From The New England Journal of Medicine, December 28, 2000
Principles and Practice of Sleep Medicine encompasses the pathophysiology, diagnosis, and treatment of disorders resulting from disruptions of the sleep-wake cycle and circadian rhythm. This is a relatively new area for medical practice. Some 50 years ago, rapid-eye-movement (REM) sleep was discovered by Eugene Aserinsky and Nathaniel Kleitman at the University of Chicago, and 25 years ago the first clinical center for sleep disorders in the United States was established in the department of psychiatry at Stanford University. Now, the obstructive sleep apnea syndrome, the restless-legs syndrome, and narcolepsy are recognized as common diseases requiring clinical resources and attention. Disorders such as insomnia (abnormal initiation and maintenance of sleep) or parasomnias (abnormal motor movements during sleep) have firm foundations in systems neuroscience research. A National Institutes of Health (NIH) program, the National Center for Sleep Disorders Research (http://rover.nhlbi.nih.gov/about/ncsdr/ index.htm), was mandated by Congress in 1993 to assess intraagency research, propose and facilitate a research agenda, transfer technical information, and educate physicians and the public about sleep, chronobiology, and related disorders. The fiscal year 2000 estimate of NIH funding for this field was $133 million. This third edition of Sleep Medicine is by far the best in regard to editorial oversight, writing, and presentation. The attempt to bring together the ideas and the facts underlying the recognition and management of sleep disorders was successful. Disorders of interest to other specialty areas -- sleep apnea and pulmonary medicine, insomnia and psychiatry or psychology, and narcolepsy and neurology -- are covered in sufficient detail to satisfy knowledgeable clinicians in those specialties. Pediatric conditions, however, are covered in a separate publication (Richard Ferber and Meir Kryger, eds. Principles and Practice of Sleep Disorders in Children. Philadelphia: W.B. Saunders, 1995). Certain sections, such as those on sleep-disordered breathing, narcolepsy, and insomnia, have improved incrementally with each edition. However, other sections, such as those on chronobiology and disorders of circadian rhythm and on cardiovascular disease, are far better now than in previous editions in regard to scope, basic science, and relevance to patient care. The information and references are as up to date as those in a textbook can be; even the breaking story of hypocretin (orexin) is discussed in a short paragraph on the pathogenesis of narcolepsy. Many of the chapters conclude with a short synopsis or conclusion section, something that I appreciated as a mnemonic device; these sections could be read first to orient the more casual or novice reader. Clinical epidemiology is a relatively new concept for sleep medicine. As a result, those looking for evidence-based medicine or comparisons of treatment outcomes for common disorders -- sleep apnea, restless legs, and insomnia -- will find what little information is currently available. The need to incorporate formal approaches to recognition and treatment is acknowledged, as is the hope that such data will help overcome some of the prejudices (and ignorance) encountered in discussions of sleep disorders in teaching programs and in primary care. A strategy for recognizing the high prevalence of sleep disorders and achieving the goal of better sleep might result in improved outcomes for both patients and doctors. This is, first of all, a textbook that is essential for trainees in sleep medicine and a standard reference for centers that see patients with sleep disorders. Yet the presentation and information will also be useful to those studying pulmonary medicine and neurology, in which knowledge of sleep disorders is a required component of training programs approved by the Accreditation Council on Graduate Medical Education. The book could be a useful consultative tool for psychiatry, internal-medicine, and psychology training programs, as sleep problems and disorders are commonly encountered in the treatment of patients. For neuroscience programs, it could provide students and faculty with a concise review of the clinical problems and disorders relevant to basic-science research in sleep and circadian biology. Kingman P. Strohl, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

ANNOTATION

The book contains black-and-white illustrations.

FROM THE PUBLISHER

Kryger, Meir H., MD, FRCPC(Univ of Manitoba); Roth, Thomas, PhD(Univ of Michigan); Dement, William C., MD, PhD(Stanford Univ)

