Review of Sleep Medicine

Cover......Page 1
Front matter......Page 2
Copyright
......Page 4
Contributing Authors......Page 5
Preface to the Second Edition......Page 8
Preface to the First Edition......Page 9
Acknowledgments......Page 10
Acknowledgments......Page 11
Abbreviations......Page 12
Sleep Medicine Board Exams......Page 15
Prevalence of Sleep Disorders......Page 18
Mammalian Sleep Patterns......Page 19
Human Sleep Deprivation......Page 21
Medical Profession......Page 22

References......Page 23
Homeostasis Process S......Page 26
Entrainment of Circadian Rhythms......Page 27
Functional Neuroanatomical Basis of Arousal and Wakefulness......Page 28
Functional Neuroanatomical Basis of Sleep......Page 30
Neurophysiology of NREM Sleep......Page 32
Narcolepsy......Page 33
Restless Legs Syndrome and Periodic Leg Movement Disorder......Page 34
References......Page 35
Immunology and Sleep......Page 40
Organization of Endocrine Rhythms Affected by Sleep......Page 42
Pathophysiology......Page 43
What is a proposed mechanism of action of modafinil?......Page 116
Behavioral Insomnia of Childhood (Sleep-Onset Association Disorder)......Page 44
Peripheral Respiratory Mechanisms......Page 45
Other Respiratory Responses During Sleep......Page 46
Heart and Coronary Circulation During Sleep......Page 47
Cutaneous Circulation......Page 48
Muscle Circulation......Page 49
References......Page 100
Definitions......Page 53
Physiologic Consequences......Page 56
Clinical Evaluation......Page 57
Therapy......Page 59
Central Sleep Apnea......Page 61
Central Apnea Associated with Baseline Hypercapnia......Page 62
Human Leukocyte Antigen (HLA) Typing......Page 94
Snoring......Page 67
Upper Airway Resistance Syndrome......Page 68
Congenital Central Hypoventilation Syndrome......Page 69
References......Page 70
Arousals from Sleep......Page 76
Sympathetic Activation......Page 77
Stroke......Page 78
Pulmonary Hypertension......Page 79
Premature Ventricular Complexes......Page 80
References......Page 81
The characteristics of sleepiness and associated symptoms......Page 84
Other Symptoms......Page 86
Classification of the disorders associated with hypersomnia......Page 87
Clinical interview of the sleepy patient......Page 88
Inadequate Sleep Hygiene......Page 107
Epworth Sleepiness Scale (ESS)......Page 91
Sleep Logs and Actigraphy......Page 92
Nocturnal Polysomnography (NPSG)......Page 93
Behavioral Treatment......Page 109
Computed Tomography or Magnetic Resonance Imaging of the Brain and Other Secondary Explorations......Page 96
Wake-Promoting Therapeutics......Page 97
Sodium Oxybate......Page 98
Conclusion and perspectives......Page 99
Signs and Symptoms......Page 104
Psychophysiologic Insomnia (Conditioned Insomnia)......Page 105
Paradoxical Insomnia (Sleep State Misperception)......Page 106
Insomnia Resulting from Drug or Substance Use......Page 108
Modern Hypnotics......Page 110
References......Page 112
EEG: Setup......Page 114
Filters......Page 115
Distribution of Location of Waveforms......Page 119
Normal Sleep......Page 120
Epileptiform Abnormalities and Seizures......Page 125
Localization-Related Epilepsy (Partial Epilepsy)......Page 127
Frontal Lobe Seizures
......Page 129
Rhythmic Midtemporal Theta of Drowsiness......Page 135
Wickets......Page 139
Physiologic Artifacts......Page 145
Nonphysiologic Artifacts......Page 149

