Additional Information
Book Details
Abstract
Written by Richard Berry, MD, author of the popular Sleep Medicine Pearls, Fundamentals of Sleep Medicine is a concise, clinically focused alternative to larger sleep medicine references. A recipient of the 2010 AASM Excellence in Education award, Dr. Berry is exceptionally well qualified to distill today's most essential sleep medicine know-how in a way that is fast and easy to access and apply in your practice.
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Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices.
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Get clear guidance on applying the AASM scoring criteria.
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Reinforce your knowledge with more than 350 review questions.
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Get the answers you need quickly thanks to Dr. Berry's direct and clear writing style.
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Access the complete contents online at Expert Consult, including videos demonstrating parasomnias, leg kicks, and more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Fundamentals of Sleep Medicine | i | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Preface | vii | ||
| Acknowledgments | viii | ||
| Table of Contents | ix | ||
| Online Video Content | x | ||
| 1 Sleep Stages and Basic Sleep Monitoring | 1 | ||
| Chapter Points | 1 | ||
| Eeg Electrode Placement | 1 | ||
| EEG Derivations | 2 | ||
| EEG Patterns | 3 | ||
| Eog Monitoring for Sleep | 7 | ||
| Eye Movement Patterns | 8 | ||
| Chin (Submental) EMG Monitoring | 9 | ||
| Clinical review questions: | 10 | ||
| Answers | 10 | ||
| References | 11 | ||
| 2 The Technology of Sleep Monitoring: | 13 | ||
| Chapter Points | 13 | ||
| Referential and Bipolar Recording | 14 | ||
| Sampling Rate | 16 | ||
| Monitor Resolution | 16 | ||
| Time Window for Display | 17 | ||
| Filters (Low-Frequency, High-Frequency, and Notch Filters) | 17 | ||
| Low-Frequency Filter | 17 | ||
| High-Frequency Filters | 19 | ||
| 60-Hz or Notch Filters | 19 | ||
| Amplifier Filter Settings for Digital Sleep Recording | 20 | ||
| Clinical Example of the Effects of Filter Settings | 20 | ||
| Digitial PSG System Overview | 20 | ||
| Montages for Digital Recording | 21 | ||
| Channel Settings/Montages | 22 | ||
| Impedance Checking and Referential Display View | 23 | ||
| Video-Audio PSG | 24 | ||
| Grounds | 24 | ||
| Clinical Review Questions | 25 | ||
| Answers | 26 | ||
| References | 26 | ||
| 3 Sleep Staging in Adults | 27 | ||
| Chapter Points | 27 | ||
| Scoring by Epochs | 27 | ||
| Stage W (Wake) | 27 | ||
| Stage N1 | 31 | ||
| Stage N2 | 31 | ||
| Start and Continuation of Stage N2 | 31 | ||
| End of Stage N2: Effects of Arousals | 34 | ||
| End of Stage N2: Effect of MBM | 34 | ||
| Stage N3 | 35 | ||
| Stage R | 36 | ||
| Definite REM Sleep (REM Rule A) | 36 | ||
| Continuation of REM Sleep (REM Rule B) | 37 | ||
| End of REM Sleep | 37 | ||
| End of REM Sleep: Transition to Stage W or N3 | 37 | ||
| End of REM Sleep: Increase in Chin EMG Activity | 37 | ||
| End of REM Sleep: Arousal Followed by LAMF EEG and SEMs | 37 | ||
| End of REM Sleep: MBM Followed by LAMF EEG and SEMs | 38 | ||
| End of REM Sleep: Appearance of Nonarousal KCs or SSs in the EEG | 39 | ||
| Transitions between Definite Stage N2 and Stage R | 40 | ||
| Epochs with a Mixture of SSs/KCs and REMs | 42 | ||
| Transitions Between Stage N1 and Stage R (FAQ V7 AASM Scoring Rules) | 43 | ||
| Effects of Arousals and MBMs: Stage N2 Versus Stage R Rules | 43 | ||
| Major Body Movements | 44 | ||
| Arousal Rules | 45 | ||
| References | 46 | ||
| 4 Biocalibration, Artifacts, and Common Variants of Sleep | 49 | ||
| Chapter Points | 49 | ||
| Calibrations and Biocalibrations | 49 | ||
| Calibrations | 49 | ||
| Biocalibrations | 50 | ||
| Artifacts | 51 | ||
| Electrode Popping | 52 | ||
| 60-Cycle Artifact | 54 | ||
| Slow-Frequency (Sweat) Artifact | 54 | ||
| ECG Artifact | 55 | ||
| Pulse Artifact | 56 | ||
| Muscle Artifact | 56 | ||
| Snoring/Respiratory Chin EMG Artifact | 56 | ||
| Eye Movement Artifact | 56 | ||
| Ground Artifact | 56 | ||
| Common Variants Seen During Sleep Monitoring | 56 | ||
| Alpha Non–Rapid Eye Movement Sleep Anomaly | 56 | ||
| Drug Spindles | 59 | ||
| Eye Movements Associated with Selective Serotonin Reuptake Inhibitor Medications | 59 | ||
| Transient Muscle Activity during Rapid Eye Movement Sleep | 59 | ||
| Clinical Review Questions | 62 | ||
| Answers | 63 | ||
| References | 64 | ||
| 5 Sleep Staging in Infants and Children | 65 | ||
| Chapter Points | 65 | ||
| Bipolar Electroencephogram Recording | 65 | ||
| Sleep in the Premature Infant and Infants Younger Than 48 Weeks CA | 65 | ||
| Sleep Stages in the Newborn | 65 | ||
| EEG Patterns | 65 | ||
| Premature Infants | 66 | ||
| Term Infants | 66 | ||
| Sleep Architecture | 67 | ||
| Scoring Sleep in Infants Older Than 48 Weeks CA and Children | 70 | ||
| AASM Pediatric Rules for Scoring Sleep | 70 | ||
| Ages for which AASM Pediatric Sleep Scoring Rules Apply | 70 | ||
| Terminology of Sleep Stages | 70 | ||
| Scoring Sleep Stage | 70 | ||
| Dominant Posterior Rhythm | 70 | ||
| Additional Waveforms of Wakefulness | 70 | ||
| Pediatric Stage W Rules | 72 | ||
| Waveforms for Scoring Pediatric Stage N1 | 72 | ||
| Pediatric Stage N1 Rules | 72 | ||
| Pediatric Stage N2 | 72 | ||
| Pediatric Stage N3 | 74 | ||
| Pediatric Stage R | 74 | ||
| Pediatric Arousal Rules | 74 | ||
| Clinical Review Questions | 76 | ||
| Answers | 76 | ||
| References | 77 | ||
| 6 Sleep Architecture Parameters, Normal Sleep, and Sleep Loss | 79 | ||
