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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_41_библиотеки_им_акад_М_И_Перельмана
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Contents
9 Sleep and Hypoventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Amanda J. Piper
10 Perioperative Care of Patients with Obstructive Sleep Apnea
Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Kara L. Dupuy-McCauley, Haven R. Malish, and Peter C. Gay
11 Sleep-Disordered Breathing (SDB) in Pediatric Populations . . . . . . . 215
Carol L. Rosen
Part III Non-respiratory Sleep Disorders
12 Diagnosis of Insomnia Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Rachel Atkinson and Christopher Drake
13 Management of Insomnia Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Gwendolyn C. Carlson, Michelle R. Zeidler,
and Jennifer L. Martin
14 Circadian Rhythm Sleep-Wake Disorders . . . . . . . . . . . . . . . . . . . . . . 297
Mia Y. Bothwell and Sabra M. Abbott
15 Narcolepsy and Idiopathic Hypersomnia . . . . . . . . . . . . . . . . . . . . . . . 327
Imran Ahmed and Michael Thorpy
16 Non-REM Parasomnias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Nathan A. Walker and Bradley V. Vaughn
17 Rapid Eye Movement Parasomnias . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Jordan Taylor Standlee and Margaret A. Kay-Stacey
18 Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Salam Zeineddine and Nidhi S. Undevia
Part IV Sleep in Special Conditions
19 Sleep in Critical Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Michael T. Y. Lam, Atul Malhotra, Jamie Nicole LaBuzetta,
and Biren B. Kamdar
20 Sleep in Hospitalized Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
Nancy H. Stewart and Vineet M. Arora
21 Sleep in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Louise M. O’Brien
22 Sleep in Older Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Armand Michael Ryden and Cathy Alessi
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Contributors
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Sabra M. Abbott Northwestern University Feinberg School of Medicine,
Department of Neurology, Chicago, IL, USA
Imran Ahmed Sleep-Wake Disorders Center, Monteore Medical Center, and
Albert Einstein College of Medicine, Bronx, NY, USA
CathyAlessi David Geffen School of Medicine at University of California, Los
Angeles, Los Angeles, CA, USA
Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los
Angeles Healthcare System, Los Angeles, CA, USA
VineetM.Arora Department of Medicine, University of Chicago Medical Center,
Chicago, IL, USA
Rachel Atkinson University of Toledo College of Medicine and Life Sciences,
Toledo, OH, USA
M. Safwan Badr Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Internal Medicine, Harper University Hospital, Wayne State
University School of Medicine, Detroit, MI, USA
JuditeBlanc
Mia Y.Bothwell University of Illinois at Urbana-Champaign Medical Scholars
Program, Champaign, IL, USA
Anthony Q. Briggs New York University Langone Health, Department of
Population Health, New York, NY, USA
New York University Langone Health, Department of Psychiatry, New York, NY, USA
GwendolynC.Carlson Department of Mental Health, VA Greater Los Angeles
Healthcare System, VA Health Services Research and Development Service
(HSR&D) Center for the Study of Healthcare Innovation, Implementation and
Policy, Los Angeles, CA, USA
University of Miami, Miller School of Medicine, Miami, FL, USA
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Department of Psychiatry and Biobehavioral Sciences, David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, CA, USA
NishantChaudhary Division of Pulmonary, Critical Care, and Sleep Medicine,
Department of Medicine, University Hospitals of Cleveland, Case Western Reserve
University, Cleveland, OH, USA
SusmitaChowdhuri Sleep Medicine Section, Medical Service John D. Dingell
VA Medical Center, Detroit, MI, USA
Department of Medicine, Wayne State University, Detroit, MI, USA
Alicia Chung New York University Langone Health, Department of Population
Health, New York, NY, USA
Nancy Collop Emory Sleep Center, Emory University School of Medicine,
Atlanta, GA, USA
Janet H. Dailey Pharmacy Benets Management Services, Veterans Health
Administration, Washington, DC, USA
Christopher Drake Henry Ford Sleep Disorders and Research Center,
Detroit, MI, USA
Kara L. Dupuy-McCauley Center for Sleep Medicine, Mayo Clinic,
Rochester, MN, USA
Contributors
Erica Feldman University of California, San Diego, Department of Medicine,
Internal Medicine, La Jolla, CA, USA
BarryG.Fields Emory University, Division of Pulmonary, Allergy and Critical
Care Medicine, Atlanta, GA, USA
PeterC.Gay Department of Medicine, Mayo Clinic, Rochester, MN, USA
Geoffrey Ginter
Wayne State University School of Medicine, Detroit, MI, USA
Scott Hoff Emory Sleep Center, Emory University School of Medicine,
Atlanta, GA, USA
Girardin Jean-Louis University of Miami, Miller School of Medicine,
Miami, FL, USA
BirenB.Kamdar Department of Medicine, Division of Pulmonary, Critical Care
and Sleep Medicine, University of California San Diego Health, La Jolla, CA, USA
MargaretA.Kay-Stacey Northwestern University Feinberg School of Medicine,
Department of Neurology, Chicago, IL, USA
