Principles and Practice of Sleep Medicine - E-Book (eBook)

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William C. Dement, Meir H. Kryger, Thomas Roth (Autoren)

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2010 | 5. Auflage
1766 Seiten
Elsevier Health Sciences (Verlag)
978-1-4377-2773-9 (ISBN)

Infos

Principles and Practice of Sleep Medicine, 5th Edition, by Meir H. Kryger, MD, FRCPC, Thomas Roth, PhD, and William C. Dement, MD, PhD, delivers the comprehensive, dependable guidance you need to effectively diagnose and manage even the most challenging sleep disorders. Updates to genetics and circadian rhythms, occupational health, sleep in older people, memory and sleep, physical examination of the patient, comorbid insomnias, and much more keep you current on the newest areas of the field. A greater emphasis on evidence-based approaches helps you make the most well-informed clinical decisions. And, a new more user-friendly, full-color format, both in print and online, lets you find the answers you need more quickly and easily. Whether you are preparing for the new sleep medicine fellowship examination, or simply want to offer your patients today's best care, this is the one resource to use!

• Make optimal use of the newest scientific discoveries and clinical approaches that are advancing the diagnosis and management of sleep disorders.

• Stay on top of the hottest topics in sleep medicine with 56 new chapters, including:
• Postpartum Sleep Disturbances
• Fatigue Risk Management
• What does Brain Imaging Reveal about Sleep Genesis and Maintenance?
• Physician Examination of the Sleep Patient
• Forensic Sleep Medicine
• Pathophysiology and Models of Insomnia
• Treatment of Insomnia: Developing Treatment Guidelines
• Restrictive Lung Disorders
• Sleep Medicine in the Elderly: Obstructive
• Obstructive Sleep Apnea, Metabolic, and Renal Disorders
• Sleep Apnea, Obesity and Bariatric Surgery
• Sleep and Renal Disease
• Theories of Dreaming
• Why We Dream
• Sleep, Stress, and Burnout
• Evaluating Sleep EEG and Sleep Stage Scoring
• And more
• Master the newest areas in the field with 5 new sections covering:
• Sleep Mechanisms and Phylogeny
• Genetics of Sleep
• Physiology in Sleep
• Occupational Sleep Medicine
• Sleep Medicine in the Elderly
• Apply evidence-based approaches wherever available.
• Find answers more easily thanks to a new user-friendly, full-color format.
• Access the complete contents online from any computer and perform rapid searches on any topic.
• Follow links to PubMed abstracts for most bibliographical references.
• Access regular updates reflecting important new clinical developments.
• View video clips demonstrating key manifestations of sleep disturbances and interviews with sleep medicine pioneers and thought leaders.
• Enhance your knowledge with hundreds of self-assessment questions.
• Download patient education handouts in multiple languages.
• Import all of the images and tables into PowerPoint.

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Principles and Practice of Sleep Medicine, 5th Edition, by Meir H. Kryger, MD, FRCPC, Thomas Roth, PhD, and William C. Dement, MD, PhD, delivers the comprehensive, dependable guidance you need to effectively diagnose and manage even the most challenging sleep disorders. Updates to genetics and circadian rhythms, occupational health, sleep in older people, memory and sleep, physical examination of the patient, comorbid insomnias, and much more keep you current on the newest areas of the field. A greater emphasis on evidence-based approaches helps you make the most well-informed clinical decisions. And, a new more user-friendly, full-color format, both in print and online, lets you find the answers you need more quickly and easily. Whether you are preparing for the new sleep medicine fellowship examination, or simply want to offer your patients today's best care, this is the one resource to use! Make optimal use of the newest scientific discoveries and clinical approaches that are advancing the diagnosis and management of sleep disorders. Stay on top of the hottest topics in sleep medicine with 56 new chapters, including: Postpartum Sleep Disturbances Fatigue Risk Management What does Brain Imaging Reveal about Sleep Genesis and Maintenance? Physician Examination of the Sleep Patient Forensic Sleep Medicine Pathophysiology and Models of Insomnia Treatment of Insomnia: Developing Treatment Guidelines Restrictive Lung Disorders Sleep Medicine in the Elderly: Obstructive Obstructive Sleep Apnea, Metabolic, and Renal Disorders Sleep Apnea, Obesity and Bariatric Surgery Sleep and Renal Disease Theories of Dreaming Why We Dream Sleep, Stress, and Burnout Evaluating Sleep EEG and Sleep Stage Scoring And more Master the newest areas in the field with 5 new sections covering: Sleep Mechanisms and Phylogeny Genetics of Sleep Physiology in Sleep Occupational Sleep Medicine Sleep Medicine in the Elderly Access the complete contents online, fully searchable, and follow links to abstracts for most bibliographical references. Apply evidence-based approaches wherever available. Find answers more easily thanks to a new user-friendly, full-color format.

