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Surgical Management of Sleep Apnea and Snoring

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Surgical Management of Sleep Apnea and Snoring BOOKS,FILMS,TAPES,&SOFTWARE new standards for polysomnographic scor- management. Approximately two thirds of and the authors of these 3 chapters faced ing. Though it is not likely there will be the chapters are devoted to specific proce- daunting tasks. Although sleep surgery has major changes, such changes would put this dures, and the detailed discussions of tech- made tremendous strides, these topics con- volume out of date. niques and the role of surgery in the treat- stitute much of the art of surgical treatment. Overall, the book is a useful adjunct for ment of sleep-disordered breathing are the As with the surgical evaluation of patients sleep specialists and a practical reference core of the book. The illustrations, photo- (mentioned above), a more comprehensive for the busy clinician. I highly recommend graphs, and radiographs throughout are clear discussion of these topics would have been it. and very useful in elucidating key points. helpful. In particular, the anesthetic man- No surgical text would be complete with- agement of patients with sleep-disordered Adnan Naeem Habib MD out a discussion of anatomy. This book not breathing—both for upper-airway surgery Department of Medicine only offers an excellent chapter on upper- and nonupper-airway surgery—has increas- Division of Pulmonary Critical Care and airway anatomy but also a thought-provok- ingly become a topic of interest for physi- Sleep Medicine ing evolutionary perspective on that anat- cians and major specialty organizations such University Of Kentucky omy. The subsequent chapters on the as the American Society of Anesthesiology Lexington, Kentucky physiology of sleep, sleep-disordered and the American Academy of Otolaryn- breathing, and nonsurgical evaluation of gology–Head and Neck Surgery. Though The author reports no conflicts of interest re- sleep-disordered breathing are good but per- the existing literature is sparse, coverage of lated to the content of this book review. haps not as clear and thorough as those that this topic should be expanded in future edi- Surgical Management of Sleep Apnea and can be found elsewhere in the literature. Ad- tions, to reflect the attention that has been Snoring. David J Terris and Richard L mittedly, these subjects are not the primary devoted to it in the last few years. Goode, editors. Boca Raton: Informa/Tay- focus of the book, so relatively little space The bulk of this book is dedicated to lor & Francis. 2005. Hard cover, illustrated, is devoted to them. One exception was the surgical techniques, and this is the book’s 492 pages, $199.95. chapter on home sleep studies, which thor- greatest strength. A book written, by and oughly reviews the validation studies for large, by surgeons and for surgeons should Amidst the many volumes dedicated to various home sleep study technologies. provide an understanding of procedures and sleep disorders and sleep-disordered breath- As a sleep surgeon, I thought the editors’ their application, and, indeed, this is the case. ing, this is just the third book devoted to selection of individual procedures and com- The high quality of the illustrations is in- surgical treatment of snoring and obstruc- binations of procedures in a surgical plan valuable. They do not provide as much de- tive sleep apnea. Part of the explanation lies was based, in some cases, on limited infor- tail as those in the commonly-used surgical in the relative newness of sleep surgery as a mation. The devotion of an entire chapter to atlasesofotolaryngologyandhead-and-neck field. Since the initial description of uvulo- the Friedman staging system, which can be surgery that describe procedures other than palatopharyngoplasty (surgery of the soft used to select patients more likely to have those included in this book, but the illustra- palate) as a surgical treatment of snoring, good outcomes after uvulopalatopharyngo- tions and accompanying text are more than by Ikematsu in 1964,1 and the application plasty, was warranted. This chapter gives a sufficient. Each chapter presents specific as- of this procedure to treat patients with ob- clear summary of the work that has been pects of patient selection and discusses tech- structive sleep apnea, by Fujita et al in 1981,2 reported in several separate publications and nique and potential complications. the past 25 years have witnessed the devel- is valuable reading for any surgeon inter- In several cases the contributors (who in opment of many procedures designed to treat ested in snoring and obstructive sleep ap- many cases are the surgeons who devel- the soft palate and other regions of the up- nea. In contrast, other surgical evaluation oped the procedure or made important tech- per airway. techniques, such as radiographic imaging nical modifications) incorporated technical This text is designed as a reference for and video sleep endoscopy, did not receive modifications that they have developed since surgeons interested in surgical techniques the same attention and/or did not get as thor- the original publications that