Essentials of Sleep Medicine: A Practical Approach to Patients with Sleep Complaints (Respiratory Medicine)

This book provides an overview of sleep and sleep disorders for practicing clinicians. Sleep disorders represent a major portion of the chief complaints seen by pulmonologists and other clinicians. Patients with sleep-related conditions often present with non-specific complaints that require a broad and detailed knowledge of the wide range of sleep disorders and their consequences. This concise, evidence-based review of sleep medicine offers a guide to pulmonologists, primary care physicians, and all clinicians involved in caring for patients with sleep disorders. Providing a focused, scientific basis for the effects of sleep on human physiology, especially cardiac and respiratory physiology, chapters also outline a differential diagnosis for common sleep complaints and an evidence-based approach to diagnosis and management. This includes a review of the current standards of practice and of emerging technology and unresolved issues awaiting further research. In all, this book provides a clear diagnostic and management program for all the different sleep disorders and includes key points and summaries. This new edition expands the scope of the previous to include additional sleep disorders and the most affected populations. Six new chapters are added on health disparities in sleep medicine, models of care for patients with sleep disorders/care coordination, sleep disordered breathing in pediatric populations, sleep in hospitalized patients, sleep in pregnancy, and sleep in older patients. Essentials of Sleep Medicine is an invaluable resource for physicians, clinical psychologists, respiratory care practitioners, polysomnographic technologists, graduate students, clinical researchers, and other health professionals seeking an in-depth review of sleep medicine. Foreword Preface Contents Contributors Part I: Introduction to Sleep Medicine Chapter 1: Normal Sleep Normal Sleep Stages and Architecture Breathing During Sleep: Ventilation and the Upper Airway Summary of Normal Breathing and Ventilation During Sleep Effect of Sleep on Control of Breathing Effect of Sleep on Upper-Airway Structure and Function Cardiovascular Function During Sleep Endocrine Function During Sleep Gastrointestinal Function During Sleep Renal Function During Sleep References Chapter 2: Pharmacology of Sleep Introduction Sleep-promoting Drugs Benzodiazepines Nonbenzodiazepine Receptor Agonists (Non-BzRAs) Melatonin Melatonin Receptor Agonist: Ramelteon Orexin Antagonists: Suvorexant and Lemborexant Antidepressants Antidepressants Used Off-Label Antipsychotic Agents OTC Drugs Wake-promoting Drugs Amphetamines and Methylphenidate Modafinil and Armodafinil Modafinil Efficacy Sodium Oxybate Solriamfetol Pitolisant Novel Drugs in Pipeline Conclusion References Chapter 3: Sleep Health among Racial/Ethnic groups and Strategies to achieve Sleep Health Equity Introduction Prevalence and Burden of Poor Sleep Health Sleep Duration Sleep Disorders Chronotype and Circadian Rhythms Sleep Architecture Sleep Efficiency Sleep Quality and Sleepiness Causes of Poor Sleep Health Biological Causes Psychosocial Causes Physical and Built Environment Causes Health Consequences of Poor Sleep Health Conclusion References Chapter 4: The Future of Sleep Medicine: A Patient-Centered Model of Care A Patient-Centered Model of Sleep Care Primary Care and Broader Medical Community Collaboration (Point A) Non-Sleep Specialty Care Collaboration (Point B) Development of Sound Screening Protocols (Point C) Leverage Telemedicine (Point D) Putting It All Together References Part II: Sleep Disordered Breathing Chapter 5: Obstructive Sleep Apnea: Clinical