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Atlas of Clinical Sleep Medicine E-Book

Atlas of Clinical Sleep Medicine E-Book

Meir H. Kryger

(2009)

Additional Information

Book Details

Abstract

Accurately diagnose and treat adult and pediatric sleep disorders with exceptional visual guidance from world-renowned sleep expert Dr. Meir H. Kryger. Atlas of Clinical Sleep Medicine is an easy-to-read, highly illustrated atlas that details the physiologic, clinical, morphologic, and investigational aspects of the full range of sleep disorders you encounter in everyday practice -- and helps you interpret the visual manifestations of your patients’ sleep disorders so you can manage them most effectively.

  • Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
  • Visually grasp how sleep affects each body system thanks to a full-color compendium that correlates the physiology of sleep with the relevant findings.
  • Determine the best and most up-to-date drug therapy with information about the latest drugs available as well as those in clinical trials.
  • Compare your patients’ polysomnograms to a wealth of high-quality recordings taken from the latest machines used by institutions around the world.
  • Score, interpret, and diagnose sleep disorders employing the scoring rules from the latest AASM scoring manual.
  • Stay current with the latest on sleep and psychiatric disease, circadian desynchrony, dreaming, insomnia, home sleep testing, new sleep apnea treatments, and more.
  • Understand the correlation between sleep and other health issues – such as stroke and heart failure.
  • Find diagnostic and treatment information quickly and easily thanks to a highly illustrated, easy-to-read format that highlights key details.

Table of Contents

Section Title Page Action Price
Front Cover cover
Expert Consult ad IFC2
Atlas of Clinical Sleep Medicine, 2/e i
Copyright Page iv
Dedication v
Contributors vii
Foreword to the Second Edition xi
Foreword to the First Edition xii
Preface to the Second Edition xiii
Preface to the First Edition xiv
Technical Details xiv
Polysomnogram Recordings xvi
Acknowledgments xix
Table Of Contents xxi
Video Contents xxiii
Chapter 4 xxiii
Chapter 11 xxiii
Chapter 12 xxiii
Chapter 20 xxiii
Chapter 21 xxiii
1 Sleep in Art and Literature 1
Mythology 1
Religion 3
Rest 4
Innocence 5
Dreams, Danger, and Death 6
Selected Readings 9
2 History of Sleep Medicine and Physiology 10
Timeline 10
3 Biology of Sleep 22
3.1 Sleep Mechanisms 22
Nervous System Control 22
Arousal Systems 22
Sleep-Promoting Systems 23
Sleep Drive 23
Control of Rapid Eye Movement Sleep 23
Control of the Timing of Sleep 23
Selected Readings 28
3.2 Localization and Neurochemistry of Sleep-Wake Physiology and Pathophysiology 28
Wakefulness 28
NREM Sleep-Promoting Systems 28
Sleep Homeostasis 28
REM Sleep–Promoting Systems 28
Circadian Rhythm 28
Explanatory Diagrams 29
The Waking State 29
NREM Sleep 29
Pontine Generator in REM Sleep 30
Network Responsible for REM Sleep 30
Network Responsible for REM Sleep During Idiopathic REM Behavior Disorder 33
Network Responsible for Paradoxical Sleep During REM Behavior Disorder in Narcoleptics 33
Network Responsible for Paradoxical Sleep During Cataplexy in Narcoleptics 33
Acknowledgment 33
References 33
3.3 Circadian Rhythms Regulation 34
Selected Readings 36
3.4 Physiologic Regulation in Sleep 37
Physiologic Systems Interactions and Variability during Sleep 39
Acknowledgments 40
