La médecine du sommeil : 1965-2015

Résumé

La médecine du sommeil a maintenant 50 ans. À l’Université de Montréal, le Centre d’étude du sommeil naissait il y a environ 40 ans et a grandi pour devenir en 2012 le Centre d’études avancées en médecine du sommeil (CÉAMS). Le CÉAMS, c’est 14 chercheurs, plus de trente stagiaires de recherche et un personnel hautement qualifié. C’est un laboratoire de 1,500 mètres carrés comprenant 10 salles d’enregistrement polygraphique du sommeil, 3 laboratoires d’isolation temporelle pour l’étude des rythmes circadiens, un laboratoire d’enregistrement EEG à haute densité, un système d’imagerie SPECT à haute résolution et une clinique qui agit comme lieu de formation clinique et comme centre de référence pour plusieurs pathologies du sommeil, telles que la narcolepsie, le bruxisme, le syndrome des jambes sans repos et le trouble comportemental en sommeil paradoxal. Cet article raconte l’histoire du CÉAMS, ses principales réalisations et ses projets d’avenir en parallèle avec le développement général de la médecine du sommeil.

Mots clés : médecine du sommeil, histoire, recherche fondamentale, diagnostic, traitement

Abstract

Sleep Medicine: 1965 to 2015

The Département de psychiatrie de l’Université de Montréal houses one of the first sleep centers founded 40 years ago. This center contributed to virtually every aspect of sleep medicine. It grew considerably over time to become one of the largest sleep centers worldwide. It is now called the Center for Advanced Research in Sleep Medicine (CARSM). Fourteen researchers and more than 30 research PhDs and postdoctoral fellows are working together in a 1,500 square-meter facility that includes separate units for fundamental and clinical studies and for the sleep disorders clinic. It has 10 polysomnographic recording rooms, 3 isolated units devoted to chronobiological studies, a high resolution SPECT imaging laboratory specifically devoted to sleep research, a high-density EEG unit and a psychophysiological laboratory to study the interaction between pain and sleep. This article relates the history of the CARSM and also presents a personal sleep odyssey.

The CARSM has been very active in the description of clinical features and definitions of the phenotype of most sleep disorders. It contributed specifically to the development of diagnostic tools in narcolepsy (the multiple sleep latency test in different age groups), in nocturnal epilepsy (development of a method to localize the primary focus using in-depth electrodes recording during rapid eye movement sleep), in sleep bruxism (a method for scoring masticatory muscle activity during sleep and definition of cut-off values), in the restless legs syndrome (RLS: the suggested immobilisation test), in sleepwalking (sleep deprivation and experimental awakenings) and REM sleep behaviour disorder (RBD: development of the first polygraphic method to diagnose RBD).

The CARSM also contributed to the knowledge on the epidemiology of sleep disorders, conducting the first population-based prevalence study of RLS and of sleep bruxism. Researchers at the CARMS also looked at the impact of sleep disorders like narcolepsy, RLS, sleep apnea and the parasomnias on daytime cognitive functions and cardiovascular health. The CARSM collaborates with researchers throughout the world to elucidate the genetic bases of several disorders, especially narcolepsy, RLS, RBD and parasomnias in children and adults, through large well-defined cohorts of patients and normal subjects.

Finally, the CARSM has made original contributions to the development of new treatments of sleep disorders, especially the dopaminergic treatments of RLS (first with levodopa and then with pramipexole). Current research also involves the identification of prodromal markers of Parkinson disease and dementia in patients with RBD as to build a ready-to trial cohort to test the efficacy of neuroprotective agents.

In summary, the CARSM is a center dedicated to basic and clinical research on sleep and circadian rhythms. It is located at the Hôpital du Sacré-Coeur de Montréal but involves several other researchers at the Université de Montréal and at other universities in Canada and in the world.

Key words: sleep medicine, history, fundamental research, diagnosis, treatment