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Sleep Medicine: A Guide to and Its ciated with excessive daytime sleepiness. example is in Chapter 7, “,” which Disorders, 2nd edition. John M Shneerson Chapter 7 discusses the complex and often examines the various hyperarousable states MA DM FRCP. Oxford, United Kingdom: perplexing topic of insomnia. Chapter 8 dis- that can lead to insomnia. Blackwell Publishing. 2005. Hard cover, il- cusses and , causes and In general, the material is well selected lustrated, 325 pages, $125. treatments. Chapter 9 discusses motor dis- and organized. I am most impressed with orders, including the (motor ac- the author’s ability to present complex top- is a multidisciplinary med- tivities such as , sleep talking, ics and concepts in a naturally flowing, eas- ical specialty, newly recognized by the and rapid-eye-movement sleep-behavior ily understood narrative. This is particularly American Board of Medical Specialties. disorder). Chapter 10 covers obstructive evident in the chapter on the physiologic Physicians practicing sleep medicine have sleep , which has received much press basis of sleep and wakefulness. Furthermore, backgrounds in many fields, including pul- lately. Chapter 11 discusses central sleep the presentation on drugs and sleep is out- monary medicine, internal medicine, neu- apnea and hypoventilation. The final chap- standing. It describes drug effects on sleep rology, and psychiatry. Sleep disorders af- ter examines medical disorders and how they stages and the circadian rhythm, and dis- flict many people and many remain can impact sleep. There are 10 appendixes, cusses pharmacokinetic aspects of specific undiagnosed because of lack of clinical rec- among which are validated questionnaires medications and mechanisms of action. Very ognition of the more than 90 sleep diag- that are very useful in the practice of sleep few books have examined drugs and sleep noses. Physicians play a critical role in rec- medicine. in such a concise and well-done manner. ognizing sleep disorders and play a key The author’s key audience is physicians, Another outstanding aspect of this book management role in their diagnosis and treat- including sleep specialists, pulmonologists is Chapter 9, “Motor Disorders,” which dis- ment. Respiratory therapists and polysom- (respirologists), neurologists, psychiatrists, cusses parasomnias, including sleepwalk- nographic technologists also play key roles and general/internal medicine physicians ing, sleep terrors, arousal disorders, hypneic in diagnosing many sleep disorders, espe- who evaluate patients with sleep disorders. jerks, , chorea, and tics. For the non- cially sleep-disordered . Respira- Pediatric aspects of sleep are integrated neurologist this section is especially help- tory therapists are instrumental in providing throughout the text, so pediatricians may or ful. The statements, in general, are accurate, therapy for many sleep disorders, by pro- may not find this book useful. Although not although sometimes they are simplified for viding nasal continuous positive airway specifically written for respiratory therapists clarity. pressure, bi-level , or nurses, the book may be helpful as a This book includes only an introduction nocturnal ventilation, and oxygen therapy reference. Since this book does not go into to polysomnographic methods; it would not to patients with sleep-disordered breathing. detail concerning , it is be adequate for physicians, respiratory ther- Because sleep medicine crosses many med- probably not useful for polysomnographic apists, or sleep technologists seeking to gain ical specialties and is a rapidly changing technologists who want specific technical expertise in polysomnography. Limited in- field, it is a challenge to remain up to date, information. formation is provided on sleep-stage scor- but Shneerson provides a relatively up-to- Shneerson is from the United Kingdom ing and technical aspects of polysomnogra- date, concise review of sleep medicine and and has a fine command of syntax and gram- phy, which is covered in only 14 pages. The its more than 90 sleep disorders. Since he is mar. He provides clear explanations for very the sole author, the book suffers less inter- complex topics. It is easy to follow his diagnostic criteria used in the United States chapter repetition than do multi-author thought processes, because the writing is are not included. For instance, sleep-disor- books. The book is divided into 12 chap- very clear, concise, and readable. This is a dered breathing in the United Kingdom is ters. The first chapter deals with normal sleep