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Fast Facts: Obstructive Sleep Apnea FREE TO VIEW

Lee K. Brown, MD, FCCP
Chest. 2005;128(3):1893-1894. doi:10.1378/chest.128.3.1893
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By Barbara Phillips and Matthew T. Naughton, eds. Oxford, UK: Health Press Limited, 2004; 76 pp; $28.00

As a longstanding practitioner of sleep medicine, one of the more disappointing tasks that I have found associated with my specialty has been the need to educate, not the general public, but rather fellow physicians concerning the basics of sleep disorders and their treatment. In truth, it sometimes seems that more attention is paid to subjects with sleep apnea in the lay press than in medical school and graduate medical education, and consequently the general public at times appears more informed about many of these disorders than their doctors. A concise and accurate text covering one or more of the common sleep disorders could be a particularly welcome addition to the reading list of many non-sleep medicine physicians. I was therefore delighted to receive a copy of Fast Facts: Obstructive Sleep Apnea in a recent shipment of books to be reviewed.

As stated on the back cover, the “Fast Facts” series aims at “keeping you up-to-date with best practice when time is at a premium.” The format for each chapter combines text, figures, tables, photographs, a list called “key facts,” and a list of “key references” into a cohesive array of teaching modalities that is far different from the usual monotony of medical textbooks. The photographs and many of the figures are in full color and beautifully reproduced, and the fonts employed are relatively large and easy on the eyes. A table of contents appears on the front cover, with color-keyed tabs allowing the reader to easily navigate to a chapter of interest. The chapters divide the subject of obstructive sleep apnea into the standard subtopics found in any textbook of clinical medicine: epidemiology and risk factors, clinical presentation, medical complications, diagnosis, medical management, surgical management, and future trends. The authors are well-known scientists and practitioners of sleep medicine who are also sought-after speakers on the subject, not just because of their expertise but also because of their ability to render complex ideas into easily digestible prose. Thus, they represent a particularly ideal choice for authoring a book such as this.

The dangers of simplification can be numerous. One can eliminate controversial topics and present only well-established facts, thus depriving the reader of important, but not completely proven, information. One can present disputed information but not provide sufficient explanation of its controversial nature, or present opinion as fact, so that the reader accepts it as “holy grail.” One can also merely eliminate details that do not seem particularly important to the writer, or seem so self-evident as to not bear repeating, but which then deprives the audience for a simplified text of important material. In general, Fast Facts: Obstructive Sleep Apnea bypasses these potential pitfalls. For the most part, opinion is appropriately confined to the chapter on future trends, and perhaps a bit less appropriately to the introduction. Areas of controversy are generally identified, and a sufficient explanation of the nature of the conflicting facts or weaknesses of the evidence is presented; however, oximetry is accurately identified as an unproven tool in the text but misrepresented in the “key facts” table as being a “useful screening and diagnostic tool.” Some information is omitted that might have best been included: trisomy 21 is presented as a craniofacial risk factor for obstructive sleep apnea in a table, but upper airway morphology only partially explains the very high prevalence of sleep-disordered breathing in this disorder and more detail might have been helpful; the pathogenetic mechanisms presented to explain central sleep apnea in congestive heart failure fail to stress the issue of mild hypoxemia leading to hypocapnia and unstable ventilatory control, so that the clinician may not realize the important role of nocturnal oxygen in treatment; also, the distinction between hypoventilatory and hyperventilatory central sleep apnea could have been stressed, especially given that treatment may differ so radically.

Overall, however, these are minor quibbles indeed. Fast Facts: Obstructive Sleep Apnea serves very well an admirable purpose: to equip the non-sleep practitioner with the tools necessary to make an informed referral for sleep medicine consultation, to understand the reasons behind the diagnostic and treatment decisions made by that consultant, and to recognize when ongoing management of the sleep apnea patient is or is not going well, and thus when to call for help. Fast Facts: Obstructive Sleep Apnea will not convert the generalist into a sleep medicine expert but clearly will make that individual a better, and better-informed, generalist.




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