| Chapter Points | 79 | ||
| Normal Sleep in Adults | 79 | ||
| Changes in Sleep Architecture with Aging (Adults) | 81 | ||
| Sleep Latency and REM Latency | 82 | ||
| TST and Sleep Efficiency | 82 | ||
| WASO and Stage N1 (as a Percentage of TST) | 82 | ||
| Stage N2 (as a Percentage of TST) | 82 | ||
| Stage N3 (as a Percentage of TST) | 82 | ||
| Stage R (as a Percentage of TST) | 83 | ||
| Sleep Architecture (as a Percentage of SPT) | 83 | ||
| Alternations in REM Latency | 83 | ||
| Gender Differences | 84 | ||
| First-Night Effect | 84 | ||
| Comparison of Sleep Staging Between the Aasm Scoring Manual and Rechtschaffen and Kales | 85 | ||
| Normal Sleep in Infants and Children | 85 | ||
| Sleep Architecture in Infants | 85 | ||
| Children | 85 | ||
| Arousals | 85 | ||
| Sleep Fragmentation | 86 | ||
| Total Sleep Deprivation | 87 | ||
| Selective Sleep Deprivation | 87 | ||
| Recovery from Sleep Loss | 88 | ||
| Chronic Partial Sleep Deprivation (Restriction) | 88 | ||
| Clinical Review Questions | 89 | ||
| Answers | 89 | ||
| References | 89 | ||
| 7 Neurobiology of Sleep | 91 | ||
| Chapter Points | 91 | ||
| Major Brain Areas Important for Sleep and Wake | 91 | ||
| Hypothalamic Areas | 91 | ||
| Lateral Hypothalamus | 91 | ||
| Ventrolateral Preoptic Nucleus | 92 | ||
| Tuberomammillary Nucleus | 94 | ||
| Brainstem Regions | 94 | ||
| Dopamine Regions | 94 | ||
| Reticular Formation | 95 | ||
| Dorsal RAS | 95 | ||
| Lateral Dorsal Tegmentum/Pedunculopontine Tegmentum. | 95 | ||
| Ventral RAS | 96 | ||
| Dorsal Raphe Nucleus | 96 | ||
| Locus Coeruleus | 96 | ||
| Basal Forebrain | 96 | ||
| Control of Nrem Sleep | 96 | ||
| Features of Rem Sleep | 96 | ||
| Control of REM Sleep | 97 | ||
| Effects of Medications | 98 | ||
| Adenosine: A Possible Mediator of Sleepiness after Prolonged Wakefulness | 99 | ||
| Clinical Review Questions | 99 | ||
| Answers | 100 | ||
| References | 100 | ||
| 8 Monitoring Respiration—Technology and Techniques | 101 | ||
| Chapter Points | 101 | ||
| Techniques to Measure Airflow or Tidal Volume | 101 | ||
| Measuring Respiratory Effort | 107 | ||
| Measuring SaO2 | 109 | ||
| Pulse Oximetry | 110 | ||
| SpO2 and Sleep Monitoring | 111 | ||
| Measurement of PaCO2 During Sleep | 112 | ||
| PETCO2 | 113 | ||
| TcPCO2 Monitoring | 113 | ||
| Accuracy of PETCO2 and TcPCO2 | 113 | ||
| Snoring Sensors | 115 | ||
| Clinical Review Questions | 116 | ||
| Answers | 116 | ||
| References | 116 | ||
| 9 Monitoring Respiration—Event Definitions and Examples | 119 | ||
| Chapter Points | 119 | ||
| Respiratory Events in Adults | 119 | ||
| History of Respiratory Event Definitions | 119 | ||
| Recommended Respiratory Sensors in Adults | 121 | ||
| Definition of Apnea (AASM Scoring Manual) | 121 | ||
| Apnea Scoring Rules in Adults (AASM Scoring Manual) | 122 | ||
| Apnea Types | 122 | ||
| Hypopnea Scoring Rules in Adults | 122 | ||
| Hypopnea (Recommended) | 122 | ||
| Hypopnea (Alternative) | 122 | ||
| Event Duration Rules | 122 | ||
| Clarification of Event Duration Criteria for Apneas and Hypopneas | 123 | ||
| RERA Rule in Adults (AASM Scoring Manual) | 124 | ||
| RERA Detection | 124 | ||
| Hypopnea or RERA? | 127 | ||
| Relationship of Arousal and Respiratory Event | 127 | ||
| Scoring Apneas and Hypopneas during Wake | 127 | ||
| Classification of Hypopneas | 127 | ||
| Chest-Abdominal Paradox | 128 | ||
| False Classification of Apneas as Central | 130 | ||
| Hypoventilation in Adults | 130 | ||
| Hypoventilation Rule (AASM Scoring Manual) | 131 | ||
| Cheyne-Stokes Breathing Rule | 132 | ||
| Respiratory Parameters Reported in PSG (Adults) | 132 | ||
| Respiratory Event Scoring Rules in Children | 134 | ||
| Ages for Which Pediatric Scoring Rules Should Be Used | 134 | ||
| Recommended Sensors in Children by AASM Scoring Manual | 135 | ||
| Apnea Rules for Children | 135 | ||
| Obstructive Apnea | 135 | ||
| Mixed Apnea | 135 | ||
| Central Apnea | 136 | ||
| Hypopnea Rule (Children) | 136 | ||
| RERA Rules for Children | 136 | ||
| Hypoventilation Rule for Children | 137 | ||
| Obstructive Hypoventilation | 138 | ||
| Periodic Breathing Rule for Children | 138 | ||
| Respiratory Parameters Reported in PSG (Children) | 138 | ||
| Clinical Review Questions | 139 | ||
| Answers | 139 | ||
| References | 139 | ||
| 10 Sleep and Respiratory Physiology | 141 | ||
| Chapter Points | 141 | ||
| Arterial Blood Gases | 141 | ||
| Oxygen Transport and Saturation | 142 | ||
| Determinants of PaCO2 | 145 | ||
| Normal Changes in Ventilation During Sleep | 145 | ||
| Tests of Ventilatory Control | 146 | ||
| Acid-Base Physiology | 148 | ||
| Pulmonary Function Testing | 149 | ||
| Obesity | 152 | ||
| Muscle Strength | 152 | ||
| Muscle Forces | 152 | ||
| Maximum Inspiratory Pressure and Maximum Expiratory Pressure | 153 | ||
| Clinical Review Questions | 153 | ||
| Answers | 154 | ||
| References | 154 | ||
| Appendix 10-1 Severity Criteria for Pulmonary Function Testing | 157 | ||
| 11 Cardiac Monitoring during Polysomnography | 159 | ||
| Chapter Points | 159 | ||
| ECG RECORDING DURING POLYSOMNOGRAPHY | 160 | ||
| SINUS RHYTHM AND NORMATIVE DATA FOR HEART RATE | 162 | ||
| CONDUCTION SYSTEM | 164 | ||
| BRADYCARDIA AND AV BLOCK DURING SLEEP | 164 | ||
| Sinus Pause/Asystole | 165 | ||
| AV Block | 166 | ||
| Aberrant Conduction | 167 | ||
| Premature Beats | 167 | ||
| TACHYCARDIAS DURING SLEEP | 168 | ||
| Narrow-Complex Tachycardia | 168 | ||
| Afib and Atrial Flutter | 170 | ||
| Wide-Complex Tachycardia | 172 | ||
| ADVERSE EVENTS DURING PSG | 172 | ||
| PACEMAKERS AND WIDE-COMPLEX QRS | 172 | ||
| References | 173 | ||