Inhalt

Front cover 1
Principles and Practice of Sleep Medicine 2
Copyright page 5
Dedication 6
Contributors 10
Foreword 24
Preface 28
Acknowledgments 30
Abbreviations 32
Instructions for online access 1805
Table of contents 36
Part I: Principles of Sleep Medicine 44
Chapter 1: History of Sleep Physiology and Medicine 46
Abstract 46
SLEEP AS A PASSIVE STATE 46
THE ELECTRICAL ACTIVITY OF THE BRAIN 47
THE ASCENDING RETICULAR SYSTEM 48
EARLY OBSERVATIONS OF SLEEP PATHOLOGY 48
SIGMUND FREUD AND THE INTERPRETATION OF DREAMS 49
CHRONOBIOLOGY 49
THE DISCOVERY OF REM SLEEP 49
ALL-NIGHT SLEEP RECORDINGS AND THE BASIC SLEEP CYCLE 50
REM SLEEP IN ANIMALS 51
THE DUALITY OF SLEEP 52
PREMONITIONS OF SLEEP MEDICINE 52
SLEEP-ONSET REM PERIODS AND CATAPLEXY 52
THE NARCOLEPSY CLINIC: A FALSE START 52
EUROPEAN INTEREST 52
BENZODIAZEPINES AND HYPNOTIC EFFICACY STUDIES 53
THE DISCOVERY OF SLEEP APNEA 53
ITALIAN SYMPOSIA 53
BIRTH PANGS 53
THE EARLY DEVELOPMENT OF SLEEP MEDICINE CLINICAL PRACTICE 54
CLINICAL SIGNIFICANCE OF EXCESSIVE DAYTIME SLEEPINESS 55
FURTHER DEVELOPMENT OF SLEEP MEDICINE 55
THE TURN OF THE CENTURY AND BEYOND 56
REFERENCES 57
Chapter 2: Normal Human Sleep: 59
Abstract 59
SLEEP DEFINITIONS 59
SLEEP ONSET 60
PROGRESSION OF SLEEP ACROSS THE NIGHT 63
REFERENCES 68
Chapter 3: Normal Aging 70
Abstract 70
SLEEP ARCHITECTURE 70
CIRCADIAN RHYTHMS IN AGING 73
CAUSES AND CONSEQUENCES OF POOR SLEEP IN OLD AGE 75
RESTLESS LEGS SYNDROME AND PERIODIC LIMB MOVEMENTS IN SLEEP 76
SLEEP-DISORDERED BREATHING 77
WHY DO OLDER PEOPLE NAP? 79
BASIC SCIENCE CONSIDERATIONS 79
SUMMARY 80
REFERENCES 80
Chapter 4: Daytime Sleepiness and Alertness 85
Abstract 85
INTRODUCTION 85
EPIDEMIOLOGY OF SLEEPINESS 85
NATURE OF SLEEPINESS 86
ASSESSMENT OF SLEEPINESS 88
DETERMINANTS OF SLEEPINESS 90
CLINICAL AND PUBLIC HEALTH SIGNIFICANCE OF SLEEPINESS 93
REFERENCES 94
Chapter 5: Acute Sleep Deprivation 97
Abstract 97
TOTAL SLEEP DEPRIVATION 97
PHYSIOLOGIC EFFECTS OF SLEEP DEPRIVATION 102
SLEEP FRAGMENTATION 104
RECOVERY SLEEP 105
CONCLUSIONS 107
Acknowledgements 107
REFERENCES 107
Chapter 6: Chronic Sleep Deprivation 110
Abstract 110
INCIDENCE OF CHRONIC SLEEP RESTRICTION 110
THEORETICAL PERSPECTIVES ON SLEEP NEED AND SLEEP DEBT 110
EFFECTS OF CHRONIC SLEEP RESTRICTION 112
PHYSIOLOGIC EFFECTS 116
Acknowledgments 116
REFERENCES 116
Chapter 7: Neural Control of Sleep in Mammals 119
Abstract 119
DIVERSE BRAIN REGIONS MODULATE WAKING AND NREM SLEEP 119
RETICULAR ACTIVATING SYSTEM AND DELINEATION OF AROUSAL SYSTEMS 120
WAKE-ON, REM-OFF AROUSAL SYSTEMS 121
WAKE-ON, REM-ON AROUSAL SYSTEMS 122
SLEEP-PROMOTING MECHANISMS 122
THE ORCHESTRATION OF SLEEP BY THE POA HYPNOGENIC SYSTEM 124
THALAMIC–CORTICAL INTERACTIONS AND THE GENERATION OF THE SLEEP EEG 125
INTEGRATION OF CIRCADIAN RHYTHMS AND SLEEP 129
THE POA, THERMOREGULATION, AND CONTROL OF SLEEP 129
HIERARCHICAL CONTROL MODEL 129
SLEEP-PROMOTING NEUROCHEMICAL AGENTS 130
SUMMARY 132
Acknowledgments 132
REFERENCES 132
Chapter 8: REM Sleep* 135
Abstract 135
CHARACTERISTICS OF REM SLEEP 135
REM GENERATION MECHANISMS 136
CONTROL OF MUSCLE TONE 144
NARCOLEPSY AND HYPOCRETIN 146
THE FUNCTIONS OF REM SLEEP 148
REFERENCES 151
Chapter 9: Phylogeny of Sleep Regulation 155
Abstract 155
SLEEP REGULATION IN MAMMALS 155
SLEEP REGULATION IN NONMAMMALIAN VERTEBRATES 162
SLEEP REGULATION IN INVERTEBRATES 163
OUTLOOK 165
REFERENCES 166
Chapter 10: Sleep in Animals: 169
Abstract 169
ADAPTIVE INACTIVITY 169
QUANTITATIVE ANALYSES OF THE CORRELATES OF SLEEP DURATION 170
THE DIVERSITY OF SLEEP 172
SLEEP IN MONOTREMES 173
REINDEER 175
BIRDS 175
WALRUS 176
SLEEP IN CETACEANS (DOLPHINS AND WHALES) 176
SLEEP IN OTARIIDS (EARED SEALS) 178
SLEEP REBOUND 178
CONCLUSION 179
Acknowledgment 179
REFERENCES 179
Chapter 11: Introduction 182
REFERENCES 183
Chapter 12: Circadian Clock Genes 184
Abstract 184
REFERENCES 191
Chapter 13: Genetics of Sleep in a Simple Model Organism: 194
Abstract 194
DROSOPHILA AS A MODEL SYSTEM FOR GENETICS 194
DROSOPHILA AS A MODEL FOR STUDIES OF SLEEP 195
DROSOPHILA CIRCADIAN BEHAVIOR REVEALS CONSERVED MECHANISMS BETWEEN FLIES AND HUMANS 196
CELLULAR AND MOLECULAR BASIS OF DROSOPHILA SLEEP 197
SPECIFIC NEURAL CIRCUITS ARE IMPORTANT FOR SLEEP–WAKE REGULATION 197
GENETICS AND PHARMACOLOGY OF SLEEP: WHICH MOLECULES REGULATE SLEEP? 198
WHICH GENES ARE REGULATED BY SLEEP–WAKE? 201
SUMMARY 201
REFERENCES 201
Chapter 14: Genetic Basis of Sleep in Rodents 204
Abstract 204
REFERENCES 214
Chapter 15: Genetic Basis of Sleep in Healthy Humans 218
Abstract 218
REFERENCES 225
Chapter 16: Genetics of Sleep and Sleep Disorders in Humans 227
Abstract 227
REFERENCES 238
Chapter 17: Relevance of Sleep Physiology for Sleep Medicine Clinicians 242
Abstract 242
REFERENCES 243
Chapter 18: What Brain Imaging Reveals about Sleep Generation and Maintenance 244
Abstract 244
REFERENCES 255
Chapter 19: Cardiovascular Physiology: 258
Abstract 258
REFERENCES 266
Chapter 20: Cardiovascular Physiology: 269
Abstract 269
INTRODUCTION 269
THE CARDIOVASCULAR AUTONOMIC NERVOUS SYSTEM: DEFINITION AND FUNCTIONS 269
MEASURES TO EXPLORE AUTONOMIC CHANGES DURING SLEEP AND THEIR PHYSIOLOGICAL SIGNIFICANCE 270
SLEEP RELATED CARDIOVASCULAR AUTONOMIC CHANGES 273
IMPACT OF AGING ON NEURAL CIRCULATORY RESPONSE TO NORMAL SLEEP 275
EFFECTS OF DISORDERED SLEEP AND PRIMARY AUTONOMIC DYSFUNCTION ON DAY–NIGHT AUTONOMIC CHANGES 276
SYMPATHETIC ACTIVATION IN OBSTRUCTIVE SLEEP APNEA 277
SUMMARY 278
REFERENCES 278
Chapter 21: Respiratory Physiology: 280
Abstract 280
RESPIRATORY NEUROBIOLOGY: BASIC OVERVIEW 280
SLEEP NEUROBIOLOGY: BASIC OVERVIEW 282
CONTROL OF RESPIRATORY MOTONEURONS 283
DETERMINANTS OF RESPIRATORY MOTONEURON ACTIVITY 284
NEUROMODULATION OF RESPIRATORY MOTONEURONS ACROSS SLEEP–WAKE STATES 286
CONTROL OF RESPIRATORY NEURONS 289
Acknowledgments 291
REFERENCES 291
Chapter 22: Respiratory Physiology: 293
Abstract 293
INTRODUCTION 293
PHYSIOLOGY OF VENTILATORY CONTROL DURING SLEEP 293
ADDED RESISTANCE AND AIRWAY OCCLUSION DURING SLEEP 295
AROUSAL RESPONSES 295
CONTROL OF BREATHING RHYTHM DURING SLEEP 297
UPPER AIRWAY–OPENING MUSCLES DURING SLEEP 297
FACTORS INFLUENCING RESPIRATORY CONTROL DURING SLEEP 297
