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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. |