| 12 Monitoring of Limb Movements and Other Movements during Sleep | 175 | ||
| Chapter Points | 175 | ||
| Limb Monitoring Techniques | 175 | ||
| Criteria for LMs and PLMs | 176 | ||
| LMs Associated with Respiratory Events Are Not Scored | 177 | ||
| Association of Arousals with PLM | 178 | ||
| Periodic Limb Movements in Sleep | 178 | ||
| Periodic Limb Movements in Wake | 178 | ||
| Suggested Immobilization Test | 179 | ||
| Clinical Significance of PLMS | 179 | ||
| Other LMs during Sleep | 180 | ||
| Alternating Leg Muscle Activation | 180 | ||
| Hypnagogic Foot Tremor | 181 | ||
| Excessive Fragmentary Myoclonus | 181 | ||
| Bruxism | 182 | ||
| PSG Characteristics of Bruxism | 183 | ||
| Rhythmic Movements and the Sleep-Related Rhythmic Movement Disorder | 184 | ||
| PSG Findings in RM | 184 | ||
| RBD: Scoring PSG Features | 185 | ||
| Clinical Review Questions | 187 | ||
| Answers | 187 | ||
| References | 187 | ||
| 13 Polysomnography, Portable Monitoring, and Actigraphy | 189 | ||
| Chapter Points | 189 | ||
| Polysomnography | 189 | ||
| PSG for Patients with SRBDs (see Table 13–1) | 190 | ||
| PSG Titration and PSG on CPAP (see Table 13–2) | 191 | ||
| PSG Indications: Nonrespiratory Disorders | 192 | ||
| PSG Indicated (see Tables 13–3 and 13–4) | 192 | ||
| PSG NOT Indicated (see Tables 13–3 and 13–4) | 192 | ||
| Approach to the Sleepy Patient on PAP Treatment | 192 | ||
| Approach to Reading the PSG | 192 | ||
| Portable Monitoring (home sleep testing, out of center sleep testing) | 192 | ||
| Developments in the Use of PM | 193 | ||
| Accuracy of PMs | 194 | ||
| Clinical Use of PM | 197 | ||
| Indications for Attended PM | 197 | ||
| Indications for Unattended PM | 198 | ||
| Patient Selection for PM | 199 | ||
| Recommended PM Methodology | 199 | ||
| Types of PM Devices | 199 | ||
| Peripheral Arterial Tonometry | 200 | ||
| Practical Considerations in PM | 201 | ||
| Integration of PM into the Overall Patient Care Algorithm | 202 | ||
| Overall Approach to Using PSG and PM | 203 | ||
| Actigraphy | 205 | ||
| Indications | 206 | ||
| Actigraphy in OSA | 207 | ||
| Patients with Hypersomnia | 207 | ||
| Actigraphy in Insomnia | 207 | ||
| Clinical Review Questions | 208 | ||
| Answers | 210 | ||
| References | 211 | ||
| Appendix 13-1 AASM Practice Parameters for Polysomnography (Selected Statements) | 213 | ||
| Polysomnography in Other Medical Disorders | 213 | ||
| Alternate Tools | 214 | ||
| 4.3 Narcolepsy | 214 | ||
| 4.4 Parasomnias and Seizure Disorders | 214 | ||
| 4.5 Restless Legs Syndrome and Periodic Limb Movement Disorder | 214 | ||
| 4.6 Depression with Insomnia | 214 | ||
| 4.7 Circadian Rhythm Sleep Disorders | 214 | ||
| Appendix 13-2 Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients | 215 | ||
| 3. Methodology for Portable Monitoring | 215 | ||
| Appendix 13-3 First Coast Services Durable Medical Area Contractor (DMAC Region I) | 217 | ||
| Local Carrier Determinations for Polysomnography and Sleep Testing (L29949)—Excerpts | 217 | ||
| Accreditation | 217 | ||
| Physician Training/Certification | 217 | ||
| Home Sleep Testing | 217 | ||
| 14 Subjective and Objective Measures of Daytime Sleepiness | 219 | ||
| Chapter Points (see also Box 14–6) | 219 | ||
| Subjective Measures | 219 | ||
| Objective Measures | 221 | ||
| Multiple Sleep Latency Test | 221 | ||
| MSLT Protocol | 221 | ||
| Other MSLT Considerations | 223 | ||
| MSL Values in Normal Populations and Patients | 223 | ||
| Factors Affecting the MSLT MSL | 224 | ||
| Number of SOREMPs | 224 | ||
| Utility of the MSLT for Diagnosis of Narcolepsy | 225 | ||
| Normative MSLT Findings in Children and Adolescents | 225 | ||
| Clinical Examples of MSLTs | 225 | ||
| Clinical Example | 225 | ||
| Nap 1 | 226 | ||
| Nap 2 | 226 | ||
| Nap 3 | 226 | ||
| Nap 4 | 226 | ||
| Nap 5 | 226 | ||
| Clinical Example | 227 | ||
| Maintenance of Wakefulness Test | 227 | ||
| Specific Indications for the Use of the MWT | 229 | ||
| MWT Protocol | 229 | ||
| MWT Normative Data | 229 | ||
| Relationship between the MSLT and the MWT | 229 | ||
| MSLT and MWT Changes with Treatment | 230 | ||
| The MSLT and MWT Assessment of Safety or “Fit for Duty” | 231 | ||
| Limitations of MSLT and MWT | 232 | ||
| Clinical Review Questions | 232 | ||
| Answers | 233 | ||
| References | 234 | ||
| Appendix 14-1 Federal Aviation Administration Policy Concerning Fitness to Fly in Sleep Apnea Patients | 235 | ||
| 15 Obstructive Sleep Apnea Syndromes: | 237 | ||
| Chapter Points | 237 | ||
| History And Definitions | 237 | ||
| Diagnostic Criteria | 238 | ||
| Epidemiology Of Osa | 238 | ||
| Prevalence and Progression | 238 | ||
| Risk Factors | 239 | ||
| Obesity | 239 | ||
| Male Sex | 239 | ||
| Age | 239 | ||
| Postmenopausal Status | 239 | ||
| Ethnicity | 240 | ||
| Smoking | 240 | ||
| Alcohol Intake | 240 | ||
| Hypothyroidism | 240 | ||
| Acromegaly | 241 | ||
| Diagnosis Of Osa | 241 | ||
| OSA Symptoms and Key Historical Points | 241 | ||
| Physical Examination | 242 | ||
| Laboratory Testing in OSA | 244 | ||
| Prediction of the Presence of OSA | 244 | ||
| Diagnostic Testing for Suspected Sleep Apnea | 244 | ||
| Portable Monitoring | 247 | ||
| Variants Of Snoring And Osa | 248 | ||
| Primary (Simple) Snoring | 248 | ||
| Upper Airway Resistance Syndrome | 249 | ||
| Obesity Hypoventilation Syndrome | 249 | ||
| Diagnosis of OHS | 249 | ||
| Treatment of OHS | 250 | ||
| Overlap Syndrome | 250 | ||
| Pediatric Osa | 251 | ||
| Epidemiology of Pediatric OSA | 252 | ||
| Diagnosis | 252 | ||
| Clinical Review Questions | 254 | ||
| Answers | 254 | ||
| References | 254 | ||