CLINICAL SEQUELAE OF ABNORMAL VENTILATORY RESPONSES 298
REFERENCES 299
Chapter 23: Normal Physiology of the Upper and Lower Airways 302
Abstract 302
REFERENCES 309
Chapter 24: Respiratory Physiology: 312
Abstract 312
PHYSIOLOGIC ADJUSTMENT TO HIGH ALTITUDE 312
PERIODIC BREATHING 314
TREATMENT 319
SLEEP AT HIGH ALTITUDE AFTER LONG-TERM ADAPTATION 320
CONCLUSIONS 321
REFERENCES 321
Chapter 25: Sleep and Host Defense 324
Abstract 324
INTRODUCTION 324
THE ACUTE PHASE RESPONSE AND HOST DEFENSE 324
SLEEP CHANGES AFTER INFECTIOUS CHALLENGE 325
SLEEP LOSS EFFECTS ON IMMUNE FUNCTION 328
SLEEP AND IMMUNITY SHARE COMMON REGULATORY MOLECULES 329
Acknowledgments 331
REFERENCES 331
Chapter 26: Endocrine Physiology in Relation to Sleep and Sleep Disturbances 334
Abstract 334
MODULATION OF ENDOCRINE FUNCTION BY SLEEP–WAKE HOMEOSTASIS AND CIRCADIAN RHYTHMICITY 334
THE GROWTH HORMONE AXIS 335
THE CORTICOTROPIC AXIS 336
THE THYROID AXIS 337
PROLACTIN SECRETION 338
THE GONADAL AXIS 339
GLUCOSE REGULATION 339
SLEEP AND APPETITE REGULATION 340
WATER AND ELECTROLYTE BALANCE DURING SLEEP 341
CHRONIC SLEEP RESTRICTION: IMPACT ON ENDOCRINE AND METABOLIC FUNCTION 341
REDUCED SLEEP QUALITY AND SLEEP DISORDERS: IMPACT ON ENDOCRINE AND METABOLIC FUNCTION 344
OSA 346
AGE-RELATED SLEEP ALTERATIONS: IMPLICATIONS FOR ENDOCRINE FUNCTION 346
SLEEP DISTURBANCES IN METABOLIC AND ENDOCRINE DISORDERS 349
REFERENCES 350
Chapter 27: Gastrointestinal Physiology in Relation to Sleep 355
ABSTRACT 355
INTRODUCTION 355
HISTORICAL ASPECTS 355
GASTRIC FUNCTION DURING WAKE AND SLEEP 356
GASTRIC MOTOR FUNCTION DURING SLEEP 357
SWALLOWING AND ESOPHAGEAL FUNCTION 358
INTESTINAL MOTILITY DURING SLEEP 360
SLEEP, ABDOMINAL PAIN, AND IRRITABLE BOWEL SYNDROME 361
EFFECT OF INTESTINAL MOTILITY ON SLEEP 361
COLONIC AND ANORECTAL FUNCTION DURING SLEEP 362
CONCLUSIONS 363
REFERENCES 363
Chapter 28: Body Temperature, Sleep, and Hibernation 366
Abstract 366
INTRODUCTION 366
CIRCADIAN REGULATION OF CORE BODY TEMPERATURE 366
RELATIONSHIP BETWEEN THE SLEEP REGULATORY AND THE THERMOREGULATORY SYSTEM 367
HIBERNATION 373
REFERENCES 374
Chapter 29: Memory Processing in Relation to Sleep 378
Abstract 378
MEMORY SYSTEMS AND MEMORY CONSOLIDATION 379
METHODS FOR STUDYING THE ROLE OF SLEEP FOR MEMORY CONSOLIDATION 380
SLEEP AND DECLARATIVE MEMORY 382
SLEEP AND NONDECLARATIVE MEMORIES 383
SLEEP-DEPENDENT MECHANISMS OF BRAIN PLASTICITY AND MEMORY CONSOLIDATION 385
Conclusions 386
REFERENCES 387
Chapter 30: Sensory and Motor Processing during Sleep and Wakefulness 391
Abstract 391
MODULATION OF SENSORY PROCESSES DURING SLEEP AND WAKEFULNESS 391
MODULATION OF SENSORIMOTOR PROCESSES DURING SLEEP AND WAKEFULNESS 395
RESPIRATORY REFLEXES DURING SLEEP AND WAKEFULNESS 397
REFERENCES 401
Chapter 31: Introduction: 403
INTEGRATION OF THE CIRCADIAN CLOCK AND SLEEP–WAKE SYSTEMS 403
REGULATING SLEEP AMOUNT: A HOMEOSTATIC AND A CIRCADIAN INPUT 404
REFERENCES 405
Chapter 32: Circadian Rhythms in Mammals: 406
Abstract 406
THE NATURE OF CIRCADIAN RHYTHMS 406
PARAMETERS AND MEASUREMENT OF CIRCADIAN RHYTHMS 407
ADAPTIVE SIGNIFICANCE OF CIRCADIAN RHYTHMS 408
ENVIRONMENTAL INFLUENCES 409
CIRCADIAN RHYTHMS ACROSS THE LIFESPAN 415
CONCLUSION 416
REFERENCES 416
Chapter 33: Anatomy of the Mammalian Circadian System 419
Abstract 419
REFERENCES 429
Chapter 34: Physiology of the Mammalian Circadian System 433
Abstract 433
THE SUPRACHIASMATIC NUCLEUS: MASTER CIRCADIAN PACEMAKER 433
MULTIPLE-OSCILLATOR NATURE OF THE CIRCADIAN SYSTEM 437
SUMMARY AND CONCLUSIONS 441
Acknowledgments 441
REFERENCES 441
Chapter 35: The Human Circadian Timing System and Sleep–Wake Regulation 445
Abstract 445
IDENTIFYING THE MAMMALIAN CIRCADIAN PACEMAKER 445
INFLUENCE OF SLEEP AND CIRCADIAN RHYTHMS ON HUMAN PHYSIOLOGY 445
EFFECTS OF LIGHT ON HUMAN CIRCADIAN RHYTHMS 447
NONPHOTIC CIRCADIAN PHASE RESETTING AND REENTRAINMENT 450
INVESTIGATING CIRCADIAN AND SLEEP–WAKE DEPENDENT MODULATION 451
AGING AND CIRCADIAN SLEEP–WAKE REGULATION 457
INFLUENCE OF SOCIAL FACTORS 458
CONCLUSION 458
Acknowledgments 458
REFERENCES 459
Chapter 36: Melatonin and the Regulation of Sleep and Circadian Rhythms 463
Abstract 463
MELATONIN: SYNTHESIS, RECEPTORS, AND CIRCADIAN SECRETION PATTERN 463
PHYSIOLOGIC ROLE OF MELATONIN IN THE REST–ACTIVITY CYCLE: CONSEQUENCES FOR SLEEP 465
CIRCADIAN RHYTHM SLEEP DISORDERS OF EXOGENOUS CAUSES ASSOCIATED WITH ALTERED MELATONIN SECRETION PATTERN 466
CIRCADIAN RHYTHM SLEEP DISORDERS OF ENDOGENOUS ORIGIN 468
CENTRAL NERVOUS SYSTEM DISORDERS ASSOCIATED WITH ALTERATION OF MELATONIN SECRETION PATTERNS 469
CONCLUSION 469
REFERENCES 470
Chapter 37: Sleep Homeostasis and Models of Sleep Regulation 474
Abstract 474
REFERENCES 484
Chapter 38: Circadian Rhythms in Sleepiness, Alertness, and Performance 488
Abstract 488
REFERENCES 495
Chapter 39: Animal Models for Disorders of Circadian Functions: 499
Abstract 499
DESTROYING THE MASTER CIRCADIAN CLOCK IN THE SCN: EFFECTS ON HEALTH AND WELL-BEING 499
IMPORTANCE OF “RESONANCE” OF THE TIMING OF THE INTERNAL CIRCADIAN CLOCK WITH THAT OF THE ENTRAINING LD CYCLE 500
HEALTH AND LONGEVITY IN ANIMAL MODELS OF SHIFT-WORK CONDITIONS 501
GENETIC MODELS FOR EXAMINING THE EFFECTS OF DISRUPTED RHYTHMS AND DISEASE 503
CONCLUSIONS 503
REFERENCES 504
Chapter 40: Animal Models for Disorders of Chronobiology: 506
Abstract 506
REFERENCES 510
Chapter 41: Circadian Disorders of the Sleep–Wake Cycle 513
Abstract 513
REFERENCES 522
Chapter 42: Hypnotic Medications: 526
Abstract 526
REFERENCES 533
Chapter 43: Clinical Pharmacology of Other Drugs Used as Hypnotics 535
Abstract 535
REFERENCES 548
Chapter 44: Wake-Promoting Medications: Basic Mechanisms and Pharmacology 553
Abstract 553
CENTRAL NERVOUS STIMULANTS: DEFINITIONS 553
AMPHETAMINES AND AMPHETAMINE-LIKE COMPOUNDS 553
MODAFINIL AND ARMODAFINIL 563
MAZINDOL 565
BUPROPION 565
SELEGILINE (l-DEPRENYL) 565
ATOMOXETINE AND REBOXETINE 565
CAFFEINE 565
FUTURE STIMULANT TREATMENTS 566
CONCLUSION 567
REFERENCES 567
Chapter 45: Wake-Promoting Medications: 570
Abstract 570
THE HISTORY OF WAKE-PROMOTING MEDICATIONS 570
CAFFEINE 571
SYMPATHOMIMETIC ALERTING AGENTS 573
