News – September 2012

CIRUS chief investigator wins prestigious RPA Foundation Medal

Sleep expert Professor Ron Grunstein has been awarded the 2012 RPA Foundation Medal for his work on sleep disorders, particularly his research on the metabolic and neurobiological links between sleep problems and Parkinson’s disease.

Professor Grunstein, who has worked at Royal Prince Alfred Hospital since 1988, is a staff specialist physician in Respiratory and Sleep Medicine, has an honorary appointment in respiratory and sleep medicine at St Vincent’s Hospital, Sydney, and heads the Sleep and Circadian Research Group at the Woolcock Institute of Medical Research.

Professor Grunstein has a strong interest in translational clinical research in sleep health and was involved in the early development of nasal CPAP (continuous positive airway pressure) at RPA in 1980, and non-invasive ventilatory support for sleep-breathing disorders.

His current main interests involve the metabolic and neurobiological effects of sleep loss, particularly on shift workers and the elderly.

He will use part of his $50,000 winner’s cheque to set up long term studies into the ways in which certain sleep disorders, such as acting out during rapid eye movement (REM) sleep, can predict the development of neurological disorders such as Parkinson’s disease.

“About three decades ago it was apparent there was a link between people who act out their dreams during REM sleep, such as thrashing about, cycling, hitting walls etc, but we are now looking for specific markers that allow us to much more accurately predict which of those people might develop Parkinson’s disease, and perhaps delay or prevent its progression,’’ Professor Grunstein said.

“We have very few prodromal markers of Parkinson’s, yet over a 10 year period about 60 to 70 per cent of those people (who act out during REM sleep) will develop the disease. The money from this award will allow us to do brain imaging on these people.”

Although one of the first to work with CPAP technology for sleep apnoea 30 years ago, Professor Grunstein and his team are now looking at a more holistic approach to the condition.

“CPAP is still the gold standard treatment yet most people will still not use it. Only 25 per cent of people prescribed CPAP will use it for more than six hours a night. That’s a big challenge for us and we are now looking at the behavioural and psychological issues, dental devices and medications which sedate the mind but not the upper airway.”

Until recently it was considered that up to 25 per cent of men and 10 per cent of women aged between 40 and 60 suffered from sleep apnoea, but new studies are indicating that incidence is higher, presumably due to an increase in obesity.

Professor Grunstein said his team was also looking at ways to involve pharmacists in screening customers for insomnia and apnoea, and help deliver treatments.

“The economic cost of insomnia is billions of dollars in lost productivity, absenteeism, and increased rates of depression. Why we sleep, what happens when we don’t sleep, what are the consequences for society – it is a huge challenge.”

Professor Grunstein has been a visiting scientist at the University of Gothenburg, Sweden and other overseas universities.

He was awarded the Nathaniel Kleitman Award of the American Academy of Sleep Medicine in 2011 and the Distinguished Achievement Award of the Australasian Sleep Association in 2010.

He also serves as chief medical advisor to Sleep Disorders Australia, an advocacy body for patients with sleep disorders, and has advised Australian, British and European Union road regulatory bodies on sleep disorders.

Professor Grunstein has served as associate editor of Sleep and a member of the editorial board of the Journal of Sleep Research, Sleep Medicine Reviews, Sleep Medicine and Respiratory Research; was the president of the World Federation of Sleep Research and Sleep Medicine Societies (2007-11) representing more than 12,000 researchers and clinicians and was president of the Australasian Sleep Association 1994-1997.

He also has a long standing interest in health communication through the media and in 2008 was appointed a public member of the Australian Press Council.

But his arrival on the sleep unit at RPA 31 years ago was serendipitous.

In his final three months of his course, Professor Grunstein visited Stanford University in California with two peers.

“I got allocated to their sleep unit and, to be honest, I was a bit disappointed because I wanted to work in the emergency department. But almost immediately I was fascinated. It was one of the first centres in the United States and there was nothing like it in Australia.”

Part of the attraction was the bizarre effects sleep and its deprivation can have on the human body and brain.

“I’ve had a man who snored so loudly that guys from the other side of the river came over and said it was common courtesy to turn off the engine of your boat at night, and body corporates taking legal action to get people out of home units because of the noise they’ve made,” he said.

“I’ve even had a lover of rugby league who used to pick up his wife’s head while he was asleep and try to pass it to another player.”

But throughout his decades of work, it is his team and the hospital to which he attributes the honour.

“You don’t win an award like this on your own. I have a very dedicated team who have worked very hard behind the scenes. My name may be on the cheque but we have won this by working together.

“If I had to comment on my greatest achievement, I’d like to think that in a national and international sense I’ve been responsible for the professional development of sleep medicine and someone who has argued very strongly that it needs to be a speciality of its own.”

Professor Warwick Britton, Bosch Professor of Medicine and Professor of Immunology at the University of Sydney and RPA’s Director of Research, said Professor Grunstein was chosen by a panel of three eminent judges from a strong field of applicants.

“Professor Grunstein’s work has changed the face of sleep disorders, not only in Australia, but globally, in the past three decades.

“Sleep, and its metabolic and neurological effects on the body as a whole, is now a major field of research and with the $50,000 from this medal, it is clear that Professor Grunstein and his team will again put RPA at the forefront of sleep research internationally,” Professor Britton said.

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