JamieNicoleLaBuzetta Department of Neurosciences, Division of Neurocritical
Care, University of California San Diego Health, La Jolla, CA, USA
Department of Internal Medicine, Harper University Hospital,
Contributors
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Michael T. Y. Lam Department of Medicine, Division of Pulmonary, Critical
Care, Sleep Medicine and Physiology, University of California San Diego Health,
La Jolla, CA, USA
Atul Malhotra Department of Medicine, Division of Pulmonary, Critical Care,
Sleep Medicine and Physiology, University of California San Diego Health,
La Jolla, CA, USA
HavenR.Malish Sleep Medicine, Mayo Clinic, Rochester, MN, USA
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Jennifer L. Martin
Affairs Greater Los Angeles Healthcare System, Department of Medicine, David
Geffen School of Medicine, University of California, Los Angeles, Los
Angeles, CA, USA
Jesse Moore New York University Langone Health, Department of Population
Health, New York, NY, USA
Louise M. O’Brien Division of Sleep Medicine, Department of Neurology,
Michigan Medicine, Ann Arbor, MI, USA
Department of Obstetrics & Gynecology, Michigan Medicine, Ann Arbor, MI, USA
AmandaJ.Piper Department of Respiratory and Sleep Medicine, Royal Prince
Alfred Hospital, Camperdown, NSW, Australia
Faculty of Medicine and Health, University of Sydney, Camperdown, NSW,
Australia
JannaRaphelson University of California, San Diego, Department of Medicine,
Internal Medicine, La Jolla, CA, USA
AprilRogers St. John’s University, New York, NY, USA
Carol L. Rosen Department of Pediatrics, Case Western Reserve University
School of Medicine, Cleveland, OH, USA
IleneM.Rosen Division of Sleep Medicine, Perelman School of Medicine at the
University of Pennsylvania PCAM, Philadelphia, PA, USA
Geriatric Research, Education and Clinical Center, Veteran
James A. Rowley Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Internal Medicine, Harper University Hospital, Wayne State
University School of Medicine, Detroit, MI, USA
ArmandMichaelRyden Pulmonary, Critical Care and Sleep Medicine Division,
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
David Geffen School of Medicine at University of California, Los Angeles, Los
Angeles, CA, USA
AziziA.Seixas University of Miami, Miller School of Medicine, Miami, FL, USA
JordanTaylorStandlee Northwestern University Feinberg School of Medicine,
Department of Neurology, Chicago, IL, USA
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NancyH.Stewart Department of Medicine, University of Kansas Medical Center,
Kansas City, KS, USA
Kingman P. Strohl Division of Pulmonary, Critical Care, and Sleep Medicine,
Department of Medicine, University Hospitals of Cleveland, Case Western Reserve
University, Cleveland, OH, USA
MichaelThorpy Sleep-Wake Disorders Center, Monteore Medical Center, and
Albert Einstein College of Medicine, Bronx, NY, USA
Contributors
ArlenerTurner
NidhiS.Undevia Department of Medicine, Division of Pulmonary and Critical
Care Medicine, Loyola Center for Sleep Disorders, Loyola University Medical
Center, Maywood, IL, USA
Bradley V. Vaughn Department of Neurology, University of North Carolina,
Chapel Hill, NC, USA
Nathan A. Walker Department of Neurology, University of North Carolina,
Chapel Hill, NC, USA
EllitaWilliams New York University Langone Health, Department of Population
Health, New York, NY, USA
EricYeh Division of Pulmonary, Critical Care, and Sleep Medicine, Department
of Medicine, University Hospitals of Cleveland, Case Western Reserve University,
Cleveland, OH, USA
Michelle R. Zeidler Sleep Disorders Center, VA Greater Los Angeles VA
Healthcare System, Department of Medicine, David Geffen School of Medicine,
University of California, Los Angeles, Los Angeles, CA, USA
SalamZeineddine Department of Medicine, John D.Dingell VA Medical Center
and Wayne State University School of Medicine, Detroit, MI, USA
University of Miami, Miller School of Medicine, Miami, FL, USA
Part I
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Introduction to Sleep Medicine
Chapter 1
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Normal Sleep
JamesA.Rowley andM.SafwanBadr
Keywords NREM sleep · REM sleep · EEG · Upper airway resistance ·
Hypocapnic apneic threshold · Critical closing pressure (Pcrit) · Heart rate
variability · Esophageal sphincter
Normal Sleep Stages andArchitecture
Normal human sleep is generally divided into four stages. Consensus denitions for
the visual scoring of sleep were published in 2007 and the reader is referred to the
American Academy of Sleep Medicine Scoring Manual for full denitions and criteria for the scoring of sleep on polysomnograms as these are periodically updated
[1, 2]. The following will provide a brief overview of the electroencephalographic
(EEG) characteristics of the different sleep stages (see also Fig.1.1).
Full wakefulness is characterized by mixed-frequency, low-amplitude EEG
activity, often in association with high chin muscle tone, eye blinks, and rapid eye
movements. As the patient transitions to sleep with eyes closed, wakefulness is
characterized by a 8–13Hz sinusoidal activity called alpha sleep. Alpha sleep is best
recorded over the occipital region and is attenuated by eye opening.
