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Obstructive Sleep Apnea : Obstructive Sleep Apnea: Diagnosis and Treatment (Sleep Disorders)

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I often thought of this mantra during my on-call nights when, as a Stanford sleep medicine fellow, I was awakened from sleep by a technologist informing me that one of the clinic patients had repetitive obstructive apneas with significant oxygen desaturations. The technologist would typically ask, “can I start the patient on CPAP?” Invariably, I would mutter a drowsy “yes,” often chiding myself that on the previous day I should have clearly written the respiratory thresholds for starting continuous positive airway pressure on the patient’s sleep-study order sheet. This anecdote illustrates the fact that continuous positive airway pressure has become such an important and ubiquitous treatment for obstructive sleep apnea since its development over a quarter century ago. The modern sleep specialist has new diagnostic tools and other treatments, such as upper airway surgery and oral appliances, for patients with obstructive sleep apnea; nevertheless, our field is still in its adolescence with respect to the diagnosis and treatment of obstructive sleep apnea and other sleep disorders.

The reader might wonder why a neurologist is editing a two-volume set of books on obstructive sleep apnea, since it is a sleep-related breathing disorder and would therefore appear to be within the domain of pulmonary physicians. However, besides pulmonologists—neurologists, psychiatrists, internists, pediatricians, and otolaryngologists have entered the field of sleep medicine. Many clinicians now treat patients with sleep disorders on a full-time basis. Sleep medicine has truly become multidisciplinary, and a sleep clinician is expected to diagnose and treat a wide range of sleep disorders, from insomnia to restless legs syndrome, that were previously referred by internists to other specialists.
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