Master the basics of sleep medicine with this easy to read, award-winning text! Fundamentals of Sleep Medicine, 2nd Edition, by Drs. Richard B. Berry, Mary H. Wagner, and Scott M. Ryals, is an ideal resource for sleep medicine fellows and trainees, sleep technicians, and sleep medicine practitioners as a concise, clinically focused alternative to larger references. Beginning with core content, it then proceeds to information useful for everyday practice—all written in a clear, direct style designed for quick and easy access.
1. Introduction - p. 193 2. Arterial blood gases - p. 193 3. Determinants of PaCO2 - p. 194 4. Apneic threshold - p. 196 5. Brief summary of brainstem centers involved in ventilatory control - p. 199 6. Upper airway muscles - p. 201 7. Tests of ventilatory control and changes during sleep - p. 204 8. Acid-base physiology - p. 206 9. Pulmonary function testing - p. 207 10. Clinical review questions - p. 218 11. Answers - p. 219 12. Suggested reading - p. 220 13. References - p. 220 14. 14. Cardiac monitoring during polysomnography - p. 222 15. 15. Monitoring of limb movements and other movements during sleep - p. 240 16. 16. Polysomnography, home sleep apnea testing, and actigraphy - p. 257 17. Polysomnography—putting it all together - p. 257 18. Indications for polysomnography and home sleep apnea testing - p. 261 19. Polysomnography report and interpretation - p. 266 20. Polysomnography in children - p. 274 21. Home sleep apnea testing (HSAT) - p. 275 22. Actigraphy - p. 288 23. Clinical review questions - p. 293 24. Answers - p. 295 25. Selected references - p. 295 26. References - p. 295 27. 17. Subjective and objective measures of sleepiness - p. 298 28. 18. Obstructive sleep apnea syndrome in adults—diagnosis, epidemiology, variants - p. 320 29. History and definitions - p. 320 30. Adult OSA—diagnostic criteria - p. 320 31. Evaluation of patients - p. 321 32. Epidemiology of adult OSA - p. 328 33. Variants of OSA - p. 330 34. Clinical review questions - p. 339 35. Answers - p. 340 36. Suggested reading - p. 340 37. References - p. 341 38. 19. Pathophysiology of obstructive sleep apnea - p. 344 39. Pathogenesis of upper airway obstruction - p. 344 40. Upper airway activity during apnea and hypopnea - p. 356 41. Gender and OSA - p. 362 42. Arterial oxygen desaturation in OSA - p. 362 43. Endotypes of obstructive sleep apnea - p. 363 44. Clinical review questions - p. 365 45. Answers - p. 366 46. References - p. 366 47. 20. Clinical consequences of obstructive sleep apnea and benefits of treatment - p. 370 48. Introduction - p. 370 49. Pathophysiology of the adverse effects of OSA - p. 370 50. Mortality - p. 372 51. OSA and related cardiovascular disease/effect of CPAP - p. 373 52. Symptom and polysomnography subtypes and cardiovascular risk - p. 377 53. Excessive daytime sleepiness and neurocognitive dysfunction - p. 377 54. Automobile accidents and sleep apnea - p. 378 55. Arterial hypertension - p. 379 56. Pulmonary hypertension (PH) - p. 382 57. Arrhythmias - p. 385 58. Coronary artery disease - p. 388 59. Inflammation, atherosclerosis, thrombosis, and endothelial dysfunction - p. 390 60. Congestive heart failure (CHF) - p. 390 61. Stroke and OSA - p. 391 62. Diabetes and OSA - p. 392 63. Nonalcoholic liver disease - p. 393 64. Erectile dysfunction - p. 393 65. Nocturia - p. 393 66. Clinical review questions - p. 394 67. Answers - p. 395 68. Suggested reading - p. 395 69. References - p. 395 70. 21. Obstructive sleep apnea and obesity hypoventilation syndrome treatment overview - p. 402 71. 22. Medical treatment of obstructive sleep apnea including treatment of residual sleepiness with medications - p. 422 72. 