Selected Readings 41
3.5 Cytokines, Host Defense, and Sleep 42
Selected Readings 44
3.6 Control of Breathing 45
Normal Sleep 45
Sleep Apnea 45
3.7 Central and Autonomic Regulation in Cardiovascular Physiology 53
Overview 53
Heart Rate Surges 53
Heart Rhythm Pauses 54
Physiologic Mechanisms That Underlie Nocturnal Cardiac Events 54
Summary 54
Selected Readings 56
3.8 Interactive Regulation of Sleep and Feeding 56
Selected Readings 58
3.9 Endocrine Physiology 58
Overview of Endocrine Physiology 58
Central Mechanisms that Control Pituitary Hormone Secretion over the 24-Hour Day 58
Temporal Variations of Plasma Levels of Hormones 59
Glucose Regulation and Hunger 59
Conditions That Affect Hormones and Metabolism 59
Aging 59
Disease States that Reduce Slow-Wave Sleep 59
Sleep Deprivation 60
References 64
Suggested Readings 64
4 Normal Sleep 65
4.1 Sleep in Animals and the Phylogeny of Sleep 65
Selected Readings 70
4.2 Normal Sleep in Humans 70
How Much Sleep is Enough? 70
Neurophysiology of Sleep and Wakefulness 70
Wakefulness 70
Transition Between Wakefulness and Sleep 71
Sleep Mechanisms: From Wakefulness Into Sleep 71
Transition from Wakefulness into Non–Rapid Eye Movement Sleep 71
Staging of Sleep 73
Normal Sleep 74
Factors that Affect Sleep 87
Sleep Changes in Children 87
Sleep Changes with Aging 90
Sleep Characteristics That Change with Age and Their Possible Neurophysiologic Mechanisms 95
Circadian Characteristics That Change with Age 97
Selected Readings 97
5 Sleep Restriction 98
Sleep Restriction 98
Individual Differences in Vulnerability to Sleep Restriction 98
Selected Readings 104
6 Pharmacology 105
Drugs with Hypnotic Properties 105
Zolpidem 106
Zopiclone and Eszopiclone 109
Zaleplon 109
Ramelteon 109
Doxepin 109
Diphenhydramine 111
Sedating Antidepressants 111
Atypical Antipsychotics 112
Ethanol 112
Agents in Development 112
Wakefulness-Promoting Medications 113
Amphetamines and Related Compounds 113
Modafinil 113
Sodium Oxybate 113
Caffeine 116
Selected Readings 116
7 Dreaming in Normal and Disrupted Sleep 117
What is Dreaming? 117
Brain Basis of Dream Experience 117
Factors that Influence Dream Content 118
Disruption of Dreaming Pathologic Conditions 118
Sleep Disorders 118
Psychiatric Disorders 119
References 119
8 Impact, Presentation, and Diagnostic Considerations 120
Impact 120
Presentation and Diagnostic Considerations 121
Clinical Evaluation 121
History of the Present Illness 122
Sleep-Disordered Breathing. 122
Insomnia. 122
Excessive Sleepiness. 123
Abnormal Sleep-Related Behaviors and Movements. 126
Impact of Sleep Disorders on the Patient. 128
Medical History 128
Physical Examination 129
Self-Administered Instruments 129
Sleep Diaries 129
Epworth Sleepiness Scale 129
Apnea Questionnaires 129
Selected Readings 133
9 Circadian System Disorders 134
9.1 Circadian Rhythm Disorders 134
Delayed Sleep-Phase Type/Delayed Sleep-Phase Disorder 134
Advanced Sleep-Phase Type/Advanced Sleep-Phase Disorder 135
Non–24-Hour Sleep-Wake Disorder, Free-Running Type, and Nonentrained Type 136
Irregular Sleep-Wake Type and Irregular Sleep-Wake Disorder 136
Shift-Work Type and Shift-Work Disorder 137
Jet Lag Type and Jet Lag Disorder 137
Selected Readings 140
9.2 Circadian Desynchrony and Health 140
The Circadian System 140
Disruption of the Circadian System 140
Metabolism 141
Cardiovascular Disease 141
Cancer 143
Inflammatory Bowel Disease/Colitis 144
Pregnancy Outcomes 146
Conclusions 146
Selected Readings 146
