BOOK
Principles and Practice of Sleep Medicine E-Book
Meir H. Kryger | Thomas Roth | William C. Dement
(2015)
Additional Information
Book Details
Abstract
For nearly 30 years, Dr. Meir Kryger’s must-have guide to sleep medicine has been the gold standard in this fast-changing field. This essential, full-color reference includes more than 20 unique sections and over 170 chapters covering every aspect of sleep disorders, giving you the authoritative guidance you need to offer your patients the best possible care.
- Evidence-based content helps you make the most well-informed clinical decisions.
- An ideal resource for preparing for the sleep medicine fellowship examination.
- New content on sleep apnea, neurological disorders, legal aspects of sleep medicine, dental sleep medicine genetics, circadian disorders, geriatrics, women’s health, cardiovascular diseases, and occupational sleep medicine, keeps you fully up to date.
- Updates to scientific discoveries and clinical approaches ensure that you remain current with new knowledge that is advancing the diagnosis and management of sleep disorders.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Expert Consult IFC | IFC1 | ||
| Principles and Practice of Sleep Medicine | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| From the Arts | vii | ||
| Contributors | ix | ||
| Foreword | xxxiii | ||
| Sixth Edition Preface | xxxv | ||
| First Edition Preface | xxxv | ||
| Acknowledgments | xxxvii | ||
| Table Of Contents | xxxix | ||
| Video Contents | xlvii | ||
| Additional Videos | xlvii | ||
| Abbreviations | xlix | ||
| Continuing Medical Education (CME) and Maintenance of Certification (MOC) for PPSM, Sixth Edition | lii | ||
| I Principles of Sleep Medicine | 1 | ||
| 1 Normal Sleep and Its Variants | 3 | ||
| 1 History of Sleep Physiology and Medicine | 3 | ||
| Chapter Highlights | 3 | ||
| Sleep as a Passive State | 3 | ||
| The Electrical Activity of the Brain | 4 | ||
| The Reticular Activating System | 5 | ||
| Early Observations of Sleep Pathology | 5 | ||
| Sigmund Freud and the Interpretation of Dreams | 6 | ||
| Chronobiology | 6 | ||
| The Discovery of Rapid Eye Movement Sleep | 7 | ||
| All-Night Sleep Recordings and the Basic Sleep Cycle | 8 | ||
| Rapid Eye Movement Sleep in Animals | 8 | ||
| Duality of Sleep | 9 | ||
| Precursors of Sleep Medicine | 9 | ||
| Sleep-Onset REM Periods and Cataplexy | 9 | ||
| The Narcolepsy Clinic: A False Start | 9 | ||
| European Interest | 10 | ||
| Benzodiazepines and Hypnotic Efficacy Studies | 10 | ||
| The Discovery of Sleep Apnea | 10 | ||
| Italian Symposia | 10 | ||
| Birth Pangs | 11 | ||
| Early Development of Stanford Sleep Medicine Clinical Practice | 11 | ||
| Clinical Significance of Excessive Daytime Sleepiness | 12 | ||
| Further Development of Sleep Medicine | 13 | ||
| The 21st Century and Beyond | 13 | ||
| Summary | 14 | ||
| Review Questions | 14.e3 | ||
| Answers | 14.e4 | ||
| Selected Readings | 14 | ||
| References | 14.e1 | ||
| 2 Normal Human Sleep: | 15 | ||
| Chapter Highlights | 15 | ||
| What Characteristics and Measures are Used to Define Sleep? | 15 | ||
| Sleep Onset | 17 | ||
| Definition of Sleep Onset | 17 | ||
| Electromyogram | 17 | ||
| Electrooculogram | 17 | ||
| Electroencephalogram | 17 | ||
| Behavioral Concomitants of Sleep Onset | 17 | ||
| Simple Behavioral Task | 17 | ||
| Visual Response | 18 | ||
| Auditory Response | 18 | ||
| Olfactory Response | 18 | ||
| Response to Meaningful Stimuli | 18 | ||
| Hypnic Myoclonia | 18 | ||
| Memory Near Sleep Onset | 19 | ||
| Learning and Sleep | 19 | ||
| Progression of Sleep Across the Night | 19 | ||
| Pattern of Sleep in a Healthy Young Adult | 19 | ||
| First Sleep Cycle | 20 | ||
| NREM-REM Cycle | 20 | ||
| Distribution of Sleep Stages Across the Night | 20 | ||
| Length of Sleep | 20 | ||
| Generalizations About Sleep in the Healthy Young Adult | 20 | ||
| Factors Modifying Sleep Stage Distribution | 21 | ||
| Age | 21 | ||
| Prior Sleep History | 21 | ||
| Circadian Rhythms | 22 | ||
| Temperature | 22 | ||
| Drug Ingestion | 22 | ||
| Pathology | 23 | ||
| Narcolepsy. | 23 | ||
| Sleep Apnea Syndromes. | 23 | ||
| Sleep Fragmentation. | 23 | ||
| Summary | 24 | ||
| Review Questions | 24.e2 | ||
| Answers | 24.e3 | ||
| Selected Readings | 24 | ||
| References | 24.e1 | ||
| 3 Normal Aging | 25 | ||
| Chapter Highlights | 25 | ||
| Sleep Architecture | 26 | ||
| Percentage of Time Spent in Each Sleep Stage | 26 | ||
| Arousals during Sleep | 27 | ||
| Comorbidities | 28 | ||
| Slow Wave Sleep | 28 | ||
| Circadian Rhythms in Aging | 29 | ||
| Causes and Consequences of Poor Sleep in Old Age | 30 | ||
| Causes | 30 | ||
| Potential Consequences | 31 | ||
| Restless Legs Syndrome and Periodic Limb Movements during Sleep | 33 | ||
| Sleep-Disordered Breathing | 34 | ||
| Risk Factors | 34 | ||
| Outcomes | 34 | ||
| Why Do Older People Nap? | 35 | ||
| Basic Science Considerations | 36 | ||
| Summary | 38 | ||
| Acknowledgments | 38 | ||
| Selected Readings | 38 | ||
| References | 38.e1 | ||
| Review Questions | 38.e7 | ||
| Answers | 38.e8 | ||
| 4 Daytime Sleepiness and Alertness | 39 | ||
| Chapter Highlights | 39 | ||
| Epidemiology of Sleepiness | 39 | ||
| Risk Factors for Sleepiness | 40 | ||
| Nature of Sleepiness | 40 | ||
| Physiologic Need State | 40 | ||
| Neural Substrates of Sleepiness | 41 | ||
| Assessment of Sleepiness | 42 | ||
| Quantifying Sleepiness | 42 | ||
| Relation of Sleepiness to Behavioral Functioning | 43 | ||
| Clinical Assessment of Sleepiness | 43 | ||
| Determinants of Sleepiness | 44 | ||
| Quantity of Sleep | 44 | ||
| Quality of Sleep | 45 | ||
| Circadian Rhythms | 45 | ||
| Central Nervous System Drugs | 46 | ||
| Sedating Drug Effects | 46 | ||
| Alerting Drug Effects | 46 | ||
| Influence of Basal Sleepiness | 47 | ||
| Central Nervous System Pathologies | 47 | ||
| Clinical and Public Health Significance of Sleepiness | 47 | ||
| Summary | 48 | ||
