Students of Florey Stroke: Elie Gottlieb

A conversation with: Elie Gottlieb, PhD student

Elie Gottlieb is a final-year PhD Candidate enrolled through the University of Melbourne working within Professor Amy Brodtmann’s Vascular Neurodegeneration and Clinical Cognitive Neuroscience Laboratory at the Florey. Elie's work has resulted in several publications in high-impact journals and awards, and his findings have been presented at multiple international conferences. 

PhD student Elie Gottlieb

What is your research about?

My research aims to untangle the link between sleep and stroke. I have shown that poor sleep is a potential risk factor for stroke, and that post-stroke sleep problems may worsen stroke severity and reduce recovery. I am now exploring how sleep-wake dysfunction affects the brain after stroke.

I am also attempting to understand how stroke in one hemisphere of the brain affects sleep. We know that dolphins only sleep one hemisphere of their brain at a time. In a similar way, do stroke patients have different sleep patterns in the stroke-affected versus healthy hemisphere?

Understanding these sleep-related brain changes can help us develop sleep treatments to improve the lives of stroke survivors.

“If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made.” - Allan Rechtschaffen

What inspired you to pursue stroke research? 

My research interests serendipitously led to stroke through an internship with Professor Amy Brodtmann in 2015. We identified an understudied but critical link between sleep and stroke and I was inspired to further investigate that relationship with my current PhD. 

A renowned sleep physician and pioneer in the field, Allan Rechtschaffen, once said that “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made.” We sleep a third of our lives, and while we sleep we don’t forage for food, we don’t mate, and we’re incredibly vulnerable. There must be some essential function for optimal sleep. This function is especially critical after stroke, and we’re beginning to understand how healthy sleep is vital for overall brain health.

What would you like to do in the future?

My goal is to create a novel and revolutionary sleep-modifying device or treatment that will help those at-risk of sleep problems (patients with neurological diseases, especially those with stroke) get uninterrupted and restorative sleep. 

Elie Gottlieb is researching the relationship between stroke and sleep.

How are you understanding the link between stroke and sleep?

My research uses a multi-modal approach – including MRI, polysomnography, and radioimmunoassay – to disentangle the bidirectional impact of sleep and circadian rhythm dysfunction in human ischaemic stroke.  My current research focuses on characterising sleep architecture and circadian rhythm dysfunction after very chronic stroke (> 3 years). 

We recently showed that sleep and circadian rhythm dysfunction are bi-directionally associated with both the pathogenesis and evolution of human ischaemic stroke. Chronic sleep dysfunction, characterised by excessively long sleep duration or sleep disorders, significantly increase the risk of ischaemic stroke. Inversely, stroke is associated with sleep and endogenous circadian rhythm disruption which may be associated with post-stroke severity and functional outcome. 

My PhD aims to further disentangle these findings by characterising sleep architecture and bi-hemispheric sleep parameters using gold-standard polysomnography and a validated multi-sensor armband. I have also examined the potential neuroanatomical pathogenesis of sleep-wake dysfunction post-stroke using advanced MRI methods.

My future goal is to examine the potential for pharmacologically or behaviourally enhanced sleep to aid neurological recovery and abate sleep-potentiated neurodegeneration after stroke.

More on Elie Gottlieb's research projects:

CANVAS (Cognition and Neocortical Volumes After Stroke)

Our primary interest is to understand whether stroke and ischaemic brain injury cause neurodegeneration. This is currently being investigated in one of our major research projects, the NHMRC-funded, Cognition and Neocortical Volume After Stroke (CANVAS) Study, which is now in its fifth year of data collection.  In this study, stroke participants undergo an MRI scan, cognitive assessments, and sleep-activity monitoring within a few weeks of their events, and again, 3 months, 1 year, 3 years, and 5 years later. By comparing their results with a healthy, age-matched control group with no history of stroke or dementia, we can determine whether brain volume change is associated with post-stroke dementia and elucidate potential causal mechanisms, including sleep, genetic markers, amyloid deposition and vascular risk factors.

SACRAS (Sleep and Circadian Rhythms After Stroke):

This is a sub-study of the aforementioned CANVAS study and includes stroke participants and healthy controls who have already completed their CANVAS assessments. The primary goal is to disentangle the link between sleep and stroke using the gold-standard for sleep detection, polysomnography, and the gold-standard for circadian rhythm detection, 24-hour melatonin collection. By using the pre-existing MRI and neuropsychological data from CANVAS, we can determine whether sleep and circadian rhythm dysfunction after stroke is associated with post-stroke dementia, neurodegeneration, or various brain metrics.