Contemporary Sleep Medicine-For Physicians


by

Octavian C. Ioachimescu

DOI: 10.2174/97816080515331110101
eISBN: 978-1-60805-153-3, 2011
ISBN: 978-1-60805-836-5



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Indexed in: Scopus

Contemporary Sleep Medicine should be of interest to a large number of readers interested in sleep medicine. It is divided into two pa...[view complete introduction]

Table of Contents

Guest Editor's Foreword

- Pp. i

Teofilo Lee-Chiong

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Editor's Preface

- Pp. ii-iii (2)

Octavian Ioachimescu

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List of Contributors

- Pp. iv-vi (2)

Octavian C. Ioachimescu and Teofilo Lee-Chiong

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Famous Quotes about Sleep

- Pp. vii-ix (3)

Octavian C. Ioachimescu and Teofilo Lee-Chiong

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Why Do We Sleep? Human Sleep: Neurobiology and Function

- Pp. 3-13 (11)

J. Shirine Allam and Christian Guilleminault

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Epidemiology of Sleep Disorders

- Pp. 14-39 (26)

Mihai Teodorescu and Rahul Kakkar

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Sleep History and Physical Examination

- Pp. 40-48 (9)

David A. Schulman

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Sleep Testing and Monitoring

- Pp. 49-57 (9)

Kumar S. Budur

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Snoring and Upper Airway Resistance Syndrome

- Pp. 58-70 (13)

Kannan Ramar and Eric J. Olson

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Obstructive Sleep Apnea

- Pp. 71-110 (40)

Arman Qamar, Kavitha S. Kotha and Octavian C. Ioachimescu

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Central Sleep Apnea

- Pp. 111-120 (10)

Naveen Kanathur, John Harrington, Vipin Malik and Teofilo Lee- Chiong

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Obesity Hypoventilation Syndrome

- Pp. 121-136 (16)

Stephen W. Littleton and Babak Mokhlesi

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Insomnia

- Pp. 137-155 (19)

Lina Fine, Boris Dubrovsky and Arthur J. Spielman

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Circadian Rhythm Sleep Disorders

- Pp. 156-181 (26)

Saiprakash B. Venkateshiah

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Narcolepsy

- Pp. 182-192 (11)

Emmanuel Mignot

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Idiopathic Hypersomnia

- Pp. 193-200 (8)

Dan Cohen, Asim Roy and Randip Singh

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Sleep-Related Movement Disorders

- Pp. 201-219 (19)

Brian Koo

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Parasomnias

- Pp. 220-225 (6)

Kumar S. Budur

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Sleep and Aging

- Pp. 226-246 (21)

Yohannes Endeshaw

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Medications and Sleep

- Pp. 247-258 (12)

Francoise J. Roux and Meir H. Kryger

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Sleep and Cardiovascular Disorders

- Pp. 259-272 (14)

J. Shirine Allam

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Sleep and Metabolic Syndrome

- Pp. 273-301 (29)

Alexander Babayeuski and Octavian C. Ioachimescu

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Sleep Apnea and Cerebrovascular Disorders

- Pp. 302-310 (9)

Henry Klar Yaggi

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Sleep and Epilepsy

- Pp. 311-322 (12)

Silvia Neme-Mercante and Nancy Foldvary-Schaefer

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Pediatric Sleep Issues

- Pp. 323-335 (13)

Paul R. Carney, Sachin S. Talathi and James D. Geyer

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Index

- Pp. 336-340 (5)

Octavian C. Ioachimescu

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Foreword

Needless to say, conventional medicine was, at least until recently, a two-third science, and clinicians and medical researchers had limited their practice and queries, respectively, to a 2/3 patient and world. Human physiology and pathologic processes were examined only in people awake and mostly during the day; changes in these systems brought about by circadian rhythms and sleep were often ignored and considered unimportant

Several factors could explain this penchant or, worse, prejudice, for disregarding the influence of sleep on the health, or lack thereof, of individuals and of society as a whole. Firstly, there was a lack of resources to conduct research at night. Unlike clinical medicine that had to meet the needs of the ill patient twenty-four hours a day, medical researchers never fully embraced the idea of shift work in their research career. Even among clinicians, the end of the typical "working" day is greeted with the time-honored sign-out as patient care is handed over to the doleful nocturnist (i.e., a physician working only at night) who responds begrudgingly to nighttime calls from patients, pharmacies or the hospital staff. Nighttime for the medical clinician and researcher is, similar to most other professions, a time for uninterrupted repose and rest.

