Kiran Maski, MD, a 2012 American Brain Foundation Clinical Research Training Fellow, knew she wanted to be a neurologist the first time she held a brain in her medical school anatomy class and marveled at its complexities.
After graduating from the University of Wisconsin Medical School, she trained in pediatrics at Tufts-New England Medical Center and completed a child neurology residency at Children's Hospital Boston in 2009. Currently, Dr. Maski is an instructor of neurology at Harvard Medical School and clinician in the departments of child neurology and sleep medicine at Children's Hospital Boston.
Dr. Maski will use her clinical research fellowship to look at sleep disturbances and memory in autistic children. She spoke with Neurology Today about why sleep is so important for cognition, and how she hopes studying sleep in children may contribute to improvements in daytime cognition and behavior.
WHAT IS YOUR RESEARCH QUESTION?
I'm looking specifically at the impact of sleep disturbances on a process called memory consolidation in children with autism spectrum disorders (ASD). Over the last ten years, there's been a large body of research showing that sleep is an important component for memory and learning. During memory consolidation a memory trace gets strengthened over a period time. This process has been shown to be sleep-dependent in prior work from my research mentor, Dr. Robert Stickgold.
Recent research has shown that healthy children also show sleep-dependent memory consolidation. Given that children with ASD often are reported to have disturbances in sleep, we aim to study this process in children with ASD, ages 9–18 years, compared to typically developing children.
WHAT IS YOUR HYPOTHESIS?
Our hypothesis is that children with autism will not show overnight sleep-dependent memory consolidation compared to children with typical development. My focus in the project is to show that the process of sleep-dependent memory consolidation is reliant on specific sleep microarchitecture — slow wave density and sleep spindles found in NREM [non-rapid eye movement] sleep. To collect our data, we are using a declarative memory task given to subjects before and after sleep and will compare performance over an equivalent wake period. To assess sleep architecture over the sleep periods, we are using home polysomnography and analyzing the EEG data collected using spectral analysis and wavelet detection algorithms developed by the Stickgold lab.
HAVE ANY SPECIFIC PATIENTS INSPIRED YOUR RESEARCH?
In my child neurology residency, I began to routinely ask patients and their parents about sleep problems and was amazed by how frequent sleep disturbances were reported in children with a spectrum of neurological conditions. Sleep disturbances in the patient can lead to difficulties with daytime functioning but also affect sleep and well being of all family members. As a result, helping patients with sleep problems is rewarding because it not only benefits the patients' daytime behaviors and possibly cognition, but also improves the family dynamics.
HOW DO YOU HELP FAMILIES DEAL WITH THE SLEEP PROBLEMS?
I trained in part with Dr. Richard Ferber during my sleep fellowship at Children's Hospital Boston and always include a behavioral approach to evaluating and treating sleep disorders even in the most complex neurological patients. I can recall one four-year-old patient with autism and cognitive impairment who was having difficulty falling asleep and then having long wakings at night despite being on four sleep medications.
In taking a history, the parents were using a sleep schedule that was more appropriate for a much younger child because they were told it was more appropriate for his “cognitive age.” We simply adjusted his sleep schedule to hours appropriate for his chronological age and eliminated daytime napping which resulted in improved sleep onset and more consolidated sleep. In this case, we were even able to wean his sleep medications and the family was very grateful. Of course, not every case is this simplistic but it taught me never to forget the basics of sleep hygiene!
WHY HAS DR. STICKGOLD, YOUR MENTOR, BEEN SO INFLUENTIAL IN YOUR WORK?
Dr. Stickgold is the director of the Center for Sleep and Cognition at Beth Israel Deaconess Hospital, and a pioneer in the field of memory and sleep. When I was starting out in sleep medicine, I found his work to be very intriguing because we spend nearly a third of our lives in sleep without a clear explanation for its purpose. His work offers one possible explanation that sleep is necessary for memory and learning as well as emotional modulation.
This is particularly intriguing because children undergo rapid changes to sleep requirements and sleep architecture during time periods in which there is also rapid acquisition of motor, language, and social skills. I was very interested in working with him to extend some of his paradigms into the pediatric field.
DID YOU ALWAYS WANT TO STUDY SLEEP MEDICINE?
When I was a resident, I started to ask my patients about sleep quantity and quality, and it was like the floodgates opened! I recognized that sleep was often not discussed in clinics because we as practitioners don't ask, or parents/guardians do not think anything could be done about those problems and don't offer the information. As I did more research, I found that sleep is a critical part of daytime affect, behaviors, pain modulation, cognition and emotional processing — and yet, improving sleep disturbances was rarely considered a therapeutic target.
I am very grateful to have trained in a multidisciplinary sleep fellowship where I worked with neurologists, pediatricians, otolaryngologists, pulmonologists, craniofacial surgeons, and behavior specialists to understand the complexities of sleep and sleep disorders.
AN Clinical Research Training Fellowships are funded by American Academy of Neurology and the American Brain Foundation, and provide $55,000 per year for two years, plus $10,000 per year for tuition to support formal education in clinical research methodology at the fellow's institution or elsewhere. Twelve fellowships were awarded for 2012, and more than 80 training fellowships have been awarded through the program since its inception in 1996. For more information about the program, visit http://bit.ly/egrG8L.
Listen as Dr. Kiran Maski talks about how she hopes to use her AAN fellowship to study sleep medicine and daytime cognition in children with autism, and how to improve family dynamics in the process http://bit.ly/LyTglc.©2012 American Academy of Neurology
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