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Sleep Medicine Pearls, Second Edition FREE TO VIEW

Naim S. Bashir
Chest. 2004;125(1):357-358. doi:10.1378/chest.125.1.357
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By Richard B. Berry, MD. Philadelphia, PA: Hanley & Belfus, 2002; 388 pp; $45.00

The theme of Sleep Medicine Pearls, Second Edition is similar to that of the original edition, although much has been added in this iteration. The format is consistent with the usual “Pearls” series approach: case-based questions that arise during sleep disorders practice are used to illustrate the important concepts and controversies that prevail in this field of medicine. Figures, tracings, tabulated data, and detailed explanations in the form of answers to these questions enhance the knowledge base of the reader. Key points, termed clinical pearls, that underlie important concepts are restated at the end of each case. References relating to each of the topics discussed are provided for those interested in a more thorough review of the topic. At the end, Appendices I, II, and III respectively summarize the classification of sleep disorders, the characteristics of each stage of sleep, and tabulate the causes of insomnia and of excessive daytime sleepiness. These appendices, and the glossary that follows, give the reader new to the field of sleep medicine a quick grasp of the nomenclature and aid in the interpretation of the preceding chapters.

The field of sleep medicine encompasses many disciplines, and today’s sleep specialists come from varied specialties, including pulmonology, neurology, psychiatry, otolaryngology, internal medicine, pediatrics, psychology, and dentistry. Nevertheless, arguably the most significant impact on public health stems from sleep-related breathing disorders. Significant complications of these disorders include excessive daytime sleepiness that may cause automobile and other accidents, and elevated cardiovascular and cerebrovascular risk. The presence of these known complications and associations magnifies the need for an in-depth understanding of the diagnosis and management of these disorders irrespective of the sleep specialist’s primary discipline. In keeping with this need, the book dedicates numerous case discussions to the diagnosis and management of sleep-disordered breathing. Important additions in this edition include a discussion on monitoring of respiration during sleep, along with current controversies in this area. The need for assessment of airflow limitation, as with the use of nasal pressure monitoring, is reviewed along with use of auto-titrating continuous positive airway pressure. The newly adopted Medicare definition of hypopnea is compared with other definitions and reviewed along with Medicare guidelines for continuous positive airway pressure reimbursement. The Maintenance of Wakefulness Test is now being required by a number of agencies to assess the ability of an individual to stay awake during various critical tasks, and this is reviewed in the second edition along with the traditional Multiple Sleep Latency Test.

Pediatric sleep-disordered breathing, related behavioral problems, and the treatment of pediatric sleep-related breathing disorders with adenotonsillectomy are also reviewed, but not in the depth I would have liked. This disorder is being recognized as having a prevalence similar to that in the adult population but with significant long-term impact developmentally and in school performance, and thus would seem to merit a stronger presence in this and future editions. New case-based questions and the grouping of questions under separate subsections have lead to a better overall organization. Modafinil as the first line of therapy for the management of excessive daytime sleepiness in narcolepsy is discussed in this edition, as are cases that help in the recognition of nocturnal seizures.

Sleep Medicine Pearls, Second Edition represents a significant improvement over the first edition of the text, which was itself a worthy addition to the sleep literature. The case-based approach with pertinent concise reviews provide a practical way for sleep specialists with varied previous exposures to understand the essentials involved in the practice of sleep medicine. The text not only educates the novice concerning the fundamentals of sleep medicine, but also can update the seasoned practitioner with respect to changes and controversies that have evolved in the field over the last few years.




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