of Health as part of a consortium of Clinical and Translational Science Awards.]]>
The laboratory houses two Kistler force plates, which allow for measurement of the forces exerted on the floor by a person standing, walking or running. In addition, equipment to record surface muscle activity (electromyography or EMG) is available. A custom treadmill allows for the control of the two legs independently (split-belt treadmill).
For more information call 443-923-2716. ]]>