book that you could sit down and read cover often diagnosed without the use of poly- and sleep development. It examines sleep to cover. It is not intended to be a reference somnography. Practice parameters recom- throughout our life cycle and provides a book on sleep disorders, so it is not heavily mended by the American Academy of Sleep backbone for further discussion in the sec- referenced, but it provides limited references Medicine are not described. One example is ond chapter, which concerns physiology and after each chapter. the diagnosis of . Though the in- control of sleep. The third chapter, “Assess- It is up to date, as evidenced by refer- formation presented is accurate, different ment of Sleep Disorders,” provides a short ences to the most recent International Clas- countries have different diagnostic and treat- review of various diagnostic techniques used sification of Diseases for sleep disorders. ment paradigms for sleep disorders, and this in sleep medicine. The fourth chapter dis- Furthermore, Chapter 4, “Drugs and Sleep,” book provides the United Kingdom perspec- cusses how drugs impact sleep, including discusses medications recently released by tive. drugs used to treat sleep disorders and the the U.S. Food and Drug Administration, in- An outstanding feature of the book is adverse effects of some drugs on sleep. The cluding pregabalin, ramelteon, and eszopi- the extensive descriptions of differential remainder of the book (Chapters 5 through clone. I think the book’s illustrations will be diagnoses of symptoms for many sleep 12) discusses the many sleep disorders. The especially helpful for understanding sleep/ disorders. Chapter 6, “Excessive Daytime book presents the disorders more from a wake mechanisms and pathophysiologic as- Sleepiness,” discusses not only sleep de- symptomatic standpoint than from a spe- pects of many sleep disorders, including ob- privation and its effects, but also other cific disease standpoint. This is appropriate, structive sleep apnea and . disorders and how they present through- since patients present with symptoms, not The author effectively uses tables to describe out the life cycle. It gives a complete dif- diseases. the differential diagnoses of sleep-related ferential diagnosis, as evidenced by the Chapter 5 examines circadian rhythm dis- symptoms and differentiate sleep disorders inclusion of narcolepsy, upper-airway-re- orders. Chapter 6 examines disorders asso- that present with common symptoms. One sistance syndrome, disorders of the pons

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and mid-brain, disorders of the hypothal- Cystic Fibrosis in the 21st Century. An- Lung Surfactant Function and Disorder. amus, Kleine-Levin syndrome, Prader- drew Bush, Eric WFW Alton, Jane C Da- Kaushik Nag, editor. Lung Biology in Health Willi syndrome, diffuse organic neuro- vies, Uta Griesenbach, Adam Jaffe, editors. and Disease, volume 201, Claude Lenfant, logic disorders, and rare disorders such as Progress in Respiratory Research, volume executive editor. Boca Raton, Florida: Tay- African sleeping sickness. The author also 34, CT Bolliger, series editor. Basel, Swit- lor & Francis. 2005. Hard cover, illustrated, lucidly describes the disease processes of zerland: S Karger. 2006. Hard cover, illus- 493 pages, $199.95. common disorders such as Parkinson’s trated, 329 pages, $180. disease, and how the disease impacts sleep. Volume 201 of the Lung Biology in Health This aspect of the book would be highly and Disease series is devoted to lung sur- useful to a to provide This is an imperiously named textbook, con- factant function and disorder. It covers all optimal care of patients with secondary sidering that the 21st Century was only 4 major areas of research about lung surfac- sleep disorders that arise from neurologic years old when these chapters were written. tant, including chemistry, biochemistry, physics, genetics, computer science, physi- diseases and other medical disorders. This But once you get past that hyperbole and ology, and medicine. The book has 19 chap- section also includes a nice description of into the book, you will find it beautifully ters and 3 parts. Each chapter is written by how sleep can influence respiratory con- written and well organized. Many of the several well-known investigators, and the ditions, including asthma, chronic bron- world’s experts have been brought together authors hail from many parts of the world. chitis, chronic obstructive pulmonary dis- to produce this superb reference. Part 1 consists of chapters on the com- ease, cystic fibrosis, and parenchymal lung There are 