Sleep Apnea: Pathogenesis, Diagnosis, and Treatment

The processes that control respiration differ substantially across the 3 sleep/awake states (awake, rapid eye movement sleep, and non-rapid-eye-movement sleep). This has important implications for clinicians caring for patients with and without underlying cardiopulmonary disease, because we now recognize an array of sleep-related breathing disorders. Some diseases, such as sleep apnea, are sleep/awake state dependent and only occur during sleep. Other diseases, such as obstructive lung diseases and congestive heart failure, are profoundly affected by the sleep state. Also, many respiratory ailments alter the quality of sleep. Given that the prevalence of obstructive sleep apnea (OSA) is second only to asthma among respiratory diseases, it is essential that clinicians understand respiration during sleep. I congratulate the authors of Breathing Disorders in Sleep for meeting their goal of putting together a book that addresses the entire spectrum of sleep-disordered breathing in a fashion that will be of great utility to practicing clinicians who may or may not have special expertise in sleep disorders medicine. Breathing Disorders in Sleep will find a home on the shelves of many different clinicians’ libraries. General pulmonologists who have not had specific training in sleep medicine may be the perfect target audience for this book. They are often called upon to consult on patients who have sleep-related breathing complaints. They will find this an excellent overview of the topic and also a suitable reference when looking for help with a specific problem. It will be an excellent resource for those studying to take the qualifying examination of the American Board of Sleep Medicine. Respiratory therapists and sleep technologists will use the text in the classroom and to study for certification examinations. Medical students and internalmedicinehousestaff should read this text during their pulmonary rotations. Primary care clinicians will find it useful as a reference tool but should also use it to educate themselves about these highly prevalent diseases. Finally, sleep medicine specialists from all backgrounds will find the text to be a concise, state-of-the-art summary of sleep and breathing. The editors thoughtfully divided the book into appropriate sections and chapters and enlisted the leading scientists in their respective fields to write the individual chapters. The chapters flow together, with very little overlap. Most of the chapters are well written and appropriately referenced. The information is current and factually correct. Though the majority of the text is devoted to the OSA syndromes, the last section of the book discusses the effects of sleep on asthma, chronic obstructive pulmonary disease, interstitial lung diseases, neuromuscular diseases, and central sleep apnea syndromes. The chapters on epidemiology, morbidity, clinical features of OSA, surgery for OSA, and central sleep apnea syndromes were outstanding. In all cases the authors present data in novel written or graphic formats that are refreshing and enlightening. The epidemiologic data from many studies are very well summarized in the chapters by Drs Young, Peppard, and Redline. They gleaned the critical statistics and placed them into a practical context for nonstatisticians. Drs Flemons and Whitelaw did a superb job with the difficult topic of clinical predictors of OSA. The table summarizing the odds ratios associated with specific clinical signs and the presence of OSA is unique and exceedingly useful. Dr Sher’s compilation of the outcomes literature for all of the commonly performed surgical procedures for OSA is by far the best I have seen. The illustrations in his chapter were extremely useful. Finally, Drs McNicholas, Phillipson, and Bradley wrote 2 exceptional chapters on central sleep apnea syndromes. Their clear writing nicely elucidated the complex physiology of disorders that can be difficult even for well-trained pulmonary physicians. The book has few limitations. The section on sleep apnea in the young and the elderly could have been edited into other sections of the book. Respiratory therapists would enjoy more information about nocturnal ventilation for non-sleep-apnea syndromes as well as more detail about continuouspositiveairwaypressureequipmentand interfaces. I think some general discussion about sleep physiology and polysomnography would have made the text a more standalone educational tool for clinicians who are not trained in sleep medicine. Finally, a discussion about the clinical approach to patients with nocturnal respiratory symptoms would be useful. Each chapter includes boxes that summarize key points. Though these boxes were an excellent idea, most of the key points were too vague to be useful as tools to study for examinations. In general I found the illustrations to be of average quality. They were few in number and often too small, making them difficult to read. There were almost no photographs. I found the book to be a very comfortable size. It could be easily held and read comfortably in a chair rather than at a desk. There were a moderate number of typographical errors, occurring at rate of 1–2 every other chapter. I did not like the font or its size. This, combined with the gloss on the pages, made it somewhat difficult to read in all but perfect lighting. I congratulate the editors on putting together a superb text on a growing and important topic. It should be recommended reading for any clinician interested in respiration or sleep.