Non-rapid eye movement (NREM) sleep composes the majority of the night
and is characterized by the predominance of homeostatic mechanisms for breathing, cardiovascular and gastrointestinal function, and normal thermoregulation.
NREM sleep is divided into 3 stages. N1 sleep is a transitional period during
which the individual still usually has some awareness of his/her environment. N1
sleep is characterized by a slowing of the background wake EEG frequencies with
J. A. Rowley (*) · M. S. Badr
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine,
Harper University Hospital, Wayne State University School of Medicine, Detroit, MI, USA
e-mail: jrowley@med.wayne.edu; sbadr@med.wayne.edu
M. S. Badr, J. L. Martin (eds.), Essentials of Sleep Medicine,
Respiratory Medicine, https://doi.org/10.1007/978-3-030-93739-3_1
3© Springer Nature Switzerland AG 2022
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b
c
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J. A. Rowley and M. S. Badr
Fig. 1.1 Representative 30-second epochs of sleep stages. (a) Wakefulness with alpha rhythm; (b)
Stage N1; (c) Stage N2 with K-complex and spindle; (d) Stage N3 (slow-wave sleep); and (e)
Stage R.For all epochs: E1-M2: left electro-oculogram; E2-M2: right electro-oculogram; Chin 2:
chin EMG; F4-M1: right frontal EEG; C4-M1: right central EEG; O2-M1: right occipital EEG
Stage R
Stage
Stage N1
Stage N2
Stage N3
Clock Time
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Normal Sleep
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5
a predominance of low amplitude activity in 4–7Hz (often referred to as theta
activity). Slow eye movements are commonly observed during N1 sleep. N2
sleep, at which time the individual generally is no longer aware of his/her environment, is characterized by the appearance of sleep spindles and K complexes
superimposed on a background of theta activity. Sleep spindles are rhythmic sinusoidal waves of 12–14Hz, usually best recorded on central EEG leads. K complexes are diphasic waves having a well-delineated sharp negative component
followed by a slow positive component. N3 sleep, commonly known as slowwave sleep, is scored when slow-wave activity is recorded on >20% of an epoch.
By denition, slow waves are of low frequency (generally 0.5–2Hz) and have
large amplitude (>75μV).
As opposed to NREM sleep, rapid eye movement (REM or Stage R) is characterized by variations and instability in cardiopulmonary function and instability of
body temperature control. In addition, Stage R is characterized by dreaming, relative atonia of all muscle groups except the diaphragm and in men, erections. On
EEG, Stage R is characterized by a low-amplitude, mixed-frequency EEG, similar
to that seen in Stage N1 sleep. In addition, Stage R is characterized by the presence
of rapid eye movements and decreased chin muscle tone. Stage R is a unique time
of the night in that dreaming occurs during Stage R sleep.
Sleep architecture describes the organization of the sleep stages over the course
of the night (Fig.1.2). The normal sleep cycle in a young adult (generally considered the standard) begins with transitioning from wakefulness to N1 sleep and then
quickly transitioning to N2 and N3 sleep. The rst occurrence of Stage R sleep is
generally at about 90minutes and individuals then cycle between NREM and REM
sleep every 90–110minutes throughout the night. In general, N3 sleep predominates in the rst half of the night while Stage R predominates in the second half of
the night. For an average individual in their second decade, Stage N1 is 2–5% of the
total sleep time, Stage N2 is 45–55%, Stage N3 13–23%, and Stage R is 20–25% [3].
W
Fig. 1.2 Representative hypnogram showing normal sleep architecture
11 12 123
45
6
100
200
300
400
500
600
Age
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J. A. Rowley and M. S. Badr
Overall sleep architecture is dependent upon stage of development and aging
(Fig.1.3). For instance, infants generally spend up to 50% of the night in Stage R
sleep and often have a cycle of REM sleep prior to NREM sleep. In addition, the
duration of the NREM-REM cycle is 60minutes through most of childhood. Over
the span of time between young adulthood to elderly, there are changes in most
sleep stages, including decreased total sleep time and sleep efciency, increased
percentage of Stages N1 and N2, decreased percentage of Stage N3 and R.These
changes with aging have been shown to be more prominent in men than
women [3, 4].
Breathing During Sleep: Ventilation andtheUpper Airway
Summary ofNormal Breathing andVentilation During Sleep
Ventilatory motor output during sleep decreases from its normal levels in wakefulness, leading to decreased tidal volume and minute ventilation. The decreased ventilation is accompanied by reduced upper-airway dilator muscle activity resulting in
decreased upper-airways caliber and increased airow resistance. These biological
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Fig. 1.3 Changes in sleep stages as a percentage of sleep time across the age span. WASO=wake
after sleep onset; REM=rapid eye movement sleep; SWS=slow-wave sleep. See text for details
10 15 25 35
Sleep Latency
WASO
REM
SWS
Stage 2
Stage 1
45
55 65 75
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