Book Review

Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects

N Engl J Med 1994; 330:1911-1912June 30, 1994

Article

Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects
Edited by Sudhansu Chokroverty. 504 pp. Boston, Butterworth-Heinemann, 1994. $125. ISBN: 0-7506-9002-X

The field of sleep-disorders medicine has expanded rapidly since the discovery of rapid-eye-movement sleep in the mid-1950s. With a base of fewer than two dozen sleep-research centers, the first program focusing on the clinical aspects of sleep was established at UCLA under the direction of Dr. Anthony Kales. The description of obstructive sleep apnea by Christian Guilleminault in the late 1970s sparked the growth of clinical interest in sleep medicine, as did the leadership of Dr. William Dement in defining the field of sleep-disorders medicine and creating an organization of clinicians in the field. Today, almost 2000 centers in the United States alone conduct sleep studies. Both Kales and Dement have promoted the realization among primary care physicians that the management of sleep disorders improves the quality of medical care and is important in preventive medicine.

Sleep Disorders Medicine is a compendium of information on the more than 80 recognized sleep disorders. It contains chapters by leaders in sleep medicine. Dr. Chokroverty, the book's editor, states in the preface that his purpose was to “produce a comprehensive treatise on sleep disorders medicine, not only for beginners but also for those who are already engaged in the art and science of sleep medicine.” I believe that he has been extremely successful in achieving that goal.

This comprehensive, up-to-date book deals with three main areas: basic aspects of sleep, technical considerations, and clinical aspects. Among the best chapters are those on obstructive sleep apnea syndrome, sleep disorders in elderly persons, and polysomnographic techniques.

Part I leaves the reader with the distinct impression that there is a lack of agreement in many areas and that we remain unable to define what sleep actually is or its precise function. The chapter on physiologic changes in sleep reviews the literature but leaves the reader confused about the true relation of these changes to sleep stage and about the clinical implications of alterations in sleep architecture. The eight chapters in part II, on technical considerations, are important for the would-be sleep specialist, but primary care physicians are likely to skim or skip them. The final section, on clinical aspects, is woefully short on clinical examples. The chapter on patients with “sleep complaints” could be strengthened by specific questions that primary care physicians should ask. Suggestions about when and how primary care physicians should treat patients themselves and when a referral is appropriate would have been helpful. Nevertheless, the answers to most questions on individual sleep disorders can be found in this book.

As a sleep specialist, I found most of the chapters comprehensive but probably too technical for the primary care physician. The National Commission on Sleep Disorders Research has confirmed that 50 million Americans suffer from sleep problems. The management of these problems requires a substantial improvement in awareness on the part of primary care physicians of sleep medicine and its principles and practice.

If Dr. Chokroverty's goal was to provide an updated source of information for those interested in pursuing sleep medicine as a specialty, he has done an excellent job. If, however, his goal was to provide a source of practical, useful, easily accessible information for the primary care physician, he has overshot the mark. For specialists, this textbook is a gourmet meal, but family practitioners may prefer meat and potatoes.

Martin B. Scharf, Ph.D.
Center for Research in Sleep Disorders, Cincinnati, OH 45246