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Sleep Medicine Pearls FREE TO VIEW

Naim S. Bashir, MD
Chest. 2002;121(2):671. doi:10.1378/chest.121.2.671
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By Richard B. Berry. Philadelphia, PA: Hanley & Belfus, Inc., 1999; 276 pp; $45

The increasing public awareness of the impact that sleep disorders can have on general health has amplified the need for a better understanding of sleep medicine by the medical community. Sleep Medicine Pearls is a welcome addition to the“ pearls” series of books that serves as a concise, practical review of this rapidly developing field. This is a text that can serve as an excellent introduction for those who have little knowledge of sleep medicine, but also as a refresher for those who are already practicing sleep medicine.

The initial chapters focus on helping the reader to understand the basic principles that underlie the collection and assessment of physiologic data during sleep. This is done utilizing illustrative examples that allow the reader to identify the relationships among important variables such as eye movements, chin tone, and sleep processes. The next few chapters focus on rules for sleep staging, the recognition and classification of respiratory events, the use of end-tidal Pco2 levels, and esophageal pressure monitoring. These chapters provide an introduction to polysomnography, multiple sleep latency testing, and the role of these studies in the evaluation of hypersomnolence.

The main body of the book concentrates on the diagnosis and management of obstructive sleep apnea syndrome (OSAS). Here again, the author skillfully uses illustrative case histories followed by a discussion of issues relevant to each case, guiding the reader through the diagnosis and management of obstructive sleep apnea. The usual management options are discussed, including continuous positive airway pressure, weight loss in obese patients, the use of oral appliances, and uvulopalatopharyngoplasty. Case histories help the reader to understand the basis on which these therapies are recommended, their limitations, and strategies for overcoming these limitations. In this section, the author also covers the relevance of and approaches to the treatment of nocturnal hypercapnia and oxyhemoglobin desaturations in patients who are obese or have COPD or restrictive pulmonary disease. The section ends with additional case histories of patients with OSAS complicating other conditions that result in daytime somnolence, such as narcolepsy and periodic limb movement disorder/restless legs syndrome.

The book ends with a chapter on insomnia that introduces the multifactorial nature of insomnia, details the features essential to insomnia history-taking, and presents a brief discussion of other sleep disorders that can lead to the development of insomnia, such as periodic limb movement disorder. Continuing the “pearls” format, illustrative case histories lead to discussions of psychophysiologic insomnia and reversed first-night effect, environmental sleep disorder, and sleep-state misperception. Sleep hygiene issues, biofeedback, meditation, and the roles of exercise and stimulus control therapy are also briefly discussed in this section. The menu of case discussions ends with circadian rhythm disorders and their management, and the relationships between sleep and depression.

The 101 illustrative cases reviewed in Sleep Medicine Pearls shed light on the diagnosis and management of a wide spectrum of sleep disorders. The breadth of information that the author has managed to squeeze into this unique member of the “pearls” series makes this volume appealing to a wide audience as both an introductory text and a reference tool.




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