10 Insomnia 148
Overview 148
Classification 148
Epidemiology 149
Pathophysiology of Insomnia 149
Types of Insomnia 151
Comorbid Insomnia 151
Primary Sleep Disorders That Present with Insomnia 152
Isolated Insomnia Disorder 154
Management of Insomnia 155
Selected Readings 158
11 Neurologic Disorders 159
11.1 Central Nervous System Hypersomnias 159
Overview 159
Classification and Prevalence 159
Clinical Features and Epidemiology 159
Cataplexy 159
Sleep Paralysis and Hallucinations 160
Excessive Daytime Sleepiness 160
Disrupted Nocturnal Sleep 160
Kleine-Levin Syndrome 161
Pathophysiology 161
Evaluation and Diagnosis 163
Epworth Sleepiness Scale and Fatigue Severity Scale 163
Overnight Polysomnography, Multiple Sleep Latency Test, and Maintenance of Wakefulness Test 164
Cerebrospinal Fluid Hypocretin Measurement and HLA Typing 171
Other Workup 171
Treatment 171
Suggested Readings 174
11.2 Movement Disorders in Sleep 174
Overview 174
Periodic Limb Movements in Sleep and Periodic Limb Movement Disorder 174
History and Definition 174
Evaluation of Periodic Limb Movements of Sleep and Wakefulness 174
Biology and Pathophysiology 177
Clinical Significance 177
Clinical Guidelines 178
Restless Legs Syndrome 178
History 178
Diagnosis 179
Medical Evaluation: Iron Status 179
Biology and Pathophysiology 180
Iron. 180
Dopamine. 182
Glutamate. 183
Evaluation of Restless Legs Syndrome Severity 183
Prevalence and Clinical Significance 184
Treatment 185
Bruxism 188
Treatment of Bruxism 189
Sleep-Related Rhythmic Movement Disorder 189
Sleep-Related Leg Cramps 191
Suggested Readings 194
11.3 Sleep and Epilepsy 195
Sleep, Seizures, and Interictal Electroencephalogram Activity 195
Nocturnal Frontal Lobe Epilepsy: Clinical Features and Differential Diagnosis From Parasomnias 198
Epilepsy and Comorbidities with Sleep Disorders 200
Obstructive Sleep Apnea Syndrome 200
Insomnia and Restless Legs Syndrome 208
Daytime Sleepiness 208
General Comments 209
Acknowledgment 212
Selected Readings 212
11.4 Sleep in Other Neurologic Disorders 212
Sleep and Dementia 212
Parkinson Disease 213
Overview 213
Epidemiology 213
Pathophysiology 213
Sleep Symptoms 213
Laboratory Findings 214
Treatment 216
REM Sleep Behavior Disorder 216
Overview 216
Epidemiology 217
Pathophysiology 217
Clinical and Laboratory Diagnosis 217
Treatment for REM Sleep Behavior Disorder 220
Alzheimer Disease 221
Overview 221
Sleep Disorders in Alzheimer Dementia 223
Treatment 223
Sundowning Syndrome 224
Sleep in Other Neurodegenerative Conditions 226
Multiple Sclerosis 226
Chronic Pain and Fibromyalgia 228
Sleep and Cerebrovascular Accidents 229
Amyotrophic Lateral Sclerosis 230
Spinal Cord Diseases 230
Postpolio Syndrome 231
Huntington Disease 231
Neuromuscular Disease 232
Myotonic Dystrophy 233
Fatal Familial Insomnia 234
Traumatic Brain Injury 234
Headache 234
Conclusion 235
Selected Readings 235
12 Parasomnias 237
Overview 237
Pathophysiology of Parasomnias 237
Disorders of Arousal: Non–Rapid Eye Movement Parasomnias 238
REM Sleep Parasomnias 245
REM Sleep Behavior Disorder 245
Sleep Paralysis 249
Abnormal Sleep Inertia 249
Experiential Parasomnias 250
Sleep Enuresis 250
Nocturnal Seizures 250
Catathrenia 251
Selected Readings 253
13 Sleep Breathing Disorders 254
13.1 Examination of the Patient with Suspected Sleep Apnea 254
Overall Inspection of the Patient 254
Facial and Jaw Structures 254
Inspection of the Face 254
Bony Structures 255
Pervasive Facial Abnormalities 255
