Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4538_Библиотеки_им_академика_М_И_Перельмана

Until 1972, when Stanford University declared the study of clinical sleep medicine a new eld and opened the rst sleep clinic in the world, our understanding of ill­ness and health had been conned to the waking patient over centuries of medical study and practice. Sleep medicine had been the purview of esoteric researchers working in isolated research labs. Onlookers were not clear as to how this eld of exploration would ever lend value to the lives of patients. A mere 20 years after REM sleep was rst identied in 1953 (and named) by then medical student William Dement [1] who would go on to become the founding father of modern sleep medi­cine, clinical sleep medicine opened enquiry of both clinical physiology and pathol­ogy of the sleeping patient, creating new frontiers in the understanding of disease. In 1973, in Italy, Dr. Elio Lugaressi [2] identied heavy snorers disease reporting the rst series of what would become the world’s rst cohort of obstructive sleep apnea patients demonstrating excessive daytime sleepiness obesity and snoring. Less than a decade later, in Australia, Dr. Colin Sullivan [3] would patent the rst prototype for continuous positive airway pressure manufacturing each facemask manually and connecting it to device that was essentially a reversed vacuum cleaner treating over 300 patients in this manner beginning in 1981. Within 10years of that I had graduated medical school and 15years later, I was treating sleep-disordered patients. A decade into my practice as a sleep specialist I referred a patient to receive one of the rst upper airway nerve stimulators for treatment of obstructive sleep apnea syndrome. And less than 5 years later, during this global pandemic, my patients are now being regularly implanted with intelligent nerve stimulators to treat central sleep apnea with transvenous phrenic nerve stimulation. This kind of prox­imity to the origin of my eld makes it extremely exciting to meet patients every day, diagnose, and then treat them—so many of them have been reporting symp­toms to an array of clinicians before the clinical constellation can be recognized by a seasoned, interested sleep specialist. I therefore underline that anybody that is in his eld can exercise an astonishing impact on the surrounding community not only of the patients entrusted to our care but also on our clinical colleagues and the very practice of our clinical discipline.

Respiratory mechanics and ventilatory control are disturbed during sleep in the COPD patient due to a number of factors. These disturbances in ventilation and gas exchange occur during sleep and are related to hypersensitive or accentuated