MODAFINIL AND ARMODAFINIL 577
SODIUM OXYBATE 578
IS ALL WAKEFULNESS THE SAME? 579
SPECIFIC USE OF WAKE-PROMOTING MEDICATIONS 580
CHANGING OR COMBINING MEDICATIONS 580
RECOMMENDATIONS AND TREATMENT PLANNING 581
CONCLUSIONS 582
REFERENCES 582
Chapter 46: Drugs That Disturb Sleep and Wakefulness 585
Abstract 585
PSYCHOTHERAPEUTIC DRUGS 585
ANTIEPILEPTIC DRUGS 592
ANTIPARKINSONIAN DRUGS 592
CARDIOVASCULAR DRUGS 594
HISTAMINE ANTAGONISTS 596
PAIN MEDICATIONS 596
OTHER DRUGS 597
CONCLUSION 598
REFERENCES 598
Chapter 47: Introduction: 604
REFERENCES 605
Chapter 48: The Neurobiology of Dreaming 606
Abstract 606
REFERENCES 616
Chapter 49: Ultradian, Circadian, and Sleep-Dependent Features of Dreaming 619
Abstract 619
REFERENCES 626
Chapter 50: Dream Content: 628
Abstract 628
METHODS FOR COLLECTING DREAM REPORTS 628
ANALYZING DREAM CONTENT: INSTRUMENTS AND ISSUES 630
QUANTITATIVE FINDINGS ON DREAM CONTENT 631
REFERENCES 635
Chapter 51: Dream Analysis and Classification: 638
Abstract 638
REFERENCES 645
Chapter 52: Dreams in Patients with Sleep Disorders 647
Abstract 647
REFERENCES 653
Chapter 53: Dreams and Nightmares in Posttraumatic Stress Disorder 656
Abstract 656
REPLICATIVE-TRAUMA NIGHTMARES: HALLMARK OF A DISORDER? 656
DREAM CONTENT WITH STRESS AND TRAUMA: BEYOND REPLICATION 657
POLYSOMNOGRAPHIC CORRELATES OF NIGHTMARES IN PTSD 658
SUMMARY AND THEORETICAL IMPLICATIONS 659
TREATMENT OF POSTTRAUMATIC NIGHTMARES AND RELATED SLEEP DISTURBANCES 659
REFERENCES 660
Chapter 54: Dreaming as a Mood-Regulation System 663
Abstract 663
MOOD-REGULATION FUNCTION OF DREAMING IN NORMAL PERSONS 663
MOOD REGULATION FUNCTION OF DREAMING IN PATIENTS WITH PARASOMNIAS 668
CLINICAL APPLICATIONS 668
REFERENCES 669
Chapter 55: Why We Dream 671
Abstract 671
BRAIN ACTIVITY DURING SLEEP 671
SLEEP-DEPENDENT MEMORY CONSOLIDATION 671
SLEEP STAGES AND DREAM CONTENT 672
DREAMS AND MEMORY SYSTEMS 672
ASSOCIATIVE NETWORKS IN SLEEP 673
DREAMING AND DECLARATIVE MEMORY PROCESSING DURING SLEEP 674
INCORPORATION OF WAKING EVENTS INTO DREAMS 675
EMOTION IN THE SLEEPING BRAIN 676
A NEUROCOGNITIVE MODEL OF DREAM CONSTRUCTION AND FUNCTION 677
Acknowledgments 678
REFERENCES 678
Part II: Practice of Sleep Medicine 682
Chapter 56: Approach to the Patient with Disordered Sleep 684
Abstract 684
REFERENCES 689
Chapter 57: Cardinal Manifestations of Sleep Disorders 690
Abstract 690
REFERENCES 700
Chapter 58: Physical Examination in Sleep Medicine 701
Abstract 701
REFERENCES 707
Chapter 59: Use of Clinical Tools and Tests in Sleep Medicine 709
Abstract 709
REFERENCES 720
Chapter 60: Classification of Sleep Disorders 723
Abstract 723
INSOMNIAS 723
SLEEP-RELATED BREATHING DISORDERS 726
HYPERSOMNIA OF CENTRAL ORIGIN 727
CIRCADIAN RHYTHM SLEEP DISORDERS 728
PARASOMNIAS 728
SLEEP-RELATED MOVEMENT DISORDERS 729
OTHER SLEEP DISORDERS 730
CURRENT AND FUTURE CLASSIFICATION CONSIDERATIONS 730
REFERENCES 733
Chapter 61: Epidemiology of Sleep Disorders 737
Abstract 737
SLEEP DURATION 737
INSOMNIA AND USE OF HYPNOTIC AGENTS 738
CIRCADIAN RHYTHMS AND THEIR DISORDERS 741
EXCESSIVE SLEEPINESS AND HYPERSOMNIA 741
NARCOLEPSY AND NARCOLEPSY-LIKE SYMPTOMS 744
SNORING, SLEEP-DISORDERED BREATHING, AND SLEEP APNEA SYNDROME 745
RESTLESS LEGS SYNDROME 751
REM SLEEP BEHAVIOR DISORDER 751
PARASOMNIAS 751
REFERENCES 752
Chapter 62: Sleep Medicine, Public Policy, and Public Health 759
Abstract 759
SLEEP IN MODERN SOCIETY 759
THE CHALLENGE 760
KEY AREAS FOR EDUCATION AND AWARENESS 760
MAKING SLEEP A MATTER OF PUBLIC HEALTH AND PUBLIC POLICY 764
CONCLUSION 765
REFERENCES 766
Chapter 63: Sleep Forensics 768
EVOLUTION OF LEGAL THOUGHT 768
EVOLUTION OF CONSCIOUSNESS THOUGHT 769
COMPLEX BEHAVIOR ARISING FROM SLEEP 771
THE DEVELOPMENT OF SLEEP FORENSICS 773
CLINICAL GUIDELINES TO ASSIST IN DETERMINING PURPORTED VIOLENCE ARISING FROM SLEEP 773
THE ROLE OF THE SLEEP MEDICINE SPECIALIST 774
CONCLUSION 774
REFERENCES 775
Chapter 64: Introduction 777
Abstract 777
FATIGUE AS A FUNCTION OF SLEEP–WAKE HISTORY, CIRCADIAN RHYTHM, AND WORK LOAD 777
MANAGING SLEEP AND CIRCADIAN RHYTHM–RELATED FATIGUE RISK 778
DROWSY DRIVING 778
MONITORING SLEEP AND WORKPLACE PERFORMANCE 779
SHIFT WORK, SHIFT-WORK SLEEP DISORDER, AND JET LAG 779
POLICE, FIRST RESPONDERS, AND THE MILITARY 779
PHARMACOLOGIC MANAGEMENT OF SLEEP AND FATIGUE 779
SLEEP, STRESS, AND BURNOUT 779
THE SCIENCE AND ART OF OCCUPATIONAL SLEEP MEDICINE 780
REFERENCES 780
Chapter 65: Performance Deficits during Sleep Loss: 781
Abstract 781
THE NATURE OF SLEEPINESS-INDUCED PERFORMANCE DEFICITS 781
FUNCTIONAL BRAIN IMAGING STUDIES OF SLEEPINESS AND PERFORMANCE 782
INFLUENCE OF THE CIRCADIAN RHYTHM OF ALERTNESS ON PERFORMANCE 783
TIME ON TASK (FATIGUE) EFFECTS 783
THE NONSPECIFICITY OF SLEEP LOSS–INDUCED PERFORMANCE DEFICITS 785
PERFORMANCE PREDICTION MODELING 785
CONCLUSION 786
Disclaimer 786
REFERENCES 786
Chapter 66: Fatigue and Performance Modeling 788
Abstract 788
COMPONENTS OF A FATIGUE MODEL 788
MODULATION OF PERFORMANCE 789
RECUPERATION DURING SLEEP 789
SLEEP ESTIMATION 791
ADAPTATION OF CIRCADIAN PHASE 791
PREDICTING PERFORMANCE 791
FATIGUE MODELING APPLIED TO OPERATIONAL SETTINGS 792
LIMITATIONS AND ENHANCEMENTS OF FATIGUE MODELS 793
REFERENCES 794
Chapter 67: Fatigue, Performance, Errors, and Accidents 796
Abstract 796
SLEEP, CIRCADIAN, AND TIME-ON-TASK FACTORS MODULATING RISK OF ERRORS AND ACCIDENTS 796
FATIGUE, PERFORMANCE IMPAIRMENT, AND WAKE- STATE INSTABILITY 797
PREDICTING ACCIDENTS 798
MODELING SLEEP–WAKE–WORK AND ACCIDENT RISK 799
CONCLUSION 801
REFERENCES 801
Chapter 68: Fatigue Risk Management 803
Abstract 803
A THEORETICAL FRAMEWORK 803
DYNAMICS OF SLEEP LOSS AND RECOVERY 804
MANAGING FATIGUE RISK 806
CHALLENGES 808
CONCLUSIONS 809
Acknowledgement 809
REFERENCES 809
Chapter 69: Drowsy Driving 812
Abstract 812
PREVALENCE AND ASSOCIATED RISKS 812
EVALUATION OF RISK IN PATIENTS WITH SLEEPINESS WHILE DRIVING 814
IMPACT OF TREATMENT AND COUNTERMEASURES ON ACCIDENT RISK 814
DRIVING LICENSE REGULATIONS 814
FUTURE CONSIDERATIONS 815
REFERENCES 816
Chapter 70: Sleep and Performance Monitoring in the Workplace: 818
Abstract 818
SLEEP, CIRCADIAN RHYTHM, WORKLOAD, AND OPERATIONAL PERFORMANCE 818
