When the insomnia that we are just not doing, just to quickly go to the "kingdom of Morpheus". And elephants believe, and sheep - and in the end still almost until morning to turn. That would be a universal cure for insomnia. But, unfortunately, it has not come up (if not take pills). But you can make yourself sleep through other effective methods of insomnia.

Sleep Medicine Reviews

Sleep Medicine Reviews RSS feed: Current Issue. Sleep Medicine Reviews provides International coverage of sleep disorders, their aetiology, diagnosis, treatment and implications for related conditions at an individual and public health level. Articles review the clinical information published in peer-reviewed journals devoted to the many disciplines involved in sleep medicine, including: pulmonology, psychiatry, psychology, physiology, otolaryngology, paediatrics, geriatrics, cardiology, dentistry, nursing, neurology and general medicine. The journal publishes narrative reviews, systematic reviews and editorials covering area of controversy and debate, as well as areas of future research. Electronic Usage An increasing number of readers access the journal online via ScienceDirect, one of the world's most advanced web delivery systems for scientific, technical and medical information. Average monthly article downloads for this journal: 8,311* * Figure is an average based on full text articles downloaded monthly via ScienceDirect between July 2007 and June 2008.

Aims & scope/editorial board

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Evidence based sleep medicine: Are we there yet?

A PubMed search for “sleep apnea” returns over 18,000 articles. In the past few decades there has been a significant increase of research focusing on the pathophysiology, diagnosis, and treatment of sleep apnea. However, as these five excellent, thorough reviews with 579 represented articles point out, there is still a long way to go in creating standard evidence based medicine practice for the diagnosis, evaluation, and treatment of sleep apnea patients. Even though great strides have been made in understanding sleep apnea and in patient care, there are many areas of the field that remain controversial or unproven.

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Airway evaluation in obstructive sleep apnea

Summary: As the interest in sleep-disordered breathing has increased, various attempts have been made to assess upper airway anatomy in patients with this relatively frequent disorder. The aim is not only to reveal potential differences in upper airway anatomy to better understand origin and pathophysiology of the disease but also to improve patient management and treatment success. The present review is based on a systematic literature search with regard to upper airway evaluation in sleep-disordered breathing; the articles were selected and discussed in light of our clinical experiences. Based on clinical assessment including endoscopy during wakefulness, the value of the Mueller Maneuver, static radiologic imaging techniques (X-ray cephalometry, computed tomography (CT) scanning and magnetic resonance imaging (MRI)), dynamic scanning protocols (e.g. ultrafast CT or cine MRI), upper airway endoscopy during sleep and sedated sleep, pressure measurements and the assessment of the critical closing pressure are discussed. Each technique itself and its history in the field of sleep medicine are briefly reviewed and problems of standardization and interpretation are discussed when appropriate. Insights into the pathophysiology of the disease gained with the help of the investigational techniques are presented and the impact of the techniques on patient management is reported. Although all these additional techniques for upper airway assessment have substantially improved our understanding of sleep-disordered breathing, their significance in daily practice is limited. In contrast to the widespread use of the Mueller maneuver and sedated endoscopy, convincing data supporting their use in terms of treatment outcome are lacking. So far, there is only very limited evidence that selected techniques improve treatment outcome for selected indications. In general, there is not enough evidence that these techniques are superior to the routine clinical assessment.

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Novel imaging techniques using computer methods for the evaluation of the upper airway in patients with sleep-disordered breathing: A comprehensive review

Summary: Patients with sleep related breathing disorders (SRBD) can be treated with nasal continuous positive airway pressure (nCPAP) or with several upper airway (UA) interventions. While nCPAP is almost always effective when clinically well tolerated, the therapeutic outcome of UA surgery and UA devices is difficult to predict. The improvement of our capability to perform the latter predictions more accurately is of great clinical importance since it will prevent patients to be treated with ineffective, sometimes irreversible, techniques. In this review we describe the importance of new imaging methods in this respect. We first refer to the most important pathophysiological mechanisms known so far to play a role in SRBD, indicating that functional imaging could elucidate these mechanisms in a patient specific manner. Then we describe the new technologies that make UA imaging more functional referring to the data as they are presently available. Finally we summarise the studies that do indicate that the use of functional imaging of the UA in SRBD patients may significantly help to predict the clinical outcome after UA interventions.

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Defining common outcome metrics used in obstructive sleep apnea

Summary: Sleep-disordered breathing a spectrum that ranges from snoring through disorder of increased airway resistance, to overt sleep apnea affects many clinical disease outcomes. Traditionally, disease outcomes have been measured by polysomnography, with the most common metric being the apnea hypopnea index (AHI). Multiple other clinical metrics are commonly used to assess the severity and impact of disease on important outcomes of obstructive sleep apnea (OSA). These allow assessment of sleepiness, quality of life, performance, and medical, especially cardiovascular outcomes. Currently the available metrics only partially explain the associated disease outcomes in different patients. This review highlights the available clinical, physiological and biomarker metrics in measuring OSA and associated co-morbidities and defines treatment goals.

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Structural effectiveness of pharyngeal sleep apnea surgery

Summary: Obstructive sleep apnea results from the combination of a structurally small upper airway combined with the loss of muscle tone during sleep. Most therapies aim to reduce apnea severity by increasing airway size and stability. Conceptually, upper airway surgery should be a highly effective method to treat obstructive sleep apnea and other forms of sleep disordered breathing.Although major reconstructive surgeries such as maxillomandibular advancement demonstrate high success rates, more limited forms of surgery often demonstrate significantly lower success rates. Reviews of such surgical procedures have uniformly ignored contributions of the structural effectiveness of surgery.The purpose of the review is to evaluate current knowledge of how surgery for OSA alters structure. The majority of data available on surgical outcomes involve uvulopalatopharyngoplasty. Data demonstrate that pre-morbid surgical anatomy and techniques have significant effects on ultimate outcomes. Further research on structural outcomes for palatopharyngoplasty, as well as other surgical procedures, is needed to improve clinical outcomes.

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Gender differences in obstructive sleep apnea and treatment implications

Summary: Obstructive sleep apnea (OSA) is a common cause of daytime sleepiness for millions of Americans. It is also a disease associated with an increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. A number of population-based studies have shown that OSA is more common in men than in women and this discrepancy is often evident in the clinical setting. There are a number of pathophysiological differences to suggest why men are more prone to the disease than women. Although the exact mechanisms are unknown, differences in obesity, upper airway anatomy, breathing control, hormones, and aging are all thought to play a role. The purpose of this review was to examine the literature on gender differences in OSA and to analyze whether or not these differences in pathogenic mechanisms affect diagnosis or treatment.

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Articles to appear in forthcoming issues

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