| Selected Readings | 48 | ||
| References | 48.e1 | ||
| Review Questions | 48.e3 | ||
| Answers | 48.e4 | ||
| 5 Sleep Deprivation | 49 | ||
| Chapter Highlights | 49 | ||
| Incidence of Sleep Deprivation | 50 | ||
| Effects of Sleep Deprivation | 50 | ||
| Acute Total Sleep Deprivation | 50 | ||
| Sleep Restriction | 51 | ||
| Individual Differences in Responses to Sleep Loss | 52 | ||
| Detection of Sleepiness | 53 | ||
| Sleep Deprivation and Brain Metabolism | 53 | ||
| Recovery From Sleep Loss | 53 | ||
| Recovery following Sleep Restriction | 53 | ||
| Recovery following Acute Total Sleep Deprivation | 54 | ||
| Summary | 54 | ||
| Acknowledgment | 54 | ||
| Selected Readings | 54 | ||
| References | 55.e1 | ||
| Review Questions | 55.e3 | ||
| Answers | 55.e4 | ||
| 6 Genetics of Normal Human Sleep | 56 | ||
| Chapter Highlights | 56 | ||
| Genetic Epidemiology of Sleep with Focus on Twin Studies | 56 | ||
| Candidate Gene Analyses for Normal Sleep and Circadian Phenotypes | 57 | ||
| Candidate Gene Analyses of Circadian Clock Genes in Humans | 57 | ||
| CLOCK | 57 | ||
| Period2 (PER2) | 57 | ||
| Casein Kinase I (CSNK1D) | 57 | ||
| DEC2 | 57 | ||
| Period3 (PER3) | 58 | ||
| Candidate Gene Analyses Related to Adenosinergic Neurotransmission in Humans | 58 | ||
| Candidate Gene Analyses Related to Glutaminergic and Dopaminergic Neurotransmission | 58 | ||
| GRIA3 | 58 | ||
| COMT | 58 | ||
| Genome-Wide Association Studies of Normal Sleep Phenotypes | 59 | ||
| Conclusions and Future Outlook | 60 | ||
| Summary | 60 | ||
| Selected Readings | 61 | ||
| References | 61.e1 | ||
| Review Questions | 61.e3 | ||
| Answers | 61.e4 | ||
| 2 Sleep Mechanisms and Phylogeny | 62 | ||
| 7 Neural Control of Sleep in Mammals | 62 | ||
| Chapter Highlights | 62 | ||
| Diverse Brain Regions Modulate Waking and Non–Rapid Eye Movement Sleep | 63 | ||
| Isolated Forebrain | 63 | ||
| Diencephalon | 63 | ||
| Thalamus | 63 | ||
| Lower Brainstem | 63 | ||
| Reticular Activating System and Delineation of Arousal Systems | 63 | ||
| Wake-on, Rapid-Eye-Movement–Off Arousal Systems | 64 | ||
| Serotonin | 64 | ||
| Norepinephrine | 65 | ||
| Histamine | 65 | ||
| Orexin | 65 | ||
| Wake-on, Rapid-Eye-Movement–on Arousal Systems | 65 | ||
| Acetylcholine | 65 | ||
| Dopamine | 65 | ||
| Glutamate | 65 | ||
| Sleep-Promoting Mechanisms | 66 | ||
| Rostral Hypothalamic Sleep-Promoting System | 66 | ||
| Sleep-Active Neurons in the Preoptic Area | 66 | ||
| Orchestration of Sleep by Sleep-Promoting Circuits of the Preoptic Area | 66 | ||
| Sleep Regulatory Functions of Melanin-Concentrating Hormone Neurons | 67 | ||
| Cortical Sleep-Active Neurons | 68 | ||
| Thalamic-Cortical Interactions and Generation of the Sleep Electroencephalogram | 69 | ||
| Sleep Spindles | 71 | ||
| Delta Waves | 72 | ||
| Slow Oscillations | 72 | ||
| Integration of Circadian Rhythms and Sleep | 73 | ||
| The Preoptic Area, Thermoregulation, and Control of Sleep | 73 | ||
| Hierarchical Sleep Control Model | 74 | ||
| Sleep-Promoting Neurochemical Agents | 74 | ||
| Adenosine | 75 | ||
| Proinflammatory Cytokines | 75 | ||
| Prostaglandin D2 | 75 | ||
| Growth Hormone–Releasing Hormone | 75 | ||
| Endoplasmic Reticular Stress. | 76 | ||
| Sleep as Detoxification or Protection from Oxidative Stress | 76 | ||
| Summary | 77 | ||
| Acknowledgments | 77 | ||
| Selected Readings | 77 | ||
| References | 77.e1 | ||
| Review Questions | 77.e4 | ||
| Answers | 77.e5 | ||
| 8 Rapid Eye Movement Sleep | 78 | ||
| Chapter Highlights | 78 | ||
| Overview | 78 | ||
| Characteristics of Rapid Eye Movement Sleep | 79 | ||
| Rapid Eye Movement Generation Mechanisms | 80 | ||
| Technical Considerations | 80 | ||
| Inactivation of Neurons by Lesions, Inhibition, Antisense Administration, or Genetic Manipulation Including Optogenetic Inhibition | 80 | ||
| Activation of Neurons by Electrical or Chemical Stimulation, Gene Activation, Insertion of Messenger RNAs, or Optogenetic Stimulation | 80 | ||
| Observation of Neuronal Activity | 81 | ||
| Summary of Technical Considerations | 82 | ||
| Transection Studies | 82 | ||
| Localized Lesion Studies | 84 | ||
| Stimulation Studies | 85 | ||
| Neuronal Activity, Transmitter Release | 86 | ||
| Medial Brainstem Reticular Formation | 86 | ||
| Cholinergic Cell Groups | 86 | ||
| Cells with Activity Selective for REM Sleep | 86 | ||
| Monoamine-Containing Cells | 86 | ||
| Other Cholinergic Cells in Lateral Pontine Regions | 87 | ||
| Fos Labeling | 87 | ||
| Control of Muscle Tone | 87 | ||
| Narcolepsy and Hypocretin | 89 | ||
| The Functions of Rapid Eye Movement Sleep | 93 | ||
| Summary | 95 | ||
| Acknowledgments | 95 | ||
| Selected Readings | 95 | ||
| References | 95.e1 | ||
| Review Questions | 95.e5 | ||
| Answers | 95.e6 | ||
| 9 Novel Techniques for Identifying Sleep Mechanisms and Disorders | 96 | ||
| Chapter Highlights | 96 | ||
| Novel Tools for Studying Sleep Circuitry | 96 | ||
| Understanding Sleep Control Using Conventional Genetics | 96 | ||
| Cre Recombinase and the Advent of New Genetic Tools | 98 | ||
| The Optogenetic Method | 98 | ||
| Optogenetics in Studying Sleep-Wake Control | 99 | ||
| The Pharmacogenetic Method | 100 | ||
| Pharmacogenetics in Studying Sleep-Wake Control | 100 | ||
| Gene Therapy Methods | 100 | ||
| CLARITY: Whole-Brain Imaging of Anatomic Pathways | 101 | ||
| Optical Live-Cell Imaging in Vivo | 101 | ||
| Summary | 101 | ||
| Acknowledgments | 102 | ||
| Selected Readings | 102 | ||
| References | 102.e1 | ||
| Review Questions | 102.e3 | ||
| Answers | 102.e4 | ||
| 10 Sleep in Animals: | 103 | ||
| Chapter Highlights | 103 | ||
| Adaptive Inactivity | 103 | ||
| Quantitative Analyses of the Correlates of Sleep Duration in Mammals | 105 | ||
| The Diversity of Sleep | 107 | ||
| Overview | 107 | ||
| Reindeer | 108 | ||
| Walrus | 108 | ||
| Sleep in Cetaceans: Dolphins and Whales | 109 | ||
| Sleep in Otariids: Eared Seals | 109 | ||
| Sleep in Monotremes | 109 | ||