40 short and well-referenced chapters, which cover all aspects of the sci- position, structure, and function of lung sur- diseases. factant. Surfactant phospholipids composi- The book is very well organized from a ence and clinical care of the patient with cystic fibrosis. Each chapter provides a con- tion in children changes both with postnatal topical standpoint, though sometimes the development and with disease. The first part cise and up-to-date review. However, only subheadings and the subsubheadings are of Chapter 1 describes surfactant phospho- Chapter 38 has direct clinical relevance to difficult to distinguish from each other. lipids molecular species in adult lungs, and the practice of respiratory care. That chap- The subsubheadings are in italics, which I during fetal and postnatal development. The ter is a “must-read” for all respiratory ther- think readers will find helpful, especially last part of this chapter discusses modifica- apists who care for patients with cystic fi- in the chapter on motor disorders, where tion of surfactant phospholipids molecular brosis. it is not always clear whether clinical fea- species in various lung diseases. Chapter 2 tures are specific for one disease or many. The book is well illustrated and com- discusses surfactant composition, synthesis, The references are up to date into 2005. prehensive. The first half of the book will and secretion. This chapter emphasizes how An example is in the first chapter’s re- be a hard slog for readers who are not temperature regulates the biophysical prop- view of the classification of sleep disor- basic scientists. Unfortunately, some of erties of surfactant and discusses in detail ders, which was released in April of 2005. the clinical chapters are not quite as up to the factors that regulate secretion of surfac- The index is carefully cross-indexed, date or accurate as is the basic-science tant, such as ventilation, phorbol esters, va- which makes it very easy to find a diag- half of the book. As an example, Chapter sopressin, lipoproteins, and adrenergic and nosis or symptom and find the appropri- 23, on lung transplantation, has a number cholinergic agonists. Both Chapters 1 and 2 ate material in the text. of inaccuracies in its explanation of the are valuable for learning the basics of sur- In conclusion, Sleep Medicine: A Guide pathogenesis of cystic fibrosis lung dis- factant. to Sleep and Its Disorders is an up-to- ease This book best serves as a reference The next 2 chapters are dedicated to hy- date, easy-to-read, well-organized text that text. The research directions are stated drophilic surfactant proteins, surfactant pro- examines sleep and wake mechanisms and clearly, and for the most part the clinical teins A and D. The discussion covers de- frequent presenting symptoms of sleep dis- recommendations are sound and evidence- tailed structure, tissue distribution, and function of these proteins in the context of orders. It will serve as a reference for respi- based. This book is an outstanding refer- other structurally related proteins such as ratory therapists, especially when patients ence for scientists and will be of interest mannose-binding lectin and the first com- with different sleep disorders come to the to physicians who care for patients with ponent of complement C1q. There is spe- laboratory for evaluation. Although it does cystic fibrosis, but it will be of passing cific emphasis on various domains of these not focus on the technical aspects of sleep interest for respiratory therapists who pri- proteins, which, after binding to surfactant medicine, it does provide an easy-to-under- marily provide clinical care for persons with cystic fibrosis. and microbial membranes and alveolar and stand introduction to the spectrum of sleep inflammatory cells, perform different func- disorders. tions, ranging from protection against alve- olar collapse to innate host defense. Several Susan M Harding MD D-ABSM Bruce K Rubin MEngr MD MBA receptors and/or binding proteins for sur- Sleep-Wake Disorders Center FAARC factant proteins A and D are also discussed. Division of Pulmonary, , and Departments of Pediatrics and Chapter 5 addresses the importance of Critical Care Medicine Biomedical Engineering hydrophobic surfactant proteins B and C: Department of Medicine Wake Forest University their evolutionary origin, biological and clin- University of Alabama at Birmingham School of Medicine ical importance, and structure-function re- Birmingham, Alabama Winston-Salem, North Carolina lationships. All 3 chapters on surfactant pro-

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