References......Page 150
Prestudy Questionnaire......Page 151
Direct Current Amplifiers......Page 152
Electroencephalography......Page 153
Electro-Oculography......Page 154
Monitoring Breathing During Sleep......Page 155
Gastroesophageal Reflux Studies......Page 156
Monitoring Recording: Documentation......Page 157
Digital Systems......Page 158
Summary......Page 163
References......Page 169
Template for 24-Hour Sleep/Wake Log......Page 171
Suggested Montages for Recording Sleep-Related Seizure Activity......Page 172
Measuring the Head for C3, C4, O1, and O2......Page 173
Maintenance of Wakefulness Test......Page 174
Bibliography......Page 175
Effects of Drugs on Sleep......Page 176
Antihistamines......Page 186
Hypnotics......Page 187
Antidepressants......Page 188
Anxiolytics......Page 189
Conclusions......Page 190
References......Page 191
Historical Aspects......Page 192
Apnea of Prematurity......Page 193
Pathophysiology......Page 196
Pathophysiology......Page 197
Etiology......Page 198
History......Page 199
Pathogenesis......Page 200
Clinical Features......Page 201
Evaluation of Autonomic Disturbance......Page 203
Cerebral Palsy......Page 204
Rett Syndrome......Page 205
Arnold Chiari Malformations......Page 206
Consequences......Page 207
Narcolepsy......Page 208
Irregular Sleep-Wake Rhythms......Page 210
Parasomnias......Page 212
References......Page 213
Questions......Page 216
Answers......Page 227
References......Page 240
Questions......Page 242
Answers......Page 249
Questions......Page 262
Answers......Page 267
Questions......Page 275
Stroke......Page 301
Extrapyramidal Diseases......Page 302
Dementia......Page 303
Epilepsy......Page 304
Polyneuropathy/Radiculopathy......Page 305
Questions 6–8: A 35-year-old female patient complains of chronic insomnia. She works as a freelance columnist for an Internet magazine. She is usually unable to fall.........Page 306
A 65-year-old businessman travels from London, United Kingdom (local time GMT) to Sydney, Australia (local time GMT + 10:00) aboard an eastward flight and plans.........Page 307
A patient with the DSPD needs to wake up early for an important appointment. His usual sleep-wake times are 3 a.m. and 11 a.m., respectively. He skips a.........Page 308
Generation of circadian rhythms is an intrinsic quality of most tissues. The synchronization of these multiple rhythms is probably achieved by which of the following mechanisms?......Page 309
Questions 29–31 are based on the followings case: The following actigraph recording (Figure 16-2) depicts the sleep pattern of a 27-year-old patient.........Page 310
Based on the visual inspection of the recording, from which of the following additional sleep disorders may this patient suffer?......Page 311
The actigraph recording shown in Figure 16-4 was performed on a 72-year-old patient living at home with his wife. The patient complained about.........Page 312
Answers......Page 314
References......Page 322
Questions......Page 324
Answers......Page 330
References
......Page 461
Questions......Page 334
Answers......Page 367

References......Page 371
Questions......Page 372
Answers......Page 378
References......Page 385
Questions......Page 387
References......Page 399
Questions
......Page 402
References
......Page 406
In electrophysiology, the preferred type of amplifier for recording bioelectric potentials is:......Page 407
Airflow can be recorded using all but the following:......Page 408
A PSG is:......Page 409
Answers......Page 410
References......Page 411
Case A Questions......Page 412
Case C......Page 413
Case D......Page 414
Case D Questions......Page 415
Discussion......Page 417
Summary......Page 418
Summary......Page 419
Summary......Page 421
References......Page 423
The patient develops cataplexy 2 years after the diagnosis of hypersomnia resulting from a medical condition. He is experiencing episodes of ``head bobbing´´ when he laughs, particularly when he tells a joke. Which of the following is the most appropriate treatment option?.........Page 424
What other clinical information can be helpful to make the diagnosis?......Page 425
What is the most useful test when making a diagnosis in this patient?......Page 426
How would you counsel this patient?......Page 427
Activity of which of the following nuclei is enhanced by benzodiazepines and nonbenzodiazepine hypnotics?......Page 429
References......Page 434
Questions......Page 435
Answers......Page 453
Questions
......Page 463
Answers......Page 474
A 40-year-old male presents with a chief complaint of EDS. He goes to bed around 10 p.m. and wakes up around 7 a.m. every day. He has no difficulty falling or staying.........Page 482
A 45-year-old male truck driver was seen for the evaluation of EDS. His wife reported very loud snoring and interrupted sleep resulting from witnessed.........Page 483
A 55-year-old male veteran is seen with symptoms of fatigue and EDS. His wife says that they have to sleep in different bedrooms because of his loud and.........Page 484
Which of the following is an accurate statement regarding the role of PSG in patients with chronic obstructive pulmonary disease (COPD)?......Page 485
A 45-year-old male patient presents to your clinic with a history of loud snoring and apnea spells witnessed by his wife. He also complains of EDS. Physical exam is.........Page 486
All of the following statements related to the use of actigraphy are true except:......Page 487
Answers......Page 488
References......Page 495
Questions......Page 497
Answers......Page 504
References......Page 515
Valuable Resources......Page 517
International Sleep Organizations......Page 518
Current Physician Sleep Medicine Fellowships Fall 2006......Page 519
Pickwick Postdoctoral Fellowship......Page 523
Patient Educational Materials......Page 524
EEG Recording Criteria......Page 526
Stage Wake......Page 528
Stage 2 NREM......Page 529
Stages 3 and 4 NREM Sleep......Page 530
Stage REM Sleep......Page 531
Stage Movement Time......Page 532
EEG Arousals, Random Body Movements, or Movement Arousal......Page 533
Bibliography......Page 539
Normal ECG parameters......Page 540
Step 1. Examine the P Wave......Page 541
Common atrial arrhythmias......Page 542
Ventricular arrhythmias......Page 546
Recording and monitoring techniques......Page 548
Further Reading......Page 555
A
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C
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E
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I
......Page 559
M
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P
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R
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S
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V
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Z
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