| Birds | 111 | ||
| Sleep Rebound | 112 | ||
| Summary | 113 | ||
| Acknowledgment | 114 | ||
| Selected Readings | 114 | ||
| References | 114.e1 | ||
| Review Questions | 114.e3 | ||
| Answers | 114.e4 | ||
| 3 Physiology in Sleep | 115 | ||
| 11 Relevance of Sleep Physiology for Sleep Medicine Clinicians | 115 | ||
| Chapter Highlights | 115 | ||
| References | 117.e1 | ||
| 12 What Brain Imaging Reveals About Sleep Generation and Maintenance | 118 | ||
| Chapter Highlights | 118 | ||
| Functional Segregation and Integration During Normal Human Sleep | 118 | ||
| Non–Rapid Eye Movement Sleep | 119 | ||
| Processing of External Stimuli during NREM Sleep | 121 | ||
| REM Sleep | 122 | ||
| Reorganization of Regional Brain Function during REM Sleep: Relation with Dream Characteristics | 122 | ||
| Brain Imaging and Other Characteristic Features of REM Sleep | 123 | ||
| Experience-Dependent Modifications of Regional Brain Function during NREM and REM Sleep | 123 | ||
| Brain Imaging and Neural Correlates of Sleep-Wake Cycle Regulation | 123 | ||
| Brain Imaging and Neural Correlates of Human Sleep Deprivation | 125 | ||
| Functional Neuroimaging in Sleep Disorders | 125 | ||
| Insomnia and Brainstem and Hypothalamic Arousal Networks | 126 | ||
| Insomnia, Disorders of Emotion, and Limbic and Paralimbic Arousal Networks | 127 | ||
| Insomnia, Disorders of Emotion, and Neocortical Arousal Networks | 129 | ||
| REM Sleep in Depression | 130 | ||
| Fatal Familial Insomnia | 130 | ||
| Summary | 131 | ||
| Acknowledgments | 131 | ||
| Selected Readings | 131 | ||
| References | 131.e1 | ||
| Review Questions | 131.e3 | ||
| Answers | 131.e4 | ||
| 13 Cardiovascular Physiology and Coupling with Respiration: | 132 | ||
| Chapter Highlights | 132 | ||
| Overview | 132 | ||
| Sleep State Control of Cardiovascular Function | 133 | ||
| Cardiorespiratory Interactions | 133 | ||
| Central Mechanisms | 133 | ||
| Cardiorespiratory Homeostasis | 135 | ||
| Sleep State–Dependent Changes in Heart Rhythm | 136 | ||
| Heart Rate Surges | 136 | ||
| Heart Rhythm Pauses | 136 | ||
| Coronary Artery Blood Flow Regulation During Sleep | 138 | ||
| Impact of Sleep on Arrhythmogenesis | 138 | ||
| Central Nervous System Sites Influencing Cardiac Electrical Stability | 138 | ||
| Autonomic Factors in Arrhythmogenesis during Sleep | 140 | ||
| Summary | 141 | ||
| Acknowledgments | 141 | ||
| Selected Readings | 141 | ||
| References | 141.e1 | ||
| Review Questions | 141.e4 | ||
| Answers | 141.e5 | ||
| 14 Cardiovascular Physiology: Autonomic Control in Health and in Sleep Disorders | 142 | ||
| Chapter Highlights | 142 | ||
| Overview | 142 | ||
| The Cardiovascular Autonomic Nervous System: Definition and Functions | 142 | ||
| Arterial Baroreflex | 143 | ||
| Cardiopulmonary Reflexes | 143 | ||
| The Chemoreflexes | 143 | ||
| Measures to Explore Autonomic Changes During Sleep and Their Physiologic Significance | 143 | ||
| Heart Rate and Arterial Blood Pressure and Their Variability | 143 | ||
| Baroreflex Sensitivity | 145 | ||
| Preejection Period | 145 | ||
| Microneurographic Recording of Sympathetic Nerve Activity | 146 | ||
| Peripheral Arterial Tone and Pulse Transit Time | 146 | ||
| Systemic Catecholamines | 146 | ||
| Sleep-Related Cardiovascular Autonomic Changes | 146 | ||
| Day-Night Changes in Neural Circulatory Control | 146 | ||
| Physiologic Responses to NREM and REM Sleep | 147 | ||
| RR Interval Variability and Electroencephalographic Coupling | 147 | ||
| Autonomic Responses Associated with Arousal from Sleep and with Periodic Leg Movements | 147 | ||
| Arousals | 147 | ||
| Periodic Leg Movements during Sleep | 148 | ||
| Impact of Aging on Neural Circulatory Response to Normal Sleep | 149 | ||
| Effects of Disordered Sleep and Primary Autonomic Dysfunction on Day-Night Autonomic Changes | 150 | ||
| Effects of Sleep Loss and Sleep Disorders on Nighttime Blood Pressure | 150 | ||
| Insomnia | 150 | ||
| Narcolepsy-Cataplexy | 150 | ||
| Loss of Diurnal Variation in Autonomic Function in Diabetes Mellitus: What Comes First? | 150 | ||
| Sympathetic Activation in Obstructive Sleep Apnea | 151 | ||
| Summary | 153 | ||
| Selected Readings | 153 | ||
| References | 154.e1 | ||
| Review Questions | 154.e3 | ||
| Answers | 154.e4 | ||
| 15 Respiratory Physiology: | 155 | ||
| Chapter Highlights | 155 | ||
| Respiratory Neurobiology: Basic Overview | 155 | ||
| Medullary Respiratory Neurons and Motoneurons | 155 | ||
| Pre-Bötzinger Complex | 156 | ||
| Neuronal Connections | 156 | ||
| Sleep Neurobiology: Basic Overview | 157 | ||
| Wakefulness | 157 | ||
| NREM Sleep | 157 | ||
| REM Sleep | 157 | ||
| Control of Respiratory Motoneurons | 159 | ||
| Determinants of Respiratory Motoneuron Activity | 159 | ||
| Tonic and Respiratory-Related Inputs to Respiratory Motoneurons | 159 | ||
| Electrical Properties of Motoneurons | 159 | ||
| Presynaptic Modulation | 161 | ||
| Tonic and Respiratory-Related Activity in Respiratory Muscle | 161 | ||
| Neuromodulation of Respiratory Motoneurons Across Sleep-Wake States | 161 | ||
| Excitatory Influences Across Sleep-Wake States | 162 | ||
| Inhibitory Influences Across Sleep-Wake States | 163 | ||
| Mechanisms Operating Across Sleep-Wake States | 164 | ||
| Control of Respiratory Neurons | 164 | ||
| Respiratory Neurons Vary in the Strength of Their Relationship to Breathing | 164 | ||
| Respiratory Neuron Activity in NREM Sleep | 164 | ||
| Respiratory Neuron Activity in REM Sleep | 165 | ||
| Neuromodulation of Respiratory Neurons across Sleep-Wake States | 165 | ||
| Summary | 166 | ||
| Acknowledgments | 166 | ||
| Review Questions | 166.e3 | ||
| Answers | 166.e5 | ||
| Selected Readings | 166 | ||
| References | 166.e1 | ||
| 16 Respiratory Physiology: | 167 | ||
| Chapter Highlights | 167 | ||
| Overview of the Control of Breathing | 167 | ||
| Central Control of Breathing | 167 | ||
| Chemical Control of Breathing | 168 | ||
| Peripheral versus Central | 168 | ||