23. Positive airway pressure treatment - p. 441 73. Introduction - p. 441 74. Mechanism of action - p. 441 75. Efficacy of PAP - p. 441 76. Indications for PAP treatment - p. 441 77. PAP technology and device flow and leak - p. 444 78. Basic PAP modes - p. 447 79. AutoBPAP - p. 451 80. Comfort measures - p. 452 81. Mask interfaces - p. 455 82. The importance of leak - p. 457 83. Interventions for PAP side effects - p. 457 84. Adherence—definitions and measurement - p. 460 85. Rates of adherence and factors influencing adherence - p. 461 86. Comorbid insomnia, hypnotics - p. 464 87. PAP titration and autotitration - p. 464 88. Starting PAP treatment without a titration - p. 472 89. Follow-up of the PAP patient/use of device data - p. 474 90. Clinical review questions - p. 478 91. Answers - p. 480 92. Suggested reading - p. 481 93. References - p. 481 94. 24. Advanced PAP modes, NIV titration, and phrenic nerve stimulation - p. 485 95. Introduction to advanced PAP modes - p. 485 96. BPAP-ST, BPAP-T, and BPAP-PC modes - p. 486 97. Importance of the backup rate and inspiratory time - p. 489 98. Choosing Ti and understanding the Ti/Ttot and i:e ratio parameters - p. 489 99. Choosing TiMin, TiMax, trigger sensitivity, and cycle sensitivity (resmed devices) - p. 491 100. Backup rate (BPAP-ST) - p. 494 101. Adaptive servoventilation (ASV) - p. 495 102. Volume assured pressure support - p. 499 103. Choosing the advanced PAP mode (VAPS versus ASV versus BPAP-ST) - p. 504 104. NIV (NPPV) titration and treatment - p. 507 105. Long-term follow-up - p. 513 106. Reimbursement for NIV devices - p. 514 107. Home mechanical ventilators - p. 517 108. Transvenous phrenic nerve stimulation - p. 519 109. Clinical review questions - p. 521 110. Answers - p. 522 111. References - p. 523 112. 25. Oral appliance treatment for obstructive sleep apnea - p. 525 113. 26. Surgical treatment for obstructive sleep apnea - p. 538 114. 27. Pediatric obstructive sleep apnea—diagnosis and treatment - p. 557 115. 28. Sleep and cardiovascular disease - p. 567 116. 29. Sleep and lung disease - p. 581 117. Introduction - p. 581 118. Obstructive ventilatory defect and associated disorders - p. 581 119. Chronic obstructive pulmonary disease - p. 582 120. Overlap Syndrome - p. 597 121. Treatment of Overlap Syndrome - p. 598 122. Asthma - p. 599 123. Clinical review questions - p. 604 124. Answers - p. 604 125. Suggested reading - p. 605 126. References - p. 605 127. 30. Central sleep apnea and sleep-related hypoventilation disorders - p. 609 128. Introduction - p. 609 129. Pathophysiology of central sleep apnea - p. 609 130. Hypocapnic central sleep apnea - p. 614 131. Non-hypocapnic CSA and hypoventilation disorders - p. 615 132. OSA, CSA, and complex sleep apnea - p. 615 133. Hypocapnic central sleep apnea disorders - p. 618 134. Non-hypocapnic CSA disorders - p. 632 135. Primary central sleep apnea of infancy - p. 636 136. Primary central sleep apnea of prematurity - p. 636 137. Sleep-related hypoventilation disorders - p. 638 138. Clinical review questions - p. 648 139. Answers - p. 649 140. Suggested reading - p. 649 141. References - p. 650 142. 31. Restless legs syndrome (Willis-Ekbom disease), periodic limb movements in sleep, and periodic limb movement disorder - p. 655 143. Introduction - p. 655 144. Restless legs syndrome - p. 655 145. Periodic limb movements in sleep - p. 663 146. Periodic limb movement disorder - p. 665 147. Treatment of RLS and PLMD - p. 667 148. Clinical review questions - p. 681 149. Answers - p. 682 150. Suggested reading - p. 683 151. References - p. 683 152. 32. Central disorders of hypersomnolence - p. 688 153. Introduction - p. 688 154. Narcolepsy - p. 688 155. Importance of hypocretin neurons - p. 693 156. Idiopathic hypersomnia - p. 707 157. Kleine-Levin syndrome (KLS) - p. 710 158. Hypersomnia due to a medical disorder - p. 711 159. Hypersomnia due to a medication or substance - p. 712 160. Hypersomnia associated with a mental disorder - p. 713 161. Insufficient sleep syndrome and long sleeper - p. 713 162. Clinical review questions - p. 715 163. Answers - p. 716 164. Suggested reading - p. 716 165. References - p. 716 166. 