| Appendix 15-1 Berlin Questionnaire | 259 | ||
| Category 1 | 259 | ||
| If you snore: | 259 | ||
| Category 2 | 259 | ||
| If yes: | 259 | ||
| Category 3: Somnolence | 259 | ||
| Scoring: | 259 | ||
| Appendix 15-2 STOP-BANG Scoring Model | 261 | ||
| 16 Pathophysiology of Obstructive Sleep Apnea | 263 | ||
| Chapter Points | 263 | ||
| Pathogenesis of Upper Airway Obstruction | 263 | ||
| Lung Volume Effects | 269 | ||
| Ventilatory Control and OSA | 270 | ||
| Stage R Effects | 270 | ||
| Gender and OSA | 272 | ||
| Mechanisms of Apnea Termination and Arousal | 273 | ||
| Upper Airway Sensation | 275 | ||
| Arterial Oxygen Desaturation | 275 | ||
| Clinical Review Questions | 276 | ||
| Answers | 277 | ||
| References | 277 | ||
| 17 Consequences of Obstructive Sleep Apnea and the Benefits of Treatment | 281 | ||
| Chapter Points | 281 | ||
| Pathophysiology | 282 | ||
| Mortality | 282 | ||
| Excessive Daytime Sleepiness and Neurocognitive Dysfunction | 284 | ||
| Automobile Accidents and Sleep Apnea | 286 | ||
| Arterial Hypertension | 286 | ||
| Pulmonary Hypertension | 288 | ||
| Arrhythmias | 289 | ||
| Coronary Artery Disease | 290 | ||
| Atherosclerosis and Thrombosis | 291 | ||
| Congestive Heart Failure | 292 | ||
| Cerebrovascular Accidents and OSA | 292 | ||
| Erectile Dysfunction | 293 | ||
| Diabetes | 293 | ||
| Nocturia | 293 | ||
| Consequences of Childhood OSA | 293 | ||
| Neurobehavioral | 294 | ||
| Metabolic and Inflammatory Consequences | 294 | ||
| Cardiovascular Consequences | 294 | ||
| Clinical Review Questions | 294 | ||
| Answers | 294 | ||
| References | 295 | ||
| 18 Obstructive Sleep Apnea Treatment Overview and Medical Treatments | 299 | ||
| Chapter Points | 299 | ||
| Introduction | 299 | ||
| Should Mild OSA Patients Be Treated? | 300 | ||
| Whom to Treat | 300 | ||
| Treatment Selection | 300 | ||
| Snoring | 300 | ||
| Mild OSA | 301 | ||
| Moderate OSA | 301 | ||
| Severe OSA | 302 | ||
| Patient Education Before Treatment | 302 | ||
| Follow-Up and Outcomes Assessment | 302 | ||
| Medical Treatments for OSA | 303 | ||
| Weight Loss | 303 | ||
| Posture and Positional Treatment | 305 | ||
| Medical Therapies to Improve Nasal Patency | 306 | ||
| Supplemental Oxygen | 306 | ||
| Persistent Daytime Sleepiness on CPAP | 307 | ||
| Modafinil, Armodafinil, and Stimulants | 307 | ||
| Overview of Treatment of Pediatric OSA | 308 | ||
| Medications for Pediatric OSA | 309 | ||
| Clinical Review Questions | 309 | ||
| Answers | 309 | ||
| References | 310 | ||
| 19 Positive Airway Pressure Treatment | 313 | ||
| Chapter Points | 313 | ||
| Mechanism of Action | 313 | ||
| Effectiveness | 314 | ||
| Modes of PAP | 314 | ||
| Volume-Targeted BPAP | 319 | ||
| Comfort Measures | 320 | ||
| Ramp | 320 | ||
| Flexible Pressure | 320 | ||
| Humidification | 321 | ||
| Interfaces | 322 | ||
| Indications for PAP Treatment | 322 | ||
| Adherence—Definitions and Measurement | 323 | ||
| PAP Adherence in Large Studies | 323 | ||
| Factors Influencing Adherence and Importance of Early Adherence | 323 | ||
| How Much Adherence Is Enough? | 324 | ||
| Interventions to Improve Adherence | 324 | ||
| Hypnotics, Alcohol, and CPAP | 324 | ||
| CPAP/BPAP Titration for OSA | 325 | ||
| General Titration Considerations | 326 | ||
| Pediatric Considerations | 326 | ||
| Monitoring during Positive-Pressure Titration | 326 | ||
| Additional Monitoring for NPPV Titration | 330 | ||
| Titration Protocol | 330 | ||
| PAP and Supplemental Oxygen | 332 | ||
| Complex Sleep Apnea | 333 | ||
| ASV Titration Protocol | 334 | ||
| Adequacy of PAP Titration | 334 | ||
| Alternative Methods of Starting PAP Treatment | 334 | ||
| Patient Selection for Alternative Titrations | 335 | ||
| Technique of Autotitration | 335 | ||
| Follow-up of Patients on PAP Treatment | 335 | ||
| NPPV Titration and Treatment | 336 | ||
| Goals of NPPV Titration and Treatment | 337 | ||
| NPPV Titration Protocol | 337 | ||
| Reimbursement for NPPV Devices | 338 | ||
| Clinical review Questions | 338 | ||
| Answers | 339 | ||
| References | 339 | ||
| Appendix 19-1 Practice Parameters for APAP and CPAP/BPAP (Selected Recommendations) | 343 | ||
| CPAP/BPAP Recommendations* | 343 | ||
| APAP Recommendations | 343 | ||
| Appendix 19-2 The details of local carrier determinations can vary by region and are frequently updated. | 345 | ||
| Initial Coverage | 345 | ||
| Sleep Tests | 345 | ||
| Continued Coverage beyond the First 3 Months of Therapy | 345 | ||
| Appendix 19-3 Medicare Criteria for Reimbursement for Respiratory-Assist Devices | 347 | ||
| Requirements for Initial Coverage for 3 Months | 347 | ||
| Coverage beyond 3 Months | 347 | ||
| 20 Oral Appliance and Surgical Treatment for Obstructive Sleep Apnea | 349 | ||
| Chapter Points | 349 | ||
| ORAL APPLIANCE TREATMENT FOR OSA | 350 | ||
| Oral Appliances | 350 | ||
| Evaluation of the Patient | 350 | ||
| Exclusions and Contraindications | 351 | ||
| Mechanism of Action of OAs | 351 | ||
| Effectiveness | 352 | ||
| Factors Predicting Effectiveness | 352 | ||
| Devices | 352 | ||
| Titration/Adjustment of OAs | 353 | ||
| Adherence to OA Treatment | 353 | ||
| Effectiveness Compared with Other Treatments | 354 | ||
| OA Treatment Guidelines | 355 | ||
| Follow-up | 356 | ||
| Centers for Medicaid and Medicare Services Coverage of OA Treatment | 356 | ||
| Side Effects and Complications | 356 | ||
| Combinations of OA with Other Treatments | 357 | ||
| Effects of OA Treatment on Consequences of OSA | 357 | ||
| Surgical Treatments for OSA | 357 | ||
| Evaluation for Possible Surgical Treatment | 357 | ||
| Indications for Surgical Treatment | 357 | ||
