Sleep Disorders in Neurology

A Practical Approach

Sebastiaan Overeem, Paul Reading, Sebastiaan Overeem, Paul Reading

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781118777268
• eBook ISBN: 9781118777220
• Edition: 2
• Topic: Medicine
• Subtopic: Neurology

The acclaimed guide to quickly and confidently diagnosing and treating sleep disorders in neurological disease—now with more algorithms and tables

The diagnosis and treatment of sleep disorders can be extremely challenging for physicians, especially when there is underlying neurological disease. In addition to the primary sleep disorders, there is a growing clinical interest in sleep disturbances associated with common neurological disorders such as Parkinson's disease. This updated and expanded edition of the critically acclaimed Sleep Disorders in Neurology: A Practical Approach provides doctors with expert recommendations and clear guidance on identifying sleep disorders in patients suffering from neurological diseases and providing effective treatment plans.

In creating this Second Edition doctors Overeem and Reading made every effort to further enhance the practical approach of the first edition by adding additional algorithms and tables to assist physicians in more rapid decision making. In addition, they expanded the content to include greater coverage of primary sleep disorders. Classification and diagnosis chapters have been revamped to follow the 3^rd International Classification of Sleep Disorders.

• Offers physicians, with a practical approach to diagnosing and treating complex sleep disorders
• Draws on the expertise of neurologists who specialize in the disorders under discussion
• Features quick-access algorithms that help physicians rapidly diagnose and treat primary and secondary sleep disorders with confidence
• Provides guidance on when to consult a sleep specialist in managing a particular sleep disorder and
• Written by a multinational author team who provide a wider perspective and range of clinical experience

Sleep Disorders in Neurology: A Practical Approach, Second Edition is an essential resource for sleep medicine specialists, as well as clinicians and health care professionals not specifically trained in sleep medicine, but who nevertheless need to manage neurologically damaged patients with increasingly recognized sleep/wake disturbances.

Part One
General Sleep Medicine

1
The Sleep History

Paul Reading¹ and Sebastiaan Overeem^2,3

¹ Department of Neurology, James Cook University Hospital, Middlesbrough, UK

² Centre for Sleep Medicine ‘Kempenhaeghe’, Heeze, The Netherlands

³ Eindhoven University of Technology, Eindhoven, The Netherlands

Introduction

It is a commonly held misperception that practitioners of sleep medicine are highly dependent on sophisticated investigative techniques to diagnose and treat sleep‐disordered patients. However, it is relatively rare for detailed tests to add indispensable diagnostic information, provided a detailed, credible and accurate 24‐hour sleep–wake history is available. In fact, there can be few areas of medicine where a good, directed history is of more diagnostic importance. In some situations, this can be extremely complex due to interacting social, environmental, medical and psychological factors. Furthermore, obtaining an accurate sleep history often requires collateral or corroborative information from bed partners or close relatives, especially in the assessment of parasomnias.

In sleep medicine, neurological patients can present particular diagnostic challenges. It can often be difficult to determine whether a given sleep–wake symptom arises from the underlying neurological disorder and perhaps its treatment or whether an additional primary sleep disorder is the main contributor. The problem is compounded by the relative lack of formal training in sleep medicine received by the majority of neurology trainees that often results in reduced confidence when faced with sleep‐related symptoms. However, it is difficult to underestimate the potential importance of disordered sleep in many chronic and diverse neurological conditions such as epilepsy, migraine, multiple sclerosis and parkinsonism.

The following framework is a personal view on how to approach sleep–wake complaints from a neurological perspective. Although the focus is on individual or particular symptoms, it should be realised that several conditions can produce a variety of symptoms across the full 24‐hour sleep–wake period. In Chapters 2 and 3, the various ways in which sleep and sleepiness can be recorded are discussed. Then, in Chapter 4, an ‘integrative’ approach to diagnosis is outlined, illustrated by case examples.

Excessive Daytime Sleepiness

Excessive daytime sleepiness (EDS) is an increasingly recognised symptom that is deemed worthy of assessment. It is relatively prevalent and disabling both in general and neurological populations [1]. Many excessively sleepy patients may present to the medical profession indirectly, most often due to adverse indirect effects on cognition, motivation or mood. Indeed, the inability to focus or maintain concentration is often the most disabling aspect of conditions causing EDS, described as ‘brain fog’ or even masquerading as dementia. A not uncommon question posed to general neurologists is whether a sleepy patient might have narcolepsy or a similar primary, presumed ‘central’ sleep disorder. Furthermore, ‘secondary’ or ‘symptomatic’ narcolepsy is evolving as a valid concept given recent major advances in unravelling the neurobiology of sleep regulation. In particular, a variety of pathologies predominantly affecting the hypothalamus can mimic elements of idiopathic (primary) narcolepsy [2].

It is widely perceived that EDS is a normal phenomenon associated with the ageing process. In fact, objective measures of sleepiness suggest that healthy elderly subjects are actually less prone to falling asleep when unoccupied during the day compared with their younger counterparts. Although afternoon planned naps are probably a normal phenomenon with many elderly people in all cultures, evidence for EDS beyond this level should be taken seriously in all age groups.

In the initial assessment of EDS, it is essential to gain an impression of the severity of symptoms and how they are impacting on an individual subject. It is also c...

Table of contents

• Cover
• Table of Contents
• Preface
• Part One: General Sleep Medicine
• Part Two: Primary Sleep Disorders
• Part Three: Sleep in Neurological Disorders
• Index
• End User License Agreement