Editorials

Zzzzz . . . A primer for sleep medicine

Thomas C. Meyer, MD, Medical Editor, WMJ

The WMJ Editorial Board meets once a year. One of the main functions of the meeting is to select the themes for the next six to eight issues. We believe this task is one of the most important things we do and there is some vigorous debate as the selections are made.

Author Affiliations: Medical Editor, Wisconsin Medical Society

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Americans sleeping less; physicians should be familiar with problems and treatments

Kesavan Kutty, MD, FACP, FCCP

Rapid evolution of technology has been the greatest catalyst to our understanding of sleep. Increasing understanding has shown that sleep is really a consequence of a highly coordinated release or inhibition of many neurotransmitters in the brain. From a clinical standpoint, disordered sleep tends to assume one of the following prototypes: excess sleep (excessive somnolence), inadequate sleep (insomnia), abnormal behavior during sleep (parasomnia), or sleep that tends to be out of synchrony with the conventional pattern for that age and/or occupation (circadian rhythm abnormality).



Author Affiliations: Doctor Kutty is a Professor of Medicine, The Medical College of Wisconsin, and he is Chairman of Medicine, St. Joseph Regional Medical Center in Milwaukee, Wis. He is also a member of the Wisconsin Medical Journal’s Editorial Board.

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Original Research

Evaluation of Excessive Daytime Sleepiness

Kevin Ruggles, MD; Nancy Hausman, MD

Excessive Daytime Sleepiness (EDS) is a difficult clinical problem, which is often indicative of a serious underlying physiologic condition. EDS is associated with automobile accidents, work-related injury, and increased use of the health care system, but it appears to be under-appreciated despite its common occurrence. There are many causes of EDS, ranging from insufficient sleep or inadequate sleep hygiene to drug effects and serious medical conditions. Assessment of EDS should begin with a detailed clinical history, and may also include self-rated instruments and ultimately physiologic tests to measure propensity to fall asleep or stay awake. Ultimately, evaluation in the sleep laboratory is often required in order to arrive at an accurate diagnosis and an appropriate therapeutic recommendation.



Author Affiliations: Doctor Ruggles is Division Medical Director and Head, Section of Epilepsy and Sleep Disorders, Marshfield Clinic. Doctor Hausman is Director, Marshfield Clinic Sleep Disorders Center.


Corresponding Author: Please address correspondence to Wisconsin Medical Society at 608.442.3800

Diagnosis of Sleep Apnea

John E. Stevenson, MD, FACP

Rapidly accumulating evidence shows that sleep apnea is a major factor influencing personal health and public safety. Diagnosis and treatment of this syndrome may well result in significant preventive medicine outcomes. The prevalence of sleep apnea is so high that evaluation and treatment must become the province of the primary care physician. Accurate, appropriate history, physical assessment and clinical management are the mainstays of care, with the judicial application of technology. A history of snoring, particularly when it is intermittent, interrupted by snorts, and accompanied by restless sleep or daytime sleepiness suggests the need for further evaluation. When co-morbid conditions such as hypertension, cardiovascular disease or type 2 diabetes are present, formal evaluation and consideration of treatment are needed. If initial evaluation reveals severe obstructive sleep apnea with observed apneas, together with excessive daytime sleepiness, clinical management with empirical application of continuous positive airway pressure (CPAP) may suffice in experienced hands.



Author Affiliations: Doctor Stevenson is Senior Consultant, Sleep by Design, LLC, Kimberly, Wis. He is a Diplomate, ABIM (Internal Medicine and Pulmonary Disease) and a Fellow, American Academy of Sleep Medicine.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Surgical Management of Snoring and Obstructive Sleep Apnea

Tanya K. Meyer, MD; B. Tucker Woodson, MD, FACS, ABSM

Primary snoring and obstructive sleep apnea (OSA) lie at separate extremes of a continuum of sleep-related breathing disorders. In the 30-year-old population, 20% of men and 5% of women will snore. These numbers rise to 60% and 40% respectively by age 60. It is estimated that 4% of adult males and 2% of adult females have OSA, which makes the disease as common as asthma. Although snoring without any features of obstruction may not have detectable health consequences per se (aside from sleep interruption of bed partners), individuals suffering from OSA have substantially increased risks for high blood pressure (2x normal), heart attack (23x normal), stroke (1.5 x normal), headaches, sexual impotence, impaired intellectual function, and depression. These individuals also pose further risk to themselves and society as their excessive sleepiness may cause them to fall asleep in the work environment, with a 15 times increased incidence in motor vehicle accidents as compared to normal drivers.



