Tiffany Braley, MD, MS

Dr. Braley is an Assistant Professor of Neurology, multiple sclerosis (MS) specialist, and clinical sleep researcher. Her research focuses on crucial connections between sleep disorders, the immune system, and neurological disorders, especially as they relate to patients with MS.

Since joining the U-M Sleep faculty, Dr. Braley, in in collaboration with Dr. Ronald Chervin (Director of the U-M Sleep Disorders Center), has worked to develop a productive, multidisciplinary clinical research program between the University of Michigan Sleep and Neuroimmunology groups. To date, this program has led to several important findings that have increased our understanding of the prevalence and risk factors for sleep disorders in MS, and predictors of MS-related fatigue.  Multiple sclerosis is an autoimmune disease of the nervous system.  Multiple sclerosis patients are particularly vulnerable to several sleep disorders including obstructive sleep apnea (OSA), restless legs syndrome, and insomnia. Dr. Braley’s research findings include important discoveries about disease-specific risk factors and clinical features that may influence vulnerability to sleep apnea in persons with MS. In particular, her findings suggest that MS patients with brainstem involvement are at risk for more severe forms of both obstructive and central sleep apnea. Subsequent work suggests that MS patients are at increased risk for OSA and other sleep disturbances, and that OSA in particular may be a highly prevalent and yet under-recognized contributor to fatigue in persons with MS.  Her work has also focused on a previously unstudied relationship between over-the-counter sleep-aid use and fatigue in MS patients.

Recent research from Dr. Braley and her colleagues in the sleep disorders center (Drs. Chervin and Kaplish) and physical medicine and rehabilitation department (Dr. Anna Kratz) has also led to new evidence that OSA is associated with diminished cognitive performance in MS.  Data from this study (published in SLEEP) led to new funding from the National Multiple Sclerosis Society to conduct a randomized, placebo-controlled trial that evaluates the effects of OSA treatment with CPAP on cognitive function in MS patients with OSA (https://clinicaltrials.gov/ct2/show/NCT02544373). To this end, Dr. Braley, and sleep disorders specialists Drs. Chervin and Hershner, have also established a new first of its kind Multidisciplinary MS Fatigue and Sleep Clinic. Multiple sclerosis patients who have problems with fatigue, sleep, or sleepiness will be referred for evaluation and care by Dr. Braley, a Sleep Center faculty member, and a sleep medicine fellow or neurology resident. Appropriate diagnostic and therapeutic care will be planned and executed in this team approach, following a model that has already worked well for many years in other multidisciplinary sleep clinics here, to provide MS patients with a unique and much needed service.

Dr. Braley’s current collaborative efforts with her sleep colleagues also focus on OSA in a broader context. Recent findings suggest that systemic or local inflammation may contribute to sleep apnea severity, and respond to treatments that target inflammation. This discovery has laid the groundwork for a new clinical trial to study the effects of a specific immunotherapy used for MS - dimethyl fumarate - in OSA patients without MS (https://clinicaltrials.gov/ct2/show/NCT02438137).  New research also includes collaboration with our health services research colleagues to study the effects of OSA on a population level.  Although OSA is common among individuals over 65, older Americans are some of the most vulnerable to under-recognition of this condition. This is a critical gap in healthcare delivery. To address this gap, Dr. Braley recently initiated a project funded by the American Sleep Medicine Foundation to characterize the scope and impact of OSA under-recognition across the U.S., and barriers to diagnosis and treatment among Medicare beneficiaries. This project will use data from large Medicare datasets to identify which patients are most likely to benefit from targeted OSA screening and treatment, and to galvanize the delivery of cost-effective, high quality sleep care for millions of Americans.

Publications authored or co-authored by Dr. Braley are listed at:

http://www.ncbi.nlm.nih.gov/pubmed/?term=braley+t+multiple+sclerosis