FROM THE CRITICS

Howard M. Kravitz

This is an updated and expanded edition of a major textbook of sleep medicine, first published in 1989. Its 16 sections comprise two major parts, normal sleep and abnormal sleep (i.e., disorders of sleep). The purpose of this new edition is to provide a text that reflects changes that have occurred in the knowledge base in sleep medicine and related developments in diagnostic and therapeutic practices. This worthy objective was not uniformly met; a number of chapters provided minimal evidence of real substantive change. The primary audience is any medical specialist who has an interest in sleep disorders. The first part of the book reviews normal sleep and covers the basic science of sleep for the clinician whose medical education was deficient in these areas or whose past knowledge has become outdated. The second part covers diagnostic and therapeutic aspects of sleep problems that clinicians are likely to see regardless of their specialty. Though the book is aimed at and written by specialists (a veritable who's who in sleep medicine), the material definitely is accessible to primary care physicians. This is a very readable and well-illustrated text. The print quality of the figure legends is improved from the first edition. Chapter references indicate inconsistent updating; some chapters show comparatively few references from the l990s, and others have been extensively revised and expanded. Notable updates include new chapters on dental appliances for snoring and sleep apnea (excellent quality photos and tables), epidemiology, the new classification system, and a new section on psychiatric disorders; pediatric sleep disorders will be covered in a companion volume. This updated bookremains an excellent reference source as well as a primary text. Its major audience will be sleep medicine specialists. Its cost may be a deterrent. Libraries should definitely carry it as a reference volume, and bookstores should carry it.

Ruzica K. Ristanovic

This edition is updated and expanded (previous editions were published in 1989 and 1994). Although the format, which consists of two major sections, Normal Sleep and Abnormal Sleep, has not changed, some chapters are artfully re-organized. Also, new chapters and contributors have been added. The most comprehensive and state-of-the-art information is presented in this enhanced and enriched updated edition. The purpose is to summarize data and ideas that have been previously published in single publications or specialized textbooks, and enable readers to learn about the basic science of sleep, such as comparative physiology of sleep, physiology and pharmacology of sleep mechanisms, chronobiology etc., as well as the clinical practice of sleep medicine such as recognition, diagnosis, and management of various sleep disorders. This is a reference for the wide spectrum of professionals practicing sleep medicine (neurologists, psychiatrists, psychologists, otorhinolaryngologists, pulmonologists, pediatricians, general practitioners, etc.) as well as neuroscientists and others with an interest in sleep medicine and/or sleep research. This edition differs significantly from the first and second editions. There is an increased number of chapters, introduction of new topics, and new contributors. This dramatic change is a reflection of substantial progress in the field of sleep medicine. The best feature of the book is comprehensive coverage of a particular topic, which is evidence-based, up-to-date, and provided by experts in particular fields. An additional and unique feature is an appendix on Sleep Medicine on the World Wide Web. This third edition represents a superb synthesis of thebasic science and clinical sleep medicine. It is well organized into two major sections in which the topics of scientific and clinical significance are addressed. The editors lead this major endeavor extremely successfully. They contribute significantly to the quality of the book by guiding organization of the sections, chapters, and the style of presentation of different materials, which results in the homogeneity of the chapters written by different authors. This book is a reflection of the growth of the field of sleep medicine. It is the best and the most comprehensive reference book in the field and will continue to be an invaluable source of information and inspiration for diverse medical professionals from a medical student to a sleep specialist.

Doody Review Services

Reviewer: Howard M. Kravitz, DO, MPH, ABSM (Rush-Presbyterian-St. Luke's Medical Center)Description: This is an updated and expanded edition of a major textbook of sleep medicine, first published in 1989. Its 16 sections comprise two major parts, normal sleep and abnormal sleep (i.e., disorders of sleep). Purpose: The purpose of this new edition is to provide a text that reflects changes that have occurred in the knowledge base in sleep medicine and related developments in diagnostic and therapeutic practices. This worthy objective was not uniformly met; a number of chapters provided minimal evidence of real substantive change. Audience: The primary audience is any medical specialist who has an interest in sleep disorders. The first part of the book reviews normal sleep and covers the basic science of sleep for the clinician whose medical education was deficient in these areas or whose past knowledge has become outdated. The second part covers diagnostic and therapeutic aspects of sleep problems that clinicians are likely to see regardless of their specialty. Though the book is aimed at and written by specialists (a veritable who's who in sleep medicine), the material definitely is accessible to primary care physicians. Features: This is a very readable and well-illustrated text. The print quality of the figure legends is improved from the first edition. Chapter references indicate inconsistent updating; some chapters show comparatively few references from the l990s, and others have been extensively revised and expanded. Notable updates include new chapters on dental appliances for snoring and sleep apnea (excellent quality photos and tables), epidemiology, the new classification system, and a new section on psychiatric disorders; pediatric sleep disorders will be covered in a companion volume. Assessment: This updated book remains an excellent reference source as well as a primary text. Its major audience will be sleep medicine specialists. Its cost may be a deterrent. Libraries should definitely carry it as a reference volume, and bookstores should carry it.

RATING

4 Stars! from Doody

ACCREDITATION