January-February 2005
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Reviewed by Lynne Lamberg |
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Joe, "the fat boy," who falls asleep knocking on a door, appears in The Posthumous Papers of the Pickwick Club by Charles Dickens, published originally in newspaper serials and then as a book in 1837. Physicians soon used "Pickwickian syndrome" to describe people who were both obese and profoundly sleepy. Physicians of the 1800s occasionally reported seeing patients who gasped for breath in their sleep. But no publications link snoring, sleep-disordered breathing, and daytime sleepiness until the 1950s. In the 1970s, researchers published reports of people who were suffocating in their sleep, and asserted this diagnosis required the examination of sleeping patients. These case reports still "did nothing to change the medical world's attitude toward the subject of sleep," Peretz Lavie observes in this book. "The excitement of sleep researchers did not infect their colleagues," asserts Lavie, the Andre Ballard professor of biological psychiatry at the Technion-Israel Institute of Technology in Haifa. "Hospital administrations did not hasten to establish laboratories for the diagnosis of sleep disorders," he says. "In many countries, there was no sleep medicine at all." It took epidemiological studies to show that millions of people have trouble breathing when they sleep, Lavie notes. The first such survey, of more than 5700 residents of San Marino, Italy, in 1976, found that 45 percent of adults reported snoring at least occasionally, and 25% said they did so every day. Snoring increased with age, and occurred more often in men than in women. It also was more common in obese people than in those of normal weight. Most critically, people who snored every night proved to have higher blood pressure than non-snorers did. A variety of later studies in other countries echo the original findings. In the early 1980s, Lavie and colleagues assessed the prevalence of sleep complaints in the general population of Israel, analyzing about 15,000 questionnaires. They also surveyed over 1500 industrial workers, and examined about 100 of them in the sleep laboratory. Their subjects included people who complained of sleep disturbances as well as those who did not. When he presented his group's findings at an international sleep meeting, Lavie recalls, a prominent American researcher declared, "It would appear that breathing disorders during sleep are particularly prevalent in the Middle East." Says Lavie: "He did not believe that possibly 4 percent of people aged 40-60 suffer from sleep disordered breathing." That estimate, now well-accepted, may even be low. The National Institutes of Health estimates that more than twelve million Americans have sleep apnea. Like Lavie's earlier book, The Enchanted World of Sleep, Restless Nights provides an engaging account of the evolution of sleep medicine. Lavie also offers a brief overview of current treatment for people with sleep apnea, including the growing use of bariatric surgery to help morbidly obese patients who have not been able to lose weight by dieting. While this book likely will appeal most to sleep professionals and students, people with sleep apnea and their families also should find it informative. |
© 2005 WebSciences and Lynne Lamberg |
RESTLESS NIGHTS:
UNDERSTANDING SNORING AND SLEEP APNEA