From The New England Journal of Medicine
A consequence of the growth of sleep medicine is the number of textbooks that attempt to capture the richness, complexity, and diversity of this specialty. With increased recognition and board certification, the field has engendered a number of books on chronobiology, sleep neurophysiology, insomnia, sleep function, and sleep and breathing. Far fewer books have attempted the daunting task of dealing with sleep medicine in its entirety. Such works, which typically have multiple authors, provide broad coverage from the viewpoint of many different disciplines. Into this arena steps Sleep Medicine. Arriving late at a party does have distinct advantages, but it also carries the burden of added scrutiny. For a new medical textbook, comparisons with existing works are inevitable, but recency of publication can be a crucial discriminating feature in a rapidly emerging field. Exciting and timely chapters on sleep and infection and on sleep endocrinology and the effects of sleep loss on glucose metabolism are fine examples of expert reporting. Several other chapters, such as those on sleep during menstruation, pregnancy, and menopause and on the forensic aspects of sleepiness (including specific legal cases), are unique to this book. The chapters on shift work and jet lag and on upper-airway imaging in persons with sleep apnea are particularly thorough and scholarly, but several of the shorter chapters related to apnea are no less valuable and are equally well written. Readers interested in sleep and breathing will find more than ample coverage of the measurement and interpretation of increased upper-airway resistance during sleep, with at least four chapters touching on this topic. Unfortunately, a weak link is the brief chapter on surgical procedures for snoring: this chapter is little more than a perfunctory tip of the hat to otolaryngologists and lacks critical mettle. There are other problems as well. The chapter on basic chronobiology fails to elucidate the human phase-response curve or to describe fully important new developments in the study of gene transcription in the regulation of the biologic clock. Another problem is that periodic limb movements in sleep are mentioned in at least seven chapters (in addition to a chapter that focuses on the monitoring of these movements), but a cogent explanation of what the movements may (or may not) mean clinically never emerges. Certain "hot" areas appear to have been missed, such as the possible relation of sleep apnea to altered endothelial function, but there is good coverage of the newly discovered orexin (or hypocretin) system and its effect on sleepiness in the chapter on narcolepsy. More generally, the cross-referencing of chapters is imperfect, and the index often does not do the book justice. Data from the Sleep Heart Health Study, for example, are often cited, but unless the study is mentioned by name in the text, the index does not list it. A positive feature of the book is the inclusion of separate chapters on technical aspects of polysomnography, entirely appropriate for a field in which procedural diagnosis has been central. Although the technical chapters are generally well done, the figures related to periodic limb movements in sleep are particularly difficult to decipher and detract from the otherwise high quality of that chapter. Childhood sleep disorders are covered in five chapters, most of which are quite good. By contrast, with the exception of the chapter on the pharmacologic treatment of insomnia, the chapters on insomnia and on sleep in psychiatric disturbances often seem to lack luster as they dwell on historical accounts or untested algorithms or remain mired in nosologic issues. This is disappointing, given the huge literature in the area of sleep and mental illness (more than 20,000 citations in Medline). This book, to quote from its preface, makes good on its desire to be a highly "practical" reference for the otherwise "busy practitioner." Its strengths clearly fall in that domain. Lee-Chiong and colleagues have made an ambitious attempt to encapsulate sleep medicine in a concise yet well-documented approach. Sleep Medicine has much to offer in recency, novelty, and breadth.
Donald L. Bliwise, Ph.D.Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