| Other Inputs to Breathing | 169 | ||
| State-Related Changes in the Control of Breathing | 170 | ||
| Sleep Onset | 170 | ||
| Stable Sleep | 170 | ||
| Brief Awakenings (Arousal from Sleep) | 170 | ||
| Arousal Threshold | 170 | ||
| Ventilatory Response to Arousal | 171 | ||
| Apnea Threshold | 172 | ||
| Loop Gain | 172 | ||
| Sex Differences | 172 | ||
| Clinical Manifestations | 172 | ||
| Summary | 172 | ||
| Acknowledgment | 173 | ||
| Review Questions | 173.e3 | ||
| Answers | 173.e4 | ||
| Selected Readings | 173 | ||
| References | 173.e1 | ||
| 17 Physiology of Upper and Lower Airways | 174 | ||
| Chapter Highlights | 174 | ||
| Anatomy and Physiology | 174 | ||
| Respiratory Muscles | 174 | ||
| Elastic Forces and Lung Volumes | 175 | ||
| Breathing Cycle and Minute Ventilation | 175 | ||
| Resistance | 176 | ||
| Effects of Obesity and Body Posture on Lung Volumes | 176 | ||
| Effects of Sleep on Lung Volume | 176 | ||
| Effects of Sleep on Breathing Pattern and Blood Gases | 177 | ||
| Upper Airway | 177 | ||
| Collapsing Forces | 178 | ||
| Dilating Forces | 179 | ||
| Effects of Sleep on Upper Airway Muscle Activity | 180 | ||
| Factors Influencing Stabilizing and Collapsing Forces | 180 | ||
| Conclusions | 181 | ||
| Summary | 181 | ||
| Selected Readings | 181 | ||
| References | 181.e1 | ||
| Review Questions | 181.e4 | ||
| Answers | 181.e5 | ||
| 18 Respiratory Physiology | 182 | ||
| Chapter Highlights | 182 | ||
| Overview | 182 | ||
| Acclimatization | 182 | ||
| Sleep Architecture | 184 | ||
| Mechanisms Causing Periodic Breathing | 184 | ||
| Plant Gain at Altitude | 185 | ||
| Controller Gain at Altitude | 185 | ||
| Short-term Potentiation and Periodic Breathing | 186 | ||
| Other Factors Influencing Periodic Breathing | 186 | ||
| Periodic Breathing and Hypoxic Ventilatory Response | 186 | ||
| Periodic Breathing Changes with Both Magnitude and Duration of Hypoxic Stimulus | 186 | ||
| A Role of Cerebral Blood Flow in Breathing Stability at Altitude | 186 | ||
| Role of Arousal from Sleep | 188 | ||
| Management of Periodic Breathing at Altitude | 189 | ||
| Medical Gases | 189 | ||
| Pharmacologic Interventions | 189 | ||
| Devices | 190 | ||
| Other Sleep-Related Conditions Affected by High Altitude | 191 | ||
| Nasal Obstruction and High Altitude | 191 | ||
| Obstructive Sleep Apnea and High Altitude | 191 | ||
| Treatments for OSA and Snoring at High Altitude | 191 | ||
| Insomnia at High Altitude | 191 | ||
| Headache at High Altitude | 191 | ||
| Sleep in High-Altitude Natives | 192 | ||
| Summary | 192 | ||
| Selected Readings | 192 | ||
| References | 192.e1 | ||
| Review Questions | 192.e3 | ||
| Answers | 192.e4 | ||
| 19 Sleep and Host Defense | 193 | ||
| Chapter Highlights | 193 | ||
| The Acute Phase Response and Host Defense | 193 | ||
| Infection-Induced Alterations in Sleep | 195 | ||
| Viral Infections and Altered Sleep | 195 | ||
| Bacterial Challenge | 196 | ||
| Effects of Sleep Loss on Immune Function | 197 | ||
| Mechanisms Linking Sleep and Immunity | 199 | ||
| Summary | 200 | ||
| Acknowledgments | 201 | ||
| Review Questions | 201.e4 | ||
| Answers | 201.e5 | ||
| Selected Readings | 201 | ||
| References | 201.e1 | ||
| 20 Endocrine Physiology in Relation to Sleep and Sleep Disturbances | 202 | ||
| Chapter Highlights | 202 | ||
| Modulation of Endocrine Function by Sleep-Wake Homeostasis and Circadian Rhythmicity | 202 | ||
| The Growth Hormone Axis | 203 | ||
| The Corticotropic Axis | 204 | ||
| The Thyroid Axis | 205 | ||
| Prolactin Secretion | 205 | ||
| The Gonadal Axis | 206 | ||
| Glucose Regulation | 207 | ||
| Sleep and Appetite Regulation | 207 | ||
| Water and Electrolyte Balance during Sleep | 208 | ||
| Recurrent Sleep Restriction: Impact on Endocrine and Metabolic Function | 209 | ||
| Laboratory Studies of Experimental Sleep Restriction | 209 | ||
| Pituitary and Pituitary-Dependent Hormones | 209 | ||
| Glucose Metabolism | 211 | ||
| Neuroendocrine Control of Appetite | 212 | ||
| Hunger, Satiety, and Food Intake | 212 | ||
| Energy Expenditure | 213 | ||
| Epidemiologic Studies Linking Habitual Short Sleep and the Risk for Obesity and Diabetes | 213 | ||
| Reduced Sleep Quality and Sleep Disorders: Impact on Endocrine and Metabolic Function | 213 | ||
| Experimental Reduction of Sleep Quality | 213 | ||
| Prospective Epidemiologic Studies Linking Poor Sleep Quality to Diabetes Risk | 214 | ||
| Insomnia | 214 | ||
| Obstructive Sleep Apnea | 215 | ||
| Age-Related Sleep Alterations: Implications for Endocrine Function | 215 | ||
| Growth Hormone Axis | 215 | ||
| Prolactin Secretion | 216 | ||
| Pituitary-Adrenal Axis | 216 | ||
| Pituitary-Gonadal Axis | 216 | ||
| Sleep Disturbances in Metabolic and Endocrine Disorders | 216 | ||
| Obesity | 216 | ||
| Type 2 Diabetes | 217 | ||
| Polycystic Ovary Syndrome | 218 | ||
| Summary | 218 | ||
| Review Questions | 219.e7 | ||
| Answers | 219.e8 | ||
| Selected Readings | 219 | ||
| References | 219.e1 | ||
| 21 Thermoregulation in Sleep and Hibernation | 220 | ||
| Chapter Highlights | 220 | ||
| Circadian Regulation of Core Body Temperature | 220 | ||
| Relationship Between the Sleep Regulatory and the Thermoregulatory System | 221 | ||
| Covariation of Sleep and Thermophysiologic Variables | 221 | ||
| Baseline Conditions | 221 | ||
| Changed Circadian Conditions | 223 | ||
| Intervention Studies in Humans | 224 | ||
| Changing Temperatures | 224 | ||
| Changing Sleep Pressure | 225 | ||
| Intervention Studies in Rodents | 225 | ||
| Changing Temperature | 225 | ||
| Changing Sleep Pressure | 226 | ||
| Brain Temperature, Electroencephalogram, and Thermosensitive Neurons | 226 | ||
| Hibernation | 227 | ||
| Thermoregulation and Metabolic Rate Reduction | 227 | ||
| Torpor and Sleep | 227 | ||
| Summary | 228 | ||
| Review Questions | 228.e4 | ||
| Answers | 228.e5 | ||
| Selected Readings | 228 | ||
| References | 228.e1 | ||
| 22 Memory Processing in Relation to Sleep | 229 | ||