33. Insomnia diagnosis and treatment - p. 720 167. Chronic insomnia disorder (CID) - p. 720 168. Treatment of insomnia - p. 728 169. Pharmacologic treatment of insomnia - p. 733 170. Clinical review questions - p. 743 171. Answers - p. 744 172. Suggested reading - p. 745 173. References - p. 745 174. 34. Circadian rhythm sleep-wake disorders - p. 748 175. Introduction - p. 748 176. Suprachiasmatic nucleus - p. 748 177. Melatonin - p. 748 178. Circadian rhythm sleep-wake disorders - p. 750 179. Markers of circadian phase - p. 750 180. Shifting the circadian rhythms - p. 751 181. Genomics of CRSWD - p. 757 182. Circadian rhythm sleep-wake disorders - p. 759 183. Clinical review questions - p. 776 184. Answers - p. 777 185. References - p. 778 186. 35. Clinical electroencephalography and nocturnal epilepsy - p. 781 187. 36. Parasomnias - p. 806 188. Introduction - p. 806 189. Evaluation of parasomnias - p. 806 190. NREM parasomnias - p. 806 191. Sleep-related eating disorder - p. 812 192. NREM parasomnia in anti-IgLON-5 disease - p. 814 193. Nocturnal epilepsy versus NREM parasomnia - p. 814 194. Sleep-related dissociative disorders - p. 815 195. Parasomnias usually associated with REM sleep - p. 815 196. Other parasomnias - p. 823 197. Isolated symptoms and normal variants - p. 825 198. Clinical review questions - p. 827 199. Answers - p. 828 200. Suggested reading - p. 828 201. References - p. 828 202. 37. Psychiatry and sleep - p. 832 203. Introduction - p. 832 204. Mood disorders and mood episodes - p. 832 205. Depressive disorders - p. 832 206. Bipolar disorders - p. 837 207. Treatment of unipolar depression - p. 840 208. Treatment of bipolar disorders - p. 846 209. Anxiety disorders affecting sleep - p. 848 210. Generalized anxiety disorder - p. 850 211. Posttraumatic stress disorder - p. 850 212. Clinical review questions - p. 852 213. Answers - p. 853 214. Suggested reading - p. 853 215. References - p. 853 216. 38. Sleep and nonrespiratory physiology - p. 856 217. 39. Sleep in medical disorders and pregnancy - p. 874 218. 40. Sleep and neurological disorders - p. 886 219. Glossary - p. e1 220. Index - p. 905
Master the basics of sleep medicine with this easy to read, award-winning text! Fundamentals of Sleep Medicine, 2nd Edition, by Drs. Richard B. Berry, Mary H. Wagner, and Scott M. Ryals, is an ideal resource for sleep medicine fellows and trainees, sleep technicians, and sleep medicine practitioners as a concise, clinically focused alternative to larger references. Beginning with core content, it then proceeds to information useful for everyday practice—all written in a clear, direct style designed for quick and easy access.
1. Introduction - p. 193 2. Arterial blood gases - p. 193 3. Determinants of PaCO2 - p. 194 4. Apneic threshold - p. 196 5. Brief summary of brainstem centers involved in ventilatory control - p. 199 6. Upper airway muscles - p. 201 7. Tests of ventilatory control and changes during sleep - p. 204 8. Acid-base physiology - p. 206 9. Pulmonary function testing - p. 207 10. Clinical review questions - p. 218 11. Answers - p. 219 12. Suggested reading - p. 220 13. References - p. 220 14. 14. Cardiac monitoring during polysomnography - p. 222 15. 15. Monitoring of limb movements and other movements during sleep - p. 240 16. 16. Polysomnography, home sleep apnea testing, and actigraphy - p. 257 17. Polysomnography—putting it all together - p. 257 18. Indications for polysomnography and home sleep apnea testing - p. 261 19. Polysomnography report and interpretation - p. 266 20. Polysomnography in children - p. 274 21. Home sleep apnea testing (HSAT) - p. 275 22. Actigraphy - p. 288 23. Clinical review questions - p. 293 24. Answers - p. 295 25. Selected references - p. 295 26. References - p. 295 27. 17. Subjective and objective measures of sleepiness - p. 298 28. 18. Obstructive sleep apnea syndrome in adults—diagnosis, epidemiology, variants - p. 320 29. History and definitions - p. 320 30. Adult OSA—diagnostic criteria - p. 320 31. Evaluation of patients - p. 321 32. Epidemiology of adult OSA - p. 328 33. Variants of OSA - p. 330 34. Clinical review questions - p. 339 35. Answers - p. 340 36. Suggested reading - p. 340 37. References - p. 341 38. 