CRC SLP APN: PATHGNS DIAG TREAT PDF

PREFACE

This book represents another step forward in the study of a common disorder, obstructive sleep apnea. Since the original description of the disorder by Gastout et al. in 1965 (1), much has been learned. We have recognized how common the disorder is based on landmark studies such as that by Young et al. from the Wisconsin Sleep Cohort (2). We have learned a lot about the consequences of obstructive sleep apnea and there is growing interest in its role as a risk factor for cardiovascular disease (3). Chapters in this book indicate our growing knowledge about the biomechanics of the upper airway, upper airway structures, and the complex neurobiology that underlie the sleep-related decrements in the activity of the relevant upper airway muscles (4) and the neurobiology of arousal. Moreover, we are beginning to study the genetics of the disorder and finding evidence of family aggregation (5). Fortunately, with growing awareness of the high prevalence of this disorder and its important consequences, new treatments have become available. Foremost among these is the use of nasal continuous positive airway pressure (6). However, none of the currently available treatments is ideal, and the search continues for new treatment approaches, some of which are modifications of those currently available, while others are more forward-looking but not yet attainable. All of these issues are covered in chapters in this book. Our constantly improving knowledge generated by science has firmly established obstructive sleep apnea as a major common disorder (7) and is overcoming the skepticism of our colleagues in other areas of medicine.

The research and conclusions presented in this volume would not have been possible without the leadership of the National Heart, Lung and Blood Institute (NHLBI) at the National Institutes of Health. In 1988, at a time when skepticism about this disorder was high, the Institute took the bold step of establishing the Special Centers of Research in Cardiopulmonary Disorders of Sleep. The Institute has continued its strong support of sleep research and, with the establishment of the National Center for Sleep Disorders Research (NCSDR), has continued to facilitate new scientific developments in this field.

Thus this book owes a great debt of gratitude to Dr. Claude Lenfant, Director of NHLBI; Dr. James Kiley, founding Director of NCSDR; and Dr. William Dement, whose leadership of the National Commission on Sleep Disorders Research (8) facilitated the establishment of the NCSDR. Their contributions have been invaluable to the millions of patients who have obstructive sleep apnea.

At a more local level, I wish to thank my longtime Administrative Assistant, Daniel C. Barrett, whose great efforts made publication of this book possible. I also thank my wonderful colleagues in the Center for Sleep and Respiratory Neurobiology at the University of Pennsylvania. We have had great fun conducting our research together as a collegial group of scholars. Many of them—Richard O. Davies, David F. Dinges, Warren B. Gefter, Andrew Goldberg, Joan C. Hendricks, Leszek Kubin, Richard J. Schwab, Sigrid C. Veasey, and Terri E. Weaver—have contributed chapters to this volume, as have Basil Petrof and Richard Horner, investigators who spent time training with us at the University of Pennsylvania. Finally, I want to thank my understanding wife (Frances), children (the 4 A's), and now grandchildren, who have endured with my workaholic habits.