TECHNIQUES FOR MEASURING SLEEP AND PERFORMANCE IN THE OPERATIONAL ENVIRONMENT 820
A REVIEW OF FIELD SLEEP AND PERFORMANCE STUDIES 821
METHODOLOGICAL FACTORS IN FIELD STUDIES OF SLEEP AND PERFORMANCE 821
USEFULNESS OF FIELD STUDIES OF SLEEP AND PERFORMANCE 824
SLEEP AND PERFORMANCE STUDIES AND THE MANAGEMENT OF FATIGUE-ASSOCIATED RISK OF ERROR, INCIDENT, AND ACCIDENT 824
THE FUTURE OF SLEEP AND PERFORMANCE MONITORING IN THE WORKPLACE 824
REFERENCES 824
Chapter 71: Shift Work, Shift-Work Disorder, and Jet Lag 827
Abstract 827
SHIFT WORK 827
SHIFT-WORK DISORDER 830
JET LAG 834
CONCLUSIONS 837
Acknowledgments 838
REFERENCES 838
Chapter 72: Sleep Problems in First Responders and the Military 842
Abstract 842
REFERENCES 850
Chapter 73: Pharmacologic Management of Performance Deficits Resulting from Sleep Loss and Circadian Desynchrony 852
Abstract 852
PHARMACOLOGIC STRATEGIES FOR IMPROVING COGNITIVE PERFORMANCE 853
PHARMACOLOGIC STRATEGIES FOR IMPROVING SLEEP 854
CONCLUSION 855
REFERENCES 855
Chapter 74: Sleep, Stress, and Burnout 857
Abstract 857
THE CROSS-SECTIONAL CONNECTION BETWEEN STRESS AND SLEEP 857
THE PROSPECTIVE CONNECTION BETWEEN STRESS AND SLEEP 858
RUMINATION AND ANTICIPATION 859
POSTTRAUMATIC STRESS 859
SLEEP PHYSIOLOGY THAT SEEMS TO LINK SLEEP WITH STRESS 859
SIMILARITY OF MORBIDITY DUE TO STRESS AND SLEEP LOSS 860
BURNOUT AND SLEEP 860
MEASURING STRESS 861
CONCLUSION 861
REFERENCES 861
Chapter 75: Insomnia: 865
EPIDEMIOLOGY 865
DIAGNOSIS AND ASSESSMENT 865
PATHOPHYSIOLOGY AND BIOLOGICAL FINDINGS 866
TREATMENT 867
DEVELOPMENT OF TREATMENT GUIDELINES 868
FUTURE DIRECTIONS 868
Acknowledgments 868
REFERENCES 868
Chapter 76: Insomnia: 870
Abstract 870
EPIDEMIOLOGY 870
RISK FACTORS 876
CONCLUSIONS 878
REFERENCES 878
Chapter 77: Insomnia: 881
Abstract 881
REFERENCES 890
Chapter 78: Models of Insomnia 893
THE DEFINITION OF INSOMNIA 893
THE STIMULUS CONTROL MODEL 893
THE 3P MODEL 894
THE NEUROCOGNITIVE MODEL 896
THE PSYCHOBIOLOGICAL INHIBITION MODEL 898
THE DROSOPHILA MODEL 901
THE CAGE EXCHANGE MODEL OF ACUTE INSOMNIA 903
CONCLUSION 905
Acknowledgement 906
REFERENCES 906
Chapter 79: Psychological and Behavioral Treatments for Insomnia I: 909
Abstract 909
CURRENT TREATMENT PRACTICES 909
TREATMENTS 909
TREATMENT OUTCOME EVIDENCE 912
SUMMARY AND CONCLUSION 924
Acknowledgment 925
REFERENCES 925
Chapter 80: Psychological and Behavioral Treatments for Insomnia II: 927
Abstract 927
INTERVENTION TOOLS 927
METHODS OF DELIVERING TREATMENT 933
TREATMENT DOSING 936
TREATMENT ACCEPTABILITY AND ADHERENCE ISSUES 937
APPLICATIONS TO PATIENTS WITH COMORBID PSYCHIATRIC CONDITIONS 939
APPLICATIONS TO PATIENTS WITH COMORBID MEDICAL CONDITIONS 940
USE WITH YOUNGER AND OLDER ADULTS 942
SUMMARY AND CONCLUSIONS 943
REFERENCES 943
Chapter 81: Pharmacologic Treatment of Insomnia: 948
Abstract 948
EFFICACY AND EFFECTIVENESS 948
SAFETY 953
CONSIDERATIONS FOR PHARMACOTHERAPY 955
CONCLUSION 956
REFERENCES 956
Chapter 82: Pharmacologic Treatment: 959
Abstract 959
MELATONIN AND MELATONIN RECEPTOR AGONISTS 959
SEDATING ANTIDEPRESSANTS 964
ANTIPSYCHOTICS 966
ANTICONVULSANTS 967
ANTIHISTAMINES 967
CHLORAL HYDRATE 968
SODIUM OXYBATE 968
HERBALS 969
SUMMARY OF CLINICAL CIRCUMSTANCES WHERE OTHER AGENTS MIGHT BE PREFERRED 969
SUMMARY AND CONCLUSIONS 970
Acknowledgments 971
REFERENCES 971
Chapter 83: Treatment Guidelines for Insomnia 974
Abstract 974
THE ROLE OF CLINICAL PRACTICE GUIDELINES 974
DEVELOPMENT OF INSOMNIA CLINICAL GUIDELINES 975
OPEN QUESTIONS, CHALLENGES, AND FUTURE DIRECTIONS 979
REFERENCES 979
Chapter 84: Narcolepsy: 981
Abstract 981
ANIMAL MODELS OF NARCOLEPSY 982
PHARMACOLOGY OF NARCOLEPSY 983
HYPOCRETIN AND INVOLVEMENT IN NARCOLEPSY 985
GENETIC ASPECTS OF HUMAN NARCOLEPSY 987
CLINICAL OVERLAPS OF THE HYPOCRETIN DEFICIENCY SYNDROME 989
HYPOCRETIN COMPOUNDS AS POTENTIAL THERAPEUTIC TARGETS 994
CONCLUSION 995
REFERENCES 995
Chapter 85: Narcolepsy: 1000
Abstract 1000
CLINICAL FEATURES 1000
ONSET OF CLINICAL SYMPTOMS 1002
DIAGNOSTIC PROCEDURES 1002
TREATMENT 1004
REFERENCES 1009
Chapter 86: Idiopathic Hypersomnia 1012
Abstract 1012
HISTORY 1012
EPIDEMIOLOGY 1012
PATHOGENESIS 1012
CLINICAL FEATURES 1013
DIAGNOSIS 1014
DIFFERENTIAL DIAGNOSIS 1017
TREATMENT 1020
CLINICAL COURSE AND PREVENTION 1021
PITFALLS 1021
REFERENCES 1021
Chapter 87: Parkinsonism 1023
Abstract 1023
DEFINITION 1023
HISTORICAL ASPECTS 1024
CLINICAL FEATURES 1024
EPIDEMIOLOGY 1027
PATHOGENESIS 1028
DIAGNOSIS 1029
TREATMENT 1031
REFERENCES 1033
Chapter 88: Sleep and Stroke 1036
Abstract 1036
REFERENCES 1053
Chapter 89: Sleep and Neuromuscular Diseases 1059
Abstract 1059
REFERENCES 1065
Chapter 90: Restless Legs Syndrome and Periodic Limb Movements during Sleep 1069
Abstract 1069
REFERENCES 1077
Chapter 91 1081
Chapter 92: Epilepsy, Sleep, and Sleep Disorders 1091
HISTORICAL ASPECTS 1091
EPIDEMIOLOGY 1091
PATHOGENESIS 1092
CLINICAL FEATURES 1093
DIAGNOSTIC EVALUATION 1101
TREATMENT 1102
CLINICAL COURSE 1102
PITFALLS AND CONTROVERSIES 1102
Acknowledgments 1102
REFERENCES 1102
Chapter 93: Other Neurologic Disorders 1107
Abstract 1107
HEADACHE 1107
MANAGEMENT 1110
HEAD TRAUMA 1110
MULTIPLE SCLEROSIS 1111
HEREDITARY NEURODEGENERATIVE AND METABOLIC DISORDERS 1112
ACUTE ENCEPHALITIDES 1113
BRAIN TUMORS 1114
SPINAL CORD DISEASE 1114
REFERENCES 1115
Chapter 94: Non-REM Arousal Parasomnias 1118
Abstract 1118
EPIDEMIOLOGY AND RISK FACTORS 1119
PATHOGENESIS 1119
CLINICAL FEATURES 1120
DIAGNOSIS 1122
DIFFERENTIAL DIAGNOSIS 1122
TREATMENT 1122
CLINICAL COURSE AND PREVENTION 1123
PITFALLS AND CONTROVERSIES 1123
REFERENCES 1123
Chapter 95: REM Sleep Parasomnias 1126
Abstract 1126
REFERENCES 1135
Chapter 96: Other Parasomnias 1141
Abstract 1141
NORMAL SLEEP PHENOMENA 1141
MISCELLANEOUS PRIMARY SLEEP PARASOMNIAS 1141
SECONDARY SLEEP PARASOMNIAS 1143
FUNCTIONAL DISORDERS 1145
REFERENCES 1145
Chapter 97: Idiopathic Nightmares and Dream Disturbances Associated with Sleep–Wake Transitions 1149
Abstract 1149
REFERENCES 1156
Chapter 98: Disturbed Dreaming as a Factor in Medical Conditions 1159
Abstract 1159
REFERENCES 1168
Chapter 99: Sleep Bruxism 1171
Abstract 1171
ETIOLOGY 1171
EPIDEMIOLOGY AND RISK FACTORS 1171