| Surgical Options | 357 | ||
| Tracheostomy | 357 | ||
| Nasal Obstruction | 358 | ||
| Palatal Implants | 358 | ||
| Laser-Assisted Uvuloplasty | 358 | ||
| Radiofrequency Ablation | 359 | ||
| Uvulopalatopharyngoplasty | 359 | ||
| Uvulopalatal Flap | 360 | ||
| Genioglossus Advancement/Hyoid Advancement | 360 | ||
| Maxillomandibular Advancement | 361 | ||
| MMA Procedure | 362 | ||
| Outcomes of MMA | 362 | ||
| Tongue Procedures | 362 | ||
| Tongue Base Suspension Suture | 362 | ||
| Overall Surgical Approach | 362 | ||
| Success Rates of Upper Airway Surgery | 363 | ||
| Surgery for Pediatric OSA | 363 | ||
| Tonsillectomy and Adenoidectomy | 363 | ||
| Rapid Maxillary Expansion | 364 | ||
| Clinical Review Questions | 365 | ||
| Answers | 366 | ||
| References | 366 | ||
| Appendix 20-1 Summary of AASM Practice Parameters for the Use of Oral Appliances for Treatment of Snoring and Obstructive Sleep Apnea | 369 | ||
| Appendix 20-2 Excerpts from Local Coverage Determination for Oral Appliances for Obstructive Sleep Apnea (L28606) | 371 | ||
| Appendix 20-3 Summary of Practice Parameters for Surgical Treatment of Obstructive Sleep Apnea in Adults | 373 | ||
| 21 Central Sleep Apnea and Hypoventilation Syndromes | 375 | ||
| Chapter Points | 375 | ||
| Classification of Csa Syndromes | 377 | ||
| Pathophysiology of Csa | 379 | ||
| Effects of Normal Physiologic Changes | 379 | ||
| Ventilatory Control in Hypocapnic CSA | 380 | ||
| Apneic Threshold | 381 | ||
| Loop Gain | 382 | ||
| Upper Airway and Posture Effects | 382 | ||
| Hypocapnic Csa Syndromes | 382 | ||
| Patterns of Ventilation in ICSA and CSB | 382 | ||
| Idiopathic CSA (Primary CSA) | 383 | ||
| Pathophysiology of Idiopathic CSA | 384 | ||
| Polysomnography | 384 | ||
| Treatment of ICSA | 384 | ||
| Csb with Csa | 385 | ||
| Polysomnography in CSB-CSA | 385 | ||
| Pathophysiology of CSB-CSA | 386 | ||
| Treatment of CSB-CSA | 386 | ||
| Complex Sleep Apnea | 390 | ||
| Pathophysiology | 390 | ||
| Incidence and Natural History | 390 | ||
| Polysomnography | 390 | ||
| Treatment of CompSA | 390 | ||
| High-Altitude Periodic Breathing | 391 | ||
| Pathophysiology | 392 | ||
| Treatment | 392 | ||
| Hypercapnic Csa and hypoventilation syndromes not due to lung disease | 392 | ||
| Mechanisms of Hypercapnic CSA and/or Hypoventilation | 393 | ||
| Evaluation of Patients with Suspected Hypoventilation | 393 | ||
| Congenital Central Hypoventilation Syndrome | 394 | ||
| Other Neural Disorders Causing Central Hypoventilation | 396 | ||
| Chiari’s Malformation | 396 | ||
| CSA Due to Medication (Opiate/Narcotic-Induced CSA) | 396 | ||
| Treatment | 397 | ||
| Primary Sleep Apnea of Infancy | 397 | ||
| Restrictive Thoracic Cage Disorders | 398 | ||
| Treatment of Restrictive Thoracic Cage Disorders | 400 | ||
| Neuromuscular Weakness | 400 | ||
| Treatment of Nocturnal Hypoventilation Due to NMD | 401 | ||
| Clinical Review Questions | 401 | ||
| Answers | 402 | ||
| References | 403 | ||
| Appendix 21–1 Sleep-Related Hypoventilation Syndromes—Diagnostic Criteria | 407 | ||
| 22 Sleep and Obstructive Lung Disease | 409 | ||
| Chapter Points | 409 | ||
| Obstructive Ventilatory Dysfunction | 409 | ||
| Chronic Obstructive Pulmonary Disease | 411 | ||
| Sleep in COPD | 412 | ||
| Etiology of Abnormal Nocturnal Gas Exchange | 412 | ||
| Normal Individuals | 412 | ||
| Sleep-Related Changes in Respiration in COPD | 413 | ||
| Non–Rapid Eye Movement | 414 | ||
| Rapid Eye Movement | 414 | ||
| Mismatch | 415 | ||
| Time of Night and Circadian Variation in Lung Function | 416 | ||
| COPD Types and Respiration during Sleep | 416 | ||
| Sleep Quality in COPD | 417 | ||
| Treatment of Sleep-Related Hypoxemia in COPD | 417 | ||
| Bronchodilators | 418 | ||
| Hypnotics in COPD Patients | 419 | ||
| Nocturnal Noninvasive Positive-Pressure Ventilation | 420 | ||
| Overlap Syndrome | 420 | ||
| Treatment of OLS | 420 | ||
| Asthma | 421 | ||
| Epidemiology | 421 | ||
| Etiology of Nocturnal Asthma | 422 | ||
| Airway Inflammation | 422 | ||
| Melatonin | 422 | ||
| Factors Worsening Nocturnal Asthma | 423 | ||
| Allergens in the Bedroom | 423 | ||
| Gastroesophageal Reflux | 423 | ||
| OSA/Obesity | 424 | ||
| Diagnosis of Nocturnal Asthma | 424 | ||
| Chronotherapy | 424 | ||
| Treatment of Nocturnal Asthma | 424 | ||
| Clinical Review Questions | 425 | ||
| Answers | 426 | ||
| References | 426 | ||
| 23 The Restless Leg Syndrome, Periodic Limb Movements in Sleep, and the Periodic Limb Movement Disorder | 429 | ||
| Chapter Points | 429 | ||
| Restless Legs Syndrome | 430 | ||
| The Essential RLS Diagnostic Criteria | 431 | ||
| Supportive Clinical Features | 431 | ||
| Differential Diagnosis of RLS/PLMS | 432 | ||
| Causes of RLS | 433 | ||
| Familial Patterns and Genetics | 434 | ||
| Pathophysiology of RLS | 434 | ||
| Clinical Features of RLS | 434 | ||
| Prevalence of RLS | 434 | ||
| Onset and Clinical Course of RLS | 435 | ||
| Sleep Disturbance Associated with RLS | 435 | ||
| Medical Evaluation in RLS | 435 | ||
| PSG Findings in RLS Patients | 436 | ||
| RLS in Children | 437 | ||
| Periodic Limb Movements in Sleep | 437 | ||
| PLMSI and PSG Findings | 437 | ||
| PLMS and Arousals | 438 | ||
| Differential Diagnosis of PLMS | 438 | ||
| Clinical Significance of the PLMSI and PLMS Arousal Index | 438 | ||
| PLMS and Other Disorders | 439 | ||
| Periodic Limb Movement Disorder | 439 | ||
| Prevalence and Manifestations of PLMD | 439 | ||
| PSG and Objective Findings | 439 | ||
| Treatment of RLS and PLMD | 440 | ||
| Nonpharmacologic Treatments | 440 | ||
| Dopaminergic Medications | 440 | ||
| Augmentation | 442 | ||