| Chapter Highlights | 229 | ||
| Memory Systems and Memory Consolidation | 229 | ||
| Main Methods for Studying the Role of Sleep for Memory Consolidation | 230 | ||
| Posttraining Sleep Deprivation | 230 | ||
| Posttraining Sleep Modifications | 231 | ||
| Within-Sleep Stimulations | 232 | ||
| Sleep and Declarative Memory | 232 | ||
| Semantic Memory | 232 | ||
| Episodic Memory | 233 | ||
| Emotion in Episodic Memory | 233 | ||
| Sleep and Nondeclarative Memories | 233 | ||
| Sleep and Perceptual Learning | 234 | ||
| Sleep and Motor Learning | 234 | ||
| Sleep and Perceptual-Motor Learning | 235 | ||
| Sleep and Priming | 235 | ||
| Sleep-Dependent Mechanisms of Brain Plasticity and Memory Consolidation | 236 | ||
| Ponto-Geniculo-Occipital Waves | 236 | ||
| Hippocampal Rhythms | 236 | ||
| Sleep Spindles and Slow Waves | 236 | ||
| Conclusions | 237 | ||
| Summary | 238 | ||
| Review Questions | 238.e5 | ||
| Answers | 238.e6 | ||
| Selected Readings | 238 | ||
| References | 238.e1 | ||
| 23 Sensory and Motor Processing During Sleep and Wakefulness | 239 | ||
| Chapter Highlights | 239 | ||
| Modulation of Sensory Processes During Sleep and Wakefulness | 239 | ||
| Sensory Pathways and Mechanisms | 239 | ||
| Modulation of Sensory Processes Including Those Related to Pain | 241 | ||
| Processing Related to Pain during Sleep and Wakefulness | 242 | ||
| Clinical Correlates | 242 | ||
| Modulation of Sensorimotor Processes During Sleep and Wakefulness | 243 | ||
| Sensorimotor Pathways and Mechanisms | 243 | ||
| Processing of Somatic Reflexes during Sleep and Wakefulness | 243 | ||
| Clinical Correlates | 244 | ||
| Sleep Bruxism | 244 | ||
| Periodic Limb Movement Disorder and Restless Legs Syndrome | 244 | ||
| Narcolepsy | 245 | ||
| Respiratory Reflexes During Sleep and Wakefulness | 245 | ||
| Specific Reflexes | 245 | ||
| Airway Negative-Pressure Reflex | 245 | ||
| Laryngeal and Bronchopulmonary Reflexes | 246 | ||
| Processing of Chemoreflexes during Sleep and Wakefulness | 247 | ||
| Clinical Correlates | 249 | ||
| Summary | 249 | ||
| Selected Readings | 249 | ||
| References | 249.e1 | ||
| Review Questions | 249.e3 | ||
| Answers | 249.e4 | ||
| 24 Opiate Action on Sleep and Breathing | 250 | ||
| Chapter Highlights | 250 | ||
| Historical Context for Ongoing Social-Medical Issues Concerning Opiates: Opiophilia and Opiophobia | 250 | ||
| Sleep Medicine, Pain Medicine, and Health Policy | 251 | ||
| Opiates and Opioid Pharmacology | 251 | ||
| Opiates Disrupt the Temporal Organization of Sleep and Wakefulness | 253 | ||
| Opiates Promote Torpor-like States | 254 | ||
| Clinical Relevance of Opiate-Induced Respiratory Depression | 254 | ||
| Opiates and Sleep-Disordered Breathing | 257 | ||
| Obesity and Opiate-Induced Respiratory Depression | 257 | ||
| Geriatric Population Is Vulnerable to Opiate-Induced Respiratory Depression | 257 | ||
| Opiates Alter Breathing in Children | 258 | ||
| Chronic Pain | 258 | ||
| Substance Abuse, Opiates, and Respiratory Control | 258 | ||
| Emerging Opportunities for Research on Opiates, Sleep, and Pain | 258 | ||
| Summary | 259 | ||
| Selected Readings | 259 | ||
| References | 259.e1 | ||
| Review Questions | 259.e5 | ||
| Answers | 259.e6 | ||
| 25 Pathophysiology of Sleep-Wake Disturbances After Traumatic Brain Injury | 260 | ||
| Chapter Highlights | 260 | ||
| Introduction to Traumatic Brain Injury | 260 | ||
| Pathophysiology of Traumatic Brain Injury | 261 | ||
| Traumatic Brain Injury and Neurodegenerative Diseases | 261 | ||
| Behavioral and Cognitive Consequences of Traumatic Brain Injury | 261 | ||
| Biomarkers of Outcome after Traumatic Brain Injury | 261 | ||
| Pathophysiology of Posttraumatic Sleep-Wake Disturbances | 262 | ||
| Experimental Models of Traumatic Brain Injury and Studies of Sleep-Wake Behavior in Animals | 262 | ||
| Fluid Percussion | 262 | ||
| Controlled Cortical Impact Model | 262 | ||
| Weight Drop Model | 262 | ||
| Inflammation Mediators from Animal Studies | 264 | ||
| Impaired Neurotransmitter Signaling in Animal Models of Traumatic Brain Injury | 264 | ||
| Impaired Neurotransmitter Signaling in Human Traumatic Brain Injury | 265 | ||
| Cortical Hypoexcitability and Transcranial Magnetic Stimulation | 265 | ||
| Neuroimaging of Sleep | 265 | ||
| Circadian Rhythms | 266 | ||
| Circadian Studies in Acute Traumatic Brain Injury | 266 | ||
| Circadian Studies in Post–Acute Traumatic Brain Injury | 266 | ||
| Circadian Studies in Chronic Traumatic Brain Injury | 266 | ||
| Clock Genes | 266 | ||
| Neuroendocrine Dysfunctions | 267 | ||
| Effects of Prolonged Sedation | 267 | ||
| Repetitive Traumatic Brain Injury | 267 | ||
| Pain | 267 | ||
| Psychiatric Comorbid Illness | 268 | ||
| Sleep and Brain Recovery | 268 | ||
| Summary | 269 | ||
| Selected Readings | 269 | ||
| References | 269.e1 | ||
| Review Questions | 269.e3 | ||
| Answers | 269.e4 | ||
| 4 Genetics and Genomic Basis of Sleep | 270 | ||
| 26 Introduction | 270 | ||
| References | 271.e1 | ||
| 27 Genetics and Genomics of Circadian Clocks | 272 | ||
| Chapter Highlights | 272 | ||
| The Mammalian Cellular Circadian Clock | 272 | ||
| Circadian Clock Properties and Clock Genes | 272 | ||
| Positive Elements | 273 | ||
| Clock | 273 | ||
| Bmal1 | 274 | ||
| Negative Elements | 274 | ||
| The Period Genes | 274 | ||
| Cryptochromes | 275 | ||
| Modulators and Other Components of the Clock | 275 | ||
| Timeless | 275 | ||
| The CASEin Kinase 1 Gene | 275 | ||
| Rev-erb alpha and ROR | 276 | ||
| Fbxl3 and Fbxl21 | 276 | ||
| NPAS2 | 276 | ||
| Dec1 and Dec2 | 276 | ||
| Other Regulators of the Clock | 276 | ||
| Output Regulation | 277 | ||
| Transcriptional Output of the Clock | 277 | ||
| Output from the Suprachiasmatic Nucleus | 279 | ||
| Input Regulation | 279 | ||
| Melanopsin | 279 | ||
| Rab3a | 279 | ||
| Conclusions and Future Directions | 279 | ||
| Summary | 280 | ||
| Acknowledgments | 280 | ||