described the for treatment of snoring and obstructive ough a discussion of their association with procedures. For transpalatal advancement sleep apnea. Others may find (1) the de- surgical outcomes. A more complete assess- pharyngoplasty, these modifications are not scription of patient evaluation and nonsur- ment of the growing literature would have found elsewhere in the literature. Others, gical treatment too brief, and (2) the discus- been welcome. such as the chapter on tracheotomy, present sion of surgical procedures too detailed and With the emphasis on surgical treatment, a range of techniques that are summarized esoteric. While surgeons will probably need not surprisingly the discussion of nonsurgi- clearly. Some of the chapters (eg, those on to supplement the text with additional read- cal options, such as positive airway pres- distraction osteogenesis and maxilloman- ing and training, the book provides a sound sure and oral appliances, is limited. How- dibular advancement) are somewhat brief framework from which the interested reader ever, the chapter on oral appliances was or simply do not provide sufficient detail can approach the patient with snoring or thorough enough and very practical; the pre- for the reading surgeon to be able to per- obstructive sleep apnea, with an awareness sentation of many devices, with photo- form the procedure. Nevertheless, the book of available procedures. graphs, is appropriate for surgeons, who may otherwise succeeds with flying colors in its The chapters cover the anatomy and phys- not be providing these devices themselves presentation of surgical procedures and their iology of sleep and sleep-disordered breath- but should be aware of their characteristics. technical aspects. ing, nonsurgical treatments (such as posi- Patient (and procedure) selection and an- The final 2 chapters are more philosoph- tive airway pressure therapy and oral esthesia management (intraoperative and ical than the rest and provide editorial per- appliances), and surgical evaluation and postoperative) are both far-reaching topics, spective in 2 areas: the evaluation of surgi- RESPIRATORY CARE • DECEMBER 2006 VOL 51 NO 12 1477 BOOKS,FILMS,TAPES,&SOFTWARE cal outcomes and the “Ideal Procedure for The first chapter gives a very brief over- SNPper) of the gene(s) of interest. Because Snoring and Obstructive Sleep Apnea.” To- view of human genetics and is well written, of their relevance in association analyses, gether, they provide much food for thought but could have been strengthened by ex- tools for power calculations and the explo- for sleep surgeons and other health-care pro- panding the focus beyond coding variation ration of linkage disequilibrium are expertly viders. Despite the progress of the past 25 and by providing more details regarding hap- discussed. It would have enhanced this book years, sleep surgery remains in its infancy lotypes and microsatellites as key elements to include other key databases for associa- in terms of the available procedures, the se- of disease susceptibility or modifying the tion studies, such as the HapMap, and the lection among them, and the understanding phenotype (and not simply as tools to map resequencing efforts of hundreds of inflam- of outcomes. Advances in our understand- the functional variants). The second chapter matory genes, such as the Seattle SNPs, the ing of upper-airway physiology, snoring, highlights the importance of environmental National Institute of Environmental Health and obstructive sleep apnea will enable bet- impact on the setting of the disease, and the Sciences (NIEHS) project, or the Innate Im- ter application of existing procedures and heterogeneity of disease status. For the lat- munity database. The last portion of the the development of new procedures to build ter, the author’s proposition of using differ- chapter concerns microarray methods, prac- on the foundations described in this book. ent tests to characterize the phenotype is tical guidelines to perform these experi- more than justified, with several tests listed, ments, probe alternatives, normalization, Eric J Kezirian MD MPH including measurement of lung function, air- and detection of differentially expressed Department of Otolaryngology way responsiveness, allergy testing, and in- genes, clustering, and annotation. Chapter 6 Head and Neck Surgery flammation. outlines the available strategies to charac- University of California, San Francisco Chapter 3 provides a very good back- terize and study the functional consequences San Francisco, California ground on the methods for the study of as- of genetic variation and gives useful infor- sociation of genetic variants with disease mation about algorithms to allocate the ge- susceptibility and how linkage disequilib- netic variation in the context of a gene (eg, REFERENCES rium is utilized in association studies, the promoter, splice site, and poly-A signal). 1. Ikematsu T. Study of snoring, 4th report: advantages and disadvantages of cohort and The chapter also deals with the expression therapy. Nippon Jibiinkoka Gakkai Kaiho case-control studies, environmental effects and purification of recombinant proteins, the 1964;64:434–435.
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