The Woolcock Institute of Medical Research

Dr Elie Matar says his work as a clinician-researcher is driven by a responsibility to push the boundaries of medicine for the collective good.

“The type of contributions I make to the field of sleep medicine as a clinician-researcher go beyond what I can do for the patient I have in front of me in the Clinic. They might translate to many patients across Australia and around the world.”

Dr Matar’s medical training has taken him around the world – from the Woolcock where he completed his post-graduate training to the Mayo Clinic in the US, the University of Cambridge and London’s National Hospital of Neurology and Neurosurgery – and back again. He is a member of our Sleep and Circadian Research group and sees patients in the Woolcock Clinic. He is one of a very few neurologists in Australia with a dual accreditation in sleep medicine and specialises in the management of patients suffering from neurological sleep disorders.

“I think I’m a product of a place like the Woolcock, which has a multidisciplinary view about sleep medicine. The multidisciplinary approach means we really think about the patient holistically and try to gather the skill sets around to help that particular patient.”

CHANGING FOCUS

Dr Matar says that the traditional focus of sleep medicine in Australia on respiratory factors is changing and none too soon. He cites the International Classification of Sleep Disorders, which catalogues and groups conditions into themes.

“Sleep-disordered breathing is only one of the seven major categories of sleep disorders, with the others having mainly a neurological basis – conditions like circadian and sleep-wake disorders, insomnia, restless legs and parasomnias, are neurological conditions but since most sleep training in Australia has been focussed on sleep-related breathing, it’s become ingrained in the system.”

“Sleep intersects with every organ system in our bodies – in fact every single cell in your body has its own internal clock that's regulated by the circadian system. So, sleep is a nuanced and complex field of medicine. There isn't a single system, I think, that's not adversely impacted by poor sleep – immunological function, cancer risk, cardiovascular, metabolic, neurological, psychiatric, and endocrine. At its extremes, sleep disorders interact with everything.”

A TEAM APPROACH

So, how does somewhere like the Woolcock Clinic address the complexity of sleep medicine?

“There’s no silver bullet when it comes to complex conditions,” says Dr Matar “but step one is the recognition of potential intersections of other organ systems playing a role in someone's sleep. At the Woolcock there's an understanding, and in part this is informed by its research, of the multifactorial nature of sleep disturbances.”

The Woolcock hosts monthly case conferences where respiratory sleep physicians, neurologists, psychologists, psychiatrists, paediatric sleep physicians, ENTs, dentists and allied health professionals get together to look at complex cases and ask “what’s psychiatry’s input here? what's the neurology input? what's the respiratory sleep input? And so forth.” That dialogue is good for the patient and builds the clinicians’ cross-disciplinary knowledge.

How does that benefit patients?

“The Woolcock’s research is at the cutting edge. Clinicians and their patients also have access to the latest research, trials and projects being conducted within the building. Some patients come with this idea of ‘what else is there for me?’ That may be assessing the impact of someone’s sleep on cognition and risk of future dementia, or enrolling in a cannabinoid trial for insomnia, or using medicines to help treat OSA instead of CPAP. Some patients have very complex conditions, they’re at the end of the line for common treatments and looking for something else.”

“Everyone who gets involved in research gains a better understanding of the disease – from the underlying mechanisms to the nuances of diagnosis, investigations and management – and that benefits everyone.”

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