| Opioids/Opiates | 443 | ||
| Anticonvulsant Medications | 443 | ||
| Sedative Hypnotics | 443 | ||
| RLS Treatment Algorithm | 444 | ||
| Daily RLS | 444 | ||
| Refractory/Severe RLS | 445 | ||
| Clinical Review Questions | 446 | ||
| Answers | 446 | ||
| References | 447 | ||
| 24 Hypersomnias of Central Origin | 451 | ||
| Chapter Points | 451 | ||
| Narcolepsy Syndromes | 451 | ||
| History | 452 | ||
| Epidemiology | 453 | ||
| Genetics | 453 | ||
| HLA Typing | 453 | ||
| Importance of Hcrt Neurons | 453 | ||
| Pathophysiology of Narcolepsy | 454 | ||
| N+C Group | 454 | ||
| N–C Group | 454 | ||
| Mechanisms of Cataplexy | 454 | ||
| Manifestations of Narcolepsy | 455 | ||
| Excessive Daytime Sleepiness (N+C and N–C) | 455 | ||
| Sleep-Related Hallucinations (N+C and N–C) | 456 | ||
| Sleep Paralysis (N+C and N–C) | 457 | ||
| Disturbed Nocturnal Sleep and Other Symptoms: N+C, N–C | 457 | ||
| Cataplexy: N+C | 457 | ||
| Diagnostic Testing for Narcolepsy | 457 | ||
| History | 457 | ||
| Polysomnography | 458 | ||
| Multiple Sleep Latency Test | 458 | ||
| HLA Typing | 459 | ||
| CSF Hcrt Levels | 459 | ||
| Diagnostic Criteria and Important Findings for N+C and N–C Forms of Narcolepsy | 459 | ||
| Narcolepsy with Cataplexy (N+C) | 459 | ||
| N+C Manifestations | 460 | ||
| Onset of N+C | 460 | ||
| Polysomnography | 460 | ||
| Multiple Sleep Latency Test | 460 | ||
| Other Studies in N+C | 460 | ||
| Narcolepsy without Cataplexy (N–C) | 460 | ||
| Polysomnography (N–C) | 460 | ||
| MSLT Findings (N–C) | 460 | ||
| Treatment of Narcolepsy | 460 | ||
| Treatment of EDS | 460 | ||
| Stimulant Medications | 462 | ||
| Modafinil and Armodafinil | 463 | ||
| Sodium Oxybate | 464 | ||
| Other Interventions for Daytime Sleepiness | 465 | ||
| Choosing Treatment for Daytime Sleepiness | 465 | ||
| Treatment of Cataplexy, HGH/HPHs, and SP | 465 | ||
| Future Treatments for Narcolepsy | 466 | ||
| Narcolepsy in Children | 467 | ||
| Narcolepsy Due to Medical Condition | 468 | ||
| Disorders Associated with NDMC, Isolated Cataplexy, or HDMC | 469 | ||
| Genetic Disorders Causing NDMC or Isolated Cataplexy | 469 | ||
| Prader-Willi Syndrome | 469 | ||
| Myotonic Dystrophy | 469 | ||
| Rare Genetic Disorders Causing NDMC or Isolated Cataplexy | 469 | ||
| Idiopathic Hypersomnia | 470 | ||
| IH with Long Sleep Time (IH+LST) | 470 | ||
| Manifestations | 470 | ||
| Autonomic Dysfunction | 470 | ||
| Prevalence | 470 | ||
| Onset | 470 | ||
| Polysomnography | 470 | ||
| Multiple Sleep Latency Test | 470 | ||
| CSF Hcrt | 470 | ||
| Diagnostic Approach | 470 | ||
| 25 Insomnia | 481 | ||
| Chapter Points | 481 | ||
| Prevalence of Insomnia and Risk Factors | 482 | ||
| Insomnia Subtypes | 482 | ||
| Evaluation of Insomnia Complaints | 483 | ||
| Questionnaires, Sleep Logs, and Actigraphy | 485 | ||
| Questionnaires | 485 | ||
| Sleep Logs | 486 | ||
| Actigraphy | 487 | ||
| Polysomnography | 488 | ||
| Physiologic Findings in Primary Insomnia | 489 | ||
| Individual Insomnia Subtypes | 489 | ||
| Adjustment Insomnia (Acute Insomnia) | 489 | ||
| 26 Circadian Rhythm Sleep Disorders | 515 | ||
| Chapter Points | 515 | ||
| Melatonin | 516 | ||
| The SCN and Sleep-Wake Cycle | 517 | ||
| Markers of Circadian Phase | 518 | ||
| Shifting the Circadian Rhythms | 520 | ||
| Phase Shifting by Light | 520 | ||
| Phase-Response Curve for Light | 521 | ||
| Phase Shifting by Exogenous Melatonin | 522 | ||
| Melatonin PRC Curve | 522 | ||
| Summary of Effects of Light and Melatonin | 523 | ||
| Genomics of CRSD | 524 | ||
| Circadian Rhythm Sleep Disorders | 525 | ||
| Morningness-Eveningness Questionnaire | 526 | ||
| Sleep Logs and Actigraphy | 526 | ||
| Delayed Sleep Phase Disorder | 526 | ||
| Epidemiology | 526 | ||
| Pathophysiology | 527 | ||
| Sleep Logs and Actigraphy | 527 | ||
| Treatment of DSPD | 528 | ||
| Advanced Sleep Phase Disorder | 529 | ||
| Epidemiology | 529 | ||
| Pathophysiology | 529 | ||
| Diagnosis | 529 | ||
| Morningness-Eveningness Questionnaire | 529 | ||
| Sleep Logs and Actigraphy | 529 | ||
| Core Body Temperature, Dim Light Melatonin Onset | 529 | ||
| Treatment | 529 | ||
| CRSD—Irregular Sleep-Wake Type | 530 | ||
| Epidemiology | 530 | ||
| Etiology | 531 | ||
| Sleep Logs and Actigraphy | 531 | ||
| Diagnosis of ISWR | 531 | ||
| Treatment of ISWR | 531 | ||
| CRSD—Free-Running Type (Non–24-Hour Sleep-Wake Syndrome) | 532 | ||
| Epidemiology | 532 | ||
| Pathophysiology | 533 | ||
| Sleep Logs and Actigraphy | 533 | ||
| CBTmin and DLMO | 533 | ||
| Treatment of CRSD-FRT | 533 | ||
| CRSD–Jet Lag Type | 533 | ||
| Epidemiology | 534 | ||
| Pathophysiology | 534 | ||
| Antidromic Entrainment | 535 | ||
| Symptoms Associated with Jet Lag CRSD | 535 | ||
| Treatment of Jet Lag | 535 | ||
| Eastward Flights | 535 | ||
| Westward Flights | 536 | ||
| Crossing More than Eight Time Zones | 537 | ||
| Circadian Rhythm Sleep Disorder— Shift-Work Type | 537 | ||
| Epidemiology | 537 | ||
| Risk Factors | 537 | ||
| Pathophysiology | 537 | ||
| Sleep Logs and Diaries | 538 | ||
| Circadian Markers | 538 | ||
| Night Shift Work | 538 | ||
| Rotating Shifts | 539 | ||
| Complications of Night Shifts | 539 | ||
| Treatment of Shift-Work Disorder | 539 | ||
| CRSD—Due to Medical Condition (Box 26–16) | 540 | ||
| Disorders Associated with CRSD | 540 | ||
| Treatment | 540 | ||
| CRSD—Not Otherwise Specified | 540 | ||
| CRSD Due to Drug or Substance | 540 | ||
| Clinical Review Questions | 540 | ||
| Answers | 541 | ||
| References | 542 | ||
| 27 Clinical Electroencephalography and Nocturnal Epilepsy | 545 | ||
| Chapter Points | 545 | ||
| Electroencephalographic Monitoring | 545 | ||