| Review Questions | 280.e4 | ||
| Answers | 280.e5 | ||
| Selected Readings | 280 | ||
| References | 280.e1 | ||
| 28 Genetics and Genomic Basis of Sleep in Simple Model Organisms | 281 | ||
| Chapter Highlights | 281 | ||
| Drosophila as a Model System for Genetics | 281 | ||
| Drosophila as a Model for Studies of Sleep | 282 | ||
| Drosophila Circadian Behavior Reveals Conserved Mechanisms between Flies and Humans | 283 | ||
| Cellular and Molecular Basis of Drosophila Sleep | 284 | ||
| Specific Neural Circuits Are Important for Sleep-Wake Regulation | 284 | ||
| Arousal Neurotransmitters: Monoaminergic Arousal Pathways | 285 | ||
| Sleep Neurotransmitters: Gamma-aminobutyric Acid and Adenosine Sleep Pathways | 286 | ||
| Genetics and Pharmacology of Sleep: Which Molecules Regulate Sleep? | 286 | ||
| Circadian Clock Pathway | 287 | ||
| Dopamine Arousal Pathways | 287 | ||
| Stress and Immune Pathways | 287 | ||
| Membrane Excitability | 287 | ||
| Signal Transduction | 288 | ||
| Which Genes are Regulated by Sleep-Wake? | 288 | ||
| Summary: Drosophila | 288 | ||
| Newer Genetic Model Systems for Studying Sleep | 289 | ||
| Zebrafish as a Model System for Genetics | 289 | ||
| Zebrafish as a Model System for Studying Sleep | 290 | ||
| Signaling Mechanisms Regulating Sleep in Zebrafish | 290 | ||
| Melatonin Promotes Sleep | 290 | ||
| Hypocretin Stabilizes Sleep-Wake States | 291 | ||
| Neuropharmacology Regulating Sleep | 291 | ||
| In Vivo Analysis of Circuit Function in Zebrafish | 291 | ||
| Summary: Zebrafish | 292 | ||
| Caenorhabditis elegans as a Model System for Genetics | 292 | ||
| Caenorhabditis elegans as a Model System for Studying Sleep | 292 | ||
| Shared Molecular Mechanisms between Lethargus and Sleep in Other Animals | 293 | ||
| Protein Kinase Signaling Can Promote or Inhibit Sleep-Like States | 293 | ||
| Growth and Differentiation Pathways Modulate Sleep | 293 | ||
| Neuromodulatory Signaling and Lethargus | 293 | ||
| Simple Neural Circuits Regulating Lethargus | 294 | ||
| Individual Neurons that Regulate Behavioral Quiescence in Caenorhabditis elegans | 294 | ||
| Gating of Sensory Stimuli Is an Important Mechanism Regulating Behavioral Quiescence | 294 | ||
| Summary: Caenorhabditis elegans | 295 | ||
| Summary | 295 | ||
| Acknowledgments | 295 | ||
| Selected Readings | 295 | ||
| References | 295.e1 | ||
| Review Questions | 295.e5 | ||
| Answers | 295.e6 | ||
| 29 Genetics and Genomic Basis of Sleep in Rodents | 296 | ||
| Chapter Highlights | 296 | ||
| Gene Expression, mRNAs, and Microarray Studies | 297 | ||
| Identification of Naturally Occurring Alleles That Influence Sleep or Sleep-Related Traits | 300 | ||
| Mutagenesis and Knockout Approaches | 305 | ||
| Summary | 309 | ||
| Selected Readings | 309 | ||
| References | 309.e1 | ||
| Review Questions | 309.e4 | ||
| Answers | 309.e5 | ||
| 30 Genetics and Genomic Basis of Sleep in Healthy Humans | 310 | ||
| Chapter Highlights | 310 | ||
| Evidence for Traitlike and Genotype-Dependent Differences in Diurnal Preference, Sleep Timing, Sleep Electroencephalography, Sleep Architecture, and Sleep Duration | 310 | ||
| Genes Contributing to Human Morningness-Eveningness and Timing of Sleep | 310 | ||
| Candidate Genes | 310 | ||
| Genome-wide Association Studies | 312 | ||
| The Sleep Electroencephalogram is among the Most Heritable Traits in Humans | 313 | ||
| Genes Contributing to the Sleep Electroencephalogram | 314 | ||
| Circadian Clock Genes | 314 | ||
| Adenosinergic Neuromodulation | 314 | ||
| Neurotransmitters | 314 | ||
| Signaling Pathways | 315 | ||
| Genes Contributing to Sleep Architecture | 315 | ||
| Slow Wave Sleep | 316 | ||
| Genes Contributing to Habitual Sleep Duration | 316 | ||
| Circadian Clock Genes | 316 | ||
| Neurotransmitters | 316 | ||
| Transporters | 317 | ||
| Genome-wide Association Studies | 317 | ||
| Genetic Basis of Sleep-Wake Regulation: Interaction between Circadian and Homeostatic Systems | 317 | ||
| Circadian Clock Genes | 317 | ||
| Adenosinergic Neuromodulation | 318 | ||
| Neurotransmitters | 318 | ||
| Transporters | 318 | ||
| Signaling Pathways | 319 | ||
| Immune Response | 319 | ||
| Human Sleep Pharmacogenetics | 319 | ||
| Adenosinergic Neuromodulation | 319 | ||
| Dopaminergic Neurotransmission | 320 | ||
| Concluding Remarks | 320 | ||
| Summary | 320 | ||
| Acknowledgments | 320 | ||
| Selected Readings | 321 | ||
| References | 321.e1 | ||
| Review Questions | 321.e4 | ||
| Answers | 321.e5 | ||
| 31 Genetics and Genomic Basis of Sleep Disorders in Humans | 322 | ||
| Chapter Highlights | 322 | ||
| Approach to Identifying Genetic Variants in Humans | 322 | ||
| Overview | 322 | ||
| Heritability Estimation | 323 | ||
| Linkage Analysis | 324 | ||
| Candidate Gene Studies | 325 | ||
| Genome-Wide Association Studies | 328 | ||
| Rare Variant Analysis | 328 | ||
| Current and Future Directions: Sequencing, Copy Number Variation, and Epigenetics | 329 | ||
| Genetics of Sleep Duration | 330 | ||
| PER3 Variable Number of Tandem Repeats | 331 | ||
| Chronotype and Circadian Rhythm Sleep Disorders | 332 | ||
| Genetics of Insomnia | 333 | ||
| Narcolepsy | 333 | ||
| Restless Legs Syndrome | 335 | ||
| Genetics of Obstructive Sleep Apnea | 337 | ||
| Genetics of Congenital Hypoventilation | 338 | ||
| Summary | 338 | ||
| Selected Readings | 339 | ||
| References | 339.e1 | ||
| Review Questions | 339.e6 | ||
| Answers | 339.e7 | ||
| 5 Chronobiology | 340 | ||
| 32 Introduction | 340 | ||
| Integration of the Circadian Clock and Sleep-Wake Systems | 341 | ||
| Regulating Sleep Amount: a Homeostatic and a Circadian Input | 341 | ||
| Selected Readings | 342 | ||
| References | 342.e1 | ||
| 33 Anatomy of the Mammalian Circadian System | 343 | ||
| Chapter Highlights | 343 | ||
| The Master Circadian Clock in the Suprachiasmatic Nucleus | 343 | ||
| Suprachiasmatic Nucleus Inputs | 344 | ||
| Retina | 345 | ||
| Intergeniculate Leaflet | 346 | ||
