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Sleep Medicine in Clinical Practice

2nd Edition, September 22, 2010

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Active, Most Current

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ISBN: 978-1-61631-005-9
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Product Details:

  • Revision: 2nd Edition, September 22, 2010
  • Published Date: September 22, 2010
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 348
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:

Since the publication of the first edition of this book, much has changed in sleep medicine. Our knowledge of sleep science, especially neurobiology, has dramatically increased. New therapies for sleep disorders have been developed and old ones modified. Understanding of the adverse physiologic effects of sleep deprivation and sleep fragmentation has grown. Over 12,000 scientific papers with "sleep" in their titles have been indexed in the PubMed database in the past five years! The influential Institute of Medicine of the National Academies has completed two major reports on sleep and society: Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem (1) and Resident Duty Hours: Enhancing Sleep, Supervision, and Safety (2). The American Academy of Sleep Medicine (AASSM) has completed and published two seminal works, the second edition of the International Classification of Sleep Disorders (3) and the AASM Manual for the Scoring of Sleep and Associated Events (4). The U.S. Accreditation Council for Graduate Medical Education (ACGME) began accrediting sleep medicine fellowships and 71 programs had been accredited by October 2009. The American Board of Medical Specialties approved a multidisciplinary specialist examination in sleep medicine set jointly by representatives of six primary specialties. In 2007, 1882 candidates sat for the first examination (5). Thus, sleep medicine has not only developed scientifically in the past half decade, but has achieved recognition as a growing medical specialty whose practitioners can greatly enhance the quality of their patients' health.

As a result of these changes, we have extensively modified the second edition of this book. New developments in the science of sleep are incorporated. In particular, the chapter on the physiology of sleep has been essentially rewritten with special reference to the role of the preoptic nuclei and the hypocretin system. We emphasize advances in understanding the metabolic, cardiovascular, and behavioral consequences of sleep deprivation. We discuss new concepts in the pathogenesis of sleep disorders, such as the current understanding of autoimmunity in narcolepsy, the role neurodegenerative diseases play in REM sleep behavior disorder, and the genetic basis of restless legs syndrome. The chapters on the diagnosis of sleep disorders incorporate the technical recommendations and scoring rules set out in the AASM manual. We discuss current data on interpreting the multiple sleep latency and maintenance of wakefulness tests. The classification of sleep disorders follows the nosology described in the second edition of the International Classification of Sleep Disorders. Diagnostic controversies, such as the classification of idiopathic hypersomnia and the concept of complex sleep apnea, are explored. New diagnostic techniques and therapeutic advances are discussed, such as home sleep testing and the role of adaptive servoventilation in the management of sleep apnea. We have updated drug therapy for conditions such as narcolepsy, insomnia, parasomnias, and sleep-related movement disorders, with practical algorithms for patient management. We have paid attention to novel adverse reactions, such as impulse control disorders as a result of dopaminergic therapy, cardiac arrhythmias with use of stimulants and atypical neuroleptic agents, and parasomnias associated with short-acting hypnotics. Wherever possible, recommendations are evidence based and incorporate AASM standards of practice parameters. The bibliography has been thoroughly updated and includes references to new studies published in 2009. Tables and figures have been modified or redrawn. We believe the second edition provides a state-of-the-art authoritative account of the practice of sleep medicine. Although much has been modified, the basic structure of the book remains the same as the first edition. The content is still structured around sleep symptoms rather than disorders and is aimed at the practicing sleep clinician. The authors remain the same, still representing the different perspectives that specialists in neurology, psychiatry, and pulmonology bring to the field of sleep medicine. The book remains based on the way sleep medicine is practiced at the Mayo Clinic, a method that has formally grown over a quarter of a century with roots delving back to the 1930s and earlier. In Rochester, the comprehensive Center for Sleep Medicine now has 20 consultants, 4 sleep medicine fellows, and 28 laboratory beds. Active sleep medicine centers are also part of Mayo Clinic in Arizona and Florida. Multiple research and educational programs supplement the clinical practice. We hope the second edition will continue to be useful to a number of audiences, including sleep medicine fellows and other trainees, program directors of sleep medicine fellowships designing curricula, practicing sleep physicians who might like to explore how the specialty is practiced at a center different from theirs, and physicians in other specialties intrigued by the growth of this new area. At Mayo Clinic we are committed to team work and interdisciplinary collegiality. Therefore, we thank our colleagues for their insights into the practice of sleep medicine and their contributions to the approaches discussed in this book. We include not only the physician staff, but also our nurses, technologists, and fellows from whom we continue to learn every day. Paul Honermann of the Mayo Section of Illustration and Design was responsible for much of the artwork. Roberta Schwartz of the Mayo Department of Publications shared her insights and wisdom. Susan Miller assisted with obtaining copyright permissions. We also thank Sandra Beberman, Aimee Laussen, and others at Informa Healthcare for their encouragement, assistance, and support. Finally, we thank our families for their forbearance and understanding while we worked long hours at completing this book.