Epidemiology and Presenting Manifestations Introduction Population Epidemiology Office Epidemiology Sleep Medicine Practices OSA in Medical, Neurologic, and Psychiatric Disorders Sleep Detection and Gaps in Knowledge References Chapter 6: Obstructive Sleep Apnea: Diagnosis with Polysomnography and Portable Monitors Introduction Prevalence and Epidemiology Risk Factors Clinical History Physical Exam Diagnosis of OSA Overnight Polysomnography (PSG) Reduction of Nasal Pressure Signal ≥30% and Oxygen Desaturation ≥4% Split Night Study (Diagnosis Combined with Titration) Portable Monitoring (PM) Types of PMs (Type II–IV) When Should PM Be Considered for Diagnosis of OSA? Current Roles of Autotitrating Positive Airway Pressure (APAP) Cost-effectiveness of PSG vs. PM Utilities of Multiple Sleep Latency Test (MSLT) in OSA Future Outlook Summary Outline References Chapter 7: A Brief Review of Treatment of Obstructive Sleep Apnea PAP Alternatives Oral Appliances Positional Therapy Surgery Maxillomandibular Advancement (MMA) Uvulopalatopharyngoplasty (UPPP) Laser-Assisted Uvuloplasty (LAUP) Radiofrequency Therapies Multilevel Surgery Hypoglossal Nerve Stimulation (HNS) Conclusion References Chapter 8: Central Sleep Apnea: Pathophysiology and Clinical Management Determinants of Central Apnea During NREM Sleep Hypocapnia Short-Term Potentiation Duration of Hyperpnea Role of Upper Airway Reflexes Mechanisms Perpetuating Breathing Instability Pathophysiologic Classification of Central Sleep Apnea Central Sleep Apnea Secondary to Hypoventilation Central Apnea Secondary to Hyperventilation Central Apnea Risk Factors Sleep State Age and Gender Medical Conditions Clinical Features and Diagnosis Management Positive Pressure Therapy Pharmacological Therapy Supplemental O2 and CO2 Transvenous Phrenic Nerve Stimulation A Suggested Approach References Chapter 9: Sleep and Hypoventilation General Introduction Normal Sleep Breathing Compensatory Mechanisms in Hypoventilation Syndromes Identifying and Defining Sleep Hypoventilation Daytime Measures to Identify Sleep Hypoventilation Nocturnal Monitoring to Identify Sleep Hypoventilation Disease-Specific Issues in Sleep Hypoventilation Obesity Hypoventilation Syndrome Neuromuscular Disorders COPD Summary References Chapter 10: Perioperative Care of Patients with Obstructive Sleep Apnea Syndrome Introduction Epidemiology and Risk Factors for OSA Postoperative Risks Associated with OSA Preoperative Evaluation Preoperative Risk Assessment and OSA Screening Protocols Preoperative Screening for Suspected OSA The Berlin Questionnaire The American Society of Anesthesiologists’ Checklist The STOP Questionnaire The STOP-Bang Model Sleep Apnea Clinical Score Preoperative Screening in Suspected OSA Preoperative Screening in Known OSA Preoperative OSA Treatment Intraoperative OSA Management Tracheal Intubation Choice of Anesthetics/Anesthetic Technique Extubation Postoperative OSA Management Postoperative Pain Control Postoperative Monitoring Oximetry Capnography Management Algorithms PACU Postoperative Use of Positive Airway Pressure Positive Airway Pressure and Postoperative Risk Reduction Conclusion References Chapter 11: Sleep-Disordered Breathing (SDB) in Pediatric Populations Introduction Obstructive Sleep Apnea and Obstructive SDB in Children and Teens [1–4] Differences Between OSA Presentation Between Children and Adults Association with Obesity Special Populations at Higher Risk for OSA and Obstructive SDB [23–30] Down’s Syndrome [31–34] Prader–Willi Syndrome [36–42] Craniofacial Abnormalities [24, 26] Pierre Robin Sequence Cleft Lip/Palate [43] Craniosynostosis Treacher Collins Syndrome Skeletal Dysplasias [44–46] Sickle Cell Disease [48, 49] Neuromuscular Diseases Spinal Muscular