Intech

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Contents

Chapter 1

Chapter 2 Chapter 3

Chapter 4 Chapter 5

Chapter 6 Chapter 7

Chapter 8

Preface IX

Sleep and Pregnancy: Sleep Deprivation, Sleep Disturbed Breathing and Sleep Disorders in Pregnancy 1

Michelle A. Miller, Manisha Ahuja and Francesco P. Cappuccio

Adolescents with Sleep Disturbance: Causes and Diagnosis 21

Akemi Tomoda and Mika Yamazaki

Sleep Disorders Diagnosis and Management in Children with Attention Deficit/Hyperactivity Disorder (ADHD) 31

Rosalia Silvestri and Irene Arico

Elemental Mercury Exposure and Sleep Disorder 47

Alfred Bogomir Kobal and Darja Kobal Grum

Evaluation of the Upper Airway in Patients with Snoring and OSA 65

Bhik Kotecha

Upper Airway Resistance Syndrome -A Twenty-Five Years Experience 75

Felix del Campo Matías, Tomas Ruiz Albi and Carlos Zamarrón Sanz

Breathing Sleep Disturbances and Migraine: A Dangerous Synergy or a Favorable Antagonism? 87

C. Lovati, M. Zardoni, D. D'Amico, M. Pecis, L. Giani, E. Raimondi, P. Bertora, D. Legnani, G. Bussone, C. Mariani

Sleep-Disordered Breathing in Neurological Diseases 95

Rafat Rola

VI Contents

Chapter 9 The Effects of Sleep-Related Breathing Disorders on Waking Performance 117

Chapter 10 Parasomnias 149

F. Gokben Hizli and Nevzat Tarhan

Chapter 11 Risk Factors and Treatment of

Restless Legs Syndrome in Adults 159

John A. Gjevre and Regina M. Taylor-Gjevre

Chapter 12 Screening Methods for REM Sleep Behavior Disorder 181

Masayuki Miyamoto, Tomoyuki Miyamoto, Keisuke Suzuki, Masaoki Iwanami and Koichi Hirata

Preface

For progress to be maintained in a clinical field like sleep medicine, unimpeded, unrestricted access to data and the advances in clinical practice should be available. The reason this book is exciting is that it breaks down the barriers to dissemination of information. Researchers at the forefront of areas that have limited funding can find it difficult to get data from randomised, double-blind, (placebo-controlled), crossover or parallel group studies, etc., and so may be limited to the lowest level of scientific research, i.e. single case, or restricted observational series.

Nonetheless, data is data, and whilst the interpretation may be suspect (which can happen with even the best controlled studies), the data is the most valuable asset in a research paper. Of course insight that either consolidates or furthers our understanding is vital, but without data it can be nothing more than an armchair idea. Many journals require the highest levels of scientific rigour, which may make some research inaccessible - really a form of scientific censorship. Also established areas, or newly established areas can develop castes of mind that censor material by exclusion. Finally, access to scientific material can be very expensive. There are now numerous sleep journals but only larger departments are likely to be able to pay for these so a publisher that allows ready and free internet access has to be welcomed.

The chapters in this book reflect leading edge ideas, reflections and observations. Even though the modern era of sleep research evolved from Aserinksky's observations of rapid eye movements in the sleep of babies, most work is nonetheless done in adults. There is much less formal work done in youngsters and virtually none in utero and pregnancy itself is virtually unexplored. So, Dr Miller et al's chapter reviewing sleep in pregnancy is particularly welcome as it incorporates current thinking in how disordered sleep impacts other adult pathological processes. Dr Tomoda and Dr Yamakazi's data-driven chapter on adolescents with sleep disturbance focuses on metabolic and endocrine data which sheds light on why gastrointestinal distress may arise in some children. Dr Silvestri and Dr Arico's review examines the interrelationship of sleep disorders with the growing problem of Attention Deficit/Hyperactivity Disorder, a disorder which attracts considerable debate as to the role of sleep as a fundamental component or a state that exacerbates this complex condition.

Dr Kobal Grum and Dr Kobal's interesting work combines naturalistic observations in a quite unique observational setting found in Hg° mines. Armed with these occupational

X Preface data, they consider the pathological mechanisms, given our current understanding of the neurobiology of sleep, that result in sleep disorders in these workers.

Sleep-related breathing disorders dominate sleep medicine so it is not surprising that there are several chapters in this area. The historical division in medicine of physicians and surgeons can be seen in this area or sleep disorders. It is dominated by respiratory physicians. However, surgeons also have a place, depending on the physical structures. Another curiosity in this area is that, whilst sleep apnoea demands treatment because of the adverse physical and social consequences if it is not treated, "snoring" is not regarded as such an urgent problem. However, there is evidence in terms of personal and social consequences as well as its symptomatic value, that highlight the need for more research in this area. Dr Kotecha's chapter is entirely pragmatic and practical, focussing on the evaluation of the upper airway so that the appropriate therapies can be applied.

Dr Del Campo et al's timely chapter on Upper Airway Resistance Syndrome also highlights an area that is subject to discussion. As a diagnostic entity, it is not clear whether it is at one end of the obstructive sleep apnoea continuum or exists in its own right.

Dr Lovati et al take the book into another area, the possible bidirectional processes that can affect sleep and other disorders - in their case the two-way dynamics between sleep and migraine. From another perspective, Dr Rola examines the impact of stroke and neurological disorders on sleep disorders, bringing to the neurologists' attention the need to consider sleep a mediating factor in their nosological entities. Dr Buttner's broad ranging and comprehensive review goes beyond sleep apnoea and considers it and other disorders and their neuropsychiatric consequences on objective measures of performance.

Sleep disorders can be easily classified into three main areas: those that cause unwanted sleep or sleepiness, those that cause unwanted wakefulness and those that involve unwanted behaviours during sleep - the parasomnias. Dr Hizli Sayar and Dr Tarhan's review provides a helpful introduction into this area. Restless Legs Syndrome - a disorder which twenty years ago was 'treated' by a multitude of disparate therapies and which was only unified by its symptomatology. In recent years the mechanisms have become clearer and there is a degree of unification. Dr Taylor-Gjevre and Dr Gjevre's review brings the relevant clinical literature together in one location. The final chapter is extremely helpful in introducing methods of screening and evaluating REM Behaviour Disorder. This disorder is most easily confirmed using sleep laboratory methods (polysomnography and video), but these methods are expensive, so cheaper clinical methods are welcome and are discussed by Dr Miyamoto.

Chris Idzikowski

Director, Edinburgh Sleep Centre and the Sleep Assessment and Advisory Service, Edinburgh,

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