| Bipolar Monitoring and Standard Montages | 546 | ||
| Waveform and Seizure Terminology | 548 | ||
| Phase Reversal | 549 | ||
| Localization in Referential and PSG Montages | 549 | ||
| Normal Sleep Waveforms in the 10-Second Window | 551 | ||
| Eye Movements and Bell’s Phenomenon | 551 | ||
| Posterior Rhythm | 551 | ||
| Positive Occipital Sharp Transients of Sleep and Lambda and Mu Rhythms | 552 | ||
| Ictal Activity | 554 | ||
| Classification of Seizures and Terminology | 556 | ||
| Nocturnal Epilepsy | 556 | ||
| Focal Nocturnal Epilepsy— General Characteristics | 557 | ||
| Temporal Lobe Epilepsy | 559 | ||
| Mesial TLE | 559 | ||
| Neocortical TLE | 559 | ||
| PSG and TLE | 559 | ||
| Nocturnal Frontal Lobe Epilepsy | 559 | ||
| NFLE Syndromes | 560 | ||
| Familial NFLE | 561 | ||
| Supplemental Motor Area Epilepsy | 561 | ||
| Parasomnia Versus NFLE | 561 | ||
| Benign Epilepsy of Childhood with Centrotemporal Spikes | 562 | ||
| Generalized Epilepsy Syndromes with Nocturnal Seizures | 562 | ||
| Generalized Epilepsy Syndromes | 562 | ||
| Generalized Seizures During or After Sleep | 562 | ||
| Epilepsy with GTC Seizures on Awakening | 562 | ||
| Juvenile Myoclonic Epilepsy | 562 | ||
| Absence Epilepsy | 563 | ||
| Lennox-Gastaut Syndrome | 563 | ||
| Ictal Effects on Sleep | 563 | ||
| Antiepileptic Drugs—Effects on Sleep | 563 | ||
| Epilepsy and Obstructive Sleep Apnea | 563 | ||
| Clinical Review Questions | 565 | ||
| Answers | 566 | ||
| References | 566 | ||
| 28 Parasomnias | 567 | ||
| Chapter Points | 567 | ||
| Nrem Parasomnias | 568 | ||
| Confusional Arousals | 568 | ||
| Prevalence | 568 | ||
| Precipitating and Predisposing Factors | 569 | ||
| Variants of Confusional Arousals | 569 | ||
| PSG Findings during Confusional Arousals | 569 | ||
| Diagnosis of Confusional Arousals | 569 | ||
| Differential Diagnosis of Confusional Arousals | 569 | ||
| Treatment of Confusional Arousals | 569 | ||
| Sleepwalking (Somnambulism) | 569 | ||
| Epidemiology and Familial Pattern of Sleepwalking | 570 | ||
| Familial, Precipitating, and Predisposing Factors | 570 | ||
| PSG in Sleepwalking | 571 | ||
| Diagnosis of Sleepwalking | 571 | ||
| Differential Diagnosis of Sleepwalking | 571 | ||
| Sleep-Related Sexual Behavior and Sleep-Related Violence | 571 | ||
| Sleep Disorders and the Law | 572 | ||
| Treatment of Sleepwalking | 572 | ||
| Sleep Terrors | 572 | ||
| Epidemiology | 573 | ||
| Precipitating and Predisposing Factors | 573 | ||
| PSG Findings Associated with Sleep Terrors | 573 | ||
| Diagnosis of Sleep Terrors | 573 | ||
| Treatment of Sleep Terrors | 573 | ||
| Differential Diagnosis of NREM Parasomnias | 573 | ||
| Parasomnias Usually Associated With Rem Sleep (Stage R) | 574 | ||
| REM Sleep Behavior Disorder (RBD; Including Variants) | 574 | ||
| Epidemiology of RBD | 574 | ||
| Pathophysiology of RBD | 574 | ||
| Classifications and Causes of RBD | 574 | ||
| Pseudo-RBD | 575 | ||
| PSG in RBD | 575 | ||
| Diagnosis of RBD | 575 | ||
| Variants of RBD | 577 | ||
| REM Sleep without Atonia | 577 | ||
| Parasomnia Overlap Disorder | 577 | ||
| Status Dissociatus | 577 | ||
| Differential Diagnosis of RBD | 577 | ||
| Treatment of RBD | 577 | ||
| Recurrent Isolated Sleep Paralysis | 578 | ||
| Epidemiology of Sleep Paralysis | 578 | ||
| Precipitating Events | 578 | ||
| Diagnosis of Recurrent Sleep Paralysis | 578 | ||
| Differential Diagnosis of Recurrent Sleep Paralysis | 578 | ||
| Treatment of Sleep Paralysis | 578 | ||
| Nightmare Disorder | 578 | ||
| Epidemiology of Nightmare Disorder | 579 | ||
| PSG Recordings in Nightmare Disorder | 579 | ||
| Diagnosis of Nightmare Disorder | 579 | ||
| Differential Diagnosis | 579 | ||
| Treatment of Nightmare Disorder | 579 | ||
| Other Parasomnias | 579 | ||
| Sleep-Related Dissociative Disorders | 579 | ||
| Types of Dissociative Disorders Associated with Sleep | 580 | ||
| Dissociative Identity Disorder | 580 | ||
| Dissociative Fugue State | 580 | ||
| Dissociative Disorder Not Otherwise Specified | 580 | ||
| Epidemiology | 580 | ||
| Diagnosis of SRDD | 580 | ||
| Treatment of SRDDs | 580 | ||
| Sleep Enuresis | 580 | ||
| Primary Enuresis | 581 | ||
| Secondary Enuresis | 581 | ||
| PSG in Evaluation of Enuresis | 581 | ||
| Treatments for Enuresis | 581 | ||
| Sleep-Related Groaning—Catathrenia | 581 | ||
| Epidemiology | 581 | ||
| Polysomnography | 581 | ||
| Diagnosis of Catathrenia | 582 | ||
| Differential Diagnosis of Catathrenia | 582 | ||
| Treatment of Catathrenia | 583 | ||
| Exploding Head Syndrome | 583 | ||
| Epidemiology | 583 | ||
| Diagnosis | 583 | ||
| Demographics | 583 | ||
| Polysomnography | 583 | ||
| Differential Diagnosis of Sleep-Related Headaches | 583 | ||
| Treatment of Exploding Head Syndrome | 583 | ||
| Sleep-Related Hallucinations | 583 | ||
| Epidemiology | 584 | ||
| Factors Precipitating SRH | 584 | ||
| Associations with SRHs | 584 | ||
| PSG in SRHs | 584 | ||
| Diagnosis of SRHs | 584 | ||
| Treatment | 584 | ||
| Sleep-Related Eating Disorders | 584 | ||
| Demographics | 585 | ||
| Pathophysiology | 585 | ||
| Causes of SRED and Association with Other Sleep Disorders | 585 | ||
| PSG in SRED | 585 | ||
| SRED Complications | 585 | ||
| Diagnosis | 585 | ||
| Differential Diagnosis | 585 | ||
| Treatment | 585 | ||
| Parasomnia, Unspecified | 585 | ||
| Parasomnia Due to Drug or Substance | 585 | ||
| Parasomnia Due to Medical Condition | 586 | ||
| Other Nocturnal Behaviors In The Differential Diagnosis Of Parasomnia | 586 | ||
| Sleep Talking (Somniloquy) | 586 | ||
| Hypnic Jerks | 586 | ||
| Propiospinal Myoclonus | 587 | ||
