Table Of ContentOxford Case Histories
in Sleep Medicine
Oxford Case Histories
Series Editors
Sarah Pendlebury and Peter Rothwell
Oxford Case Histories in Neurosurgery (Harutomo Hasegawa, Matthew
Crocker, and Pawan Singh Minhas)
Oxford Case Histories in TIA and Stroke (Sarah T. Pendlebury,
Ursula G. Schulz, Aneil Malhotra, and Peter M. Rothwell)
Oxford Case Histories in Rheumatology (Joel David, Anne Miller,
Anushka Soni, and Lyn Williamson)
Oxford Case Histories in Cardiology (Rajkumar Rajendram, Javed Ehtisham,
and Colin Forfar)
Oxford Case Histories in Respiratory Medicine (John Stradling,
Andrew Stanton, Najib M. Rahman, Annabel H. Nickol, and Helen E. Davies)
Oxford Case Histories in Gastroenterology and Hepatology (Alissa
J. Walsh, Otto C. Buchel, Jane Collier, and Simon P. L. Travis)
Neurological Case Histories (Sarah T. Pendlebury, Philip Anslow,
and Peter M. Rothwell)
Oxford Case
Histories in Sleep
Medicine
Himender Makker
Consultant Physician in Respiratory Medicine,
North Middlesex University and University College
London (UCL) Hospital, London, UK
Matthew Walker
Professor of Neurology, UCL Institute of Neurology,
Queen Square, London, UK
Hugh Selsick
Psychiatrist, Camden and Islington NHS Trust London
and the Royal London Hospital for Integrated Medicine,
London, UK
Bhik Kotecha
Consultant ENT Surgeon and Lead Clinician for Snoring
and Sleep Service, The Royal National Throat Nose
and Ear Hospital, UCL, London, and Barking, Havering
and Redbridge University Hospital, London, UK
Ama Johal
Senior Clinical Lecturer/Hon. Consultant Orthodontist
Academic and Clinical Lead Orthodontics Institute
of Dentistry Bart’s, and The London School of Medicine
and Dentistry, Queen Mary College, London, UK
1
1
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Preface
Our interest in sleep disorders is relatively new in the history of medi-
cine. The ability to measure physiological events during sleep has led
to the recognition of previously unknown sleep disorders. Basic under-
standing of structure and function of normal sleep has made us real-
ise the importance of sleep on quality of life, health, and survival. A
better understanding of sleep disorders has helped us to develop new
treatments.
Despite immense advances in the understanding and management
of sleep disorders over the last 50 years, many sleep disorders remain
under-diagnosed and under-treated. Opportunities for teaching and
training in sleep medicine remain limited. Available learning resources
for sleep medicine are primarily aimed at sleep specialists, leaving a gap
for non-sleep specialists.
This book provides a case-based illustrative approach to the
understanding and management of common and important sleep
disorders— snoring, sleep disordered breathing, insomnia, circadian-
rhythm disorders, and primary neurological sleep disorders. Case histo-
ries have been written by sleep medicine experts with clinical experience
of providing a multi-disciplinary sleep service. Case examples have been
selected direct from sleep clinics and focus on the recognition of pre-
senting features of sleep disorders and their clinical importance. Each
case report provides a detailed clinical description followed by a clear
explanation of the salient points. The text is supported by photographs,
diagrams, and line drawings, and concludes with a list of key learning
points. An attempt has been made to write the cases in an easy-fl owing
prose to simulate the experience of seeing and discussing a real-life
patient in a clinic. The book will be of interest to all clinicians who wish
to improve their understanding and knowledge of sleep disorders.
vi PREFACE
I wish to thank my following colleagues for their contribution to
Obstructive sleep apnoea and ENT sections of the book: Dr Fionnuala
Crummy, Consultant Respiratory Physician, University College London
Hospital, London and Mr Rob Nash, Specialist ENT Registrar, Royal
National Throat, Nose and Ear Hospital, London.
I also wish to thank Peter Stevenson and Lauren Dunn at the Oxford
University Press for their constant support and encouragement, my co-
authors for providing excellent case histories, and my secretary, Donna
Basire, for checking the manuscript tirelessly.
Himender Makker
Contents
List of abbreviations ix
Normal ranges xi
Section 1 Snoring and sleep-disordered breathing
Cases 1–24 3
Section 2 Snoring and OSA: role of dental
and ENT surgeons
Cases 25–34 167
Section 3 Neurological sleep disorders
Cases 35–45 223
Section 4 Insomnia and circadian rhythm disorders
Cases 46–55 271
List of cases by diagnosis 355
List of cases by principal clinical features at diagnosis 359
List of cases by aetiological mechanisms 363
Index 367
List of abbreviations
ABG arterial blood gases EEG Electroencephalogram
ACE angiotensin converting enzyme EMG electromyogram
AHI apnoea hypopnea index ENT ear, nose and throat
AHRF acute hypercapnic respiratory EOG electroculogram
failure EPAP Expiratory Positive Airway
ANP atrial natriuretic peptide Pressure
ASPS advanced sleep phase ESS Epworth Sleepiness Scale
syndrome FEV1 Forced Expiratory Volume in
ASV adaptive servo-ventilation first second
BiPAP bi-level positive airway FLEP frontal lobe epilepsy and
pressure parasomnias scale
BMI body mass index FRC functional residual capacity
BPD bilio-pancreatic diversion FSHD fascioscapulohumeral
BPH benign prostatic hypertrophy dystrophy
CBT Cognitive Behavioural Therapy FVC forced vital capacity
CBT-I cognitive behavioural therapy GCS Glasgow Coma Scale
for insomnia GH growth hormone
CNS central nervous system GORD gastro-oesophageal reflux
COPD chronic obstructive pulmonary disease
disease HDU High Dependency Unit
CPAP continuous positive airway HLA human leukocyte antigen
pressure ICD Implantable Cardioverter
CRP C-reactive protein Defibrillator
CRT cardiac resynchronization IGF insulin-like growth factor
therapy IPAP Inspiratory Positive Airway
CRT-D Cardiac Resynchronization Pressure
Therapy Device ITU intensive therapy unit
CSA central sleep apnoea LAUP laser assisted uvulopalatoplasty
CSF cerebrospinal fluid LPR laryngo-pharyngo reflux
CSR Cheyne–Stokes respiration MAD mandibular advancement
DaT Dopamine transporter device
DAT dopamine transporters MAS mandibular advancement
DLMO dim light melatonin onset splint
DSPS delayed sleep phase syndrome MDSA medical dental sleep appliance
DVLA Driver Vehicle Licensing MEFV maximum expiratory flow
Agency volume
ECG electrocardiogram MIFV maximum inspiratory flow
volume
EDS excessive daytime sleepiness