Atrophy [55, 57–59] Duchenne Muscular Dystrophy [55, 58, 60–63] Myotonic Muscular Dystrophy Storage Diseases Epilepsy and Vagal Nerve Stimulators Disorders Associated with Central Control of Breathing Abnormalities [76–78] Central Sleep Apnea Central Hypoventilation Syndromes [98] CCHS [99–101] ROHHAD [103–106] Familial Dysautonomia [107–109] Rett Syndrome [110–114] Hindbrain Malformations (Chiari I and Spina Bifida) [29, 115] Chiari I [86, 116–121] Chiari II [92, 122–124] CNS Tumors [89] Sleep-Disordered Breathing in Infants [125] Apnea of Prematurity [131–134] Periodic Breathing [139] Apnea of Infancy with Central Apnea [125] Terminology: Apnea of Infancy, ALTE, and BRUE SUID, SIDS and Other Sleep-Related Infant Deaths [151, 152] OSA and oSDB Presenting in Infants [3, 19, 154, 155] Polysomnography and Diagnostic Testing: Special Considerations in Children [161] PSG Interpretation in Pediatrics Accommodating Children in the Sleep Laboratory References Part III: Non-respiratory Sleep Disorders Chapter 12: Diagnosis of Insomnia Disorder Introduction Pathophysiology and Neuropsychology of Insomnia Diagnostic Criteria Clinical Evaluation of Insomnia Disorder Challenges in Insomnia Assessment Identifying Patients to Evaluate for Insomnia Disorder Approach to Assessment of Insomnia Disorder Tools for Assessment of Insomnia Disorder Sleep Diary Differential Diagnosis Treatment Options and Goals Summary References Chapter 13: Management of Insomnia Disorder Management of Insomnia Disorder Behavioral Interventions Behavioral Treatment for Insomnia: Safety Considerations Behavioral Treatments for Insomnia: Considerations for Special Populations Medication Treatments for Insomnia Nutritional Supplements Medication Treatments for Insomnia: Safety Considerations References Chapter 14: Circadian Rhythm Sleep-Wake Disorders Introduction Delayed Sleep-Wake Phase Disorder Prevalence Pathophysiology Clinical Features Diagnosis Treatment Advanced Sleep-Wake Phase Disorder Prevalence Pathophysiology Clinical Features Diagnosis Treatment Non-24-Hour Sleep-Wake Disorder Prevalence Pathophysiology Clinical Features Diagnosis Treatment Irregular Sleep-Wake Rhythm Disorder Prevalence Pathophysiology Clinical Features Diagnosis Treatment Shift Work Disorder Prevalence Pathophysiology Clinical Features Diagnosis Treatment Jet Lag Disorder Prevalence Pathophysiology Clinical Features Diagnosis Treatment Conclusion References Chapter 15: Narcolepsy and Idiopathic Hypersomnia Introduction Clinical Features Narcolepsy Idiopathic Hypersomnia Epidemiology Narcolepsy Idiopathic Hypersomnia Pathophysiology Narcolepsy Idiopathic Hypersomnia Diagnosis Narcolepsy Idiopathic Hypersomnia Differential Diagnosis Excessive Sleepiness Due to Head Trauma Treatment Nonpharmacologic Management Pharmacologic Management of Symptoms Common to Both Narcolepsy and Idiopathic Hypersomnia Pharmacologic Management of Symptoms Specific to Narcolepsy Cataplexy Fragmented Nocturnal Sleep Conclusion References Chapter 16: Non-REM Parasomnias Introduction Non-REM Related Parasomnias Disorders of Arousal Pathology Associated Conditions Diagnosis Management Confusional Arousals Clinical Presentation Epidemiology Pathophysiology Diagnosis Treatment Sleepwalking (Also Known as Somnambulism) Clinical Presentation Epidemiology Pathophysiology/Etiology Diagnosis Treatment Sleep Terrors (Also Known as Night Terrors or Pavor Nocturnum) Clinical Presentation Epidemiology Etiology/Pathophysiology Diagnosis Treatment Sleep-Related Eating Disorder Clinical Presentation Epidemiology Etiology/Pathophysiology Diagnosis Differential Diagnosis Treatment REM-Related Parasomnias REM Sleep Behavior Disorder Clinical Presentation Epidemiology Etiology/Pathophysiology Diagnosis