PATHOPHYSIOLOGY 1172
CLINICAL FEATURES 1175
DIAGNOSTIC EVALUATION 1176
TREATMENT/MANAGEMENT 1178
PITFALLS AND CONTROVERSIES 1180
Acknowledgments 1180
REFERENCES 1180
Chapter 100: Central Sleep Apnea and Periodic Breathing 1183
Abstract 1183
PATHOPHYSIOLOGY 1184
EPIDEMIOLOGY 1189
CLINICAL FEATURES AND CONSEQUENCES 1189
DIAGNOSTIC EVALUATION 1191
TREATMENT 1191
SUMMARY 1192
REFERENCES 1193
Chapter 101: Anatomy and Physiology of Upper Airway Obstruction 1196
Abstract 1196
UPPER AIRWAY FUNCTION 1196
NORMAL UPPER AIRWAY ANATOMY 1196
STATIC AND DYNAMIC PROPERTIES OF THE NORMAL PHARYNGEAL AIRWAY 1196
PHARYNGEAL MUSCLES 1200
DIFFERENCES IN STATIC UPPER AIRWAY ANATOMY IN PATIENTS WITH SLEEP APNEA 1203
DYNAMIC PHYSIOLOGIC CHANGES IN UPPER AIRWAY STRUCTURES 1207
OBSTRUCTION OF THE PHARYNX DURING SLEEP 1208
EFFECT OF TREATMENT OF OBSTRUCTIVE SLEEP ON UPPER AIRWAY CALIBER 1208
INTERACTION OF ANATOMIC AND NEUROLOGIC FACTORS ON PHARYNGEAL AIRWAY CLOSURE DURING SLEEP: A SCHEMATIC MODEL 1210
REFERENCES 1212
Chapter 102: Snoring 1215
Abstract 1215
HISTORICAL PERSPECTIVE 1215
DEFINITIONS 1215
PATHOPHYSIOLOGY AND MEASUREMENT OF SNORING 1215
EPIDEMIOLOGY OF SNORING 1216
HEALTH EFFECTS OF NONAPNEIC SNORING 1216
CLINICAL FEATURES AND DIAGNOSTIC ASSESSMENT 1217
TREATMENT 1219
CONCLUSION 1223
REFERENCES 1223
Chapter 103: Genetics of Obstructive Sleep Apnea 1226
Abstract 1226
REFERENCES 1234
Chapter 104: Cognition and Performance in Patients with Obstructive Sleep Apnea 1237
Abstract 1237
REFERENCES 1246
Chapter 105: Clinical Features and Evaluation of Obstructive Sleep Apnea and Upper Airway Resistance Syndrome 1249
Abstract 1249
EPIDEMIOLOGY 1249
DEFINITION OF ABNORMAL BREATHING EVENTS 1250
CLINICAL SIGNS AND SYMPTOMS 1250
UPPER AIRWAY RESISTANCE SYNDROME 1255
RISK FACTORS 1256
CLINICAL EXAMINATION 1256
SUMMARY 1259
REFERENCES 1259
Chapter 106: Medical Therapy for Obstructive Sleep Apnea 1262
Abstract 1262
BEHAVIORAL INTERVENTIONS 1262
ENDOCRINE CONSIDERATIONS 1266
PHARMACOLOGIC INTERVENTIONS 1266
MECHANICAL THERAPY 1269
PITFALLS AND CONTROVERISES 1272
Acknowledgments 1272
REFERENCES 1272
Chapter 107: Positive Airway Pressure Treatment for Obstructive Sleep Apnea– Hypopnea Syndrome 1276
Abstract 1276
NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE 1276
PRACTICAL ASPECTS OF TREATMENT 1277
PROBLEMS AND SIDE EFFECTS 1280
ADHERENCE 1282
AUTOTITRATING CPAP 1284
MANAGEMENT OF CPAP FAILURE 1284
COMPLEX SLEEP APNEA 1288
HEALTH OUTCOMES AND NASAL CPAP 1288
CPAP AND HEART FAILURE 1288
Acknowledgments 1288
REFERENCES 1289
Chapter 108: Surgical Management for Obstructive Sleep-Disordered Breathing 1293
Abstract 1293
HISTORICAL PROSPECTIVE 1293
RATIONALE 1293
INDICATIONS AND CONTRAINDICATIONS 1293
PRETREATMENT RECOMMENDATIONS AND CONCERNS 1293
CLINICAL EVALUATION IN ASSESSING SURGICAL CANDIDACY 1294
APPROACH TO SURGICAL TREATMENT 1295
ISSUES IN EVIDENCE- BASED MEDICINE 1295
TWO-PHASED SURGICAL PROTOCOL 1296
AASM SURGICAL PRACTICE PARAMETERS 1304
SURGICAL RISK MANAGEMENT FOR OBSTRUCTIVE SLEEP-DISORDERED BREATHING 1306
REFERENCES 1306
Chapter 109: Oral Appliances for Sleep- Disordered Breathing 1309
Abstract 1309
TYPES OF APPLIANCES 1309
MECHANISM OF ACTION 1309
CLINICAL OUTCOMES 1311
PREDICTORS OF TREATMENT OUTCOME 1314
SIDE EFFECTS AND COMPLICATIONS 1315
TREATMENT COMPLIANCE 1315
CLINICAL PROTOCOL FOR ORAL APPLIANCE THERAPY 1316
SUMMARY 1317
FUTURE DIRECTIONS 1317
REFERENCES 1318
Chapter 110: Management of Obstructive Sleep Apnea–Hypopnea Syndrome 1321
Abstract 1321
EPIDEMIOLOGY AND RISK FACTORS 1321
PATHOGENESIS 1322
CLINICAL FEATURES 1322
DIAGNOSIS 1323
CLINICAL COURSE AND PREVENTION 1327
TREATMENT 1327
COMMON CLINICAL PROBLEMS ENCOUNTERED IN MANAGING PATIENTS WITH OSAH 1330
REFERENCES 1333
Chapter 111: Sleep in Patients with Asthma and Chronic Obstructive Pulmonary Disease 1337
Abstract 1337
NOCTURNAL ASTHMA 1337
CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1342
REFERENCES 1347
Chapter 112: Restrictive Lung Disorders 1351
Abstract 1351
OBESITY 1351
OBESITY–HYPOVENTILATION SYNDROME 1353
KYPHOSCOLIOSIS 1355
INTERSTITIAL LUNG DISEASE 1357
REFERENCES 1359
Chapter 113: Noninvasive Ventilation to Treat Chronic Ventilatory Failure 1361
Abstract 1361
INDICATIONS FOR NOCTURNAL NPPV 1361
TECHNICAL CONSIDERATIONS FOR NPPV 1364
MANAGEMENT OF COMPLICATIONS DURING NPPV 1368
OUTCOMES OF NOCTURNAL NPPV 1368
CONCLUSION 1371
REFERENCES 1371
Chapter 114: Obstructive Sleep Apnea and Metabolic Dysfunction 1374
Abstract 1374
REFERENCES 1379
Chapter 115: Obstructive Sleep Apnea, Obesity, and Bariatric Surgery 1382
Abstract 1382
REFERENCES 1389
Chapter 116: Sleep and Cardiovascular Disease: 1392
Abstract 1392
REFERENCES 1395
Chapter 117: Sleep-Related Cardiac Risk 1396
Abstract 1396
REFERENCES 1403
Chapter 118: Cardiac Arrhythmogenesis during Sleep: 1406
Abstract 1406
VENTRICULAR ARRHYTHMIAS 1406
NOCTURNAL ASYSTOLE AND QT-INTERVAL PROLONGATION 1407
ATRIAL FIBRILLATION 1407
SUDDEN INFANT DEATH SYNDROME 1409
THE BRUGADA SYNDROME AND SUDDEN UNEXPLAINED NOCTURNAL DEATH 1409
SLEEP-DISRUPTING EFFECTS OF CARDIAC MEDICATIONS 1410
REFERENCES 1411
Chapter 119: Cardiovascular Effects of Sleep- Related Breathing Disorders 1413
Abstract 1413
ARTERIAL BLOOD GAS ABNORMALITIES AND THEIR CONSEQUENCES 1413
ACUTE HEMODYNAMIC EFFECTS OF SLEEP APNEA 1416
SUMMARY 1421
REFERENCES 1421
Chapter 120: Systemic and Pulmonary Hypertension in Obstructive Sleep Apnea 1424
Abstract 1424
SYSTEMIC HYPERTENSION 1424
PULMONARY HYPERTENSION 1431
REFERENCES 1433
Chapter 121 1436
Abstract 1436
EPIDEMIOLOGY 1436
Chapter 122: Heart Failure 1443
Abstract 1443
EPIDEMIOLOGY OF HEART FAILURE AND SLEEP-RELATED BREATHING DISORDERS 1443
MECHANISMS OF SLEEP-RELATED BREATHING DISORDERS IN HEART FAILURE 1446
PATHOLOGIC CONSEQUENCES AND PROGNOSTIC SIGNIFICANCE OF SLEEP-RELATED BREATHING DISORDERS 1447
CLINICAL PRESENTATION OF OBSTRUCTIVE AND CENTRAL SLEEP APNEA IN PATIENTS WITH HEART FAILURE 1449
TREATMENT OF SLEEP-RELATED BREATHING DISORDERS IN PATIENTS WITH HEART FAILURE 1450
REFERENCES 1455
Chapter 123: Sleep and Fatigue in Cancer Patients 1459
Abstract 1459
EPIDEMIOLOGY 1459
PATHOGENESIS 1461
TREATMENT 1462
