Offering a practical approach to the introduction of sleep medicine, this easy-to-use, concise volume uses actual patient cases from the Cleveland Clinic Sleep Disorders Center. A wide spectrum of diagnoses are included to expose the reader to the extensive range of sleep-wake disorders that a patient can experience. Written in a concise format designed to illustrate the signs and symptoms, diagnostic criteria, workup and routine treatment of patients presenting to the sleep clinic, this volume serves as a practical text perfect for the busy primary-care practitioner seeking to improve her knowledge of sleep-wake disorders. Whenever possible, tracings from diagnostic tests, photography, and video clips are provided to enhance clinical presentations and to aid in recognition of abnormities identified in the sleep laboratory.
Nancy Foldvary-Schaefer, D.O. Director Cleveland Clinic Sleep Disorders Center Neurological Institute Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Kumar Budur, MD Cleveland Clinic Sleep Disorders Center Neurological Institute Department of Psychiatry Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Jyoti Krishna, MD Head, Pediatric Sleep Disorders Cleveland Clinic Sleep Disorders Center Neurological Institute Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Table of Contents Introduction to the Sleep Clinic N. Foldvary-Schaefer, K Budur, J. Krishna (lead K. Budur) (emphasis on provider and patient diversity; behavioral and group therapy clinics; special exam rooms: ENT/on-site blood draws, Utox screening, etc) Video of sleep clinics Introduction to the Sleep Laboratory N. Foldvary-Schaefer, K Budur, J. Krishna (lead J. Krishna) (emphasis on instrumentation, variety of hook-ups and studies and hotel labs) Video of sleep lab Insomnia (Section Head : K. Budur) 1. Psychophysiological Insomnia V. Luppa (emphasis on diagnosis and pharmacological management) K. Budur 2. Psychophysiological Insomnia M. Drerup (emphasis on non-pharmacological management) Consider video quiz for poor sleep hygiene, "what's wrong with this bed room" 3. Insomnia Due to Mental Disorder K. Ashton (emphasis on Depression/ Anxiety and Insomnia) K. Budur 4. Behavioral Insomnia of Childhood M. Richards (emphasis on limit setting/sleep onset association and behavioral interventions) 5. Paradoxical Insomnia M. Zaharna K. Budur 6. Insomnia Due to Medical Condition K. Adury (emphasis on fibromyalgia/pain and K. Budur common medical conditions associated with Insomnia) Sleep-Related Breathing Disorders (Section Head: N. Foldvary-Schaefer) Central Sleep Apnea Syndromes 7. Primary Central Sleep Apnea H. Mermingis (emphasis on diagnosis and different treatment options) Z. Alsheikhtaha 8. Central Sleep Apnea Due to Cheyne Stokes Breathing Pattern I. Sriubiene Consider video of a patient S. Baccaray N. Foldvary-Schaefer 9. Central Sleep Apnea Due to Medical Condition not CSR B. Cohen J. Krishna 10. Complex Sleep Apnea H. Mermingis (emphasis on diagnosis and ASV) Z. Alsheikhtaha Obstructive Sleep Apnea Syndromes 11. OSA, Adult- Use of portable monitoring and screening tools for OSA S. Baccaray (emphasis on standard signs and symptoms of OSA in adults N. Andrews and indications/contra-indications for PM) N. Foldvary-Schaefer Consider video of a patient: hook-up 12. OSA, Adult Challenging PAP - Behavioral strategies W. Novak (emphasis on PAP treatments and need for behavioral J. Sliwinski interventions: desensitization in challenging cases, etc) Consider video of a patient with CPAP desensitization 13. OSA, Adult - Obesity/Metabolic Syndrome/Bariatric surg /Perioperative Issues R. Kaw Consider a photograph and hypnogram pre and post C. Bae bariatric surgery 14. OSA, Adult - Craniofacial anomaly/ Mandibular Advancement S. Ibrahim Consider video of a patient with craniofacial anomaly and R. Armstrong components of a good ENT exam 15. Adult OSA -Upper airway surgery A. Kominsky (emphasis on patient selections, interventions, success rates) Consider video 16. Pediatric OSA - Supraglottoplasty R. Seth (emphasis on surgery for pediatric OSA) J. Krishna P. Krakovitz Consider video of a laryngoscopy/surgery 17 Pediatric OSA - Severe OSA -Urgent assessment J. Krishna (emphasis on pediatric OSA and identifying high risk patients) J. Sciuva 18. OSA - PAP interfaces L. Aboussuan (emphasis on mechanical problems) Z. Zahand Consider video of mask fitting P. Podmore 19. Pediatric OSA - Obesity J. Krishna (emphasis on metabolic