19. Pathophysiology of obstructive sleep apnea - p. 344 39. Pathogenesis of upper airway obstruction - p. 344 40. Upper airway activity during apnea and hypopnea - p. 356 41. Gender and OSA - p. 362 42. Arterial oxygen desaturation in OSA - p. 362 43. Endotypes of obstructive sleep apnea - p. 363 44. Clinical review questions - p. 365 45. Answers - p. 366 46. References - p. 366 47. 20. Clinical consequences of obstructive sleep apnea and benefits of treatment - p. 370 48. Introduction - p. 370 49. Pathophysiology of the adverse effects of OSA - p. 370 50. Mortality - p. 372 51. OSA and related cardiovascular disease/effect of CPAP - p. 373 52. Symptom and polysomnography subtypes and cardiovascular risk - p. 377 53. Excessive daytime sleepiness and neurocognitive dysfunction - p. 377 54. Automobile accidents and sleep apnea - p. 378 55. Arterial hypertension - p. 379 56. Pulmonary hypertension (PH) - p. 382 57. Arrhythmias - p. 385 58. Coronary artery disease - p. 388 59. Inflammation, atherosclerosis, thrombosis, and endothelial dysfunction - p. 390 60. Congestive heart failure (CHF) - p. 390 61. Stroke and OSA - p. 391 62. Diabetes and OSA - p. 392 63. Nonalcoholic liver disease - p. 393 64. Erectile dysfunction - p. 393 65. Nocturia - p. 393 66. Clinical review questions - p. 394 67. Answers - p. 395 68. Suggested reading - p. 395 69. References - p. 395 70. 21. Obstructive sleep apnea and obesity hypoventilation syndrome treatment overview - p. 402 71. 22. Medical treatment of obstructive sleep apnea including treatment of residual sleepiness with medications - p. 422 72. 23. Positive airway pressure treatment - p. 441 73. Introduction - p. 441 74. Mechanism of action - p. 441 75. Efficacy of PAP - p. 441 76. Indications for PAP treatment - p. 441 77. PAP technology and device flow and leak - p. 444 78. Basic PAP modes - p. 447 79. AutoBPAP - p. 451 80. Comfort measures - p. 452 81. Mask interfaces - p. 455 82. The importance of leak - p. 457 83. Interventions for PAP side effects - p. 457 84. Adherence—definitions and measurement - p. 460 85. Rates of adherence and factors influencing adherence - p. 461 86. Comorbid insomnia, hypnotics - p. 464 87. PAP titration and autotitration - p. 464 88. Starting PAP treatment without a titration - p. 472 89. Follow-up of the PAP patient/use of device data - p. 474 90. Clinical review questions - p. 478 91. Answers - p. 480 92. Suggested reading - p. 481 93. References - p. 481 94. 24. Advanced PAP modes, NIV titration, and phrenic nerve stimulation - p. 485 95. Introduction to advanced PAP modes - p. 485 96. BPAP-ST, BPAP-T, and BPAP-PC modes - p. 486 97. Importance of the backup rate and inspiratory time - p. 489 98. Choosing Ti and understanding the Ti/Ttot and i:e ratio parameters - p. 489 99. Choosing TiMin, TiMax, trigger sensitivity, and cycle sensitivity (resmed devices) - p. 491 100. Backup rate (BPAP-ST) - p. 494 101. Adaptive servoventilation (ASV) - p. 495 102. Volume assured pressure support - p. 499 103. Choosing the advanced PAP mode (VAPS versus ASV versus BPAP-ST) - p. 504 104. NIV (NPPV) titration and treatment - p. 507 105. Long-term follow-up - p. 513 106. Reimbursement for NIV devices - p. 514 107. Home mechanical ventilators - p. 517 108. Transvenous phrenic nerve stimulation - p. 519 109. Clinical review questions - p. 521 110. Answers - p. 522 111. References - p. 523 112. 25. Oral appliance treatment for obstructive sleep apnea - p. 525 113. 26. Surgical treatment for obstructive sleep apnea - p. 538 114. 27. Pediatric obstructive sleep apnea—diagnosis and treatment - p. 557 115. 28. Sleep and cardiovascular disease - p. 567 116. 29. Sleep and lung disease - p. 581 117. Introduction - p. 581 118. Obstructive ventilatory defect and associated disorders - p. 581 119. Chronic obstructive pulmonary disease - p. 582 120. Overlap Syndrome - p. 597 121. Treatment of Overlap Syndrome - p. 598 122. Asthma - p. 599 123. Clinical review questions - p. 604 124. Answers - p. 604 125. Suggested reading - p. 605 126. References - p. 605 127. 