| Differential Diagnosis of Nocturnal Behavior | 587 | ||
| The Differential Diagnosis Of Parasomnias | 587 | ||
| Clinical Review Questions | 588 | ||
| Answers | 589 | ||
| References | 590 | ||
| 29 Psychiatry and Sleep | 593 | ||
| Chapter Points | 593 | ||
| Mood Disorders | 593 | ||
| Depression Questionnaires and Severity Rating Scales | 594 | ||
| Mood Episodes | 594 | ||
| Major Depressive Episode | 594 | ||
| Impact of MDE on Sleep | 595 | ||
| Manic Episode | 596 | ||
| Impact of Mania on Sleep | 596 | ||
| Mixed Episode | 596 | ||
| Hypomanic Episode | 596 | ||
| Impact of Hypomania on Sleep | 597 | ||
| Summary of Minimum Episode Durations | 597 | ||
| Mood Disorders | 597 | ||
| Major Depressive Disorder | 597 | ||
| Sleep and MDD | 598 | ||
| Differential Diagnosis of Sleep Disturbance in MDE | 599 | ||
| Treatment of Depression | 599 | ||
| Effects of Antidepressants on Sleep | 600 | ||
| Pharmacotherapy for Co-morbid Insomnia of Psychiatric Disorders | 600 | ||
| Dysthymic Disorder | 602 | ||
| Cyclothymic Disorder | 603 | ||
| Bipolar Disorders | 603 | ||
| Bipolar Depression | 603 | ||
| Sleep in Bipolar Disorder | 603 | ||
| Genetics in Mood Disorders | 604 | ||
| Treatment of Bipolar Disorders | 604 | ||
| Acute Mania | 604 | ||
| Mixed Episode | 605 | ||
| Maintenance Treatment | 605 | ||
| Bipolar Depression | 605 | ||
| Anxiety Disorders | 606 | ||
| 30 Sleep and Nonrespiratory Physiology—Impact on Selected Medical Disorders | 615 | ||
| Chapter Points | 615 | ||
| Endocrine Physiology and Sleep | 615 | ||
| Growth Hormone | 615 | ||
| Etiology of Sleep-Related GH Burst | 616 | ||
| GHRH and GH—Effects on Sleep | 616 | ||
| Changes in GH Secretion with Age | 616 | ||
| Sleep and the Corticotropic Axis | 617 | ||
| Sleep Deprivation and Sleep Loss | 617 | ||
| Sleep and the Thyroid Axis | 617 | ||
| TSH Secretion | 619 | ||
| Thyroid Hormone Levels | 619 | ||
| Sleep and Prolactin Secretion | 619 | ||
| Evidence for the Role of PRL in Regulation of Sleep | 620 | ||
| Summary of Control of Hormone Secretion | 620 | ||
| Sleep and the Gonadal Axis | 621 | ||
| Leptin and Ghrelin | 621 | ||
| Obesity and Sleep Duration | 622 | ||
| Sleep and Glucose Tolerance | 622 | ||
| Sleep and Gastrointestinal Physiology and Disorders | 622 | ||
| Gastric and Intestinal Function | 622 | ||
| Gastroesophageal Reflux and Sleep | 623 | ||
| Normal Gastroesophageal Physiology | 623 | ||
| Nocturnal Gastroesophageal Reflux | 623 | ||
| pH Monitoring | 624 | ||
| Nocturnal Asthma and GER | 624 | ||
| GER and OSA | 625 | ||
| Sleep-Related Laryngospasm | 625 | ||
| Treatment of Nocturnal GER | 625 | ||
| Sleep and Rheumatology | 626 | ||
| Fibromyalgia Syndrome | 626 | ||
| Manifestations of Fibromyalgia | 626 | ||
| Sleep in FS | 626 | ||
| Treatment of FS | 626 | ||
| Sleep and Renal | 627 | ||
| Renin-Aldosterone and Sleep | 627 | ||
| Clinical Review Questions | 628 | ||
| Answers | 628 | ||
| References | 628 | ||
| 31 Sleep and Neurologic Disorders | 631 | ||
| Chapter Points | 631 | ||
| Sleep and Neurodegenerative Disorders | 631 | ||
| Synucleopathies | 631 | ||
| Dementias | 632 | ||
| Alzheimer’s Disease | 632 | ||
| Etiology of Sleep Disturbances in AD | 632 | ||
| Sleep Disturbances in AD | 632 | ||
| OSA in AD | 632 | ||
| Treatment of AD | 633 | ||
| Medication-Induced Insomnia in AD | 633 | ||
| Progressive Supranuclear Palsy | 633 | ||
| Physical Examination | 634 | ||
| Epidemiology in PSP | 634 | ||
| Histology | 634 | ||
| Sleep in PSP | 634 | ||
| Polysomnography in PSP | 634 | ||
| Corticobasal Degeneration | 634 | ||
| Frontotemporal Dementia | 634 | ||
| Parkinsonism Syndromes (PD, PD+) | 634 | ||
| Differential Diagnosis of Parkinsonism | 634 | ||
| Parkinson’s Disease | 634 | ||
| Differential Diagnosis of PD | 635 | ||
| Treatment of PD | 635 | ||
| Sleep-Related Manifestations of PD | 636 | ||
| Sleep Disturbance Due to Motor Manifestations | 636 | ||
| Daytime Sleepiness in PD | 636 | ||
| Nocturnal Behavior: RBD, Nocturnal Hallucinations, Nocturnal Psychosis | 637 | ||
| Dementia in PD | 637 | ||
| Diffuse Lewy Body Dementia | 638 | ||
| Manifestations of DLBD | 638 | ||
| Visual Hallucinations | 638 | ||
| Sensitivity to DA Blockers | 638 | ||
| Dementia Variant | 638 | ||
| Multiple System Atrophy | 638 | ||
| Symptoms | 639 | ||
| Epidemiology of MSA | 639 | ||
| Diagnosis | 639 | ||
| Pathology of MSA | 639 | ||
| Vocal Cord Palsy and Stridor in MSA | 639 | ||
| Central Apnea and Cheyne-Stokes Breathing | 640 | ||
| Treatment of MSA | 640 | ||
| Other Neurodegenerative Disorders | 640 | ||
| Fatal Familial Insomnia | 640 | ||
| Topography of Degeneration | 640 | ||
| FFI Manifestations | 640 | ||
| Diagnosis | 640 | ||
| Positron Emission Tomography Scan | 640 | ||
| Summary | 640 | ||
| Sleep Disturbances in Stroke | 640 | ||
| Clinical Review Questions | 641 | ||
| Answers | 642 | ||
| References | 642 | ||
| Appendix 31-1 Medications Used to Treat Alzheimer’s Disease | 645 | ||
| Glossary | 647 | ||
| A | 647 | ||
| B | 647 | ||
| C | 647 | ||
| D | 647 | ||
| E | 647 | ||
| F | 647 | ||
| H | 648 | ||
| I | 648 | ||
| K | 648 | ||
| L | 648 | ||
| M | 648 | ||
| N | 648 | ||
| O | 648 | ||
| P | 648 | ||
| R | 648 | ||
| S | 649 | ||
| T | 649 | ||
| U | 649 | ||
| V | 649 | ||
| W | 649 | ||
| Index | 651 | ||
| A | 651 | ||
| B | 652 | ||
| C | 652 | ||
| D | 653 | ||
| E | 653 | ||
| F | 653 | ||
| G | 654 | ||
| H | 654 | ||
| I | 654 | ||
| J | 655 | ||
| K | 655 | ||
| L | 655 | ||
| M | 655 | ||
| N | 656 | ||
| O | 656 | ||
| P | 657 | ||
| Q | 659 | ||
| R | 659 | ||
| S | 659 | ||
| T | 660 | ||
| U | 661 | ||
| V | 661 | ||
| W | 661 | ||
| Z | 661 |