Secondly, there was a lack of resources to conduct research on the sleeping person. How is he/she to be evaluated: by observation alone (relatively inexpensive but admittedly poorly sensitive and specific) or using polysomnography? Is he/she to be awakened as biologic processes (e.g., airflow or intraocular pressure) are measured, or left undisturbed? Often, these are dictated not by the specific physiologic parameters being monitored, but simply by the tools available to study them.

Finally, and most importantly, there was a lack of appreciation that humans are not an 18-hour species. Almost every biologic system affects, and is affected, by sleep. In addition, circadian rhythms alter physiologic processes to such an extent that measurements obtained in the daytime are commonly significantly different from nighttime results (e.g., hormones and inflammatory markers). The incidence of pathologic disorders wax and wane throughout the course of a 24-hour day as, for example, sudden cardiac death, asthma and sleep-related seizures tend to occur more often during the night and early morning. Finally, medical disorders and interventions used to treat them are affected as well by sleep (e.g., effects of the timing of hemodialysis on the prevalence and severity of sleep disordered breathing in patients with end-stage renal failure).

Medicine is increasingly becoming "holistic" but unless it addresses the totality of a person's health-related physical, psychological, spiritual and social needs including the often-overlooked eight-hour period from "lights-out" to "lights-on", can it truly and honestly claim to be so?

Teofilo Lee-Chiong, MD
Guest Editor
Professor of Medicine
School of Medicine - University of Colorado Denver
Chief, Division of Sleep Medicine, Department of Medicine - National Jewish Health
Colorado


Preface

We live in an interesting world. We are fueled every day by strong curiosity and desire to know, understand and fix problems, illnesses and abnormal conditions, and that's probably the main reason why we are all in this noble profession of medicine. Healing power is, as we all know, daughter of the mother Knowledge. Day in and day out, we take care of patients using our skills and profound of knowledge, learning new facts, embracing new technologies and applying new methodologies, all subdued to the purpose of curing diseases, taking care of patients, understanding the human body and mind, preventing future illnesses and epidemics.

I have been privileged to get trained in multiple fields, starting with Internal Medicine and followed by Pulmonary, Critical Care and last, but not least, Sleep Medicine. Among all medical fields, Sleep Medicine is a very young subspecialty and it seems to me that it lives golden age of childhood in a ravishing, very fast-transforming world. Sleep Medicine is not only an offspring of an era, but also a significant and active participant in this amazing cognitive journey. Let me state upfront my strong conviction that understanding why and how we sleep and how various sleep disturbances influence our life is not a minor task or duty. We owe this to us, to our patients, to the society, to previous and future generations.

Typically, our biological sciences' cognitive travels start in the lab, or at the bench side, with various simplified animal models which are put in place in order to answer simple or more complex questions; the results may show some "significance", especially if we are "lucky". They are generally followed by necessary confirmatory, small-scale, human studies, which may reproduce the previous research findings, again, if we are "lucky". Ultimately, in the quest of more statistical power and strength of significance, we end-up designing and conducting more complex, expensive and sometimes multi-decade long epidemiological studies. The problem is that, once completed, these studies are either negative (and then we stimulate our sharp analytical activity to explain why) or show some type of connection or "association". In this latter scenario, we discover what we already knew, i.e., that the epidemiological studies do not establish causality, or we start refining the analyses by correcting for multiple confounders (some of which not completely independent from each other) and, in the end, we dilute most of the findings towards neutrality. Curious beings, the human researchers have the natural tendency to go back to the laboratory and design other experiments, which start other quests for proof. Isn't this the abbreviated and at the same time the short journey of medical knowledge? How many times didn't we reverse written-in-stone axioms? How many times didn't we flip positions? How many times didn't we accept to be shattered in our strongest beliefs? The time may have come to change our research paradigms.

There are many ways we can improve our knowledge grasp, learning efficiency and the application of what we find in daily life. One of them is to revamp and reform the research methodologies and study designs. But equally important, especially for our learning of where we are in our journey, is that we need better localization methodologies (like GPS technology?), better collaborative models and better integrative approaches to research and information. At the same time, our information and data repositories need to become more interactive, up-to-date and more available.

