Book Review

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem

N Engl J Med 2007; 356:199-200January 11, 2007

Article

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
By the Committee on Sleep Medicine and Research. Edited by Harvey R. Colten and Bruce M. Altevogt. 404 pp., illustrated. Washington, DC, National Academies Press, 2006. $48.95. ISBN: 978-0-309-10111-0

The field of sleep medicine has grown rapidly over the past 30 years, in large part due to the following events: the appointment of the National Commission on Sleep Disorders Research, which led to the creation of the National Center on Sleep Disorders Research within the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH), and to the recognition of sleep medicine as an independent medical specialty by the American Board of Medical Specialties, which led to the establishment of accredited sleep medicine fellowship training programs by the Accreditation Council for Graduate Medical Education.

With the publication of Sleep Disorders and Sleep Deprivation, the field marks yet another defining event. The book is a comprehensive report on the current state of sleep medicine that was commissioned by the Institute of Medicine at the request of the American Academy of Sleep Medicine, the National Center on Sleep Disorders Research, the National Sleep Foundation, and the Sleep Research Society. The report was designed to achieve four primary goals: review and quantify the public health significance of sleep health, sleep loss, and sleep disorders; identify gaps in the public health system related to the understanding and management of sleep problems; identify barriers to and opportunities for improving and stimulating multidisciplinary and interdisciplinary research and education in sleep medicine and biology; and develop a comprehensive plan for enhancing sleep medicine and sleep research to improve public health. A 14-member multidisciplinary team of experts was appointed, and workshops were held to gather information from experts in the field and from interested federal, private, and nonprofit organizations.

This book presents a thorough yet concise review of normal sleep and biologic rhythms, the pathophysiology and treatment of sleep disorders, the epidemiology of sleep disorders, and the dire and generally underrecognized personal and societal consequences of sleepiness and sleep disorders. The enormous public health burden of sleep disorders and sleep deprivation and the limited capacity of physicians to identify and treat sleep disorders are emphasized, as is the woeful, if not nearly complete, lack of education on the subject at all levels — the lay public, undergraduate students, and graduate medical and allied health professionals alike. Nearly 20% of automobile crashes involve driver sleepiness unrelated to alcohol, and the total direct and indirect costs of sleepiness and sleep disorders amount to hundreds of billions of dollars annually in the United States. Despite these facts, most medical students have never performed a clinical evaluation of a patient with a sleep disorder. The sections of the book that address these issues will be of interest and value to the general public, to medical professionals at all levels, and to policymakers.

Of particular value are those sections dealing with the coordination of research initiatives at the NIH and the organization of research, clinical care, and education in academic health centers. The book strongly recommends that the NIH redouble its efforts to advance the field to the extent that a workforce adequately trained in sleep medicine becomes available. This means more NIH funding for grants, training programs, career development, mentoring, and centers of excellence, all of which will require more efficient and effective integration of sleep programs within the agency's various institutes. (An estimated 50 million to 70 million Americans have sleep-related problems, yet only 0.07% of the NIH's budget is invested in addressing them.) An NIH-funded National Somnology and Sleep Medicine Research Network is proposed to improve the efficiency and increase the amount of research on uncommon sleep disorders.

The final and most important recommendation in the book calls for organizing existing and future sleep programs in academic health centers as interdisciplinary sleep programs that encompass relevant basic and clinical disciplines. This recommendation recognizes that sleep medicine requires more integration of clinical and basic science disciplines than do most other fields. There is now a lack of researchers on the basic science of sleep, as well as a lack of sleep clinicians — inadequate numbers are being trained to deal with the magnitude of sleep-related clinical and socioeconomic issues. The book also recommends fiscal independence for sleep programs in academic medical centers, with any excess revenue to be returned for program development rather than siphoned off by a parent department or institution to subsidize unprofitable programs.

This book, coming on the heels of official recognition of sleep medicine by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education, is a boon to the field. It will be of great interest to anyone interested in sleep medicine and should be mandatory reading for governmental and academic health-center policymakers. The Institute of Medicine, the Committee on Sleep Medicine and Research, and the contributing consultants should be commended for a most valuable and successful report.

Mark W. Mahowald, M.D.
University of Minnesota, Minneapolis, MN 55455
mahow022@umn.edu