Obstructive Sleep Apnea: Diagnosis and Treatment: Diagnosis and Treatment PDF

Preface

I often thought of this mantra during my on-call nights when, as a Stanford sleep medicine fellow, I was awakened from sleep by a technologist informing me that one of the clinic patients had repetitive obstructive apneas with significant oxygen desaturations. The technologist would typically ask, "can I start the patient on CPAP?" Invariably, I would mutter a drowsy "yes," often chiding myself that on the previous day I should have clearly written the respiratory thresholds for starting continuous positive airway pressure on the patient's sleep-study order sheet. This anecdote illustrates the fact that continuous positive airway pressure has become such an important and ubiquitous treatment for obstructive sleep apnea since its development over a quarter century ago. The modern sleep specialist has new diagnostic tools and other treatments, such as upper airway surgery and oral appliances, for patients with obstructive sleep apnea; nevertheless, our field is still in its adolescence with respect to the diagnosis and treatment of obstructive sleep apnea and other sleep disorders.

The reader might wonder why a neurologist is editing a two-volume set of books on obstructive sleep apnea, since it is a sleep-related breathing disorder and would therefore appear to be within the domain of pulmonary physicians. However, besides pulmonologists—neurologists, psychiatrists, internists, pediatricians, and otolaryngologists have entered the field of sleep medicine. Many clinicians now treat patients with sleep disorders on a full-time basis. Sleep medicine has truly become multidisciplinary, and a sleep clinician is expected to diagnose and treat a wide range of sleep disorders, from insomnia to restless legs syndrome, that were previously referred by internists to other specialists.

It is indeed a testament to the ever-increasing knowledge base on obstructive sleep apnea that there is a need for a two-volume set of books on this topic. The first volume, Obstructive Sleep Apnea: Pathophysiology, Comorbidities, and Consequences covers the pathophysiology, comorbidities, and consequences of obstructive sleep apnea, with sections exploring the features, factors, and characteristics of this disorder as well as its associations and consequences. This volume focuses on the diagnosis and treatment of obstructive sleep apnea, and includes a section on special conditions, disorders, and clinical issues. The authors and I have tried to conform the conditions and disorders described in this book to the second edition of the International Classification of Sleep Disorders: Diagnostic & Coding Manual published by the American Academy of Sleep Medicine in 2006, although some terms, such as obstructive sleep apnea syndrome and sleep-disordered breathing, have been retained in a few statements when appropriate. We have also tried to discuss new entities and findings such as complex sleep apnea, oxidative stress, cyclic alternating pattern, and adaptive servo-ventilation. However, given the rapidity with which the area of sleep medicine is advancing, it is highly conceivable that two volumes might not be sufficient to cover the topic of obstructive sleep apnea in just a few short years!

These books could not exist without the excellent contributions of a talented group of international authors; their detailed and comprehensive works are greatly appreciated. I am deeply indebted to the renowned and true pioneers of our field of sleep, William Dement, Christian Guilleminault, Sonia Ancoli-Israel, Chris Gillin, and Allan Rechtschaffen, who served as my mentors through various stages of my career. In all of my endeavors, I can always count on my parents, Samiko and Hiroshi Kushida, to assist me; these books were no exception. I have been very fortunate to serve, along with Dr. Dement, as Principal Investigator of the multicenter, randomized, double-blind, placebo-controlled Apnea Positive Pressure Long-Term Efficacy Study, sponsored by the National Heart, Lung, and Blood Institute of the National Institutes of Health. To date, this is the largest controlled trial funded by the National Institutes of Health in the field of sleep.

This book is dedicated not only to my parents but also to the marvelous core team of the Apnea Positive Pressure Long-Term Efficacy Study, consisting of William Dement, Pamela Hyde, Deborah Nichols, Eileen Leary, Tyson Holmes, Dan Bloch, as well as National Heart, Lung, and Blood Institute officials (Michael Twery and Gail Weinmann), site directors, coordinators, consultants, committee members, key Stanford site personnel (Chia-Yu Cardell, Rhonda Wong, Pete Silva, Jennifer Blair), Data and Safety Monitoring Board members, and other personnel without whom this project could not have functioned in such a meticulous and efficient manner.

It is my sincere hope that the reader will strive to become expert in the field of sleep. Although there is always room for improvement, awareness of sleep disorders by patients, physicians, and the general public is at an all-time high. However, available funding for sleep research and the number of young investigators interested in a career in basic or clinical sleep research are areas that need enhancement. The interested reader can directly contribute to this field in several ways: applying for membership in the American Academy of Sleep Medicine or Sleep Research Society, serving on committees in these organizations, becoming board certified in sleep medicine, submitting a sleep-related grant proposal to the National Institutes of Health, and/or just simply learning more about sleep and its disorders.

Lastly, etched forever in my memory is a sticker posted on the door of Mary Carskadon's former office at Stanford that contained words to live by: "Be alert. The world needs more lerts."