30. Central sleep apnea and sleep-related hypoventilation disorders - p. 609 128. Introduction - p. 609 129. Pathophysiology of central sleep apnea - p. 609 130. Hypocapnic central sleep apnea - p. 614 131. Non-hypocapnic CSA and hypoventilation disorders - p. 615 132. OSA, CSA, and complex sleep apnea - p. 615 133. Hypocapnic central sleep apnea disorders - p. 618 134. Non-hypocapnic CSA disorders - p. 632 135. Primary central sleep apnea of infancy - p. 636 136. Primary central sleep apnea of prematurity - p. 636 137. Sleep-related hypoventilation disorders - p. 638 138. Clinical review questions - p. 648 139. Answers - p. 649 140. Suggested reading - p. 649 141. References - p. 650 142. 31. Restless legs syndrome (Willis-Ekbom disease), periodic limb movements in sleep, and periodic limb movement disorder - p. 655 143. Introduction - p. 655 144. Restless legs syndrome - p. 655 145. Periodic limb movements in sleep - p. 663 146. Periodic limb movement disorder - p. 665 147. Treatment of RLS and PLMD - p. 667 148. Clinical review questions - p. 681 149. Answers - p. 682 150. Suggested reading - p. 683 151. References - p. 683 152. 32. Central disorders of hypersomnolence - p. 688 153. Introduction - p. 688 154. Narcolepsy - p. 688 155. Importance of hypocretin neurons - p. 693 156. Idiopathic hypersomnia - p. 707 157. Kleine-Levin syndrome (KLS) - p. 710 158. Hypersomnia due to a medical disorder - p. 711 159. Hypersomnia due to a medication or substance - p. 712 160. Hypersomnia associated with a mental disorder - p. 713 161. Insufficient sleep syndrome and long sleeper - p. 713 162. Clinical review questions - p. 715 163. Answers - p. 716 164. Suggested reading - p. 716 165. References - p. 716 166. 33. Insomnia diagnosis and treatment - p. 720 167. Chronic insomnia disorder (CID) - p. 720 168. Treatment of insomnia - p. 728 169. Pharmacologic treatment of insomnia - p. 733 170. Clinical review questions - p. 743 171. Answers - p. 744 172. Suggested reading - p. 745 173. References - p. 745 174. 34. Circadian rhythm sleep-wake disorders - p. 748 175. Introduction - p. 748 176. Suprachiasmatic nucleus - p. 748 177. Melatonin - p. 748 178. Circadian rhythm sleep-wake disorders - p. 750 179. Markers of circadian phase - p. 750 180. Shifting the circadian rhythms - p. 751 181. Genomics of CRSWD - p. 757 182. Circadian rhythm sleep-wake disorders - p. 759 183. Clinical review questions - p. 776 184. Answers - p. 777 185. References - p. 778 186. 35. Clinical electroencephalography and nocturnal epilepsy - p. 781 187. 36. Parasomnias - p. 806 188. Introduction - p. 806 189. Evaluation of parasomnias - p. 806 190. NREM parasomnias - p. 806 191. Sleep-related eating disorder - p. 812 192. NREM parasomnia in anti-IgLON-5 disease - p. 814 193. Nocturnal epilepsy versus NREM parasomnia - p. 814 194. Sleep-related dissociative disorders - p. 815 195. Parasomnias usually associated with REM sleep - p. 815 196. Other parasomnias - p. 823 197. Isolated symptoms and normal variants - p. 825 198. Clinical review questions - p. 827 199. Answers - p. 828 200. Suggested reading - p. 828 201. References - p. 828 202. 37. Psychiatry and sleep - p. 832 203. Introduction - p. 832 204. Mood disorders and mood episodes - p. 832 205. Depressive disorders - p. 832 206. Bipolar disorders - p. 837 207. Treatment of unipolar depression - p. 840 208. Treatment of bipolar disorders - p. 846 209. Anxiety disorders affecting sleep - p. 848 210. Generalized anxiety disorder - p. 850 211. Posttraumatic stress disorder - p. 850 212. Clinical review questions - p. 852 213. Answers - p. 853 214. Suggested reading - p. 853 215. References - p. 853 216. 38. Sleep and nonrespiratory physiology - p. 856 217. 39. Sleep in medical disorders and pregnancy - p. 874 218. 40. Sleep and neurological disorders - p. 886 219. Glossary - p. e1 220. Index - p. 905