Clinical Approach Treatment Recurrent Isolated Sleep Paralysis Clinical Presentation Epidemiology Etiology/Pathophysiology Diagnosis Treatment Nightmare Disorder Clinical Presentation Epidemiology Etiology/Pathophysiology Diagnosis Treatment Other Parasomnias Exploding Head Syndrome Sleep-Related Hallucinations Sleep Enuresis or Nocturnal Enuresis Approach to Distinguishing Nocturnal Events References Chapter 17: Rapid Eye Movement Parasomnias REM Sleep Behavior Disorder Definition Clinical Features Risk Factors Pathophysiology Epidemiology Diagnostic Workup Differential Diagnosis Treatment Subtypes Status Dissociatus Parasomnia Overlap Recurrent Isolated Sleep Paralysis Definition Clinical Features Risk Factors Pathophysiology Epidemiology Diagnostic Workup Differential Diagnosis Treatment Nightmare Disorder Definition Clinical Features Risk Factors Pathophysiology Epidemiology Diagnostic Workup Differential Diagnosis Treatment References Chapter 18: Movement Disorders Introduction Restless Legs Syndrome Demographics Diagnosis Associated Features Differential Diagnosis Primary Versus Secondary Factors Management Periodic Limb Movement Disorder Demographics Diagnosis Associated Features Differential Diagnosis Management Sleep-Related Leg Cramps Diagnosis Demographics Differential Diagnosis Associated Features Treatment Sleep-Related Bruxism Demographics Diagnosis Differential Diagnosis Associated Features Management Sleep-Related Rhythmic Movement Disorder Demographics Diagnosis Associated Features Differential Diagnosis Treatment Propriospinal Myoclonus at Sleep Onset Diagnosis Demographics Associated Features Differential Diagnosis Treatment Sleep-Related Movement Disorder Due to a Medical Disorder Diagnosis Sleep-Related Movement Disorder Due to a Medication or Substance Diagnosis Conclusion References Part IV: Sleep in Special Conditions Chapter 19: Sleep in Critical Illness Sleep Patterns in the ICU Sleep in Healthy Adults Sleep in Critically Ill Patients Sleep Measurement in the ICU Polysomnography Actigraphy Subjective Measures Causes of Sleep Disruption in the ICU Noise Light Care-Related Interactions Medications Mechanical Ventilation Sleep, Immunity, and Cognition in Critically Ill Patients Sleep and Immunity Sleep Disruption and Cognition Future Directions References Chapter 20: Sleep in Hospitalized Patients Sleep Loss in Adults Sleep Loss in Older Adults Health Effects of Sleep Loss in Hospitalized Patients Barriers to Healthy Sleep in Hospitalized Patients Medical Care Interruptions Environmental Factors Disrupting Sleep Patient Factors Influencing Sleep Prevalence of Sleep Disorders Among Hospitalized Patients Interventions to Improve Sleep in Hospitalized Patients Pharmacologic Melatonin Sleep Initiation and Sleep Maintenance Aids Nonpharmacologic Interventions Relaxation Techniques Bright Light Therapy Noise Reduction Sleep Hygiene Reduction of Nighttime Interruptions Sleep Education and Empowerment Multifaceted Protocols Pain and Sleep Sleep in Hospitalized Patients with Underlying Disorders of Mental Health Hospitalized Older Adults Sleep in the Intensive Care Unit (ICU) Assess and Treat Underlying Sleep Disorders Conclusions References Chapter 21: Sleep in Pregnancy Introduction Sleep in Normal Pregnancy Insufficient Sleep Sleep Quality Insomnia Sleep-Disordered Breathing Restless Leg Syndrome Mechanisms for Cardiovascular Morbidity Treatment Interventions Circadian Rhythm Disruption Maternal Sleep Position Summary References Chapter 22: Sleep in Older Patients Introduction Sleep and Aging Sleep-Disordered Breathing Insomnia Restless Legs Syndrome/Periodic Leg Movements REM Sleep Behavior Disorder Sleep Disturbance among Residents in Long-Term Care Settings References Index