Maxillary and Mandibular Insufficiency 256
Small Lower Jaw 257
Nasal Airway 260
Diseases of the Nose and Nares 260
Trauma to the Nose and Nares 260
Traumatic Injury to the Nose 260
Examination of the Palate 260
Examination of the Pharynx 260
Mallampati Classification 260
Examination of the Tonsils 263
Variants and Abnormal Airway Pharyngeal Findings 263
Examination of the Neck 264
Examination of the Abdomen 264
Examination of the Extremities 265
Peripheral Edema 265
13.2 Sleep Apnea in the Adolescent and Adult 268
Overview 268
Definitions 268
Risk Factors 269
Clinical Assessment 269
Symptoms 269
Examination 270
Laboratory Evaluation 270
Data Obtained in a Sleep Study 270
Scoring of Respiratory Events 270
Scoring Intervals 272
Nonapneic Respiratory Events 282
Adolescent Sleep-Disordered Breathing 285
Treatment 289
General Measures 289
Continuous Positive Airway Pressure 289
Oral Appliance Therapy 289
Other Treatments that Modify Pressure in the Upper Airway 294
Nasal Expiratory Positive Airway Pressure 294
Oral Pressure Therapy 296
Surgery 296
Sleep Apnea Comorbid with Other Sleep Disorders 296
Selected Readings 299
13.3 Obstructive Sleep Apnea in Children 299
Obstructive Sleep Apnea in Children 299
History and Physical Examination 299
Historical Symptoms of Obstructive Sleep Apnea in Children 299
Common Physical Examination Findings 299
Technical Considerations 300
Definitions 300
Obstructive Apnea 300
Mixed Apnea 301
Central Apnea 301
Hypopnea 301
Respiratory Effort–Related Arousal 301
Obstructive Hypoventilation 301
Expiratory Apnea/Hypopnea 301
Diagnostic Considerations 303
Treatment Options for Childhood Obstructive Sleep Apnea 303
References 307
13.4 Respiratory Diseases and the Overlap Syndromes 307
Obstructive Pulmonary Diseases 307
Restrictive Lung Diseases 308
Extrapulmonary Lung Restriction 308
Extrathoracic Upper Airway Obstruction 315
Selected Readings 315
14 Vascular Disorders 316
14.1 Cardiovascular Diseases 316
Impact of Cardiovascular Diseases 316
Effect of Sleep Disorders on Cardiovascular Physiology 316
Obstructive Sleep Apnea as a Cause of Cardiac Arrhythmias 316
Obstructive Sleep Apnea as a Cause of Coronary Artery Disease 319
Obstructive Sleep Apnea as a Cause of Systemic Hypertension 320
Heart Failure 321
Clinical Features 321
Epidemiology 321
Abnormal Breathing Patterns in Heart Failure 322
Treatment of the Abnormal Breathing Pattern in Heart Failure 324
Central Apnea 324
Obstructive Apnea 327
References 327
Suggested Readings 328
14.2 Cerebrovascular Disease and Sleep 328
Overview 328
Breathing Patterns after Stroke 328
Pathogenesis of Sleep-Related Breathing Disorders in Stroke 328
Effect of Stroke on Sleep 330
Sleep-Related Breathing Disorders as a Risk Factor for Stroke 331
Sleep-Related Breathing Disorders as a Consequence of Stroke 332
Impact of Sleep-Related Breathing Disorders on Stroke Outcomes 332
Treatment of Sleep-Related Breathing Disorders 332
Impact of CPAP Treatment 333
Summary and Future Directions 334
Selected Readings 334
15 Other Medical Disorders 335
15.1 Thyroid Disease 335
Hyperthyroidism 335
Hypothyroidism 335
Thyroid Mass Lesions 335
Selected Readings 340
15.2 Diseases of the Pituitary Gland 340
Anatomy 340
Growth Hormone Hypersecretion 340
Pathophysiology 340
Clinical Findings 341
Diagnosis 342
Treatment 343
Selected Readings 343
15.3 Gastrointestinal Disorders 343
Nocturnal Gastrointestinal Symptoms 343
Upper Gastrointestinal Tract 343
Sleep-Related Gastroesophageal Reflux 344