DIFFERENTIAL DIAGNOSIS: IS IT SLEEPINESS, FATIGUE, OR SOMETHING ELSE? 1463
PITFALLS AND CONTROVERSIES 1463
Acknowledgements 1463
REFERENCES 1463
Chapter 124: Fibromyalgia and Chronic Fatigue Syndromes 1465
Abstract 1465
EPIDEMIOLOGY 1466
PATHOGENESIS 1466
CLINICAL FEATURES 1467
DIAGNOSIS 1468
TREATMENT 1470
PITFALLS AND CONTROVERSIES 1472
CLINICAL COURSE AND PREVENTION 1473
TECHNICAL CONSIDERATIONS AND SCORING CRITERIA 1473
REFERENCES 1476
Chapter 125: Endocrine Disorders 1478
Abstract 1478
ACROMEGALY AND OTHER GROWTH HORMONE DISORDERS 1478
SEX HORMONE DISORDERS 1480
THYROID DISORDERS 1481
DISORDERED CORTICOSTEROID SECRETION AND SLEEP 1481
DIABETES AND CENTRAL OBESITY 1482
Acknowledgment 1483
REFERENCES 1483
Chapter 126: Pain and Sleep 1485
Abstract 1485
PAIN AND SLEEP 1485
PATHOGENESIS 1487
CLINICAL FEATURES 1489
DIAGNOSIS 1489
TREATMENT/MANAGEMENT 1491
CONCLUSION 1492
PITFALLS AND CONTROVERSIES 1492
Acknowledgments 1492
REFERENCES 1492
Chapter 127: Gastrointestinal Disorders 1495
Abstract 1495
NOCTURNAL GASTROINTESTINAL SYMPTOMS 1495
NOCTURNAL ACID SECRETION IN DUODENAL ULCER DISEASE 1495
GASTROESOPHAGEAL REFLUX DURING SLEEP 1496
ESOPHAGEAL ACID CLEARANCE DURING SLEEP 1497
PULMONARY COMPLICATIONS OF SLEEP-RELATED GASTROESOPHAGEAL REFLUX 1500
INTESTINAL MOTILITY DURING SLEEP AND IRRITABLE BOWEL SYNDROME 1501
CONCLUSIONS 1502
REFERENCES 1503
Chapter 128: Sleep in Chronic Kidney Disease 1505
Abstract 1505
REFERENCES 1513
Chapter 129: Anxiety Disorders 1516
Abstract 1516
PANIC DISORDER 1517
GENERALIZED ANXIETY DISORDER 1520
SOCIAL PHOBIA 1521
OBSESSIVE–COMPULSIVE DISORDER 1523
POSTTRAUMATIC STRESS DISORDER 1524
PITFALLS AND CONTROVERSIES 1526
REFERENCES 1527
Chapter 130: Mood Disorders 1531
Abstract 1531
CLASSIFICATION AND DIAGNOSIS 1531
EPIDEMIOLOGY AND RISK FACTORS 1531
PATHOGENESIS 1533
CLINICAL FEATURES 1533
TREATMENT 1537
CLINICAL COURSE AND PREVENTION 1541
PITFALLS AND CONTROVERSIES 1541
REFERENCES 1541
Chapter 131: Schizophrenia 1544
Abstract 1544
EPIDEMIOLOGY AND RISK FACTORS 1544
DIAGNOSIS 1545
PATHOGENESIS 1546
CLINICAL COURSE AND PREVENTION 1546
SLEEP-RELATED FEATURES 1546
TREATMENT 1548
CONTROVERSIES 1551
REFERENCES 1552
Chapter 132: Medication and Substance Abuse 1555
Abstract 1555
SUBSTANCE ABUSE AND DEPENDENCE 1555
DRUG DEPENDENCE AND SLEEP MEDICINE 1555
UNDERSTANDING SUBSTANCE ABUSE 1556
SLEEP–WAKE ALTERATIONS AND SPECIFIC SUBSTANCES 1558
DRUG SEEKING VERSUS THERAPY SEEKING 1563
Acknowledgment 1564
REFERENCES 1564
Chapter 133: Medical and Psychiatric Disorders and the Medications Used to Treat Them 1567
Abstract 1567
PSYCHIATRIC CONDITIONS AND SLEEP IN THE OLDER ADULT 1568
MEDICAL CONDITIONS AND SLEEP IN THE OLDER ADULT 1569
EFFECT OF MEDICATIONS ON SLEEP 1571
SUBSTANCE ABUSE IN OLDER ADULTS 1573
SPECIAL CONDITIONS 1573
SUMMARY 1575
REFERENCES 1576
Chapter 134: Obstructive Sleep Apnea in the Elderly 1579
Abstract 1579
EPIDEMIOLOGY AND DEFINITIONS 1579
CLINICAL MANIFESTATIONS AND PRESENTATION 1579
PATHOPHYSIOLOGY 1580
CLINICAL CONSEQUENCES 1580
TREATMENT 1582
DRIVING AND THE OLDER PATIENT WITH OSAH 1583
SUMMARY 1583
REFERENCES 1584
Chapter 135: Insomnia in Older Adults 1587
Abstract 1587
EPIDEMIOLOGY AND RISK FACTORS 1587
CONSEQUENCES OF INSOMNIA 1588
ETIOLOGY 1588
EVALUATION AND DIAGNOSIS 1590
TREATMENT 1590
SUMMARY 1592
Acknowledgments 1592
REFERENCES 1592
Chapter 136: Sleep in Independently Living and Institutionalized Elderly 1594
Abstract 1594
REFERENCES 1601
Chapter 137: Sex Differences and Menstrual-Related Changes in Sleep and Circadian Rhythms 1605
Abstract 1605
REFERENCES 1613
Chapter 138: Sleep Disturbances and Sleep-Related Disorders in Pregnancy 1615
Abstract 1615
REFERENCES 1627
Chapter 139: The Postpartum Period 1630
Abstract 1630
REFERENCES 1634
Chapter 140: Menopause 1635
Abstract 1635
PHASES OF THE MENOPAUSAL TRANSITION 1635
NORMAL SLEEP PATTERNS DURING MENOPAUSE 1635
COMMON CLINICAL CONDITIONS IN MIDLIFE WOMEN 1637
SUMMARY 1641
PITFALLS AND CONTROVERSIES 1642
REFERENCES 1642
Chapter 141: Monitoring and Staging Human Sleep 1645
Abstract 1645
REFERENCES 1652
Chapter 142: Monitoring Techniques for Evaluating Suspected Sleep-Disordered Breathing 1653
Abstract 1653
REFERENCES 1666
Chapter 143: Evaluating Sleepiness 1667
Abstract 1667
REFERENCES 1673
Chapter 144: Assessment Techniques for Insomnia 1675
MODELS OF THE PATHOGENESIS OF INSOMNIA 1675
ASSESSMENT METHODS OF SLEEP DISORDERS CENTERS 1677
SLEEP AND MEDICAL HISTORY QUESTIONNAIRES 1678
PSYCHOPATHOLOGY AND PERSONALITY QUESTIONNAIRES 1678
INVENTORIES OF COGNITIVE AND SOMATIC AROUSAL 1679
ASSESSMENT OF SLEEP HYGIENE AND PREFERRED SLEEP PHASE 1680
SLEEP DISTURBANCE, WAKE DISTURBANCE, AND FATIGUE 1680
PROSPECTIVE SLEEP DIARIES 1680
SUMMARY 1686
REFERENCES 1687
Chapter 145: Neurologic Monitoring Techniques 1689
Abstract 1689
METHODOLOGY 1689
ARTIFACTS AND PITFALLS 1694
RELATIVE INDICATIONS, ADVANTAGES, DISADVANTAGES, AND LIMITATIONS 1694
REFERENCES 1698
Chapter 146: Chronobiologic Monitoring Techniques 1700
Abstract 1700
BASIC CONCEPTS AND TERMINOLOGY 1700
METHODOLOGIC QUESTIONS IN THE FIELD OF CIRCADIAN RHYTHMS 1700
PARADIGMS 1701
ACTIGRAPHY 1705
MEASURING CIRCADIAN RHYTHM PARAMETERS IN GENE EXPRESSION 1706
FUTURE DIRECTIONS 1708
DISCUSSION 1708
REFERENCES 1709
Chapter 147: Actigraphy 1711
Abstract 1711
HISTORY OF WRIST ACTIGRAPHY 1711
APPLICATIONS OF WRIST ACTIGRAPHY 1713
TRICKS OF THE TRADE 1715
EDITING ACTIGRAPHY DATA 1715
LIMITATIONS 1716
SUMMARY 1716
Acknowledgments 1717
REFERENCES 1717
Chapter 148: Gastrointestinal Monitoring Techniques 1719
Abstract 1719
AMBULATORY pH MONITORING 1719
POLYSOMNOGRAPHIC RECORDING 1721
CLINICAL INTERPRETATION 1722
REFERENCES 1723
Chapter 149: Light Therapy 1725
Abstract 1725
LIGHT DELIVERY 1725
CASE MANAGEMENT, TIMING, AND DOSING 1727
INDICATIONS FOR TREATMENT 1729
TOWARD AN INTEGRATED CHRONOTHERAPEUTICS 1735
RESOURCES 1736
Acknowledgments 1736
REFERENCES 1736
Index 1740
Kryger’s Atlas of Clinical Sleep Medicine: 1768
Cardiac Rhythm Abnormalities 1768
Neurologic Diseases 1768
Movement Disorders 1771
Seizure 1771
Artifacts in Sleep Recordings 1774
New Web-Only Sections 1775
Sleep Staging 1776
Rapid Review of Polysomnographs 1776