| Midbrain Raphe Nuclei | 346 | ||
| Suprachiasmatic Nucleus Outputs | 347 | ||
| Sleep-Wake Rhythm | 347 | ||
| Circadian Regulation of Melatonin and Cortisol | 348 | ||
| Diffusible Suprachiasmatic Nucleus Output Signals | 348 | ||
| Synchronization of Central and Peripheral Oscillators | 349 | ||
| Summary | 349 | ||
| Review Questions | 350.e3 | ||
| Answers | 350.e4 | ||
| Selected Readings | 349 | ||
| References | 350.e1 | ||
| 34 Physiology of the Mammalian Circadian System | 351 | ||
| Chapter Highlights | 351 | ||
| The Suprachiasmatic Nucleus: Master Circadian Pacemaker | 351 | ||
| Pacemaker Function of the Suprachiasmatic Nucleus | 351 | ||
| Molecular Basis of the Suprachiasmatic Nucleus Pacemaker | 352 | ||
| Functional Architecture of the Suprachiasmatic Nucleus | 353 | ||
| Light Input to the Suprachiasmatic Nucleus: The Retinohypothalamic Tract | 354 | ||
| Other Functional Inputs to the Circadian Clock | 355 | ||
| Suprachiasmatic Nucleus Output Pathways | 356 | ||
| Multiple-Oscillator Nature of the Circadian System | 357 | ||
| The Circadian Timing System in Health and Disease | 359 | ||
| Conclusions | 360 | ||
| Summary | 360 | ||
| Acknowledgments | 360 | ||
| Review Questions | 361.e5 | ||
| Answers | 361.e6 | ||
| Selected Readings | 360 | ||
| References | 361.e1 | ||
| 35 Human Circadian Timing System and Sleep-Wake Regulation | 362 | ||
| Chapter Highlights | 362 | ||
| Identifying the Mammalian Circadian Pacemaker | 362 | ||
| Influence of Sleep and Circadian Rhythms on Human Physiology | 362 | ||
| Effects of Light on Human Circadian Rhythms | 364 | ||
| Photic Suppression of Melatonin Secretion | 365 | ||
| Human Phase-Response Curves to Light | 366 | ||
| Photic Resetting of the Pineal Melatonin Rhythm | 366 | ||
| Human Dose-Response Curve to Circadian Phase-Resetting Effects of Light | 367 | ||
| Nonphotic Circadian Phase Resetting and Reentrainment | 367 | ||
| Investigating Circadian and Sleep-Wake Dependent Modulation | 369 | ||
| The Kleitman Protocol | 369 | ||
| Separation from 24-Hour Environmental and Behavioral Cues | 369 | ||
| Separating Circadian Modulation and Sleep-Wake Modulation | 369 | ||
| Neurobehavioral Functions | 370 | ||
| Sleep and Wake | 370 | ||
| Internal Sleep Structure | 372 | ||
| Potential Feedback Pathways | 373 | ||
| Intrinsic Period of the Human Circadian Pacemaker | 374 | ||
| Aging and Circadian Sleep-Wake Regulation | 374 | ||
| Influence of Social and Work-Related Factors | 374 | ||
| Summary | 376 | ||
| Acknowledgments | 376 | ||
| Selected Readings | 376 | ||
| References | 376.e1 | ||
| Review Questions | 376.e4 | ||
| Answers | 376.e5 | ||
| 36 Sleep Homeostasis and Models of Sleep Regulation | 377 | ||
| Chapter Highlights | 377 | ||
| Homeostatic Regulation of Sleep | 377 | ||
| Electroencephalographic Slow Wave Activity: A Physiologic Indicator of NREM Sleep Homeostasis | 377 | ||
| Slow Wave Sleep and Slow Wave Activity | 377 | ||
| Slow Waves and Sleep Intensity | 378 | ||
| Global Time Course of Slow Wave Activity during Sleep | 378 | ||
| Nap Studies | 378 | ||
| Effect of Sleep Deprivation | 378 | ||
| Selective Slow Wave Deprivation | 378 | ||
| Ultradian Dynamics of Slow Wave Activity and Spindle Frequency Activity | 379 | ||
| Buildup of Slow Wave Activity within NREM Sleep Episodes | 379 | ||
| Slow Wave Activity and Spindle Frequency Activity | 379 | ||
| Regulation of REM Sleep | 379 | ||
| NREM versus REM Sleep Homeostasis | 379 | ||
| Effect of NREM Sleep Pressure on REM Sleep Homeostasis | 379 | ||
| Effect of REM Sleep Pressure on the NREM Sleep Electroencephalogram | 379 | ||
| Homeostatic Marker in the Waking Electroencephalogram | 380 | ||
| Independence and Interactions of Homeostatic and Circadian Processes | 380 | ||
| Models of Sleep Regulation | 381 | ||
| Two-Process Model and Related Models | 382 | ||
| Modeling REM Sleep | 385 | ||
| Neurophysiologic Models | 385 | ||
| Conclusions and Perspectives | 386 | ||
| Summary | 386 | ||
| Acknowledgments | 387 | ||
| Review Questions | 387.e5 | ||
| Answers | 387.e6 | ||
| Selected Readings | 387 | ||
| References | 387.e1 | ||
| 37 Circadian Rhythms in Sleepiness, Alertness, and Performance | 388 | ||
| Chapter Highlights | 388 | ||
| Circadian Rhythms | 388 | ||
| Self-Report Measures of Sleepiness and Alertness | 388 | ||
| Cognitive Performance | 389 | ||
| Physiologic Measures | 390 | ||
| Interindividual Differences | 390 | ||
| Circadian Rhythmicity Versus Sleep-Wake Cycles | 391 | ||
| Sleep Deprivation | 391 | ||
| Sleep-Wake Regulation | 392 | ||
| Forced Desynchrony and Ultradian Days | 392 | ||
| Circadian Regulation of Alertness and Performance in Context | 394 | ||
| Summary | 394 | ||
| Review Questions | 395.e4 | ||
| Answers | 395.e5 | ||
| Selected Readings | 395 | ||
| References | 395.e1 | ||
| 38 Central and Peripheral Circadian Clocks | 396 | ||
| Chapter Highlights | 396 | ||
| The Central Circadian Clock | 396 | ||
| Self-Sustained Oscillations | 396 | ||
| Photic Entrainment of the Master Clock | 396 | ||
| Nonphotic Phase Shifting of the Master Clock | 397 | ||
| Outputs from the Master Clock | 398 | ||
| Brain and Peripheral Circadian Clocks | 398 | ||
| Extra–Suprachiasmatic Nucleus Brain Clocks | 398 | ||
| Clocks in Peripheral Tissues | 398 | ||
| Molecular Links between Core Clock Components and Metabolism | 399 | ||
| Coupling between Central and Peripheral Clocks | 399 | ||
| Entrainment of Peripheral Clocks by Nervous Outputs of the Suprachiasmatic Nucleus | 399 | ||
| Entrainment of Peripheral Clocks by Suprachiasmatic Nucleus–Controlled Hormonal Outputs | 400 | ||
| Feedback of Peripheral Hormonal Signals to the Suprachiasmatic Nucleus | 401 | ||
| Adjusting Clocks with Feeding | 401 | ||
| Extra–Suprachiasmatic Nucleus Clocks Are Entrained by Feeding Time | 401 | ||
| Possible Mechanisms of Entrainment of Extra–Suprachiasmatic Nucleus Clocks by Food | 401 | ||
| Effect of Nutritional Cues on the Central Clock | 403 | ||