Therapeutic Considerations 345
Pulmonary Complications 345
Intestinal Motility and Lower Bowel Disorders 345
Conclusions 346
Selected Readings 346
15.4 Diabetes Mellitus 346
Key Symptoms Related to High Blood Glucose 346
Sleep Deprivation in Diabetics 346
Sleep Apnea 347
Pathophysiology and Mechanism of Obstructive Sleep Apnea in Altered Glucose Metabolism 348
Insomnia 348
Nocturnal Awakenings 349
References 349
Selected Readings 349
15.5 Sleep Disorders in Chronic Kidney Disease 349
Suggested Readings 351
16 Women’s Health 353
16.1 The Menstrual Cycle 353
Menstrual Cycle Sleep Changes 353
Premenstrual Mood and Sleep 353
Polycystic Ovary Syndrome 354
Selected Readings 354
16.2 Pregnancy and Postpartum 356
Sleep-Disordered Breathing 357
Restless Legs Syndrome 357
Labor and Delivery 357
Postpartum Sleep 358
Postpartum Sleep and Mental Health 358
Narcolepsy and Pregnancy 358
Summary 358
Selected Readings 359
16.3 Midlife Transition and Menopause 359
Thermoregulation and Vasomotor Symptoms 359
Selected Readings 360
16.4 Chronic Fatigue and Fibromyalgia Syndromes 361
Sleep Disturbance in Chronic Fatigue Syndrome and Fibromyalgia 361
Selected Readings 363
17 Sleep and Psychiatric Disease 364
Overview 364
Sleep and Depression 365
Sleep Architecture 365
Treatment of Depression and Sleep Problems 366
Sleep and Mania 367
Sleep, Nightmares, and Posttraumatic Stress Disorder 368
Sleep Architecture 368
Treatment of Nightmares in Posttraumatic Stress Disorder 368
Sleep and Generalized Anxiety Disorder 368
Sleep and Alcohol Dependence 368
Sleep and Schizophrenia 368
Screening for Sleep Disorders and Other Medical Conditions 368
Conclusion 369
Selected Readings 369
18 Diagnostic Assessment Methods in Adults 370
Overview 370
Sleep Staging 370
Recording 370
Electroencephalogram for Brain Activity 370
Eye Movements 370
Electromyogram for Skeletal Muscle Tone 371
Staging 371
Classification 371
Waves 371
Stages 371
Stage W. 371
Stage N1. 371
Stage N2. 371
Stage N3. 371
Stage R. 372
Smoothing Rules 372
Arousal Scoring 372
Electroencephalogram Speeding and Central Nervous System Arousals 372
Cyclic Alternating Pattern 375
Sleep-Related Breathing Disorders 376
Recording Technique 376
Definitions and Scoring Rules 377
Sleep Apnea 377
Hypopnea 377
Respiratory Effort–Related Arousals 379
Movements 379
Leg Movement Recording Technique 379
Periodic Leg Movement Scoring Rules 379
Other Movements 380
Electrocardiogram 380
Home Sleep Testing 381
Overall Assessment 382
Sleep Stage Changes Across the Night 382
Sleep Stage Changes as a Function of Age 385
Parameters, Pathophysiology, and Interpretation 386
Other Assessments and Interpretation 392
Multiple Sleep Latency Test 392
Maintenance of Wakefulness Test 392
Suggested Immobilization Test 392
Actigraphy 392
Summary 392
Selected Readings 393
19 Gallery of Polysomnographic Recordings 395
Obstructive Sleep Apnea (OSA) 395
Central Sleep Apnea 414
Mixed and Complex Sleep Apnea 422
Heart Failure 427
Cardiac Rhythm Abnormalities 439
Neurologic Diseases 449
Movement Disorders 449
Genetic Disorders 453
Stroke 455
Narcolepsy 458
REM Sleep Behavior Disorder 459
Seizures 461
Head Trauma 466
Multiple Sclerosis 468
Artifacts in Sleep Recordings 469
20 Gallery of Patient Interview Videos 478
Sleep-Related Breathing Disorders 478
An 8-Year-Old with Sleep Apnea (Video 20-1) 478
An 82-Year-Old Woman with Sleep Apnea (Video 20-2) 478
A 43-Year-Old Woman with Down Syndrome (Video 20-3) 478