Stemming from these convictions, and in order to improve our knowledge gaps and inherent lags, we created this electronic textbook called "Contemporary Sleep Medicine". We acknowledge that this is just a modest beginning at the feet of a new era, that of online open-source data and information and of a body of knowledge that has only upward potential of development, from design, content, delivery, accessibility or any other attribute. We designed this publication for a very wide audience, from patients, or "red" section readers, to physicians and other healthcare providers, who can navigate between the "green belt" or summary level, to "blue belt" or intermediate level, all the way to Research Outlook, or "black belt", of those readers who have an advanced level of knowledge and want to be up-to-date with the latest developments and directions in research in that particular field or condition without a need to read extensive, frequently outdated and often redundant materials. My task, the illustrious chapter authors' and that of the Guest Editor's has not been negligible at all, I can assure you. But with great vision, persistence and excellent skills of all the people involved, this publication comes to light to give us a glimpse of what we know and an even more flickery view of what we would like to find out in the future.

Octavian C. Ioachimescu, MD, PhD
Editor
Assistant Professor of Medicine, Emory University
Adjunct Clinical Assistant Professor of Medicine
Morehouse University
Medical Director, Sleep Disorders Center
Atlanta VA Medical Center
Atlanta, Georgia
USA

List of Contributors

Editor(s):
Octavian C. Ioachimescu
Emory University
USA




Contributor(s):
Allam, J. Shirine M.D.
Assistant Professor of Medicine-Emory University Adjunct Clinical Assistant Professor of Medicine
Morehouse School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine
Emory University School of Medicine
Atlanta Veterans Affairs Medical Center
Atlanta
GA, 30033
USA


Babayeusky Alexander M.D.
Atlanta Medical Center 303 Parkway Dr NE
Atlanta
GA
USA


Paul R. Carney M.D. M.S.
Departments of Pediatrics, Neurology and Neuroscience, J Crayton Pruitt Department of Biomedical Engineering
Wilder Professor and Chief, Division of Pediatric Neurology
University of Florida Mc Knight Brain Institute
Gainesville
Florida
USA


Dan Cohen M.D.
Instructor in Neurology
Harvard Medical School - Beth Israel Deaconess Medical Center
Associate Physician, Brigham and Women's Hospital
Boston
MA
USA


Boris Dubrovsky M.D.
Center for Sleep Medicine, Department of Neurology
New York Presbyterian Hospital, Weill Cornell Medical College
New York
NY
USA


Yohannes Endeshaw M.D. M.P.H.
Associate Professor, Department of Aging and Geriatric Research
College of Medicine, University of Florida
Gainesville
FL
USA


Lina Fine M.D.
Cognitive Neuroscience Doctoral Program, Department of Psychology
The City College of New York, City University of New York
New York
NY
USA


Nancy Foldvary-Schaefer D.O., M.S.
Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Director, Cleveland Clinic Sleep Disorders Center
Cleveland Clinic Neurological Institute
9500 Euclid Avenue, FA20, Cleveland
Ohio , 44195
USA


James D. Geyer M.D.
Director, Sleep Program, Associate Professor of Neurology and Sleep Medicine
Alabama Neurology and Sleep Medicine, Tuscaloosa
Alabama
USA


Christian Guilleminault M.D.
Professor of Medicine, Department of Psychiatry and Behavioral Sciences
Stanford University
Stanford
CA
USA


John Harrington M.D.
National Jewish Health
1400 Jackson Street
Denver
CO, 80213
USA


Octavian C. Ioachimescu M.D., Ph.D.
Assistant Professor of Medicine - Emory University
Division of Pulmonary, Critical Care and Sleep Medicine Emory University School of Medicine
Atlanta Veterans Affairs Medical Center, Adjunct Clinical Assistant Professor of Medicine
Morehouse School of Medicine, Medical Director
Atlanta Veterans' Affairs Sleep Disorders Center
Atlanta
GA, 30033
USA


Rahul Kakkar M.D.
North Florida South Georgia VA Health System
St. Augustine
FL
USA


Naveen Kanathur M.D.
National Jewish Health
1400 Jackson Street
Denver
CO, 80213
USA


Brian Koo M.D.
Assistant Professor of Neurology
Case Western Reserve School of Medicine
11100 Euclid Avenue
Cleveland
OH, 44106
USA


