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Volume 102, Issue 1 (2003)


 
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Editorials

Thomas C. Meyer, MD, Medical Editor, WMJ
Zzzzz . . . A primer for sleep medicine
(full text PDF)

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.

Kesavan Kutty, MD, FACP, FCCP
Americans sleeping less; physicians should be familiar with problems and treatments
(full text PDF)

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).

Original Research

Kevin Ruggles, MD; Nancy Hausman, MD
Evaluation of Excessive Daytime Sleepiness
(full text PDF)

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.

John E. Stevenson, MD, FACP
Diagnosis of Sleep Apnea
(full text PDF)

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.

Tanya K. Meyer, MD; B. Tucker Woodson, MD, FACS, ABSM
Surgical Management of Snoring and Obstructive Sleep Apnea
(full text PDF)

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.

Gary Leo, DO
Parasomnias
(full text PDF)

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.

Joseph P. McMahon, MD; Brian H. Foresman, DO; Ronald C. Chisholm, PhD
The Influence of CPAP on the Neurobehavioral Performance of Patients with Obstructive Sleep Apnea Hypopnea Syndrome: A Systematic Review
(full text PDF)

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).

Donn Dexter, MD; Jagdeep Bijwadia, MD; Dana Schilling; Gwendolyn Applebaugh, PhD
Sleep, Sleepiness and School Start Times: A Preliminary Study
(full text PDF)

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.

Your Practice

Kurt G. Krumholz, CFP, Principal, Director of Services for SVA Planners, Inc., Registered Investment Advisor
Successful investing in today’s marketplace
(full text PDF)

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.

Wisconsin Medical Society Foundation
2002 Foundation Donors
(full text PDF)

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.

Your Profession

Wisconsin Medical Society Task Force
Task Force releases report; Part I: Professionalism defined
(full text PDF)

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

Michael J. Dunn, MD Dean and Executive Vice President, Medical College of Wisconsin
Research, education provide sleep disorders wake-up call
(full text PDF)

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.

Other

Wisconsin Medical Society
Society releases plan for reforming Wisconsin’s health system
(full text PDF)

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.

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