Apnea with Cardiovascular Comorbidities (Video 20-4) 478
Apnea Presenting as Restless Sleep (Video 20-5) 479
Apnea in a Truck Driver (Video 20-6) 479
Explaining the Results (Video 20-7) 479
Teaching and CPAP Mask Fitting (Video 20-8) 479
Neurologic and Other Disorders 480
Undiagnosed Narcolepsy Patient with Cataplexy (Video 20-9) 480
Thirty-Five Years of Undiagnosed Narcolepsy (Video 20-10) 480
Hallucinations in a Male Narcolepsy Patient (Video 20-11) 480
Narcolepsy Patient with Sleep Apnea (Video 20-12) 480
Restless Legs Syndrome in a Male (Video 20-13) 481
Middle-Aged Woman with Restless Legs Syndrome (Video 20-14) 481
REM Sleep Behavior Disorder (Video 20-15) 481
Parkinson Disease with REM Sleep Behavior Disorder and Sleep Apnea (Video 20-16) 481
Multiple Sclerosis, Sleep Apnea, and Hypnagogic Hallucinations (Video 20-17) 482
Arnold-Chiari Malformation (Video 20-18) 482
Syringomyelia (Video 20-19) 482
Becker Muscular Dystrophy (Video 20-20) 482
Psychiatric Disorders (Video 20-21) 482
21 Gallery of Sleep Laboratory Video Findings 483
Obstructive Sleep Apnea 483
Apnea, Restlessness in a Child 483
Nasal Obstruction and Apnea 483
Arousal Threshold to Noise in Obstructive Sleep Apnea 484
Obstructive Sleep Apnea, Violent Body Movements 484
Obstructive Sleep Apnea, Violent Body Movements (×10) 484
Atypical Snoring After Uvulopalatopharyngoplasty 484
Vigorous Movements in Obstructive Sleep Apnea (×10) 485
Obstructive Sleep Apnea in Special Populations 485
Obesity Hypoventilation 485
Obesity Hypoventilation, Heart Failure 485
Obesity Hypoventilation, Treated 486
Obstructive Sleep Apnea in Pregnancy 486
Postpartum Obstructive Sleep Apnea 486
Postpartum Obstructive Sleep Apnea, Treated 486
Apnea in Acromegaly 487
Apnea in Acromegaly (×10) 487
Apnea and Down Syndrome 487
Upper Airway Resistance Syndrome 488
Upper Airway Resistance Syndrome, Quiet Snoring 488
Upper Airway Resistance Syndrome, Quiet Snoring (×7) 488
Upper Airway Resistance Syndrome, Variable Snoring 488
Upper Airway Resistance Syndrome, Variable Snoring (×5) 488
Central Sleep Apnea and Cheyne-Stokes Respiration 489
Idiopathic Central Apnea 489
Retinitis Pigmentosa, Central Apnea 489
Central Apnea, Obesity 489
Obstructive Sleep Apnea and Cheyne-Stokes Breathing 489
Pulmonary Edema 490
Respiratory Diseases 490
Asthma 490
Chronic Obstructive Pulmonary Disease 490
Chronic Obstructive Pulmonary Disease, Upper Airway Obstruction 491
Chronic Obstructive Pulmonary Disease, Airway Secretions, Periodic Limb Movements Disorder 491
Chronic Obstructive Pulmonary Disease, Airway Secretions, Periodic Limb Movements of Sleep (×10) 491
Overlap Syndrome 491
Overlap Syndrome, Treated 492
Pulmonary Fibrosis 492
Neurologic and Other Disorders 492
Restless Legs Syndrome, Insomnia 492
Restless Legs Syndrome and Periodic Limb Movements of Sleep (×25) 492
Restless Legs Syndrome, Sleep Apnea 493
Restless Legs Syndrome, Sleep Apnea (×10) 493
Periodic Limb Movement Disorder, Apnea (×10) 493
Periodic Limb Movement Disorder, Subtle Movements (×10) 493
Rapid Eye Movement Sleep Behavior Disorder 494
Rapid Eye Movement Sleep Behavior Disorder, Obstructive Sleep Apnea 494
Sleep Paralysis 494
Delayed Sleep Phase Syndrome 494
Epilepsy 495
Seizure Involving the Leg 495
Psychogenic “Seizures” 495
Psychogenic “Seizures,” Edge Enhanced 495
Index 497
A 497
B 498
C 498
D 499
E 500
F 501
G 501
H 501
I 502
J 502
K 502
L 503
M 503
N 503
O 504
P 505
Q 507
R 507
S 508
T 510
U 511
V 511
W 511
Y 511
Z 511
Clinical Key ad IBC3