Author Affiliations: Authors are with the Medical College of Wisconsin. Doctor Meyer is a resident in Otolaryngology and Communication Sciences; Dr. Woodson is Associate Professor Otolaryngology and Communica-tion Sciences.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society

Parasomnias

Gary Leo, DO

Parasomnias represent a wide variety of disorders that interrupt sleep and cause unusual nocturnal behavior. These disorders are reported in 1% to 10% of the population,1 with the highest preponderance in children. These disorders may be classified on the basis of the sleep stage in which they occur, or the age of first occurrence in a given patient, or the clinical behavior during the event. Clinical history from the patient and family members is usually enough to establish a diagnosis. Treatment is dependent upon the type of behavior exhibited, frequency, and disruption to patient and other family members. The importance of these disorders arises from the potential that they hold for anxiety, sleep disruption, and possible harm.

Author Affiliations: Doctor Leo is Medical Director, Sleep Laboratory, St. Joseph Regional Medical Center, Milwaukee, Wis.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society

The Influence of CPAP on the Neurobehavioral Performance of Patients with Obstructive Sleep Apnea Hypopnea Syndrome: A Systematic Review

Joseph P. McMahon, MD; Brian H. Foresman, DO; Ronald C. Chisholm, PhD

Objective: To determine what is known about neurobehavioral outcomes in patients with the obstructive sleep apnea hypopnea syndrome following treatment with continuous positive airway pressure (CPAP).

Author Affiliations: All authors are with the Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Department of Medicine, Indiana University School of Medicine. Doctor McMahon is also with the Pulmonary Section, Department of Medicine, University of Wisc

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Sleep, Sleepiness and School Start Times: A Preliminary Study

Donn Dexter, MD; Jagdeep Bijwadia, MD; Dana Schilling; Gwendolyn Applebaugh, PhD

Background: High school students are reported to be excessively sleepy, resulting in decreased academic performance, increased psycho-social problems and increased risk of morbidity and mortality from accidents. Early school start times have been noted to contribute to this problem. This report attempts to confirm the relationship of early school start times with decreased sleep and increased sleepiness.



Author Affiliations: Doctors Dexter and Bijwadia are Co-Directors, Sleep Disorders Center, Luther/Midelfort, Mayo Health System, Eau Claire, Wis. Doctor Dexter is with the Department of Neurosciences. Doctor Bijwadia is with the Department of Pulmonology. Ms. Schilling is a s

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Your Practice

Successful investing in today’s marketplace

Kurt G. Krumholz, CFP, Principal, Director of Services for SVA Planners, Inc., Registered Investment Advisor

With the stock markets in a state of decline over the past three years, many people are reviewing their investment strategies to better position themselves for future financial success.



Author Affiliations: Krumholz was named to Mutual Funds list of “100 Great Financial Planners” in 2001 and 2002. He was also selected as one of the “150 Best Financial Advisers for Doctors” by Medical Economics in 2000 and 2002.

Corresponding Author: He can be reached at 1.800.279.2616

2002 Foundation Donors

Wisconsin Medical Society Foundation

The Mission of the Wisconsin Medical Society Foundation is to advance the health of the people of Wisconsin by supporting medical and health education. The individuals and organizations named below made contributions to the Wisconsin Medical Society Foundation from January 1 to December 31, 2002. We are deeply grateful to these donors for their support.


Author Affiliations: Wisconsin Medical Society Foundation

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Your Profession

Task Force releases report; Part I: Professionalism defined

Wisconsin Medical Society Task Force

Our profession is under great stress. Many within the profession are dissatisfied with what has happened to the ancient and respected doctor-patient relationship.


Author Affiliations: Wisconsin Medical Society Task Force

Corresponding Author: Please address correspondence to Wisconsin Medical Society at 608.442.3800

Research, education provide sleep disorders wake-up call

Michael J. Dunn, MD Dean and Executive Vice President, Medical College of Wisconsin

Contrary to the axiom “if you snooze, you lose,” you may actually lose if you don’t snooze, which would place your well-being and health at risk.


Author Affiliations: Dean and Executive Vice President, Medical College of Wisconsin

Corresponding Author: Please address all correspondence to the Wisconsin Medical Society at 608.442.3800

Other

Society releases plan for reforming Wisconsin’s health system

Wisconsin Medical Society

In 1992, the Wisconsin Medical Society (Society) published WISCONSIN CARE, the Society’s recommendations for health care reform. WISCONSIN CARE was published during a time when both the US Congress and the President were debating major changes in the health care system. It was within this environment that WISCONSIN CARE was developed. WISCONSIN CARE was a visionary document proposing com-prehensive and, in some cases, dramatic changes to reform Wisconsin’s health care system.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800