Research
Committed to helping sleep investigators uncover meaningful insights through our unique metrics and advanced analysis tools.
While we support a range of research topics, several areas align closely with our platform’s strengths and novel metrics.
For studies in these areas, we offer enhanced collaboration, often with reduced or waived fees.
Research priority areas include:
Current Research Priorities
Clinical Utility of
Odds Ratio Product (ORP)
Linking sleep depth to clinical outcomes
The most significant advantage of ORP over conventional staging is its ability to identify differences in sleep depth within the same conventional sleep stage. An important clinical question is therefore whether clinical outcomes are improved when ORP in different stages is available to treating physicians investigating suspected sleep disorders.
Specific questions may include:
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Diagnostic sensitivity
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Does ORP help detect abnormalities in patients presenting with sleep complaints when conventional sleep architecture appears normal or inconclusive?
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Treatment response
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Does ORP provide insight into symptomatic improvement or deterioration following interventions (e.g., CPAP, cognitive-behavioral therapy for insomnia, or treatment for depression) when conventional sleep stage proportions remain unchanged?
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For example:
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Did ORP_NREM improve or deteriorate despite unchanged time in NREM sub-stages?
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Did ORP_WAKE increase or decrease, indicating altered sleep pressure, during therapy?
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Psychiatric associations
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Are there meaningful associations between ORP_REM and psychiatric disorders that could aid in diagnosis or monitoring?
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Predictive utility
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​Can baseline ORP predict both the degree of sleep improvement and adherence to CPAP therapy?
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Sleep Need
The Cumulative Sleep Index (CSI) combines sleep time and depth into one measure of restorative sleep. Current interpretations assume that a one-unit increase in CSI provides the same benefit whether it comes from longer sleep or deeper sleep — an assumption that still needs to be proven.
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Because CSI is quantitative and easy to measure, it offers a way to investigate the restorative function of sleep more directly.
Personalized Sleep Need
CSI also creates the possibility of defining individualized sleep requirements. Measuring CSI during a period of unrestricted, restorative sleep (for example, while on vacation) reveals a person’s true sleep need. This value then becomes their sleep target in situations of non-restorative sleep — achievable through:
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Extending time in bed, or
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Improving sleep depth with therapy.
Quantifying the restorative function of sleep
Obstructive Sleep Apnea (OSA)
Evaluating CPAP benefits in mild to moderate OSA
Further studies are needed to determine whether long-term CPAP use improves clinical outcomes in patients with mild to moderate OSA who experience excessive wake time. At this level of severity, impairment in sleep depth is minimal, making the overall benefit of CPAP less certain.
Insomnia
Rethinking the role of sleep studies in insomnia
Polysomnography (PSG) is not routinely recommended for insomnia, as conventional measures often add little to clinical management and may miss primary insomnia. However, the use of ORP has revealed distinct insomnia phenotypes that differ in health outcomes, underlying mechanisms, and potential therapy response. These findings support the use of PSG in insomnia, particularly for research purposes.
While this research has identified phenotypes based on objective ORP markers, one group, an Objectively Normal group, reported insomnia symptoms despite not having any objective disturbance. This result suggests the need for testing of additional metrics, such as regional ORP or delta characteristics to investigate objective markers further to explain the subjective/objective discrepancy.
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Insomnia with Normal Sleep Duration
Previous studies have shown:
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No significant differences in conventional sleep indices between patients with insomnia and normal sleep duration and those without insomnia.
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No major differences in ORP architecture between these groups, except for one notable finding:
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Time in full wakefulness was significantly lower in patients with insomnia, suggesting higher sleep pressure despite similar ORP distribution.
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This raises the possibility that sleep quality may be reduced in these individuals, even when conventional metrics suggest otherwise. Further investigation into sleep microstructure in this phenotype is warranted.
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Future Directions
A priority is to evaluate the effectiveness of insomnia treatments while linking outcomes to specific insomnia phenotypes, paving the way for more personalized therapy approaches.
ICU
Understanding Sleep’s Role in ICU Outcomes
Sleep is well-known to be severely disrupted in patients in intensive care units (ICUs). Independent of critical illness itself, poor sleep negatively affects organ systems essential for recovery and liberation from mechanical ventilation, including immune function, respiratory control, neuroendocrine and metabolic function, cardiovascular regulation, and mental health.
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This raises an important clinical question:
Does normalization of sleep improve outcomes in critically ill patients?
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Although sedatives are routinely used in ICUs to promote sleep, it remains unclear whether they produce normal sleep or merely act as central nervous system depressants.