Kavitha S. Kotha M.D.
Senior Fellow, Department of Medicine
Emory University School of Medicine, Division of Pulmonary
Allergy, Critical Care and Sleep Medicine
USA


Meir H. Kryger M.D.
Clinical Professor of Medicine, University of Connecticut School of Medicine and Director of Research and Education
Gaylord Sleep Medicine, 400 Gaylord Farm Road
Wallingford
CT, 06492
USA


Teophilo Lee-Chiong M.D.
National Jewish Health
1400 Jackson Street
Denver
CO, 80213
USA


Stephen W. Littleton M.D.
Attending Physician, John H. Stroger Jr. Hospital of Cook County
Assistant Professor, Rush University Medical Center
1900 W. Polk St. Room 1416
Chicago
IL, 60612
USA


Vipin Malik M.D.
National Jewish Health
1400 Jackson Street
Denver
CO, 80213
USA


Emmanuel Mignot M.D., Ph.D.
Professor of Medicine, Department of Psychiatry and Behavioral Sciences
Stanford University, Stanford University Center for Narcolepsy
701b Welch Rd Room 145
Palo Alto
CA, 80213
USA


Babak Mokhlesi M.D., M.Sc.
Associate Professor of Medicine, Section of Pulmonary and Critical Care Medicine
Director, Sleep Disorders Center and Sleep Medicine Fellowship Program
University of Chicago Pritzker School of Medicine
5841 S. Maryland Ave, MC0999, Room L11B
Chicago
IL, 60637
USA


Silvia Neme-Mercante M.D.
Associate Staff, Cleveland Clinic Sleep Disorders Center
9500 Euclid Avenue, FA20 Cleveland
Ohio, 44195
USA


Eric J. Olson M.D.
Associate Professor of Medicine, Mayo College of Medicine; Consultant
Division of Pulmonary and Critical Care Medicine
Co-Director, Center for Sleep Medicine, Mayo Clinic
Rochester
MN
USA


Arman Qamar M.D.
University of Delhi
Delhi
India


Kannan Ramar M.B.B.S., M.D.
Assistant Professor of Medicine, Mayo College of Medicine
Consultant, Division of Pulmonary and Critical Care Medicine, Mayo Clinic
Rochester
MN
USA


Francoise Roux M.D., Ph.D.
Assistant Professor of Medicine, Section of Pulmonary and Critical Care Medicine
Yale University School of Medicine
333 Cedar Street, Post Office Box 208057
New Haven
CT, 06520-8057
USA


Asim Roy M.D.
Assistant Clinical Professor of Neurology
University of Pittsburgh Medical Center
Pittsburgh
PA
USA


Kumar S. Budur M.D., M.P.H.
Associate Medical Director: Clinical Science - Neuroscience
Takeda Global Research and Development Inc.
675 North Field Drive
Lake Forest
IL, 60045
USA


David A. Schulman M.D.
Assistant Professor of Medicine - Emory University
615 Michael Street, Suite 205
Atlanta
GA, 30322
USA


Singh Randip Ph.D.
Overlake Sleep Disorders Center
Bellevue
WA
USA


Arthur J. Spielman Ph.D.
Cognitive Neuroscience Doctoral Program, Department of Psychology
The City College of New York, City University of New York
New York
NY
USA


Sachin S. Talathi Ph.D.
Division of Pediatric Neurology, Department of Pediatrics
University of Florida, Gainesville
Florida
USA


Mihai Teodorescu M.D.
University of Wisconsin
William S. Middleton VA Medical Center
Madison
WI
USA


Saiprakash Venkateshiah M.D.
Assistant Professor of Medicine, Emory University
Adjunct Clinical Assistant Professor of Medicine - Morehouse School of Medicine
Division of Pulmonary, Critical Care and Sleep Medicine, Emory University School of Medicine
Atlanta Veterans Affairs Medical Center
Atlanta
GA, 30033
USA


Henry K. Yaggi M.D. M.P.H.
Associate Professor of Medicine, Yale University School of Medicine
Section of Pulmonary and Critical Care Medicine, Medical Director
VA CT Center for Sleep Medicine, Clinical Epidemiology Research Center
950 Campbell Ave, Building 35 Annex
West Haven
CT, 06516
USA




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