syndrome in peds) J. Sciuva 20. OSA- oral appliances F. Sreshta Consider video of different oral appliances, fitting, etc Sleep-Related Hypoventilation/Hypoxemic Syndromes 21. Sleep-Related Hypoventilation/Hypoxemia Due to Pulmonary Parenchymal or Vascular Pathology N. Jaimchariyatam O. Minai 22. Sleep-Related Hypoventilation/Hypoxemia Due to Lower Airways Obstruction - Overlap Syndrome N. Jaimchariyatam O. Minai 23. Sleep-Related Hypoventilation/Hypoxemia Due to Neuromuscular and Chest Wall Disorders (Pompe's disease) (emphasis on timing of sleep study and management) L. Aboussuan Consider video N. Jaimchariyatam J. Krishna Hypersomnias of Central Origin Not Due to a Circadian Rhythm Sleep Disorder, Sleep-Related Breathing Disorder, or Other Cause of Disturbed Nocturnal Sleep (Section Head: J. Krishna) 24. Narcolepsy with cataplexy C. Griffin (emphasis on diagnosis of narcolepsy, MSLT S. Neme interpretation, and treatment of narcolepsy) N. Foldvary-Schaefer Consider video 25. Narcolepsy Due to Medical Condition R. Valentino (emphasis on differential diagnosis of hypersomnia and F. Talih medical conditions that cause narcolepsy) 26. Klein-Levin Syndrome C. Brooker (emphasis on KLS and other recurrent hypersomnias) P. Kotagal 27. Idiopathic Hypersomnia With/Without Long Sleep Time K. Budur (emphasis on management of hypersomnia; discuss MWT) N. Jaimchariyatam 28. Behaviorally Induced Insufficient Sleep Syndrome K. Budur (emphasis on consequences of sleep deprivation) N. Jaimchariyatam 29. Hypersomnia due to Drugs J. Sciuva (emphasis on preparation for MSLT: stop meds; Utox) K. Budur J. Krishna Circadian Rhythm Sleep Disorders (Section Head: K. Budur) 30. Circadian Rhythm Sleep Disorder, DSPS C. Rodriguez (emphasis on differential diagnosis of hypersomnia) 31. Circadian Rhythm Sleep Disorder, DSPS W. Novak (emphasis on actigraphy, treatment) Consider video of actigraphy and light therapy 32. Circadian Rhythm Sleep Disorder, Shift Work Disorder K. Budur (emphasis on SCN, core body temperature) 33. Circadian Rhythm Sleep Disorder, Jet Lag Type W. Novak (emphasis on circadian misalignment, FAA recommendations) Parasomnias (Section Head: N. Foldvary-Schaefer) Disorders of Arousal (From NREM Sleep) 34. Confusional Arousals - Sleepwalking A. Roy (emphasis on prevalence of arousal disorders, overlap in S. Neme presentation, provoking factors, and treatment) N. Foldvary-Schaefer Consider video 35. Sleep Terrors A. Irwin (emphasis on differential diagnosis and treatment) J. Krishna Consider video Parasomnias Usually Associated with REM Sleep 36. REM Sleep Behavior Disorder S. Neme (emphasis on diagnosis and treatment/safety measures) A. Avidan Consider video 37. RBD (pseudo RBD) C. Rodriguez (emphasis on differential diagnosis, impact of treating other sleep disorders) Consider video Other Parasomnias 38. Sleep Enuresis J. Krishna (emphasis on differential diagnosis, work up, role of sleep expert) J. Sciuva 39. Sexsomnia C. Brooker N. Foldvary-Schaefer 40 Sleep-Related Eating Disorder S. Baccaray N. Foldvary-Schaefer 41. Sleep-Related Groaning (Catathrenia) M. Grigg-Damberger Consider video N. Foldvary-Schaefer Sleep-Related Movement Disorders 42. Restless Legs Syndrome J. Lee (emphasis on diagnosis and treatment including augmentation) C. Bae Consider video 43. Restless Legs Syndrome L. L. Lim (emphasis on workup; secondary RLS) Ai Ping Chua N. Foldvary-Schaefer 44. Periodic Limb Movement Disorder F. Zarrouf (emphasis on scoring leg movements; etiology of PLMS) K. Budur Consider video 45. Hypnogenic Foot Tremor S. Ibrahim (emphasis on differential diagnosis) R. Valentino Consider video Sleep Disorders Associated with Other Conditions 46. Sleep-related epilepsy S. Neme (emphasis on frontal lobe epilepsy mimicking parasomnia) N. Foldvary-Schaefer Consider video 47. VNS, epilepsy and apnea J. Fong (emphasis on PSG findings) C. Bae Consider video K. Yang N. Foldvary-Schaefer 48. Continuous Spike Wave in Sleep (CSWS) T. Loddenkemper Consider video P. Kotagal 49. Parkinson's disease J. Vensel (emphasis on sleep in PD: hypersomnia, RBD, RLS) C. Rodriguez Consider video showing multiple sleep manifestations a in PD patient 50. Dementia with CRD W. Novak (emphasis on sleep in the aged; ASPS, Irregular SW cycle) 51. Headache D. Rothner (emphasis on multidisciplinary approach, specifically role of sleep specialist) 52. Stroke M. Alattar (emphasis on sleep in stroke patients: central apneas, hypersomnolence, etc) J. Lee-Iannotti