Textauszug

Foreword

Medicine has only recently discovered the importance of sleep, and how sleep symptoms can be the canary in the mine of serious medical and psychiatric problems that can affect all people. I can attest firsthand about the importance of sleep, and how symptoms affecting sleep can impact a person’s life. I was the Canadian Force Commander of the United Nations Assistance Mission for Rwanda between October 1993 and August 1994. During that time, a genocide resulted in the deaths of 800,000 people and I was an eyewitness having heard, smelled, seen, and touched thousands and thousands of mutilated bloated bodies of innocent civilians while trying to arrange a peace during a civil war while much of the world stood idly by. My sleep suffered, my health suffered, and I developed the symptoms of posttraumatic stress disorder. As the mission was winding down …

“After prayers, I climbed into my vehicle and took off without telling anyone. It wasn’t the first time. I had begun to suffocate in the headquarters, with its endless stream of problems and demands. I had been inventing trips to get me away from it, deciding that I had to see the troops in the field or just tour the country. In every village, along every road, in every church, in every school were unburied corpses. My dreams at night became my reality of the day, and increasingly I could not distinguish between the two.

By this point, I wasn’t bothering to make excuses anymore to disguise my quest for solitude. I would just sneak away and then drive around thinking all manner of black thoughts that I couldn’t permit myself to say to anyone for fear of the effect on the morale of my troops. Without my marking the moment, death became a desired option. I hoped I would hit a mine or run into an ambush and just end it all. I think some part of me wanted to join the legions of the dead, whom I felt I had failed. I could not face the thought of leaving Rwanda alive after so many people had died. On my travels around the country, whole roads and villages were empty, as if they’d been hit by a nuclear bomb or the bubonic plague. You could drive for miles without seeing a single human being or a single living creature. Everything seemed so dead.”

From, Roméo A. Dallaire, Shake Hands with the Devil: The Failure of Humanity in Rwanda. Carroll & Graf Publishers, New York. 2003. pp 499-500.

This is the first medical textbook that focuses on the sleep disorders that affect everyone, and that also includes the problems of first responders and the military and teaches doctors about how post traumatic stress disorder impacts sleep. I congratulate the editors.

—Lt. Gen the Hon. Roméo Dallaire, OC, CMM, GOQ, MSC, CD, (Ret’d), Senator, Canada

It is an honor for us, representing the Sleep Research Society, to help introduce the 5th edition of Principles and Practice of Sleep Medicine. This volume appears nearly fifty years after the first professional sleep research meeting in the United States on March 25 and 26, 1961, a meeting which directly led to the formation of the Sleep Research Society. According to records of Al Rechtschaffen, maintained in the University of Chicago Library, the first meeting was titled the “Conference on Research in EEG, Sleep and Dreams.” Two days of scientific sessions included topics such as: “Methods and Merits of Various Systems of Scoring,” “Equipment and Technical Problems” and “The Relation of EEG to Verbal Report.” As the session titles suggest, in 1961 sleep scientists were necessarily focused upon some of the most basic tenants of research: observation, measurement, standardization, and technology. It seems very unlikely that any of the thirty-six scientists in attendance, including Bill Dement, would have envisioned the exponential growth of knowledge about sleep and its disorders represented in the many pages of the current volume.

Sleep research has evolved to include the breadth of modern scientific approaches, and sleep medicine is germane to most medical specialties and public health concerns. In the 149 chapters of this text (including more than 50 new chapters and new sections on Genetics, Occupational Sleep Medicine, Sleep Medicine in Older People) experts describe the intricate mechanisms of biological timing, the genetic polymorphisms conferring risk for sleep disorders, sleep-immune interactions, the morbidity and mortality risks of sleep apnea, and the impact of sleep disturbance on workplace and transportation safety, just to highlight as few areas. We commend the authors on their excellent contributions which will serve to educate and inspire practitioners, researchers and students for years to come.

The Sleep Research Society congratulates Drs. Kryger, Roth, and Dement on the publication of this very impressive 5th edition of Principles and Practice of Sleep Medicine and thanks them for undertaking the important service of identifying the latest advances in the field and compiling the body of knowledge represented herein.

—James K. Walsh, PhD,, President, Sleep Research Society
Executive Director and Senior Scientist
Sleep Medicine and Research Center
St. Luke’s Hospital
Chesterfield, Missouri

—Clifford B. Saper, MD, PhD, Past-president, Sleep Research Society
James Jackson Putnam Professor of Neurology and Neuroscience,
Harvard Medical School and Beth Israel Deaconess Medical Center
Boston, Massachusetts

The success of any field of medicine is often directly proportional to the scope and comprehensiveness of the knowledge base available to physicians, scientists, trainees, and the general public. For the field of sleep medicine, we are fortunate in that there continues to be dramatic growth in this knowledge, derived from both patient care and clinical/basic research. It is revealing when we step back and reflect on how this knowledge base has developed in so short a time: It has been less than 60 years since the discovery of rapid eye movement (REM) sleep, which initiated the organized, scientific study of sleep, and barely 25 years since the invention of continuous positive airway pressure (CPAP), which comprised the first effective treatment for obstructive sleep apnea. In this short time, the sleep field has expanded to the point where we have almost 1,900 accredited sleep centers and laboratories in the United States and over 9,000 members of the American Academy of Sleep Medicine. Our field has blossomed to the point where it is truly interdisciplinary, comprising specialists from the areas of pulmonary medicine, neurology, psychiatry, internal and family medicine, pediatrics, psychology, otolaryngology, and others. Exciting breakthroughs in sleep research have impacted other disciplines of science and research as well, and it is not unusual for sleep medicine specialists to collaborate with other diverse fields of medicine such as cardiology, endocrinology, and immunology.

Despite our amazing growth, there are still many questions yet to be answered, including the holy grail of our field: the function of sleep. To explore these questions, the field requires a continued supply of dedicated and talented researchers in both the clinical and basic sciences. In addition, funding from the government, industry, and foundations; support from institutions; and strong mentorship by experienced investigators are important cornerstones to a successful independent research career. As members of the field, we must collectively strive to ensure that funding, support, and mentorship continues in order to ensure success of our field, even in times of economic downturns and increased competition from other fields. For without breakthroughs in research, there won’t be new diagnostic tools, medications, or treatments to help us manage the nearly 90 different sleep disorders that we have identified thus far.

The growth of our field and the exploration of critical research areas cannot exist without adequate education and training of our young clinicians and investigators. We are indeed privileged that we have excellent resources available that enable trainees to learn more about sleep and sleep medicine. For countless numbers of students, Principles and Practice of Sleep Medicine has served as the primary textbook, study material for the sleep medicine board certification examination, and/or the basic resource for any sleep-related condition or question about sleep. Often fondly referred to simply as “P&P”, it continues to rise in prominence and demand. I’ve had the great pleasure to learn from and collaborate with Drs. Kryger, Roth, and Dement, and not only are they among the top clinicians and scientists within our field, but they have continued to produce a sleep medicine reference that has remained the gold standard over the span of 20 years. Our field is deeply indebted to their dedication, hard work, and diligence.

—Clete A. Kushida, MD, PhD, RPSGT, President, American Academy of Sleep Medicine
Director, Stanford Center for Human Sleep Research
Stanford University, California

The American Sleep Apnea Association (ASAA) congratulates the...

Produkt-Details

• Erscheint lt. Verlag: 1.11.2010
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Pneumologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• ISBN-10: 1-4377-2773-5 / 1437727735
• ISBN-13: 978-1-4377-2773-9 / 9781437727739