2 - Evaluation and testing of the sleepy patient
from SECTION 1 - NORMAL SLEEP
Published online by Cambridge University Press: 08 August 2009
Summary
Introduction
Sleep disturbances can affect people throughout their life span, and the frequency of sleep disturbances increases as we age. Currently, there are more than 80 sleep disorders that are described in the second edition of the International Classification of Sleep Disorders (ICSD-2). There is mounting evidence showing that sleep disorders are closely related to comorbid medical and neurological diseases. Sleep deprivation has been shown to be a possible risk factor for obesity. Untreated obstructive sleep apnea (OSA) is associated with an increased risk of having elevated blood pressure and insulin resistance. Untreated OSA may also be associated with an increased risk of heart attack or stroke. Specific epilepsies occur exclusively during sleep, and sleep deprivation may provoke seizures. Individuals with REM sleep behavior disorder (RBD) are at a higher risk for developing a neurodegenerative disorder such as Parkinson's disease or dementia.
It is the responsibility of healthcare providers to inquire about sleep quality and any possible sleep disruptions in their patients. People with sleep disturbances may complain of difficulty falling asleep or maintaining sleep, abnormal behaviors during the night, daytime sleepiness or fatigue. Multiple sleep disorders can be present in one individual, causing a decreased quality of life. A systematic approach is therefore crucial in facilitating the evaluation, diagnosis, and treatment of sleep disorders.
When evaluating someone for sleep disorders, a comprehensive and detailed sleep history is often the most important part of the evaluation.
Keywords
Information
- Type
- Chapter
- Information
- Sleep Medicine , pp. 25 - 46Publisher: Cambridge University PressPrint publication year: 2008
References
, , . The first-night effect: an EEG study of sleep. Psychophysiology 1966; 2:263–6.CrossRefGoogle Scholar
Aldrich MS. Approach to the patient with disordered sleep. In: , , , eds. Principles and Practice of Sleep Medicine, 3rd edn. Philadelphia, PA: Saunders, 2000: 521–5.Google Scholar
, . Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol 2001; 18:128–47.CrossRefGoogle ScholarPubMed
, , , , , . Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003; 4:101–19.CrossRefGoogle ScholarPubMed
American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual, 2nd edn (ICSD-2). Westchester, IL: American Academy of Sleep Medicine, 2005.
, , , et al. The clinical use of the MSLT and MWT. Sleep 2005; 28:123–44.CrossRefGoogle ScholarPubMed
, , , , . Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005; 172:1447–51.CrossRefGoogle ScholarPubMed
, , , et al. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep 1986; 9:519–24.CrossRefGoogle ScholarPubMed
, , , . Comparison of the results of the Epworth Sleepiness Scale and the Multiple Sleep Latency Test. J Psychosom Res 1997; 42:145–55.CrossRefGoogle ScholarPubMed
, , , . Cost-utility of three approaches to the diagnosis of sleep apnea: polysomnography, home testing and empirical therapy. Ann Intern Med 1999; 130:496–505.CrossRefGoogle Scholar
, , . Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Sleep 2003; 26:907–13.CrossRefGoogle ScholarPubMed
, , . A link between short sleep and obesity: building the evidence for causation. Sleep 2005; 28:1217–20.CrossRefGoogle ScholarPubMed
, , . The assessment of fatigue: a practical guide for clinicians and researchers. Psychosom Res 2004; 56:157–70.CrossRefGoogle ScholarPubMed
, , . Predicting sleep apnea and excessive daytime sleepiness in the severely obese: indicators for polysomnography. Chest 2003; 123:1134–41.CrossRefGoogle Scholar
, , , et al. A normative study of the maintenance of wakefulness test (MWT). Electroencephalogr Clin Neurophysiol 1997; 103:554–62.CrossRefGoogle Scholar
, , , et al. The influence of the menstrual cycle on upper airway resistance and breathing during sleep. Sleep 2005; 28:449–56.CrossRefGoogle ScholarPubMed
, . Sleep and epilepsy: what we know, don't know, and need to know. J Clin Neurophysiol 2006; 23:4–20.CrossRefGoogle ScholarPubMed
, , , et al. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000; 117:137–41.CrossRefGoogle ScholarPubMed
, , . Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 2002; 127:13–21.CrossRefGoogle ScholarPubMed
, . Identifying the patient with sleep apnea: upper airway assessment and physical examination. Otolaryngol Clin North Am 1998; 31:919–30.CrossRefGoogle ScholarPubMed
. The clinical neurophysiology of the restless legs syndrome and periodic limb movements. Part I: diagnosis, assessment, and characterization. Clin Neurophysiol 2004; 115:1965–74.CrossRefGoogle ScholarPubMed
, . Sensitivity of the Stanford sleepiness scale to the effects of the cumulative partial sleep deprivation and recovery oversleeping. Sleep 1981; 4:83–91.CrossRefGoogle ScholarPubMed
, , . The development and use of the Stanford Sleepiness Scale [abstract]. Psychophysiology 1972; 9:150.Google Scholar
Hoffstein V. Snoring. In: , , , eds. Principles and Practice of Sleep Medicine, 3rd edn. Philadelphia, PA: Saunders, 2000: 813–26.Google Scholar
, , , et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002; 165:670–6.CrossRefGoogle ScholarPubMed
, , , et al. Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 2006; 5:572–7.CrossRefGoogle ScholarPubMed
. The 10–20 electrode system of the International Federation. Electroencephalogr Clin Neurophysiol 1958; 10:370–5.Google Scholar
, . Daytime sleepiness and sleep habits of Australian workers. Sleep 1997; 20:844–9.CrossRefGoogle ScholarPubMed
. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991; 14:540–5.CrossRefGoogle ScholarPubMed
. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992; 15:376–81.CrossRefGoogle ScholarPubMed
, , , . The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46:1121–3.CrossRefGoogle ScholarPubMed
, , , et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28:499–521.CrossRefGoogle ScholarPubMed
, , , et al. Mild to moderate sleep respiratory events: one negative night may not be enough. Chest 2000; 118:353–9.CrossRefGoogle ScholarPubMed
, , , et al. High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J 2003; 21:248–52.CrossRefGoogle ScholarPubMed
, , , et al. Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. Sleep 2003; 26:337–41.CrossRefGoogle Scholar
, , , et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32:429–34.CrossRefGoogle ScholarPubMed
, , . Falling asleep at the wheel: a close look at 1,269 fatal and serious injury-producing crashes. Behav Sleep Med 2003; 1:171–83.CrossRefGoogle Scholar
, , , . One negative polysomnogram does not exclude obstructive sleep apnea. Chest 1993; 103:756–60.CrossRefGoogle Scholar
National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13–15, 2005. Sleep 2005; 28: 1049–57.
, , , . Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep 2006; 29:903–8.CrossRefGoogle ScholarPubMed
, . Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 2004; 79:1036–46.CrossRefGoogle ScholarPubMed
, , , , . Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep 2005; 28:1299–305.CrossRefGoogle ScholarPubMed
, , . Genetic basis for sleep regulation and sleep disorders. Semin Neurol 2006; 26:467–83.CrossRefGoogle ScholarPubMed
, . A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles, CA: UCLA Brain Information Service/Brain Research Institute, 1968.
, , . First night effect and reverse first night effect in older adults with primary insomnia: does anxiety play a role?Sleep Med 2001; 2:125–33.CrossRefGoogle ScholarPubMed
, , , . The determinants of the apnea threshold during NREM sleep in normal subjects. Sleep 2006; 29:95–103.CrossRefGoogle ScholarPubMed
Schweitzer PK. Drugs that disturb sleep and wakefulness. In: , , , eds. Principles and Practice of Sleep Medicine, 4th edn. Philadelphia, PA: Elsevier Saunders; 2005: 499–518.Google Scholar
, , , et al. A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study. Sleep Medicine 2004; 5:351–7.CrossRefGoogle Scholar
, , . A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 1987; 10:541–53.Google ScholarPubMed
Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for using polysomnography to evaluate insomnia: an update. Sleep 2003; 26: 754–60.
, , . Obesity, sleep apnea, and hypertension. Hypertension 2003; 42:1067–74.CrossRefGoogle ScholarPubMed
Accessibility standard: Unknown
Why this information is here
This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.Accessibility Information
Accessibility compliance for the PDF of this chapter is currently unknown
and may be updated in the future.
- 1
- Cited by