| Conclusions | 403 | ||
| Summary | 404 | ||
| Selected Readings | 404 | ||
| References | 404.e1 | ||
| Review Questions | 404.e5 | ||
| Answers | 404.e6 | ||
| 39 Circadian Dysregulation in Mental and Physical Health | 405 | ||
| Chapter Highlights | 405 | ||
| Circadian Misalignment | 405 | ||
| Shift Work and Social Jet Lag | 405 | ||
| Shift Work and Cancer | 406 | ||
| Shift Work and Metabolic Syndrome | 407 | ||
| Circadian Dysregulation and Physical Health | 408 | ||
| Cardiometabolic Dysfunction | 408 | ||
| Pulmonary Disease | 408 | ||
| Other Disorders | 408 | ||
| Circadian Regulation and Neurologic Disorders | 408 | ||
| Circadian Dysregulation in Neurodegenerative Disease | 409 | ||
| Alzheimer Disease | 409 | ||
| Parkinson Disease | 410 | ||
| Circadian Dysregulation and Psychiatric Disorders | 411 | ||
| Circadian Dysregulation in the Pathophysiology of Psychiatric Disorders | 411 | ||
| Chronobiology as Treatment for Psychiatric Disorders | 413 | ||
| Summary | 413 | ||
| Selected Readings | 413 | ||
| References | 413.e1 | ||
| Review Questions | 413.e5 | ||
| Answers | 413.e6 | ||
| 40 Circadian Disorders of the Sleep-Wake Cycle | 414 | ||
| Chapter Highlights | 414 | ||
| Regulation and Entrainment of Circadian Rhythms | 414 | ||
| Entrainment by Light | 415 | ||
| Entrainment by Nonphotic Signals | 415 | ||
| Melatonin | 415 | ||
| Delayed Sleep-Wake Phase Disorder, Delayed Sleep Phase Type, Delayed Sleep Phase Syndrome | 415 | ||
| Clinical Features | 415 | ||
| Epidemiology | 416 | ||
| Pathogenesis | 416 | ||
| Diagnosis | 417 | ||
| Treatment | 417 | ||
| Chronotherapy | 418 | ||
| Light | 418 | ||
| Melatonin | 418 | ||
| Advanced Sleep-Wake Phase Disorder, Advanced Sleep Phase Type, Advanced Sleep Phase Syndrome | 419 | ||
| Clinical Features | 419 | ||
| Epidemiology | 419 | ||
| Pathogenesis | 419 | ||
| Diagnosis | 419 | ||
| Treatment | 420 | ||
| Non–24-Hour Sleep-Wake Disorder, Free-Running Disorder, Nonentrained Type, Hypernychthermal Syndrome | 420 | ||
| Clinical Features | 420 | ||
| Epidemiology | 420 | ||
| Pathogenesis | 420 | ||
| II Practice of Sleep Medicine | 571 | ||
| 8 Impact, Presentation, and Diagnosis | 573 | ||
| 57 Approach to the Patient with Disordered Sleep | 573 | ||
| Chapter Highlights | 573 | ||
| Chief Complaint and History | 573 | ||
| Insomnia | 574 | ||
| Excessive Sleepiness | 574 | ||
| Nocturnal Movements, Behaviors, and Sensations | 574 | ||
| Medication Use and Medical History | 574 | ||
| Family History | 574 | ||
| Social History | 574 | ||
| Review of Systems | 574 | ||
| Physical Examination | 575 | ||
| Summary | 575 | ||
| Review Questions | 575.e1 | ||
| Answers | 575.e2 | ||
| 58 Cardinal Manifestations of Sleep Disorders | 576 | ||
| Chapter Highlights | 576 | ||
| Insomnia | 576 | ||
| Excessive Daytime Sleepiness | 579 | ||
| Fatigue | 580 | ||
| Snoring | 580 | ||
| Sleep Apnea | 581 | ||
| Cataplexy | 582 | ||
| Sleep Paralysis | 582 | ||
| Hypnagogic and Hypnopompic Hallucinations | 582 | ||
| Automatic Behavior | 582 | ||
| Excessive Movement in Sleep or Parasomnia | 583 | ||
| Sleeptalking | 583 | ||
| Sleepwalking | 583 | ||
| Sleep Terrors | 583 | ||
| Confusional Arousals | 583 | ||
| Sleep-Related Groaning (Catathrenia) | 584 | ||
| Dream Enactment | 584 | ||
| Nightmares | 584 | ||
| Sleep-Related Rhythmic Movement Disorder | 584 | ||
| Sleep-Related Bruxism | 584 | ||
| Restless Legs Syndrome and Periodic Movements of Sleep | 584 | ||
| Morning Headache | 585 | ||
| Systemic Features | 585 | ||
| Pediatric Cardinal Manifestations | 585 | ||
| Summary | 586 | ||
| Selected Readings | 586 | ||
| References | 586.e1 | ||
| Review Questions | 586.e2 | ||
| Answers | 586.e3 | ||
| 59 Physical Examination in Sleep Medicine | 587 | ||
| Chapter Highlights | 587 | ||
| Sleep Apnea | 588 | ||
| Anthropometric Measurements in Patients with Suspected Sleep Apnea | 588 | ||
| Body Mass Index Calculations | 588 | ||
| Overall Inspection | 589 | ||
| Craniofacial Factors | 593 | ||
| Nasal Factors | 595 | ||
| Neck Circumference | 595 | ||
| Examination of the Pharynx | 596 | ||
| Examination of the Tonsils | 598 | ||
| Neurologic Examination | 598 | ||
| Cardiopulmonary Examination | 600 | ||
| Central Nervous System Hypersomnia | 600 | ||
| Narcolepsy | 600 | ||
| Parasomnias | 603 | ||
| Nocturnal Eating Disorder and Sleep-Related Eating Disorder | 603 | ||
| REM Sleep Behavior Disorder | 603 | ||
| Sleep-Related Movement Disorders | 603 | ||
| Willis-Ekbom Disease | 603 | ||
| Bruxism | 605 | ||
| Insomnia | 605 | ||
| Summary | 606 | ||
| Selected Readings | 606 | ||
| References | 606.e1 | ||
| Review Questions | 606.e2 | ||
| Answers | 606.e3 | ||
| 60 Use of Clinical Tools and Tests in Sleep Medicine | 607 | ||
| Chapter Highlights | 607 | ||
| Evaluation for Sleep-Related Breathing Disorders | 607 | ||
| History and Questionnaires | 607 | ||
| Physical Examination | 607 | ||
| Nocturnal Polysomnography | 609 | ||
| Modified Forms of the Polysomnogram | 610 | ||
| Home Sleep Tests | 610 | ||
| Studies of Airway Morphology | 611 | ||
| Evaluation of Hypersomnolence | 612 | ||
| History and Questionnaires | 612 | ||
| Physical Examination | 612 | ||
| Sleep Logs and Actigraphy | 612 | ||
| Nocturnal Polysomnography | 612 | ||
| Multiple Sleep Latency Test | 613 | ||
| Nocturnal Polysomnography and MSLT in the Diagnosis of Narcolepsy | 613 | ||
| Variations of the Multiple Sleep Latency Test and Other Physiologic Tests | 613 | ||
| Evaluation of Insomnia | 614 | ||
| Index | 1679 | ||
| A | 1679 | ||
| B | 1683 | ||
| C | 1685 | ||
| D | 1690 | ||
| E | 1693 | ||
| F | 1694 | ||
| G | 1696 | ||
| H | 1697 | ||
| I | 1699 | ||
| J | 1702 | ||
| K | 1702 | ||
| L | 1702 | ||
| M | 1703 | ||
| N | 1707 | ||
| O | 1709 | ||
| P | 1712 | ||
| Q | 1717 | ||
| R | 1717 | ||
| S | 1719 | ||
| T | 1727 | ||
| U | 1729 | ||
| V | 1729 | ||
| W | 1730 | ||
| X | 1730 | ||
| Y | 1730 | ||
| Z | 1730 | ||
| Clinical Key IBC | IBC1 |