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.
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